Gao Qiong,Huang Qiang,Mao Cuiping,et al.Prognostic values of different parameters acquired from fetal magnetic resonance imaging in congenital diaphragmatic hernia[J].Journal of Clinical Pediatric Surgery,,21():838-843.[doi:10.3760/cma.j.cn101785-202206003-008]
Click Copy

Prognostic values of different parameters acquired from fetal magnetic resonance imaging in congenital diaphragmatic hernia

Journal of Clinical Pediatric Surgery[ISSN:1671-6353/CN:43-1380/R] volume: 第21卷 Number: 2022 09 Page: 838-843 Column: 专题·出生结构缺陷的早期干预 Date of publication: 2022-09-28
Author(s):
Gao Qiong1;  Huang Qiang2;  Mao Cuiping3;  Gao Ya2;  Wang Yudu4;  Li Peng2
1. Department of Neonatology, Second Affiliated Hospital, Xi’an Jiaotong University, Xi’an 710004, China;
2. Department of Pediatric Surgery, Second Affiliated Hospital, Xi’an Jiaotong University, Xi’an 710004, China;
3. Department of Radiology, Second Affiliated Hospital, Xi’an Jiaotong University, Xi’an 710004, China;
4. Department of General Surgery, Central Municipal Hospital, Hanzhong 723000, China
Keywords:
Infant;  Newborn; Magnetic Resonance Spectroscopy/IS; Hernias;  Diaphragmatic;  Congenital/CO; Prognosis
DOI:
10.3760/cma.j.cn101785-202206003-008
Abstract:
Objective To perform retrospective analysis of fetal magnetic resonance imaging (MRI) to examine the prognostic values of measurement and evaluation parameters for predicting the neonatal survival of congenital diaphragmatic hernia (CDH).Methods From 2011 to 2020, MRI findings were reviewed for 50 fetuses prenatally diagnosed as CDH.Involved side was left (n=37) and right (n=13).Observed-to-expected (O/E) values of total lung volume (TLV), lung-to-liver signal intensity ratio (LLSIR), mediastinal shift angle (MSA), incomplete pulmonary baseline (IPB), liver up (LU) and retrocardiac stomach (RCS) on MRI were evaluated.Results Among them, 35 neonates survived while 15 died after birth.Lung volume (survival vs death:35.09±10.87 vs.24.29±6.86), lung-to-liver intensity ratio (survival vs death:2.68±1.01 vs.1.93±0.93) and mediastinal shift angle (survival vs death:30.88±7.07 vs.39.05±4.21) had significant differences in survival (P < 0.05).And IPB, LU and RCS on MRI were correlated with a higher mortality rate (P < 0.05).Receiver operating characteristic (ROC) analysis indicated MSA was an ideal single parameter and the prognostic value of combining 6 parameters (O/E TLV, LLSIR, MSA, IPB, LU & RCS) was optimal for predicting the prognosis.Conclusion TLV, LLSIR, MSA, IPB, LU and RCS are correlated with perinatal outcomes in terms of survival.The combination of all six parameters is optimal for predicting neonatal survival.Constructing an evaluation system based upon the above parameters may aid in predicting the occurrence of pulmonary hypoplasia, necessity for extracorporeal membrane oxygenation (ECMO) and a proper selection of surgical approaches.

References:

