Fetal Diagnosis and Therapy
Original Paper
Timing of Prenatal Magnetic Resonance Imaging in the Assessment of Congenital Diaphragmatic HerniaStyle C.C.a · Mehollin-Ray A.R.b · Verla M.A.a · Lau P.E.c · Cruz S.M.a · Espinoza J.e · Lee T.C.a · Fernandes C.J.d · Keswani S.G.a · Olutoye O.O.aaTexas Children’s Fetal Center and The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
bTexas Children’s Fetal Center, Department of Radiology, Baylor College of Medicine, Houston, TX, USA cMichael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA dTexas Children’s Fetal Center, Department of Pediatrics, Newborn Section, Baylor College of Medicine, Houston, TX, USA eTexas Children’s Fetal Center, Department of Maternal Fetal Medicine, Baylor College of Medicine, Houston, TX, USA |
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Article / Publication Details
Received: April 18, 2019
Accepted: June 18, 2019
Published online: August 15, 2019
Issue release date: March 2020
Number of Print Pages: 9
Number of Figures: 3
Number of Tables: 4
ISSN: 1015-3837 (Print)
eISSN: 1421-9964 (Online)
For additional information: https://www.karger.com/FDT
Abstract
Introduction: Fetal magnetic resonance imaging (MRI) has been used to stratify severity of congenital diaphragmatic hernia (CDH) after ultrasound diagnosis. The purpose of this study was to determine if timing of MRI influenced prediction of severity of outcome in CDH. Methods: A single institution retrospective review of all CDH referred to our institution from February 2004 to May 2017 was performed. Patients were included if they underwent at least 2 fetal MRIs prior to delivery. Prenatal MRI indices including observed-to-expected total fetal lung volume (o/e TFLV) were evaluated. Indices were categorized by trimester, either 2nd (20–27 weeks gestation) or 3rd trimester (>28 weeks gestation) and further analyzed for outcome predictability. Primary outcomes were survival, extracorporeal membrane oxygenation (ECMO), and pulmonary hypertension (PAH). Student t test and logistic and linear regression were used for data analyses. Results: Of 256 fetuses evaluated for CDH, 197 were further characterized by MRI with 57 having both an MRI in the 2nd and 3rd trimesters. There was an average of 9.95 weeks (±4.3) between the 1st and 2nd MRI. Second trimester o/e TFLV was the only independent predictor of survival by logistic regression (OR 0.890, p < 0.01). Third trimester MRI derived lung volumes were associated with, and independent predictors of, severity of PAH and need for ECMO. Interval TFLV growth was a strong predictor of PAH postnatally (OR 0.361, p < 0.01). Overall cohort survival was 79%. Conclusion: Accuracy of MRI lung volumes to predict outcomes is dependent on the gestational age at the time of exam. While MRI lung volumes at either the 2nd or 3rd trimester are predictive of morbidity, 2nd trimester lung volumes strongly correlated with mortality.
© 2019 S. Karger AG, Basel
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Article / Publication Details
Received: April 18, 2019
Accepted: June 18, 2019
Published online: August 15, 2019
Issue release date: March 2020
Number of Print Pages: 9
Number of Figures: 3
Number of Tables: 4
ISSN: 1015-3837 (Print)
eISSN: 1421-9964 (Online)
For additional information: https://www.karger.com/FDT
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