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Bedoya MA, Ketwaroo P, Gagnon MH, Taylor S, Ndibe C, Mehollin-Ray AR. Congenital Chest Lesions and Interventions. Magn Reson Imaging Clin N Am 2024; 32:553-571. [PMID: 38944440 DOI: 10.1016/j.mric.2024.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2024]
Abstract
Anomalies of the fetal chest require advanced imaging with ultrasound and MR imaging as well as expertise on the part of the interpreting pediatric radiologist. Congenital diaphragmatic hernia and congenital lung malformation are the most frequently seen, and in both conditions, the radiologist should provide both detailed anatomic description and measurement data for prognostication. This article provides a detailed approach to imaging the anatomy, in-depth explanation of available measurements and prognostic value, and keys to identifying candidates for fetal intervention. Less common congenital lung tumors and mediastinal and chest wall masses are also reviewed.
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Affiliation(s)
- M Alejandra Bedoya
- Harvard Medical School, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02113, USA
| | - Pamela Ketwaroo
- E. B. Singleton Department of Radiology, Baylor College of Medicine, Texas Children's Hospital, 6701 Fannin Street Suite 470, Houston, TX 77030, USA
| | - Marie-Helene Gagnon
- Department of Radiology and Imaging Sciences, Emory University, 1405 Clifton Road Northeast, Atlanta, GA 30322, USA
| | - Susan Taylor
- Department of Radiology and Imaging Sciences, Emory University, 1405 Clifton Road Northeast, Atlanta, GA 30322, USA
| | - Christabell Ndibe
- Department of Radiology and Imaging Sciences, Emory University, 1405 Clifton Road Northeast, Atlanta, GA 30322, USA
| | - Amy R Mehollin-Ray
- Department of Radiology and Imaging Sciences, Emory University, 1405 Clifton Road Northeast, Atlanta, GA 30322, USA.
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2
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Penikis AB, Zhou AL, Sferra SR, Engwall-Gill AJ, Miller JL, Baschat AA, Blakemore KJ, Kunisaki SM. Serial lung mass volume ratios as prognostic indicators of neonatal respiratory morbidity in fetal pulmonary malformations. Am J Obstet Gynecol MFM 2023; 5:101128. [PMID: 37572880 DOI: 10.1016/j.ajogmf.2023.101128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 08/02/2023] [Accepted: 08/05/2023] [Indexed: 08/14/2023]
Abstract
BACKGROUND Several studies have shown that the congenital pulmonary airway malformation volume ratio is a useful prognosticator of neonatal outcome in prenatally diagnosed lung lesions. However, there remains a lack of consensus on which congenital pulmonary airway malformation volume ratio values have the best predictive value because of operator dependence, inherent changes in lung lesion size throughout gestation, and the widespread use of maternal steroids. OBJECTIVE This study sought to determine the association between serial congenital pulmonary airway malformation volume ratio measurements and neonatal outcomes among fetuses with lung malformations. STUDY DESIGN This was a retrospective cohort study of fetuses with a prenatally diagnosed lung malformation managed at 2 major fetal centers from January 2010 to December 2021. Prenatal variables, including prospectively measured congenital pulmonary airway malformation volume ratio measurements (initial, maximum, and final), were analyzed. The results were correlated with 3 outcome measures, namely surgical resection before 30 days of life, a need for supplemental O2 at birth, and endotracheal intubation at birth. Statistical analyses were performed using receiver operating characteristic curve analyses, Welch 2 sample t tests, and multivariable logistic regressions (P<.05). RESULTS There were 123 fetuses with isolated lung lesions identified. Eight (6.5%) had hydrops. The mean initial congenital pulmonary airway malformation volume ratio was 0.67±0.61 cm2 at 22.9±3.9 weeks' gestation. The mean maximum congenital pulmonary airway malformation volume ratio was 1.08 ± 0.94 cm2 at 27.0 ± 4.0 weeks' gestation. The mean final congenital pulmonary airway malformation volume ratio was 0.58±0.60 cm2 at 33.2±4.1 weeks' gestation. At a mean gestational age at delivery of 38.3±2.6 weeks, 15 (12.2%) underwent neonatal lung resection for symptomatic disease. In a multivariable regression, all 3 congenital pulmonary airway malformation volume ratio measurements showed a significant correlation with neonatal lung resection (P<.001). Optimal congenital pulmonary airway malformation volume ratio cutoffs were established based on an initial congenital pulmonary airway malformation volume ratio of ≥0.8 cm2, maximum congenital pulmonary airway malformation volume ratio of ≥1.5 cm2, and a final congenital pulmonary airway malformation volume ratio of ≥1.3 cm2 with associated areas under the curve of 0.89, 0.97, and 0.93, respectively. The final congenital pulmonary airway malformation volume ratio had the highest specificity for predicting surgical lung resection in the early postnatal period. CONCLUSION Measuring congenital pulmonary airway malformation volume ratios throughout pregnancy in fetuses with pulmonary malformations has clinical value for prenatal counseling and planning care transition after delivery. Fetuses with a final congenital pulmonary airway malformation volume ratio of more than 1.3 cm2 are likely to require neonatal surgery and therefore should be delivered at tertiary care centers with a neonatal intensive care unit and pediatric surgical expertise.
