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Whitby E, Gaunt T. Fetal lung MRI and features predicting post-natal outcome: a scoping review of the current literature. Br J Radiol 2023:20220344. [PMID: 37314838 DOI: 10.1259/bjr.20220344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023] Open
Abstract
The outcome for infants with fetal lung pathologies not only depends on the nature of the pathology, but the impact it has on the developing lungs. The main prognostic factor is the degree of pulmonary hypoplasia, but this is not detectable pre-natally. Imaging techniques aim to simulate these features with a variety of surrogate measurements, including lung volume and MRI signal intensity. Despite the complexity of the various research studies and lack of consistent methodology, this scoping review aims to summarise current applications, and promising techniques requiring further investigation.
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Affiliation(s)
- Elspeth Whitby
- University of Sheffield and Sheffield Teaching Hospitals NHS foundation Trust, England, United Kingdom
| | - Trevor Gaunt
- Department of Maternal and Fetal Medicine, University College London, London, United Kingdom
- University College London Hospitals NHS Foundation Trust, London, United Kingdom
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Cerbelle V, Le Duc K, Lejeune S, Mur S, Lerisson H, Drumez E, Sfeir R, Bigot J, Verpillat P, Boukhris R, Vaast P, Mordacq C, Thumerelle C, Storme L, Deschildre A. Fetal Lung Volume Appears to Predict Respiratory Morbidity in Congenital Diaphragmatic Hernia. J Clin Med 2023; 12:jcm12041508. [PMID: 36836043 PMCID: PMC9961622 DOI: 10.3390/jcm12041508] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 02/02/2023] [Accepted: 02/09/2023] [Indexed: 02/17/2023] Open
Abstract
Congenital diaphragmatic hernia (CDH) is associated with pulmonary hypoplasia and respiratory morbidity. To assess whether respiratory morbidity during the first 2 years of life in infants with left-sided CDH is associated with fetal lung volume (FLV) evaluated by the observed-to-expected FLV ratio (o/e FLV) on antenatal magnetic resonance imaging (MRI). In this retrospective study, o/e FLV measures were collected. Respiratory morbidity in the first 2 years of life was studied according to two endpoints: treatment with inhaled corticosteroids for >3 consecutive months and hospitalization for any acute respiratory disease. The primary outcome was a favorable progression defined by the absence of either endpoint. Forty-seven patients were included. The median o/e FLV was 39% (interquartile range, 33-49). Sixteen (34%) infants were treated with inhaled corticosteroids and 13 (28%) were hospitalized. The most efficient threshold for a favorable outcome was an o/e FLV ≥ 44% with a sensitivity of 57%, specificity of 79%, negative predictive value of 56%, and positive predictive value of 80%. An o/e FLV ≥ 44% was associated with a favorable outcome in 80% of cases. These data suggest that lung volume measurement on fetal MRI may help to identify children at lower respiratory risk and improve information during pregnancy, patient characterization, decisions about treatment strategy and research, and personalized follow-up.
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Affiliation(s)
- Valentine Cerbelle
- Paediatric Pulmonology and Allergy Unit, Hôpital Jeanne de Flandre, CHU Lille, Université de Lille, F-59000 Lille, France
| | - Kévin Le Duc
- ULR2694 Metrics-Perinatal Environment and Health, Université de Lille, F-59000 Lille, France
- Department of Neonatology, Hôpital Jeanne de Flandre, CHU Lille, Université de Lille, F-59000 Lille, France
- Correspondence: ; Tel.: +33-3-20-44-58-89
| | - Stephanie Lejeune
- Paediatric Pulmonology and Allergy Unit, Hôpital Jeanne de Flandre, CHU Lille, Université de Lille, F-59000 Lille, France
| | - Sébastien Mur
- Department of Neonatology, Hôpital Jeanne de Flandre, CHU Lille, Université de Lille, F-59000 Lille, France
| | - Héloise Lerisson
- Pediatric Imaging Unit, Hôpital Jeanne de Flandre, CHU Lille, Université de Lille, F-59000 Lille, France
| | - Elodie Drumez
- ULR 2694-METRICS: Évaluation des Technologies de Santé et des Pratiques Médicales, CHU Lille, Université de Lille, F-59000 Lille, France
| | - Rony Sfeir
- Pediatric Surgery Unit, Hôpital Jeanne de Flandre, CHU Lille, Université de Lille, F-59000 Lille, France
| | - Julien Bigot
- Pediatric Imaging Unit, Hôpital Jeanne de Flandre, CHU Lille, Université de Lille, F-59000 Lille, France
- Jacquemars Giélée Imaging Center, F-59000 Lille, France
- Générale de Santé, La Louvière Ramsay Hôpital, F-59000 Lille, France
| | - Pauline Verpillat
