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Fetal lung volume and quantification of liver herniation by magnetic resonance imaging in isolated congenital diaphragmatic hernia.
- Source :
-
Ultrasound in Obstetrics & Gynecology . Jun2014, Vol. 43 Issue 6, p662-669. 8p. - Publication Year :
- 2014
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Abstract
- ABSTRACT Objective To determine associations between fetal lung and liver herniation volumes measured by magnetic resonance imaging ( MRI) and mortality/need for extracorporeal membrane oxygenation ( ECMO) in cases of isolated congenital diaphragmatic hernia ( CDH). A secondary objective was to compare prenatal MRI parameters with two-dimensional ultrasound lung measurements. Methods A retrospective review of medical records of all fetuses with isolated CDH evaluated between January 2004 and July 2012 was performed. The following MRI parameters were measured at 20-32 weeks: observed/expected total fetal lung volume (o/e- TLV), predicted pulmonary volume ( PPV), percentage of liver herniated into the fetal thorax (% LH) and the liver/thoracic volume ratio ( LiTR). These were compared with the ultrasound-determined lung-to-head ratio ( LHR) and the observed/expected LHR (o/e- LHR) in the same cohort. The predictive value of MRI and ultrasound parameters for mortality and the need for ECMO was evaluated by univariate, multivariate and factor analysis and by receiver-operating characteristics curves. Results Eighty fetuses with isolated CDH were evaluated. Overall mortality was 18/80 (22.5%). Two newborns died a few hours after birth. ECMO was performed in 29/78 (37.2%) newborns, with a survival rate of 48.3% (14/29). The side of the diaphragmatic defect was not associated with mortality ( P = 0.99) or the need for ECMO ( P = 0.48). Good correlation was observed among o/e- TLV, PPV, LHR and o/e- LHR as well as between % LH and LiTR ( r = 0.89; P < 0.01); however, fetal lung measurements and measures of liver herniation were not correlated (all P > 0.05). All parameters were statistically associated with mortality or the need for ECMO. The best combination of measurements to predict mortality was o/e- TLV and % LH, with 83% accuracy. Conclusion Mortality and the need for ECMO in neonates with isolated CDH can be best predicted using a combination of MRI o/e- TLV and % LH. Copyright © 2013 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]
Details
- Language :
- English
- ISSN :
- 09607692
- Volume :
- 43
- Issue :
- 6
- Database :
- Academic Search Index
- Journal :
- Ultrasound in Obstetrics & Gynecology
- Publication Type :
- Academic Journal
- Accession number :
- 96311507
- Full Text :
- https://doi.org/10.1002/uog.13223