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Affiliation(s)
- Annalise B Penikis
- Division of General Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD (Dr Penikis, Ms Zhou, and Drs Sferra and Kunisaki)
| | - Alice L Zhou
- Division of General Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD (Dr Penikis, Ms Zhou, and Drs Sferra and Kunisaki)
| | - Shelby R Sferra
- Division of General Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD (Dr Penikis, Ms Zhou, and Drs Sferra and Kunisaki)
| | - Abigail J Engwall-Gill
- Section of Pediatric Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, MI (Dr Engwall-Gill)
| | - Jena L Miller
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD (Drs Miller, Baschat, and Blakemore)
| | - Ahmet A Baschat
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD (Drs Miller, Baschat, and Blakemore)
| | - Karin J Blakemore
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD (Drs Miller, Baschat, and Blakemore)
| | - Shaun M Kunisaki
- Division of General Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD (Dr Penikis, Ms Zhou, and Drs Sferra and Kunisaki).
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3
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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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4
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Gerall C, Chumdermpadestuk R, Jacobs S, Weijia F, Maddocks A, Ayyala R, Miller R, Simpson L, Rothenberg S, Duron V. Prenatal ultrasound-and MRI-based imaging predictors of respiratory symptoms at birth for congenital lung malformations. J Pediatr Surg 2023; 58:420-426. [PMID: 36220748 DOI: 10.1016/j.jpedsurg.2022.08.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 07/27/2022] [Accepted: 08/31/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND Congenital lung malformations (CLM) are rare developmental anomalies of the fetal lung with a minority of patients exhibiting symptoms around the time of birth. Although ultrasound remains the gold standard, fetal MRI has recently been incorporated as an adjunct imaging modality in the workup and prenatal counseling of patients with CLM as it is thought to more accurately delineate lesion boundaries and diagnose lesion type. We evaluate what prenatal variables correlate with postnatal respiratory symptoms. METHODS We performed a retrospective review of patients with prenatal diagnosis of CLM treated at our institution between 2006-2020. Fetal ultrasound and magnetic resonance imaging (MRI) parameters including maximal congenital pulmonary airway malformation volume ratio (CVR), absolute cyst volume, and observed to expected normal fetal lung volume (O/E NFLV) were correlated with outcomes including postnatal respiratory symptoms, need for supplementary oxygen or mechanical ventilation, delay in tolerating full feeds, resection in the neonatal period. RESULTS Our study included 111 patients, all of whom underwent fetal ultrasound with 64 patients additionally undergoing fetal MRI. Postnatal respiratory symptoms were noted in 22.5% of patients, 19.8% required supplemental oxygen, 2.7% mechanical ventilation and two patients requiring urgent resection. Ultrasound parameters including absolute cyst volume and maximal CVR correlated with need for mechanical ventilation (p=0.034 and p=0.024, respectively) and for urgent resection (p=0.018 and p=0.023, respectively) and had a marginal association with postnatal respiratory symptoms (p=0.050 and p=0.052). Absolute cyst volume became associated with postnatal respiratory symptoms (p=0.017) after multivariable analysis controlling for maternal steroid administration and gestational age. O/E NFLV did not correlate with perinatal outcomes. CONCLUSION We have found that ultrasound-based measurements correlate with postnatal respiratory symptoms, while MRI derived O/E NFLV does not. Further studies are needed to elucidate the role of MRI in the prenatal workup of congenital lung malformations. TYPE OF STUDY Study of Diagnostic Test. LEVEL OF EVIDENCE Level I.
