Measurements of Lung Size in Ultrasound and Magnetic Resonance Imaging in Congenital Diaphragmatic Hernia – A Comparison of Prenatal Imaging Techniques

Yannick Alexander Schreiner; Johannes Lukas Schmidt; Meike Weis; Oliver Nowak; Thomas Kohl; Svetlana Hetjens; Neysan Rafat; Thomas Schaible

doi:10.1055/a-2525-6117

Ultraschall in der Medizin - European Journal of Ultrasound, Inhaltsverzeichnis

CC BY-NC-ND 4.0 · Ultraschall Med
DOI: 10.1055/a-2525-6117

Original Article

Measurements of Lung Size in Ultrasound and Magnetic Resonance Imaging in Congenital Diaphragmatic Hernia – A Comparison of Prenatal Imaging Techniques

Messung der Lungengröße mittels Ultraschall und Magnetresonanztomografie bei Kindern mit kongenitaler Zwerchfellhernie – ein Vergleich pränataler Bildgebungstechniken

Yannick Alexander Schreiner

¹Department of Anesthesiology, Intensive Care Medicine and Pain Care, University Medical Centre Mannheim, Mannheim, Germany (Ringgold ID: RIN36642)

,

Johannes Lukas Schmidt

²Department of Neonatology, University Medical Centre Mannheim, Mannheim, Germany (Ringgold ID: RIN36642)

,

Meike Weis

³Department of Clinical Radiology and Nuclear Medicine, University Medical Centre Mannheim, Mannheim, Germany (Ringgold ID: RIN36642)

,

Oliver Nowak

⁴Department of Obstetrics and Gynecology, University Medical Centre Mannheim, Mannheim, Germany (Ringgold ID: RIN36642)

,

Thomas Kohl

⁵German Center for Fetal Surgery & Minimally-Invasive Surgery (DZFT), University Medical Centre Mannheim, Mannheim, Germany (Ringgold ID: RIN36642)

,

Svetlana Hetjens

⁶Department of Medical Statistics and Biomathematics, University Medical Centre Mannheim, Mannheim, Germany (Ringgold ID: RIN36642)

,

Neysan Rafat

⁷Department of Neonatology, Klinikum Stuttgart Olgahospital Frauenklinik, Stuttgart, Germany (Ringgold ID: RIN9220)

,

Thomas Schaible

²Department of Neonatology, University Medical Centre Mannheim, Mannheim, Germany (Ringgold ID: RIN36642)

› Institutsangaben

Abstract

Purpose

To investigate the correlation between different prenatal imaging techniques in congenital diaphragmatic hernia (CDH) and their prognostic value.

Materials and Methods

209 fetuses with CDH were enrolled in this retrospective cohort study. The prenatal ultrasound-based and MRI-based (MRI: magnetic resonance imaging) observed-to-expected lung-to-head ratio (o/e-LHR) and MRI-based relative fetal lung volume (rFLV) were evaluated and compared. Their prediction component with respect to clinical outcome was evaluated. Mean values were compared by two-sample t-tests or the Mann-Whitney U-test. The Chi-square or Fisher’s exact test was used in order to compare qualitative parameters. Kappa coefficients, McNemar test, and Bowker’s test were used to assess the degree of agreement.

Results

The study population included 183 fetuses with left-sided and 26 fetuses with right-sided CDH. Survival did not differ significantly (74.3% vs. 80.8%, p=0.053). For every imaging technique, incidences of extracorporeal membrane oxygenation (ECMO) and chronic lung disease decreased, and the probability of survival increased gradually reaching minima and maxima for o/e-LHR and rFLV above 35%. Outcome improved if rFLV was above 35% – compared to MRI-based measurement of o/e-LHR above 35%.

Conclusion

Our data confirm the predictive value of o/e-LHR for CDH – irrespective of the diagnostic modality. MRI evaluation of o/e-LHR was not superior compared to sonography. MRI evaluation of rFLV correlated with morbidity and mortality which can be beneficial for fetuses with an otherwise good prognosis based on higher o/e-LHR as 2D imaging techniques can underestimate the fetuses’ risk for pulmonary hypertension and ECMO.

Zusammenfassung

Ziel

Die Korrelation unterschiedlicher pränataler Bildgebungsverfahren bei kongenitaler Zwerchfellhernie (CDH) zu untersuchen und einen Vergleich ihrer prognostischen Vorhersagekraft durchzuführen.

Material und Methoden

209 Feten mit CDH wurden in die Studie eingeschlossen. Die via Ultraschall und Magnetresonanztomografie (MRT) untersuchte relative Lung-to-head-Ratio (o/e-LHR) und das relative fetale Lungenvolumen (rFLV) wurden miteinander verglichen und ihre prognostische Wertigkeit evaluiert. Mittelwerte wurden mit Two-sample-t-Tests (Zwei-Stichproben-T-Tests) oder Mann-Whitney-U-Tests verglichen.

Ergebnisse

Zwischen 183 Feten mit linksseitiger und 26 mit rechtsseitiger CDH bestand kein signifikanter Unterschied im Überleben (74.3% vs. 80,8%, p=0.053). In MRT und Ultraschall nahmen mit steigendem o/e-LHR und rFLV die Rate der extrakorporalen Membran-Oxygenierung (ECMO) und chronischen Lungenerkrankung ab und das Gesamtüberleben zu. Minimal- und Maximalwerte wurden erreicht, wenn o/e-LHR und rFLV über 35% betrugen. Das Outcome verbesserte sich, wenn das rFLV über 35% betrug – verglichen mit jener Gruppe, bei der ein o/e-LHR von über 35% prognostisch zugrunde lag.

Schlussfolgerungen

Die Daten bestätigen den prognostischen Wert von o/e-LHR und rFLV bei CDH. Die MRT-Bestimmung von o/e-LHR war der Sonografie nicht überlegen. Das rFLV korreliert mit der Morbidität und Mortalität. Seine Bestimmung kann vorteilhaft sein, insbesondere für Kinder, die basierend auf höheren o/e-LHR-Werten gute Prognosen erhalten, denn 2D-Messverfahren unterschätzen die Risiken für pulmonale Hypertonie und ECMO.

Keywords

Congenital diaphragmatic hernia - Prenatal diagnostics - Fetal magnetic resonance imaging

Volltext

Referenzen

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