- Pediatric Imaging Unit, Hôpital Jeanne de Flandre, CHU Lille, Université de Lille, F-59000 Lille, France
| | - Riadh Boukhris
- Department of Neonatology, Hôpital Jeanne de Flandre, CHU Lille, Université de Lille, F-59000 Lille, France
| | - Pascal Vaast
- Obstetrics and Gynecology Unit, Hôpital Jeanne de Flandre, CHU Lille, Université de Lille, F-59000 Lille, France
| | - Clémence Mordacq
- Paediatric Pulmonology and Allergy Unit, Hôpital Jeanne de Flandre, CHU Lille, Université de Lille, F-59000 Lille, France
| | - Caroline Thumerelle
- Paediatric Pulmonology and Allergy Unit, Hôpital Jeanne de Flandre, CHU Lille, Université de Lille, F-59000 Lille, France
| | - Laurent Storme
- ULR2694 Metrics-Perinatal Environment and Health, Université de Lille, F-59000 Lille, France
- Department of Neonatology, Hôpital Jeanne de Flandre, CHU Lille, Université de Lille, F-59000 Lille, France
| | - Antoine Deschildre
- Paediatric Pulmonology and Allergy Unit, Hôpital Jeanne de Flandre, CHU Lille, Université de Lille, F-59000 Lille, France
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Soni R, Soni N, Chakkarapani A, Gupta S, Yajamanyam PK, Ali SKM, El Anbari M, Alhamad M, Anand D, More K. The Utility of Serial Echocardiography Parameters in Management of Newborns with Congenital Diaphragmatic Hernia (CDH) and Predictors of Mortality. Pediatr Cardiol 2023; 44:354-366. [PMID: 36163300 PMCID: PMC9895036 DOI: 10.1007/s00246-022-03002-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 08/29/2022] [Indexed: 02/06/2023]
Abstract
Ventricular dysfunction may be found in 40% of newborns with CDH, and is not only a predictor of disease severity, but also mortality and need for ECMO. We conducted this study to assess the utility of serial echocardiography in management of newborns with CDH and their survival outcomes. This is a retrospective study, wherein the demographic, clinical and echocardiographic data from our local CDH registry and hospital clinical database were analyzed to study the correlation of timed echocardiographic findings with mortality and other outcomes. Fourty-two newborns with CDH were admitted during the study period (M/F:19/23), with median gestation of 38 weeks (IQR:36-39) and birth weight of 2.83 kg (IQR 2.45-3.17). Thirty-one were left-sided, seven right, one central, and three bilateral hernias. Twelve infants (28%) died in early infancy. Three infants were excluded from analysis due to either palliation at birth or significant cardiac anomaly. A total of 137 echos from 39 infants were analyzed. Seventy percent of newborns who died and had an echo within the first 72 h, were noted to have suffered from moderate to severe PH. Birth weight < 2.8 kg, RVSP > 45.5 in the first 72 h and postoperative VIS > 23.5 and RSS > 4.3 were good predictors of mortality. Markers of elevated pulmonary pressures and cardiac function were useful in guiding therapy. Serial timed functional echocardiography (f-Echo) monitoring allows targeted therapy of patients with CDH. Birth weight, initial severity of pulmonary hypertension and postoperative RSS and VIS may be useful in predicting mortality.
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Affiliation(s)
- Roopali Soni
- Division of Neonatology, Sidra Medicine, Al Luqta Street, Education City North Campus, Qatar Foundation, Doha, Qatar ,Neonatal Unit, Mediclinic Parkview Hospital, Dubai, UAE
| | - Naharmal Soni
- Division of Neonatology, Sidra Medicine, Al Luqta Street, Education City North Campus, Qatar Foundation, Doha, Qatar
| | - Aravanan Chakkarapani
- Division of Neonatology, Sidra Medicine, Al Luqta Street, Education City North Campus, Qatar Foundation, Doha, Qatar ,Weill Cornell Medicine, Al-Rayyan, Doha, Qatar
| | - Samir Gupta
- Division of Neonatology, Sidra Medicine, Al Luqta Street, Education City North Campus, Qatar Foundation, Doha, Qatar
| | - Phani Kiran Yajamanyam
- Division of Neonatology, Sidra Medicine, Al Luqta Street, Education City North Campus, Qatar Foundation, Doha, Qatar
| | - Sanoj K. M. Ali
- Division of Neonatology, Sidra Medicine, Al Luqta Street, Education City North Campus, Qatar Foundation, Doha, Qatar
| | - Mohammed El Anbari
- Division of Neonatology, Sidra Medicine, Al Luqta Street, Education City North Campus, Qatar Foundation, Doha, Qatar
| | - Moath Alhamad
- Division of Neonatology, Sidra Medicine, Al Luqta Street, Education City North Campus, Qatar Foundation, Doha, Qatar ,Weill Cornell Medicine, Al-Rayyan, Doha, Qatar
| | - Dhullipala Anand
- Division of Neonatology, Sidra Medicine, Al Luqta Street, Education City North Campus, Qatar Foundation, Doha, Qatar ,Weill Cornell Medicine, Al-Rayyan, Doha, Qatar
| | - Kiran More
- Division of Neonatology, Sidra Medicine, Al Luqta Street, Education City North Campus, Qatar Foundation, Doha, Qatar.