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Affiliation(s)
- Claire Gerall
- Division of Pediatric Surgery, Department of Surgery. Columbia University Vagelos College of Physicians and Surgeons / NewYork-Presbyterian Morgan Stanley Children's Hospital, 3959 Broadway CH2N, New York, NY 10032, United States
| | - Ritah Chumdermpadestuk
- Division of Pediatric Surgery, Department of Surgery. Columbia University Vagelos College of Physicians and Surgeons / NewYork-Presbyterian Morgan Stanley Children's Hospital, 3959 Broadway CH2N, New York, NY 10032, United States
| | - Shimon Jacobs
- Department of Surgery. NYU Grossman School of Medicine/NYU Langone Health, 550 First Avenue, New York, NY 10016, United States
| | - Fan Weijia
- Department of Biostatistics. Columbia University Mailman School of Public Heath, 722 W 168th St, New York, NY 10032, United States
| | - Alexis Maddocks
- Division of Pediatric Radiology, Department of Radiology. Columbia University Vagelos College of Physicians and Surgeons / NewYork-Presbyterian Morgan Stanley Children's Hospital, 3959 Broadway CH2N, New York, NY 10032, United States
| | - Rama Ayyala
- Division of Pediatric Radiology, Department of Radiology. Cincinnati Children's Hospital. 3333 Burnet Avenue, Cincinnati, OH 45229, United States
| | - Russell Miller
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology. Columbia University Vagelos College of Physicians and Surgeons / NewYork-Presbyterian Morgan Stanley Children's Hospital, 3959 Broadway CH2N, New York, NY 10032, United States
| | - Lynn Simpson
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology. Columbia University Vagelos College of Physicians and Surgeons / NewYork-Presbyterian Morgan Stanley Children's Hospital, 3959 Broadway CH2N, New York, NY 10032, United States
| | - Steven Rothenberg
- Division of Pediatric Surgery, Department of Surgery. Rocky Mountain Hospital for Children, 2001 N High St Ste 370, Denver, CO 80205, United States
| | - Vincent Duron
- Division of Pediatric Surgery, Department of Surgery. Columbia University Vagelos College of Physicians and Surgeons / NewYork-Presbyterian Morgan Stanley Children's Hospital, 3959 Broadway CH2N, New York, NY 10032, United States.
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5
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Prayer D, Malinger G, De Catte L, De Keersmaecker B, Gonçalves LF, Kasprian G, Laifer-Narin S, Lee W, Millischer AE, Platt L, Prayer F, Pugash D, Salomon LJ, Sanz Cortes M, Stuhr F, Timor-Tritsch IE, Tutschek B, Twickler D, Raine-Fenning N. ISUOG Practice Guidelines (updated): performance of fetal magnetic resonance imaging. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2023; 61:278-287. [PMID: 36722431 PMCID: PMC10107509 DOI: 10.1002/uog.26129] [Citation(s) in RCA: 29] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 11/14/2022] [Indexed: 05/03/2023]
Affiliation(s)
- D Prayer
- Division of Neuroradiology and Musculoskeletal Radiology, Department of Radiology, Medical University of Vienna, Vienna, Austria
| | - G Malinger
- Division of Ultrasound in Obstetrics & Gynecology, Lis Maternity Hospital, Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - L De Catte
- Department of Obstetrics & Gynecology, University Hospitals Leuven, Leuven, Belgium
| | - B De Keersmaecker
- Department of Obstetrics & Gynecology, University Hospitals Leuven, Leuven, Belgium
| | - L F Gonçalves
- Fetal Imaging, William Beaumont Hospital, Royal Oak and Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - G Kasprian
- Division of Neuroradiology and Musculoskeletal Radiology, Department of Radiology, Medical University of Vienna, Vienna, Austria
| | - S Laifer-Narin
- Division of Ultrasound and Fetal MRI, Columbia University Medical Center - New York Presbyterian Hospital, New York, NY, USA
| | - W Lee
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Pavilion for Women, Houston, TX, USA
| | - A-E Millischer
- Radiodiagnostics Department, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes, Paris, France
| | - L Platt
- Department of Obstetrics and Gynecology, David Geffen School of Medicine, Los Angeles, CA, USA
| | - F Prayer
- Division of Neuroradiology and Musculoskeletal Radiology, Department of Radiology, Medical University of Vienna, Vienna, Austria
| | - D Pugash
- Department of Radiology, University of British Columbia, Vancouver, Canada; Department of Obstetrics and Gynecology, BC Women's Hospital, Vancouver, Canada
| | - L J Salomon
- Department of Obstetrics, Hôpital Necker-Enfants Malades, Assistance Publique-Hopitaux de Paris, Université Paris Descartes, Paris, France
| | - M Sanz Cortes
