MRT-basierter Quotient aus fetalem Lungen- und Ganzkörpervolumen als Prognosemarker für chronische Lungenerkrankung bei kongenitaler Zwerchfellhernie

Zusammenfassung

Hintergrund Ziel dieser Studie war die Untersuchung der prognostischen Wertigkeit des MRT-basierten Quotienten aus fetalem Lungenvolumen (FLV) und fetalem Körpervolumen (FBV) im Hinblick auf die Entwicklung einer chronischen Lungenerkrankung (CLD) bei Feten mit kongenitaler Zwerchfellhernie (CDH).

Patienten und Methoden Bei 132 Kindern erfolgte im Rahmen dieser Studie eine Evaluation bzgl. der Entwicklung einer CLD und ggf. die Zuordnung zu einer der 3 Subgruppen (mild/moderat/schwer). Das fetale Lungen- und Körpervolumen wurde mittels fetaler MRT-Volumetrie ermittelt und hieraus der individuelle FLV/FBV-Quotient errechnet. Mittels logistischer Regressionsanalyse wurde die Wahrscheinlichkeit der postnatalen Entwicklung und Graduierung einer CLD in Abhängigkeit des Quotienten errechnet. Zusätzlich erfolgte die Beurteilung der prognostischen Wertigkeit durch Berechnung der ROC-Kurven (receiver operater characteristic) und AUC-Werte (area under the curve).

Ergebnisse 61 der 132 eingeschlossenen Feten entwickelten eine CLD (46,2%). Der Quotient FLV/FBV war bei den Feten mit Diagnose einer CLD signifikant niedriger (p=0,0008, AUC 0,743). Die Entwicklung einer CLD war darüberhinaus signifikant mit dem Vorhandensein intrathorakaler Leberanteile korreliert (p<0,001) sowie mit den perinatalen Parametern niedriges Gestationsalter (p=0,0052) bzw. ECMO-Bedarf (p<0,0001).

Schlussfolgerung Der MRT-basierte Quotient FLV/FBV ist ein hochwertiger prognostischer Parameter für die Entwicklung einer CLD. Frühe therapeutische Entscheidungen werden durch die Abschätzung der Prognose bzw. der Wahrscheinlichkeit der Entwicklung einer CLD durch den FLV/FBV-Quotienten unterstützt. Die prognostische Wertigkeit kann durch Berücksichtigung der perinatalen Parameter ECMO-Bedarf und Gestationsalter bei Geburt zusätzlich verbessert werden.

Abstract

Background Our aim was to evaluate the prognostic value of magnetic resonance imaging (MRI)-based ratio of fetal lung volume (FLV) to fetal body volume (FBV) as a marker for development of chronic lung disease (CLD) in fetuses with congenital diaphragmatic hernia (CDH).

Patients and Methods FLV and FBV were measured and the individual FLV/FBV ratio was calculated in 132 fetuses. Diagnosis of CLD was established following prespecified criteria and graded into mild/moderate/severe if present. Logistic regression analysis was used to calculate the probability of postnatal development of CLD in dependence of the FLV/FBV ratio. Receiver operating characteristic curves were analysed by calculating the area under the curve to evaluate the prognostic accuracy of this marker.

Results 61 of 132 fetuses developed CLD (46.21%). The FLV/FBV ratio was significantly lower in fetuses with CLD (p=0.0008; AUC 0.743). Development of CLD was significantly associated with thoracic herniation of liver parenchyma (p<0.0001), requirement of extracorporal membrane oxygenation (ECMO) (p<0.0001) and gestational age at delivery (p=0.0052).

Conclusion The MRI-based ratio of FLV to FBV is a highly valuable prenatal parameter for development of CLD. The ratio is helpful for early therapeutic decisions by estimating the probability to develop CLD. Perinatally, gestational age at delivery and ECMO requirement are useful additional parameters to further improve prediction of CLD.

Schlüsselwörter

fetales MRT - kongenitale Zwerchfellhernie - chronische Lungenerkrankung - fetale Volumetrie - Prognose

Key words

fetal MRI - congenital diaphragmatic hernia - chronic lung disease - fetal volume - prognosis

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