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Purpose: To assess whether chronic lung disease (CLD) in surviving infants with congenital diaphragmatic hernia (CDH) is associated with lung hypoplasia on the basis of the results of antenatal observed-to-expected fetal lung volume (FLV) ratio measurement at magnetic resonance (MR) imaging., Materials and Methods: The study received approval from the institutional review board, with waiver of informed consent for this retrospective review from patients who had previously given informed consent for prospective studies. The ratio of observed to expected FLV at MR imaging was calculated in 172 fetuses with CDH. At postpartum day 28, the need for supplemental oxygen implicated the diagnosis of CLD. At day 56, patients with CLD were assigned to one of three groups-those with mild, moderate, or severe CLD-according to their demand for oxygen. Logistic regression analysis was used to assess the prognostic value of the individual observed-to-expected FLV ratio for association with postnatal development of CLD., Results: Children with CLD were found to have significantly smaller observed-to-expected FLV ratios at MR imaging than infants without CLD (P < .001). Grading of CLD revealed significant differences in observed-to-expected FLV ratio between patients with mild CLD and those with moderate (P = .012) or severe (P = .007) CLD. For an observed-to-expected FLV ratio of 5%, 99% of patients with CDH developed CLD, compared with less than 5% of fetuses with an observed-to-expected FLV ratio of 50%. Perinatally, development and grade of CLD were further influenced by the need for extracorporeal membrane oxygenation (ECMO) (P < .001) and gestational age at delivery (P = .009)., Conclusion: Manifestation of CLD in surviving infants with CDH is associated with the prenatally determined observed-to-expected FLV ratio. Early neonatal therapeutic decisions can additionally be based on this ratio. Perinatally, ECMO requirement and gestational age at delivery are useful in further improving the estimated probability of CLD.

Purpose: To retrospectively evaluate the accuracy of the absolute fetal lung volume (FLV) measured at magnetic resonance (MR) imaging and seven formulas for calculating relative FLV to predict neonatal survival and the need for extracorporeal membrane oxygenation (ECMO) in fetuses with congenital diaphragmatic hernia (CDH)., Materials and Methods: This retrospective study was approved by the research ethics committee, and informed consent was received from all mothers for previous prospective studies. In total, 68 fetuses with CDH were assessed by using MR image FLV measurement within 23-39 weeks gestation. The relative FLV was expressed as a percentage of the predicted lung volume calculated with biometric parameters according to seven formulas previously described in the literature. Applying the area under the curve (AUC), the various relative FLVs and the absolute FLV were investigated for their prognostic accuracy to predict neonatal survival and the need for ECMO therapy., Results: All relative FLVs and the absolute FLV revealed a significant difference in mean lung volume between neonates who survived and neonates who did not survive (P = .001 to P < .001) and measurement accuracy was excellent for each method (AUC, 0.800-0.900). For predicting neonatal ECMO requirement, differences in FLVs were smaller but still significant (P = .05 to <.009) and measurement accuracy was acceptable throughout (AUC, 0.653-0.739)., Conclusion: The various relative FLVs and the absolute FLV measured at MR planimetry are each highly valuable in predicting survival in fetuses with CDH. For predicting whether neonatal ECMO therapy is required, the accuracy of the absolute FLV (AUC, 0.68) and that of the relative FLVs (AUC, 0.653-0.739) was acceptable., ((c) RSNA, 2008.)

Purpose: To prospectively assess the results of logistic regression analysis that were based on magnetic resonance (MR) image fetal lung volume (FLV) measurements to predict survival and the corresponding need for extracorporeal membrane oxygenation (ECMO) therapy in fetuses with congenital diaphragmatic hernia (CDH) before and after 30 weeks gestation., Materials and Methods: Written informed consent was obtained and the study was approved by the local research ethics committee. FLV was measured on MR images in 95 fetuses (52 female neonates, 43 male neonates) with CDH between 22 and 39 weeks gestation by using multiplanar T2-weighted half-Fourier acquired single-shot turbo spin-echo MR imaging. On the basis of logistic regression analysis results, mortality and the need for ECMO therapy were calculated for fetuses before and after 30 weeks gestation., Results: Overall, higher FLV was associated with improved survival (P < .001) and decreasing probability of need for ECMO therapy (P = .008). Survival at discharge was 29.2% in neonates with an FLV of 5 mL, compared with 99.7% in neonates with an FLV of 25 mL. The corresponding need for ECMO therapy was 56.1% in fetuses with an FLV of 5 mL and 8.7% in fetuses with an FLV of 40 mL. Prognostic power was considerably lower before 30 weeks gestation., Conclusion: Beyond 30 weeks gestation, logistic regression analysis that is based on MR FLV measurements is useful to estimate neonatal survival rates and ECMO requirements. Prior to 30 weeks gestation, the method is not reliable and the FLV measurement should be repeated, particularly in fetuses with small lung volumes, before a decision is made about therapeutic options., ((c) RSNA, 2008.)

Purpose: To prospectively assess the reliability of magnetic resonance (MR) image volume measurement in fetuses with congenital diaphragmatic hernia (CDH) and the reliability and validity of measurements in in vitro lung models., Materials and Methods: This study was approved by the ethics committee, and informed consent was obtained. MR fetal lung volume (FLV) was measured in 40 consecutive fetuses with CDH by using half-Fourier acquired single-shot turbo spin-echo MR imaging and true fast imaging with steady-state precession at 24-36 weeks gestation (mean gestational age, 30.6 weeks +/- 3.5 [standard deviation]). Lung volumes were independently assessed in three orthogonal section planes by two experienced observers. Additionally, 28 in vitro lung models of defined volumes of 1-60 mL were evaluated the same way. To assess measurement validity and reliability, the intraclass correlation coefficient (ICC) and the Bland-Altman plot were used., Results: The interobserver reliability was high for both the lung models and FLV measurements (ICC, 0.999 and 0.928, respectively). Measurement validity was also good, with a mean difference between the calculated volume and the true volume of 0.4 mL (95% confidence interval: 0.30, 0.48). Measurement reliability and validity did not depend, to any considerable degree, on imaging plane or sequence (ICC range, 0.878-0.999) or on total volume., Conclusion: The reliability and validity of MR volume measurements are high. The method is independent of the sequence and the imaging plane and can be performed with a very good interobserver agreement, even in small volumes., ((c) RSNA, 2007.)