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Pavilion for Women, Houston, TX, USA
| | - F Stuhr
- Division of Neuroradiology and Musculoskeletal Radiology, Department of Radiology, Medical University of Vienna, Vienna, Austria
| | - I E Timor-Tritsch
- Division of Obstetrical & Gynecological Ultrasound, NYU Grossmann School of Medicine, New York, NY, USA
| | - B Tutschek
- Department of Obstetrics & Gynecology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany; Prenatal Zurich, Zürich, Switzerland
| | - D Twickler
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - N Raine-Fenning
- Department of Child Health, Obstetrics & Gynaecology, School of Medicine, University of Nottingham, Nottingham, UK; Nurture Fertility, The Fertility Partnership, Nottingham, UK
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6
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King A, Olutoye OO, Lee TC, Keswani SG. Surgical Management of Congenital Lung Malformations. Neoreviews 2023; 24:e84-e96. [PMID: 36720690 DOI: 10.1542/neo.24-2-e84] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Congenital lung malformations (CLMs) are commonly diagnosed prenatal lesions with varied natural history. Prenatal diagnosis and monitoring help to guide fetal interventions, delivery planning, and need for urgent perinatal surgical interventions. All prenatally diagnosed CLMs should be evaluated postnatally, typically with cross-sectional imaging, because many lesions persist despite the appearance of complete 'regression' in utero. Management of CLMs in asymptomatic infants weighs the surgical and anesthetic risk of prophylactic resection against the risk of expectant management, including the possibility of infection, malignant degeneration, and more complicated surgical resection later with loss of compensatory lung growth.
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Affiliation(s)
- Alice King
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX.,Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX.,Division of Pediatric Surgery, Department of Surgery, Texas Children's Hospital, Houston, TX
| | - Oluyinka O Olutoye
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX
| | - Timothy C Lee
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX.,Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX.,Division of Pediatric Surgery, Department of Surgery, Texas Children's Hospital, Houston, TX
| | - Sundeep G Keswani
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX.,Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX.,Division of Pediatric Surgery, Department of Surgery, Texas Children's Hospital, Houston, TX
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7
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Avena-Zampieri CL, Hutter J, Rutherford M, Milan A, Hall M, Egloff A, Lloyd DFA, Nanda S, Greenough A, Story L. Assessment of the fetal lungs in utero. Am J Obstet Gynecol MFM 2022; 4:100693. [PMID: 35858660 PMCID: PMC9811184 DOI: 10.1016/j.ajogmf.2022.100693] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 07/12/2022] [Accepted: 07/12/2022] [Indexed: 01/07/2023]
Abstract
Antenatal diagnosis of abnormal pulmonary development has improved significantly over recent years because of progress in imaging techniques. Two-dimensional ultrasound is the mainstay of investigation of pulmonary pathology during pregnancy, providing good prognostication in conditions such as congenital diaphragmatic hernia; however, it is less validated in other high-risk groups such as those with congenital pulmonary airway malformation or preterm premature rupture of membranes. Three-dimensional assessment of lung volume and size is now possible using ultrasound or magnetic resonance imaging; however, the use of these techniques is still limited because of unpredictable fetal motion, and such tools have also been inadequately validated in high-risk populations other than those with congenital diaphragmatic hernia. The advent of advanced, functional magnetic resonance imaging techniques such as diffusion and T2* imaging, and the development of postprocessing pipelines that facilitate motion correction, have enabled not only more accurate evaluation of pulmonary size, but also assessment of tissue microstructure and perfusion. In the future, fetal magnetic resonance imaging may have an increasing role in the prognostication of pulmonary abnormalities and in monitoring current and future antenatal therapies to enhance lung development. This review aims to examine the current imaging methods available for assessment of antenatal lung development and to outline possible future directions.
