Abstract
Objective:
Prognostic prediction in prenatally diagnosed congenital diaphragmatic hernia (CDH) is needed. The aim of the study was to evaluate magnetic resonance imaging (MRI) signal intensity of the fetal lung as a predictor of prognosis in CDH.
Study Design:
The subjects consisted of 12 fetuses with prenatally diagnosed CDH, who were treated soon after the birth in our institution. They all underwent MRI at 29 to 37 weeks of gestation. The ratio of the lung signal intensity to the spinal fluid signal intensity (L/SF) was calculated using region-of-interest analysis of T2-weighted images. The relationship between L/SF and clinical data was then examined.
Result:
L/SF were significantly larger in survivors compared with deaths (0.815 vs 0.614, P<0.05). In survivors, L/SF significantly correlated with duration of tracheal intubation (rs=−0.938, P<0.01).
Conclusion:
L/SF is a unique factor to predict the survival prognosis and likely to quantify the degree of pulmonary hypoplasia in CDH.
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References
Downard CD, Jaksic T, Garza JJ, Dzakovic A, Nemes L, Jennings RW et al. Analysis of an improved survival rate for congenital diaphragmatic hernia. J Pediatr Surg 2003; 38: 729–732.
Stege G, Fenton A, Jaffray B . Nihilism in the 1990s: the true mortality of congenital diaphragmatic hernia. Pediatrics 2003; 112: 532–535.
Javid PJ, Jaksic T, Skarsgard ED, Lee S, Canadian Neonatal Network. Survival in congenital diaphragmatic hernia: the experience of the Canadian Neonatal Network. J Pediatr Surg 2004; 39: 657–660.
The Ontario Congenital Anomalies Study Group. Apparent truth about congenital diaphragmatic hernia: a population based database is needed to establish benchmarking for clinical outcomes for CDH. J Pediatr Surg 2004; 39: 661–665.
Colvin J, Bower C, Dickinson JE, Sokol J . Outcomes of congenital diaphragmatic hernia: a population-based study in Western Australia. Pediatrics 2005; 116: e356–e363.
Geary MP, Chitty LS, Morrison JJ, Wright V, Pierro A, Rodeck CH . Perinatal outcome and prognostic factors in prenatally diagnosed congenital diaphragmatic hernia. Ultrasound Obstet Gynecol 1998; 12: 107–111.
Cass DL . Fetal surgery for congenital diaphragmatic hernia: the North American experience. Semin Perinatol 2005; 29: 104–111.
Graham G, Devine PC . Antenatal diagnosis of congenital diaphragmatic hernia. Semin Perinatol 2005; 29: 69–76.
Burri PH . Structural aspects of prenatal and postnatal development and growth of the lung In: McDonald JA (ed). Lung Growth and Development. Marcel Dekker: New York, 1997 pp 1–35.
Kasprian G, Balassy C, Brugger PC, Prayer D . MRI of normal and pathological fetal lung development. Eur J Radiol 2006; 57: 261–270.
Osada H, Kaku K, Masuda K, Iitsuka Y, Seki K, Sekiya S . Quantitative and qualitative evaluations of fetal lung with MR Imaging. Radiology 2004; 231: 887–892.
Coakley FV, Lopoo JB, Lu Y, Hricak H, Albanese CT, Harrison MR et al. Normal and hypoplastic fetal lungs: volumetric assessment with prenatal single-shot rapid acquisition with relaxation enhancement MR imaging. Radiology 2000; 216: 107–111.
Lipshutz GS, Albanese CT, Feldstein VA, Jennings RW, Housley HT, Beech R et al. Prospective analysis of lung-to-head ratio predicts survival for patients with prenatally diagnosed congenital diaphragmatic hernia. J Pediatr Surg 1997; 24: 567–569.
Laudy JA, Van Gucht M, Van Dooren MF, Wladimiroff JW, Tibboel D . Congenital diaphragmatic hernia: an evaluation of the prognostic value of the lung-to-head ratio and other prenatal parameters. Prenat Diagn 2003; 23: 634–639.
Gucciardo L, Deprest J, Done’ E, Van Mieghem T, Van de Velde M, Gratacos E et al. Prediction of outcome in isolated congenital diaphragmatic hernia and its consequences for fetal therapy. Best Pract Res Clin Obstet Gynaecol 2008; 22: 123–138.
