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Prenatal MRI assessment of mediastinal shift angle as a feasible and effective risk stratification tool in isolated right-sided congenital diaphragmatic hernia

  • Paediatric
  • Published:
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Abstract

Objectives

To develop a mediastinal shift angle (MSA) measurement method applicable to right-sided congenital diaphragmatic hernia (RCDH) in fetal MRI and to validate the predictive value of MSA in RCDH.

Methods

Twenty-seven fetuses with isolated RCDH and 53 controls were included in our study. MSA was measured on MRI axial image at the level of four-chamber view of the fetal heart. The angle between the sagittal midline landmark line and the left boundary landmark line touching tangentially the lateral wall of the left ventricle was used to quantify MSA for RCDH. Appropriate statistical analyses were performed to determine whether MSA can be regarded as a valid predictive tool for postnatal outcomes. Furthermore, predictive performance of MSA was compared with that of lung area to head circumference ratio (LHR), observed/expected LHR (O/E LHR), total fetal lung volume (TFLV), and observed/expected TFLV (O/E TFLV).

Results

MSA was significantly higher in the RCDH group than in the control group. MSA, LHR, O/E LHR, TFLV, and O/E TFLV were all correlated with postnatal survival, pulmonary hypertension (PH), and extracorporeal membrane oxygenation (ECMO) therapy (p < 0.05). Value of the AUC demonstrated good predictive performance of MSA for postnatal survival (0.901, 95%CI: (0.781–1.000)), PH (0.828, 95%CI: (0.661–0.994)), and ECMO therapy (0.813, 95%CI: (0.645–0.980)), which was similar to O/E TFLV but slightly better than TFLV, O/E LHR, and LHR.

Conclusions

We developed a measurement method of MSA for RCDH for the first time and demonstrated that MSA could be used to predict postnatal survival, PH, and ECMO therapy in RCDH.

Clinical relevance statement

Newly developed MRI assessment method of fetal MSA in RCDH offers a simple and effective risk stratification tool for patients with RCDH.

Key Points

• We developed a measurement method of mediastinal shift angle for right-sided congenital diaphragmatic hernia for the first time and demonstrated its feasibility and reproducibility.

• Mediastinal shift angle can predict more prognostic information other than survival in right-sided congenital diaphragmatic hernia with good performance.

• Mediastinal shift angle can be used as a simple and effective risk stratification tool in right-sided congenital diaphragmatic hernia to improve planning of postnatal management.

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Abbreviations

CDH:

Congenital diaphragmatic hernia

CDHSG:

Congenital Diaphragmatic Hernia Study Group

ECLS:

Extracorporeal life support

ECMO:

Extracorporeal membrane oxygenation

FETO:

Fetal endoluminal tracheal occlusion

LCDH:

Left-sided diaphragmatic hernia

LHR:

Lung area to head circumference ratio

MSA:

Mediastinal shift angle

O/E LHR:

Observed/expected lung area to head circumference ratio

O/E TFLV:

Observed/expected total fetal lung volume

PH:

Pulmonary hypertension

PPLV:

Percent predicted lung volume

RCDH:

Right-sided diaphragmatic hernia

TFLV:

Total fetal lung volume

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Acknowledgements

We thank Guangdong Science and Technology Department, Guangzhou Science and Technology Program and Fetal Medicine Foundation of Guangzhou Women and Children’s Medical Center for supporting research on congenital diaphragmatic hernia.

Funding

This study has received funding from the Major Projects of Guangdong Science and Technology Department, China (Grant No. 2019B020227001, No. 2019B030301004), the key projects of Guangzhou Science and Technology Program, China (Grant No. 202102010016), and Fetal Medicine Foundation of Guangzhou Women and Children’s Medical Center (Grant No.4001027).

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Authors and Affiliations

  1. Department of Fetal Medicine, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China

    Wen Ding & Yuanyuan Gu

  2. Department of Obstetrics and Gynecology, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China

    Yuanyuan Gu

  3. Department of Medical Imaging, Guangzhou Women and Children’s Medical Center, Guangzhou, China

    Haiyu Wang, Huiying Wu, Xiaochun Zhang, Rui Zhang, Hongying Wang & Li Huang

  4. Surgical Neonatal Intensive Care Unit, Guangzhou Women and Children’s Medical Center, Guangzhou, China

    Junjian Lv & Bo Xia

  5. Department of Pediatric Surgery, Guangzhou Women and Children’s Medical Center, Guangzhou, China

    Wei Zhong, Qiuming He & Longlong Hou

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  1. Wen Ding
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Correspondence to Yuanyuan Gu.

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The scientific guarantor of this publication is Yuanyuan Gu.

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The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

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Ding, W., Gu, Y., Wang, H. et al. Prenatal MRI assessment of mediastinal shift angle as a feasible and effective risk stratification tool in isolated right-sided congenital diaphragmatic hernia. Eur Radiol 34, 1524–1533 (2024). https://doi.org/10.1007/s00330-023-10178-1

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