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Affiliation(s)
- Carla L Avena-Zampieri
- Department of Women and Children's Health, King's College London, London, United Kingdom; Centre for the Developing Brain, King's College London, London, United Kingdom
| | - Jana Hutter
- Centre for the Developing Brain, King's College London, London, United Kingdom
| | - Mary Rutherford
- Centre for the Developing Brain, King's College London, London, United Kingdom
| | - Anna Milan
- Neonatal Unit, Guy's and St Thomas' National Health Service Foundation Trust, London, United Kingdom
| | - Megan Hall
- Department of Women and Children's Health, King's College London, London, United Kingdom; Centre for the Developing Brain, King's College London, London, United Kingdom
| | - Alexia Egloff
- Centre for the Developing Brain, King's College London, London, United Kingdom
| | - David F A Lloyd
- Centre for the Developing Brain, King's College London, London, United Kingdom
| | - Surabhi Nanda
- Fetal Medicine Unit, Guy's and St Thomas' National Health Service Foundation Trust, London, United Kingdom
| | - Anne Greenough
- Department of Women and Children's Health, King's College London, London, United Kingdom; Neonatal Unit, King's College Hospital, London, United Kingdom; Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, London, United Kingdom; National Institute for Health and Care Research Biomedical Research Centre, Guy's & St Thomas National Health Service Foundation Trust and King's College London, London, United Kingdom
| | - Lisa Story
- Department of Women and Children's Health, King's College London, London, United Kingdom; Centre for the Developing Brain, King's College London, London, United Kingdom; Fetal Medicine Unit, Guy's and St Thomas' National Health Service Foundation Trust, London, United Kingdom.
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8
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Prayer F, Mehollin-Ray AR, Cassady CC, Gruber GM, Brugger PC, Scharrer A, Metzelder M, Binder J, Hojreh A, Weber M, Prosch H, Prayer D, Kasprian G. Characterization of the Hyperintense Bronchus Sign as a Fetal MRI Marker of Airway Obstruction. Radiology 2021; 300:423-430. [PMID: 34032511 DOI: 10.1148/radiol.2021204565] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background Fetal MRI-based differential diagnosis of congenital lung malformations is difficult because of the paucity of well-described imaging markers. Purpose To characterize the hyperintense bronchus sign (HBS) in in vivo fetal MRI of congenital lung malformation cases. Materials and Methods In this retrospective two-center study, fetal MRI scans obtained in fetuses with congenital lung malformations at US (January 2002 to September 2018) were reviewed for the HBS, a tubular or branching hyperintense structure within a lung lesion on T2-weighted images. The frequency of the HBS and respective gestational ages in weeks and days were analyzed. Areas under the curve (AUCs), 95% CIs, and P values of the HBS regarding airway obstruction, as found in histopathologic and postnatal CT findings as the reference standards, were calculated for different gestational ages. Results A total of 177 fetuses with congenital lung malformations (95 male fetuses) and 248 fetal MRI scans obtained at a median gestational age of 25.6 weeks (interquartile range, 8.9 weeks) were included. The HBS was found in 79% (53 of 67) of fetuses with bronchial atresia, 71% (39 of 55) with bronchopulmonary sequestration (BPS), 43% (three of seven) with hybrid lesion, 15% (six of 40) with congenital cystic adenomatoid malformation, and 13% (one of eight) with bronchogenic cyst at a median gestational age of 24.9 weeks (interquartile range, 9.7 weeks). HBS on MRI scans at any gestational age had an AUC of 0.76 (95% CI: 0.70, 0.83; P = .04) for the presence of isolated or BPS-associated airway obstruction at histopathologic analysis and postnatal CT. The AUC of HBS on fetal MRI scans obtained until gestational age of 26 weeks (AUC, 0.83; 95% CI: 0.75, 0.91; P < .001) was significantly higher (P = .045) than that for fetal MRI scans obtained after gestational age 26 weeks (AUC, 0.69; 95% CI: 0.57, 0.80; P = .004). Conclusion The hyperintense bronchus sign is a frequently detectable feature at fetal MRI and is associated with airway obstruction particularly before gestational age 26 weeks. © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Dubinsky in this issue.