Peralta CF, Cavoretto P, Csapo B, Vandecruys H, Nicolaides KH . Assessment of lung area in normal fetuses at 12–32 weeks. Ultrasound Obstet Gynecol 2005; 26: 718–724.
Brewerton LJ, Chari RS, Liang Y, Bhargava R . Fetal lung-to-liver signal intensity ratio at MR imaging: development of a normal scale and possible role in predicting pulmonary hypoplasia in utero. Radiology 2005; 235: 1005–1010.
Kuwashima S, Nishimura G, Iimura F, Kohno T, Watanabe H, Kohno A et al. Low-intensity fetal lungs on MRI may suggest the diagnosis of pulmonary hypoplasia. Pediatr Radiol 2001; 31: 669–672.
Breysem L, Bosmans H, Jani J, Roubliova X, Cannie M, Deprest J et al. T2 quantifications of lungs in the fetal lamb with experimentally-induced congenital diaphragmatic hernia. Fetal Diagn Ther 2007; 22: 143–148.
Sedin G, Bogner P, Berényi E, Repa I, Nyúl Z, Sulyok E . Lung water and proton magnetic resonance relaxation in preterm and term rabbit pups: their relation to tissue hyaluronan. Pediatr Res 2000; 48: 554–559.
Hanley JA, McNeil BJ . The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology 1982; 143: 29–36.
Moore RJ, Strachan B, Tyler DJ, Baker PN, Gowland PA . In vivo diffusion measurements as an indication of fetal lung maturation using echo planar imaging at 0.5T. Magnet Reson Med 2001; 45: 247–253.
Fenton BW, Lin CS, Macedonia C, Schellinger D, Ascher S . The fetus at term: in utero volume-selected proton MR spectroscopy with a breath-hold technique-a feasibility study. Radiology 2001; 219: 563–566.
Nicolini U, Fisk NM, Rodeck CH, Talbert DG, Wigglesworth JS . Low amniotic pressure in oligohydramnios: is this the cause of pulmonary hypoplasia? Am J Obstet Gynecol 1989; 161: 1098–1101.
Harding R, Hooper SB, Dickson KA . A mechanism leading to reduced lung expansion and lung hypoplasia in fetal sheep during oligohydramnios. Am J Obstet Gynecol 1990; 163: 1904–1913.
Matsushita M, Ishii K, Tamura M, Takahashi Y, Kamura T, Takakuwa K et al. Perinatal magnetic resonance fetal lung volumetry and fetal lung-to-liver signal intensity ratio for predicting short outcome in isolated congenital diaphragmatic hernia and cystic adenomatoid malformation of the lung. J Obstet Gynaecol Res 2008; 34: 162–167.
Nishie A, Tajima T, Asayama Y, Ishigami K, Hirakawa M, Nakayama T et al. MR prediction of postnatal outcomes in left-sided congenital diaphragmatic hernia using right lung signal intensity: comparison with that using right lung volume. J Magn Reson Imaging. 2009; 30: 112–120.
Balassy C, Kasprian G, Brugger PC, Weber M, Csapo B, Herold C et al. Assessment of lung development in isolated congenital diaphragmatic hernia using signal intensity ratios on fetal MR imaging. Eur Radiol 2010; 20: 829–837.
Duncan KR, Baker PN, Gowland PA, Issa B, Moore R, Worthington B et al. Demonstration of changes in fetal liver erythropoiesis using echo-planar magnetic resonance imaging. Am J Physiol Gastrointest Liver Physiol 1997; 273: 965–967.
Brewerton LJ, Chari RS, Liang Y, Bhargava R . Fetal lung-to-liver signal intensity ratio at MR imaging: development of a normal scale and possible role in predicting pulmonary hypoplasia in utero. Radiology 2005; 235: 1005–1010.
Keller TM, Rake A, Michel SC, Seifert B, Wisser J, Marincek B et al. MR assessment of fetal lung development using lung volumes and signal intensities. Eur Radiol 2004; 14: 984–989.
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Terui, K., Omoto, A., Osada, H. et al. Prediction of postnatal outcomes in congenital diaphragmatic hernia using MRI signal intensity of the fetal lung. J Perinatol 31, 269–273 (2011). https://doi.org/10.1038/jp.2010.119
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DOI: https://doi.org/10.1038/jp.2010.119
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