Ding Wen, Gu Yuanyuan, Wang Haiyu, Wu Huiying, Zhang Xiaochun, Zhang Rui, Wang Hongying, Huang Li, Lv Junjian, Xia Bo, Zhong Wei, He Qiuming, Hou Longlong
Department of Fetal Medicine, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.
Department of Obstetrics and Gynecology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.
Eur Radiol. 2024 Mar;34(3):1524-1533. doi: 10.1007/s00330-023-10178-1. Epub 2023 Aug 30.
To develop a mediastinal shift angle (MSA) measurement method applicable to right-sided congenital diaphragmatic hernia (RCDH) in fetal MRI and to validate the predictive value of MSA in RCDH.
Twenty-seven fetuses with isolated RCDH and 53 controls were included in our study. MSA was measured on MRI axial image at the level of four-chamber view of the fetal heart. The angle between the sagittal midline landmark line and the left boundary landmark line touching tangentially the lateral wall of the left ventricle was used to quantify MSA for RCDH. Appropriate statistical analyses were performed to determine whether MSA can be regarded as a valid predictive tool for postnatal outcomes. Furthermore, predictive performance of MSA was compared with that of lung area to head circumference ratio (LHR), observed/expected LHR (O/E LHR), total fetal lung volume (TFLV), and observed/expected TFLV (O/E TFLV).
MSA was significantly higher in the RCDH group than in the control group. MSA, LHR, O/E LHR, TFLV, and O/E TFLV were all correlated with postnatal survival, pulmonary hypertension (PH), and extracorporeal membrane oxygenation (ECMO) therapy (p < 0.05). Value of the AUC demonstrated good predictive performance of MSA for postnatal survival (0.901, 95%CI: (0.781-1.000)), PH (0.828, 95%CI: (0.661-0.994)), and ECMO therapy (0.813, 95%CI: (0.645-0.980)), which was similar to O/E TFLV but slightly better than TFLV, O/E LHR, and LHR.
We developed a measurement method of MSA for RCDH for the first time and demonstrated that MSA could be used to predict postnatal survival, PH, and ECMO therapy in RCDH.
Newly developed MRI assessment method of fetal MSA in RCDH offers a simple and effective risk stratification tool for patients with RCDH.
• We developed a measurement method of mediastinal shift angle for right-sided congenital diaphragmatic hernia for the first time and demonstrated its feasibility and reproducibility. • Mediastinal shift angle can predict more prognostic information other than survival in right-sided congenital diaphragmatic hernia with good performance. • Mediastinal shift angle can be used as a simple and effective risk stratification tool in right-sided congenital diaphragmatic hernia to improve planning of postnatal management.
开发一种适用于胎儿磁共振成像（MRI）中右侧先天性膈疝（RCDH）的纵隔移位角（MSA）测量方法，并验证MSA在RCDH中的预测价值。
本研究纳入了27例孤立性RCDH胎儿和53例对照组胎儿。在胎儿心脏四腔心层面的MRI轴位图像上测量MSA。矢状中线标志线与相切于左心室侧壁的左边界标志线之间的夹角用于量化RCDH的MSA。进行了适当的统计分析，以确定MSA是否可被视为出生后结局的有效预测工具。此外，将MSA的预测性能与肺面积与头围比（LHR）、观察/预期LHR（O/E LHR）、胎儿肺总体积（TFLV）和观察/预期TFLV（O/E TFLV）的预测性能进行了比较。
RCDH组的MSA显著高于对照组。MSA、LHR、O/E LHR、TFLV和O/E TFLV均与出生后生存、肺动脉高压（PH）和体外膜肺氧合（ECMO）治疗相关（p < 0.05）。AUC值表明MSA对出生后生存（0.901，95%CI：（0.781 - 1.000））、PH（0.828，95%CI：（0.661 - 0.994））和ECMO治疗（0.813，95%CI：（0.645 - 0.980））具有良好的预测性能，这与O/E TFLV相似，但略优于TFLV、O/E LHR和LHR。
我们首次开发了RCDH的MSA测量方法，并证明MSA可用于预测RCDH的出生后生存、PH和ECMO治疗。
新开发的RCDH胎儿MSA的MRI评估方法为RCDH患者提供了一种简单有效的风险分层工具。
• 我们首次开发了右侧先天性膈疝的纵隔移位角测量方法，并证明了其可行性和可重复性。• 纵隔移位角在右侧先天性膈疝中除了能预测生存外，还能预测更多的预后信息，性能良好。• 纵隔移位角可作为右侧先天性膈疝中一种简单有效的风险分层工具，以改善出生后管理的规划。