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Affiliation(s)
- Florian Prayer
- From the Department of Biomedical Imaging and Image-guided Therapy (F.P., A.H., M.W., H.P., D.P., G.K.), Center for Anatomy and Cell Biology (P.C.B.), Department of Pathology (A.S.), Division of Paediatric Surgery, Department of Surgery (M.M.), and Department of Obstetrics and Gynaecology (J.B.), Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria; E. B. Singleton Department of Radiology, Texas Children's Hospital, Houston, Tex (A.R.M.R., C.C.C.); and Division of Anatomy and Developmental Biology, Karl Landsteiner University of Health Sciences, Krems, Austria (G.M.G.)
| | - Amy R Mehollin-Ray
- From the Department of Biomedical Imaging and Image-guided Therapy (F.P., A.H., M.W., H.P., D.P., G.K.), Center for Anatomy and Cell Biology (P.C.B.), Department of Pathology (A.S.), Division of Paediatric Surgery, Department of Surgery (M.M.), and Department of Obstetrics and Gynaecology (J.B.), Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria; E. B. Singleton Department of Radiology, Texas Children's Hospital, Houston, Tex (A.R.M.R., C.C.C.); and Division of Anatomy and Developmental Biology, Karl Landsteiner University of Health Sciences, Krems, Austria (G.M.G.)
| | - Christopher C Cassady
- From the Department of Biomedical Imaging and Image-guided Therapy (F.P., A.H., M.W., H.P., D.P., G.K.), Center for Anatomy and Cell Biology (P.C.B.), Department of Pathology (A.S.), Division of Paediatric Surgery, Department of Surgery (M.M.), and Department of Obstetrics and Gynaecology (J.B.), Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria; E. B. Singleton Department of Radiology, Texas Children's Hospital, Houston, Tex (A.R.M.R., C.C.C.); and Division of Anatomy and Developmental Biology, Karl Landsteiner University of Health Sciences, Krems, Austria (G.M.G.)
| | - Gerlinde M Gruber
- From the Department of Biomedical Imaging and Image-guided Therapy (F.P., A.H., M.W., H.P., D.P., G.K.), Center for Anatomy and Cell Biology (P.C.B.), Department of Pathology (A.S.), Division of Paediatric Surgery, Department of Surgery (M.M.), and Department of Obstetrics and Gynaecology (J.B.), Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria; E. B. Singleton Department of Radiology, Texas Children's Hospital, Houston, Tex (A.R.M.R., C.C.C.); and Division of Anatomy and Developmental Biology, Karl Landsteiner University of Health Sciences, Krems, Austria (G.M.G.)
| | - Peter C Brugger
- From the Department of Biomedical Imaging and Image-guided Therapy (F.P., A.H., M.W., H.P., D.P., G.K.), Center for Anatomy and Cell Biology (P.C.B.), Department of Pathology (A.S.), Division of Paediatric Surgery, Department of Surgery (M.M.), and Department of Obstetrics and Gynaecology (J.B.), Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria; E. B. Singleton Department of Radiology, Texas Children's Hospital, Houston, Tex (A.R.M.R., C.C.C.); and Division of Anatomy and Developmental Biology, Karl Landsteiner University of Health Sciences, Krems, Austria (G.M.G.)
