Avena-Zampieri Carla L, Uus Alena, Egloff Alexia, Davidson Joseph, Hutter Jana, Knight Caroline L, Hall Megan, Deprez Maria, Payette Kelly, Rutherford Mary, Greenough Anne, Story Lisa
Department of Women and Children's Health, King's College London, London, United Kingdom.
Biomedical Engineering Department, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom.
Pediatr Res. 2025 Sep 1. doi: 10.1038/s41390-025-04091-0.
Advanced MRI techniques, motion-correction and T2*-relaxometry, may provide information regarding functional properties of pulmonary tissue. We assessed whether lung volumes and pulmonary T2* values in fetuses with congenital diaphragmatic hernia (CDH) were lower than controls and differed between survivors and non-survivors.
Women with uncomplicated pregnancies (controls) and those with a CDH had a fetal MRI on a 1.5 T imaging system encompassing T2 single shot fast spin echo sequences and gradient echo single shot echo planar sequences providing T2* data. Motion-correction was performed using slice-to-volume reconstruction, T2* maps were generated using in-house pipelines. Lungs were segmented separately using a pre-trained 3D-deep-learning pipeline.
Datasets from 33 controls and 12 CDH fetuses were analysed. The mean ± SD gestation at scan was 28.3 ± 4.3 for controls and 27.6 ± 4.9 weeks for CDH cases. CDH lung volumes were lower than controls in both non-survivors and survivors for both lungs combined (5.76 ± 3.59 [cc], mean difference = 15.97, 95% CI: -24.51--12.9, p < 0.001 and 5.73 ± 2.96 [cc], mean difference = 16, 95% CI: 1.91-11.53, p = 0.008) and for the ipsilateral lung (1.93 ± 2.09 [cc], mean difference = 19.8, 95% CI: -28.48--16.45, p < 0.001 1.58 ± 1.18 [cc], mean difference=20.15, 95% CI: 5.96-15.97, p < 0.001). Mean pulmonary T2* values were lower in non-survivors in both lungs, the ipsilateral and contralateral lungs compared with the control group (81.83 ± 26.21 ms, mean difference = 31.13, 95% CI: -58.14--10.32, p = 0.006; 81.05 ± 26.84 ms, mean difference = 31.91, 95% CI: -59.02--10.82, p = 0.006; 82.62 ± 36.31 ms, mean difference = 30.34, 95% CI: -58.84--8.25, p = 0.011) but no difference was observed between controls and CDH cases that survived.
Mean pulmonary T2* values were lower in CDH fetuses compared to controls and CDH cases who died compared to survivors. Mean pulmonary T2* values may have a prognostic function in CDH fetuses.
This study provides original motion-corrected assessment of the morphologic and functional properties of the ipsilateral and contralateral fetal lungs in the context of CDH. Mean pulmonary T2* values were lower in CDH fetuses compared to controls and in cases who died compared to survivors. Mean pulmonary T2* values may have a role in prognostication. Reduction in pulmonary T2* values in CDH fetuses suggests altered pulmonary development, contributing new insights into antenatal assessment.
先进的MRI技术、运动校正和T2弛豫测量法，可能会提供有关肺组织功能特性的信息。我们评估了先天性膈疝（CDH）胎儿的肺容积和肺T2值是否低于对照组，以及存活者和非存活者之间是否存在差异。
无并发症妊娠的女性（对照组）和患有CDH的女性在1.5T成像系统上进行胎儿MRI检查，包括T2单次激发快速自旋回波序列和梯度回波单次激发回波平面序列，以提供T2数据。使用层到容积重建进行运动校正，使用内部管道生成T2图。使用预训练的3D深度学习管道分别对肺进行分割。
分析了33例对照组和12例CDH胎儿的数据集。扫描时对照组的平均±标准差孕周为28.3±4.3周，CDH病例为27.6±4.9周。合并的双肺中，非存活者和存活者的CDH肺容积均低于对照组（5.76±3.59[cc]，平均差异=15.97，95%CI：-24.51--12.9，p<0.001和5.73±2.96[cc]，平均差异=16，95%CI：1.91-11.53，p=0.008），同侧肺也是如此（1.93±2.09[cc]，平均差异=19.8，95%CI：-28.48--16.45，p<0.001；1.58±1.18[cc]，平均差异=20.15，95%CI：5.96-15.97，p<0.001）。与对照组相比，非存活者双肺、同侧肺和对侧肺的平均肺T2*值均较低（81.83±26.21ms，平均差异=31.13，95%CI：-58.14--10.32，p=0.006；81.05±26.84ms，平均差异=31.91，95%CI：-59.02--10.82，p=0.006；82.62±36.31ms，平均差异=30.34，95%CI：-58.84--8.25，p=0.011），但存活的对照组和CDH病例之间未观察到差异。
与对照组相比，CDH胎儿的平均肺T2值较低；与存活者相比，死亡的CDH病例的平均肺T2值较低。平均肺T2*值可能对CDH胎儿具有预后功能。
本研究提供了在CDH背景下对同侧和对侧胎儿肺的形态和功能特性进行的原始运动校正评估。与对照组相比，CDH胎儿的平均肺T2值较低；与存活者相比，死亡病例的平均肺T2值较低。平均肺T2值可能在预后评估中发挥作用。CDH胎儿肺T2值的降低表明肺发育改变，为产前评估提供了新的见解。