[1] Snyder AN, Cheng T, Burjonrappa S.A nationwide database analysis of demographics and outcomes related to extracorporeal membrane oxygenation (ECMO) in congenital diaphragmatic hernia[J].Pediatr Surg Int, 2021, 37(11):1505-1513.DOI:10.1007/s00383-021-04979-y.
[2] Qiao L, Wynn J, Yu L, et al.Likely damaging de novo variants in congenital diaphragmatic hernia patients are associated with worse clinical outcomes[J].Genet Med, 2020, 22(12):2020-2028.DOI:10.1038/s41436-020-0908-0.
[3] Ito M, Terui K, Nagata K, et al.Clinical guidelines for the treatment of congenital diaphragmatic hernia[J].Pediatr Int, 2021, 63(4):371-390.DOI:10.1111/ped.14473.
[4] Khan AA, Furey EA, Bailey AA, et al.Fetal liver and lung volume index of neonatal survival with congenital diaphragmatic hernia[J].Pediatr Radiol, 2021, 51(9):1637-1644.DOI:10.1007/s00247-021-05049-0.
[5] Oluyomi-Obi T, Kuret V, Puligandla P, et al.Antenatal predictors of outcome in prenatally diagnosed congenital diaphragmatic hernia (CDH)[J].J Pediatr Surg, 2017, 52(5):881-888.DOI:10.1016/j.jpedsurg.2016.12.008.
[6] Phillips R, Shahi N, Meier M, et al.The novel fetal MRI O/E CLV versus O/E LHR in predicting prognosis in congenital diaphragmatic hernias:can we teach an old dog new tricks?[J].Pediatr Surg Int, 2021, 37(11):1499-1504.DOI:10.1007/s00383-021-04936-9.
[7] Romiti A, Viggiano M, Conforti A, et al.Ultrasonographic assessment of mediastinal shift angle (MSA) in isolated left congenital diaphragmatic hernia for the prediction of postnatal survival[J].J Matern Fetal Neonatal Med, 2020, 33(8):1330-1335.DOI:10.1080/14767058.2018.1517329.
[8] Hattori T, Hayakawa M, Ito M, et al.The relationship between three signs of fetal magnetic resonance imaging and severity of congenital diaphragmatic hernia[J].J Perinatol, 2017, 37(3):265-269.DOI:10.1038/jp.2016.208.
[9] Zamora IJ, Mehollin-Ray AR, Sheikh F, et al.Predictive Value of MRI Findings for the Identification of a Hernia Sac in Fetuses With Congenital Diaphragmatic Hernia[J].AJR Am J Roentgenol, 2015, 205(5):1121-1125.DOI:10.2214/AJR.15.14476.
[10] Sebastià C, Gomez O, Salvador R, et al.Prognostic usefulness of derived T2-weighted fetal magnetic resonance imaging measurements in congenital diaphragmatic hernia[J].Radiologia, 2015, 57(3):239-247.DOI:10.1016/j.rx.2014.02.001.
[11] 赵云龙, 马立霜, 蒋宇林, 等.新生儿膈疝产时宫外治疗的临床经验及预后相关因素[J].临床小儿外科杂志, 2021, 20(9):808-813.DOI:10.12260/lcxewkzz.2021.09.002. Zhao YL, Ma LS, Jiang YL, et al.Clinical experience of ex-utero intrapartum treatment and prognostic factors of neonatal diaphragmatic hernia[J].J Clin Ped Sur, 2021, 20(9):808-813.DOI:10.12260/lcxewkzz.2021.09.002.
[12] Amodeo I, Borzani I, Corsani G, et al.Fetal MRI mediastinal shift angle and respiratory and cardiovascular pharmacological support in newborns with congenital diaphragmatic hernia[J].Eur J Pediatr, 2022, 181(1):323-334.DOI:10.1007/s00431-021-04207-8.
[13] Kastenholz KE, Weis M, Hagelstein C, et al.Correlation of observed-to-expected mri fetal lung volume and ultrasound lung-to-head ratio at different gestational times in fetuses with congenital diaphragmatic hernia[J].AJR Am J Roentgenol, 2016, 206(4):856-866.DOI:10.2214/AJR.15.15018.
[14] Dütemeyer V, Cordier AG, Cannie MM, et al.Prenatal prediction of postnatal survival in fetuses with congenital diaphragmatic hernia using MRI:lung volume measurement, signal intensity ratio, and effect of experience[J].J Matern Fetal Neonatal Med, 2022, 35(6):1036-1044.DOI:10.1080/14767058.2020.1740982.
[15] Matsushita M, Ishii K, Tamura M, 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].J Obstet Gynaecol Res, 2008, 34(2):162-167.DOI:10.1111/j.1447-0756.2008.00754.x.
[16] Savelli S, Bascetta S, Carducci C, et al.Fetal MRI assessment of mediastinal shift angle in isolated left congenital diaphragmatic hernia:A new postnatal survival predictive tool?[J].Prenat Diagn, 2020, 40(1):136-141.DOI:10.1002/pd.5619.

Memo

收稿日期:2022-02-18。
基金项目:西安交通大学第二附属医院新技术新疗法（201602）
通讯作者:黄强,E-mail:drhuang@xjtu.edu.cn

Last Update: 1900-01-01