Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390, USA.
Department of Pediatric Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Pediatr Radiol. 2021 Aug;51(9):1637-1644. doi: 10.1007/s00247-021-05049-0. Epub 2021 Mar 29.
Magnetic resonance imaging (MRI) assesses pulmonary hypoplasia in fetal congenital diaphragmatic hernia (CDH). Neonatal mortality may occur with CDH.
To quantify MRI parameters associated with neonatal survival in fetuses with isolated CDH.
Fetal MRI for assessing CDH included region of interest (ROI) measurements for total lung volume (TLV), herniated liver volume, herniated other organ volume and predicted lung volume. Ratios of observed lung volume and liver up volume to predicted lung volume (observed to predicted TLV, percentage of the thorax occupied by liver) were calculated and compared to neonatal outcomes. Analyses included Wilcoxon rank sum test, multivariate logistic regression and receiver operating characteristic (ROC) curves.
Of 61 studies, the median observed to predicted TLV was 0.25 in survivors and 0.16 in non-survivors (P=0.001) with CDH. The median percentage of the thorax occupied by liver was 0.02 in survivors and 0.22 in non-survivors (P<0.001). The association of observed to predicted TLV and percentage of the thorax occupied by liver with survival for gestational age (GA) >28 weeks was greater compared to GA ≤28 weeks. The ROC analysis demonstrated an area under the curve of 0.96 (95% confidence interval 0.91-1.00) for the combined observed to predicted TLV, percentage of the thorax occupied by liver and GA.
The percentage of the thorax occupied by liver and observed to predicted TLV was predictive of neonatal survival in fetuses with CDH.
磁共振成像（MRI）可评估胎儿先天性膈疝（CDH）中的肺发育不全。CDH 可能导致新生儿死亡。
定量分析与孤立性 CDH 胎儿新生儿存活率相关的 MRI 参数。
胎儿 MRI 用于评估 CDH，包括感兴趣区（ROI）测量总肺容量（TLV）、疝入肝体积、疝入其他器官体积和预测肺容量。计算观察到的肺体积与肝上体积与预测肺体积的比值（观察到的 TLV 与预测 TLV 的比值，肝脏占胸部的百分比），并与新生儿结局进行比较。分析包括 Wilcoxon 秩和检验、多变量逻辑回归和受试者工作特征（ROC）曲线。
在 61 项研究中，幸存者的观察到的 TLV 与预测 TLV 的中位数为 0.25，而非幸存者为 0.16（P=0.001）。幸存者的肝脏占胸部的百分比中位数为 0.02，而非幸存者为 0.22（P<0.001）。对于 GA>28 周的患者，观察到的 TLV 与肝脏占胸部百分比与生存率的相关性大于 GA≤28 周的患者。ROC 分析显示，联合观察到的 TLV、肝脏占胸部的百分比和 GA 的曲线下面积为 0.96（95%置信区间 0.91-1.00）。
肝脏占胸部的百分比和观察到的 TLV 预测了 CDH 胎儿的新生儿存活率。
