Section of Pediatric Surgery, Department of Surgery, Michigan Medicine, University of Michigan, Ann Arbor, Michigan.
University of Michigan Medical School, Ann Arbor, Michigan.
J Surg Res. 2024 Jan;293:259-265. doi: 10.1016/j.jss.2023.09.022. Epub 2023 Oct 5.
Prenatally diagnosed congenital lung malformations (CLMs) are monitored via ultrasound and measured by congenital pulmonary airway malformation volume ratios (CVRs) which can predict postnatal respiratory symptoms. This study compared CVR to postnatal lesion size to help guide prenatal counseling.
A retrospective chart review evaluated the prenatal imaging and postnatal outcomes for patients who were prenatally diagnosed with CLMs and had a postnatal computed tomography (CT) scan at one institution.
Fifty-seven patients were included. Four had symptoms requiring urgent resection. The remaining were discharged and had clinic follow-up with CT scan to determine next steps: five had no identified lesions, eight had lesions whose diagnosis did not warrant an operation, and 40 had lesions whose diagnosis rendered size a factor in operative decision-making. Of these 40, 26/40 patients (65%) underwent elective resection (median maximum CVR 0.97; median lesion size 4 cm) and 14/40 patients (35%) were observed without resection (median maximum CVR 0.5; median lesion size 3 cm). There was a positive correlation between prenatal CVR and postnatal lesion size, with R-squared = 0.46. Maximum CVRs were better than last CVRs when predicting whether postnatal CT size would fall above or below our institution's level of recommended resection, with an area under the curve of 0.85 and a CVR cut-point of 0.61.
For newborns with asymptomatic CLMs, higher maximum CVRs correlated with larger size on postnatal CT. A maximum CVR ≤0.6 was correlated with a smaller postnatal CT size that may be eligible for nonoperative management. While these results are not intended to recommend surgery based on higher CVRs alone, this information could potentially be used to reassure expectant parents whose babies' prenatal imaging demonstrate lower maximum CVRs.
产前诊断的先天性肺畸形（CLM）通过超声监测，并通过先天性肺气道畸形容积比（CVR）进行测量，CVR 可预测出生后的呼吸症状。本研究比较了 CVR 与出生后的病变大小，以帮助指导产前咨询。
回顾性图表审查评估了在一家机构接受产前诊断为 CLM 并进行了产后计算机断层扫描（CT）检查的患者的产前影像学和产后结果。
共纳入 57 例患者。4 例有需要紧急切除的症状。其余患者出院并进行临床随访，进行 CT 扫描以确定下一步治疗方案：5 例无明确病变，8 例病变无需手术诊断，40 例病变的诊断大小成为手术决策的因素。在这 40 例中，26/40 例（65%）患者行择期切除术（中位最大 CVR 0.97；中位病变大小 4cm），14/40 例（35%）患者未行切除术（中位最大 CVR 0.5；中位病变大小 3cm）。产前 CVR 与产后病变大小呈正相关，R-squared=0.46。最大 CVR 预测出生后 CT 大小是否高于或低于本机构推荐的切除水平的效果优于最后一次 CVR，曲线下面积为 0.85，CVR 切点为 0.61。
对于无症状 CLM 的新生儿，较高的最大 CVR 与产后 CT 上较大的病变相关。最大 CVR≤0.6 与较小的产后 CT 病变相关，可能有非手术治疗的适应证。虽然这些结果并非旨在仅凭较高的 CVR 就推荐手术，但这些信息可能有助于让其家长安心，因为他们的婴儿的产前影像学显示较低的最大 CVR。