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Mehollin-Ray AR. Prenatal lung volumes in congenital diaphragmatic hernia and their effect on postnatal outcomes. Pediatr Radiol 2022; 52:637-642. [PMID: 34435224 DOI: 10.1007/s00247-021-05153-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 05/31/2021] [Accepted: 07/12/2021] [Indexed: 11/30/2022]
Abstract
Lung volume measurement on fetal MRI is a component of the imaging workup for various prenatal conditions, but its use as a prognosticator has been most heavily studied in congenital diaphragmatic hernia (CDH). Pediatric radiologists who perform and interpret fetal MRI must be familiar with the technical aspects of lung volume measurement to guarantee accurate measurement and reporting. Variability in timing and type of measurement at different fetal centers also requires pediatric radiologists to be up-to-date with the literature and aware of their center's internal data. This paper provides both a how-to guide for measuring fetal lung volumes on MRI and a comprehensive review of the CDH outcome literature to serve as a convenient reference for the pediatric radiologist.
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Affiliation(s)
- Amy R Mehollin-Ray
- E. B. Singleton Department of Radiology, Texas Children's Hospital, Baylor College of Medicine, 6701 Fannin St., Suite 470, Houston, TX, 77030, USA.
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Role of Predictive Mortality Calculator in Antenatal Assessment of Congenital Diaphragmatic Hernia. JOURNAL OF FETAL MEDICINE 2021. [DOI: 10.1007/s40556-021-00315-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Wiggins E, Zecevic M, Hippe DS, Moshiri M, Winter T, Dubinsky TJ. Magnetic Resonance Prediction of Lung Maturity in Fetuses With Congenital Diaphragmatic Hernia. Ultrasound Q 2021; 37:272-277. [PMID: 34478427 DOI: 10.1097/ruq.0000000000000567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT To determine if lung to liver MR T2 signal ratio is predictive of neonatal outcome in fetuses with congenital diaphragmatic hernia (CDH).After Interal Review Board approval, the PACS systems at the University of Washington and University of Utah were searched for cases having an in utero fetal MR examination diagnostic of CDH. Inclusion criteria were at least 1 prior ultrasound demonstrating a CDH and an MR obtained within 1 week of that prior ultrasound.A total of 69 patients from the University of Utah and 13 from the University of Washington satisfied the inclusion criteria for a total of 82. After adjusting for gestational age and contralateral lung volume, there was little apparent association between contralateral lung to liver MR T2 signal and 5-minute Apgar score and neonatal mortality When considering neonatal Apgar and mortality, increasing contralateral lung volume was significantly associated with lower risk (hazard ratio, 0.40 per doubling; 95% confidence interval, 0.24-0.69; P = 0.001) as expected.Our data demonstrate that the lung to liver MR signal ratio was not predictive of outcome. The measurement of contralateral lung area, and gestational age at the time of the examination (time of diagnosis) are still the best predictors of poor neonatal outcome.
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Affiliation(s)
- Eve Wiggins
- Department of Radiology, University of Washington School of Medicine, Seattle WA
| | - Mladen Zecevic
- Department of Radiology, University of Washington School of Medicine, Seattle WA
| | - Dan S Hippe
- Department of Radiology, University of Washington School of Medicine, Seattle WA
| | - Mariam Moshiri
- Department of Radiology, University of Washington School of Medicine, Seattle WA
| | - Tom Winter
- Department of Radiology, University of Utah, Salt Lake City, UT
| | - Theodore J Dubinsky
- Department of Radiology, University of Washington School of Medicine, Seattle WA
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