Percent predicted lung volumes as measured on fetal magnetic resonance imaging: a useful biometric parameter for risk stratification in congenital diaphragmatic hernia

Carol E. Barnewolt, Shaun Kunisaki, Dario O. Fauza, Luanne P. Nemes, Judy A. Estroff, Russell W. Jennings

Research output: Contribution to journalArticle

Abstract

Purpose: This study was aimed at determining whether a new method of analyzing lung volumes on fetal magnetic resonance (MR) imaging could be used to predict the degree of pulmonary compromise in congenital diaphragmatic hernia (CDH). Methods: Seventeen fetuses with CDH were prospectively evaluated by MR. Lung volumes were measured using an established technique and expressed as a percentage of the predicted lung volume (PPLV). Predicted lung volume was determined by subtracting measured mediastinal volume from total measured thoracic volume. The PPLV was correlated with postnatal outcomes. Statistical analyses were performed using the Mann-Whitney, Spearman correlation, or Fisher exact tests (P < .05). Results: Of the 14 liveborn patients, the PPLV was 20.3±10.4 (gestational age at MR, 22.3 ± 5.7 weeks). The PPLV was significantly associated with extracorporeal membrane oxygenation (ECMO) use, hospital length of stay, and survival. All patients with a PPLV of less than 15 required prolonged ECMO support and had a 40% survival rate. In contrast, only 11% of patients with a PPLV of greater than 15 required ECMO, and survival was 100%. Conclusion: The PPLV as measured by fetal MR imaging can accurately predict disease severity in CDH. A value of less than 15 is associated with a significantly higher risk for prolonged support and/or death, despite aggressive postnatal management.

Original languageEnglish (US)
Pages (from-to)193-197
Number of pages5
JournalJournal of pediatric surgery
Volume42
Issue number1
DOIs
StatePublished - Jan 1 2007
Externally publishedYes

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Magnetic Resonance Imaging
Lung
Extracorporeal Membrane Oxygenation
Length of Stay
Congenital Diaphragmatic Hernias
Magnetic Resonance Spectroscopy
Survival
Gestational Age
Fetus
Thorax
Survival Rate

Keywords

  • Congenital diaphragmatic hernia
  • Fetus
  • Lung volumes
  • Magnetic resonance imaging
  • Outcome
  • Prenatal diagnosis
  • Pulmonary hypoplasia

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Surgery

Cite this

Percent predicted lung volumes as measured on fetal magnetic resonance imaging : a useful biometric parameter for risk stratification in congenital diaphragmatic hernia. / Barnewolt, Carol E.; Kunisaki, Shaun; Fauza, Dario O.; Nemes, Luanne P.; Estroff, Judy A.; Jennings, Russell W.

In: Journal of pediatric surgery, Vol. 42, No. 1, 01.01.2007, p. 193-197.

Research output: Contribution to journalArticle

Barnewolt, Carol E. ; Kunisaki, Shaun ; Fauza, Dario O. ; Nemes, Luanne P. ; Estroff, Judy A. ; Jennings, Russell W. / Percent predicted lung volumes as measured on fetal magnetic resonance imaging : a useful biometric parameter for risk stratification in congenital diaphragmatic hernia. In: Journal of pediatric surgery. 2007 ; Vol. 42, No. 1. pp. 193-197.
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abstract = "Purpose: This study was aimed at determining whether a new method of analyzing lung volumes on fetal magnetic resonance (MR) imaging could be used to predict the degree of pulmonary compromise in congenital diaphragmatic hernia (CDH). Methods: Seventeen fetuses with CDH were prospectively evaluated by MR. Lung volumes were measured using an established technique and expressed as a percentage of the predicted lung volume (PPLV). Predicted lung volume was determined by subtracting measured mediastinal volume from total measured thoracic volume. The PPLV was correlated with postnatal outcomes. Statistical analyses were performed using the Mann-Whitney, Spearman correlation, or Fisher exact tests (P < .05). Results: Of the 14 liveborn patients, the PPLV was 20.3±10.4 (gestational age at MR, 22.3 ± 5.7 weeks). The PPLV was significantly associated with extracorporeal membrane oxygenation (ECMO) use, hospital length of stay, and survival. All patients with a PPLV of less than 15 required prolonged ECMO support and had a 40{\%} survival rate. In contrast, only 11{\%} of patients with a PPLV of greater than 15 required ECMO, and survival was 100{\%}. Conclusion: The PPLV as measured by fetal MR imaging can accurately predict disease severity in CDH. A value of less than 15 is associated with a significantly higher risk for prolonged support and/or death, despite aggressive postnatal management.",
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AB - Purpose: This study was aimed at determining whether a new method of analyzing lung volumes on fetal magnetic resonance (MR) imaging could be used to predict the degree of pulmonary compromise in congenital diaphragmatic hernia (CDH). Methods: Seventeen fetuses with CDH were prospectively evaluated by MR. Lung volumes were measured using an established technique and expressed as a percentage of the predicted lung volume (PPLV). Predicted lung volume was determined by subtracting measured mediastinal volume from total measured thoracic volume. The PPLV was correlated with postnatal outcomes. Statistical analyses were performed using the Mann-Whitney, Spearman correlation, or Fisher exact tests (P < .05). Results: Of the 14 liveborn patients, the PPLV was 20.3±10.4 (gestational age at MR, 22.3 ± 5.7 weeks). The PPLV was significantly associated with extracorporeal membrane oxygenation (ECMO) use, hospital length of stay, and survival. All patients with a PPLV of less than 15 required prolonged ECMO support and had a 40% survival rate. In contrast, only 11% of patients with a PPLV of greater than 15 required ECMO, and survival was 100%. Conclusion: The PPLV as measured by fetal MR imaging can accurately predict disease severity in CDH. A value of less than 15 is associated with a significantly higher risk for prolonged support and/or death, despite aggressive postnatal management.

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