| | - Anke Scharrer
- From the Department of Biomedical Imaging and Image-guided Therapy (F.P., A.H., M.W., H.P., D.P., G.K.), Center for Anatomy and Cell Biology (P.C.B.), Department of Pathology (A.S.), Division of Paediatric Surgery, Department of Surgery (M.M.), and Department of Obstetrics and Gynaecology (J.B.), Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria; E. B. Singleton Department of Radiology, Texas Children's Hospital, Houston, Tex (A.R.M.R., C.C.C.); and Division of Anatomy and Developmental Biology, Karl Landsteiner University of Health Sciences, Krems, Austria (G.M.G.)
| | - Martin Metzelder
- From the Department of Biomedical Imaging and Image-guided Therapy (F.P., A.H., M.W., H.P., D.P., G.K.), Center for Anatomy and Cell Biology (P.C.B.), Department of Pathology (A.S.), Division of Paediatric Surgery, Department of Surgery (M.M.), and Department of Obstetrics and Gynaecology (J.B.), Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria; E. B. Singleton Department of Radiology, Texas Children's Hospital, Houston, Tex (A.R.M.R., C.C.C.); and Division of Anatomy and Developmental Biology, Karl Landsteiner University of Health Sciences, Krems, Austria (G.M.G.)
| | - Julia Binder
- From the Department of Biomedical Imaging and Image-guided Therapy (F.P., A.H., M.W., H.P., D.P., G.K.), Center for Anatomy and Cell Biology (P.C.B.), Department of Pathology (A.S.), Division of Paediatric Surgery, Department of Surgery (M.M.), and Department of Obstetrics and Gynaecology (J.B.), Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria; E. B. Singleton Department of Radiology, Texas Children's Hospital, Houston, Tex (A.R.M.R., C.C.C.); and Division of Anatomy and Developmental Biology, Karl Landsteiner University of Health Sciences, Krems, Austria (G.M.G.)
| | - Azadeh Hojreh
- From the Department of Biomedical Imaging and Image-guided Therapy (F.P., A.H., M.W., H.P., D.P., G.K.), Center for Anatomy and Cell Biology (P.C.B.), Department of Pathology (A.S.), Division of Paediatric Surgery, Department of Surgery (M.M.), and Department of Obstetrics and Gynaecology (J.B.), Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria; E. B. Singleton Department of Radiology, Texas Children's Hospital, Houston, Tex (A.R.M.R., C.C.C.); and Division of Anatomy and Developmental Biology, Karl Landsteiner University of Health Sciences, Krems, Austria (G.M.G.)
| | - Michael Weber
- From the Department of Biomedical Imaging and Image-guided Therapy (F.P., A.H., M.W., H.P., D.P., G.K.), Center for Anatomy and Cell Biology (P.C.B.), Department of Pathology (A.S.), Division of Paediatric Surgery, Department of Surgery (M.M.), and Department of Obstetrics and Gynaecology (J.B.), Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria; E. B. Singleton Department of Radiology, Texas Children's Hospital, Houston, Tex (A.R.M.R., C.C.C.); and Division of Anatomy and Developmental Biology, Karl Landsteiner University of Health Sciences, Krems, Austria (G.M.G.)
| | - Helmut Prosch
- From the Department of Biomedical Imaging and Image-guided Therapy (F.P., A.H., M.W., H.P., D.P., G.K.), Center for Anatomy and Cell Biology (P.C.B.), Department of Pathology (A.S.), Division of Paediatric Surgery, Department of Surgery (M.M.), and Department of Obstetrics and Gynaecology (J.B.), Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria; E. B. Singleton Department of Radiology, Texas Children's Hospital, Houston, Tex (A.R.M.R., C.C.C.); and Division of Anatomy and Developmental Biology, Karl Landsteiner University of Health Sciences, Krems, Austria (G.M.G.)
| | - Daniela Prayer
- From the Department of Biomedical Imaging and Image-guided Therapy (F.P., A.H., M.W., H.P., D.P., G.K.), Center for Anatomy and Cell Biology (P.C.B.), Department of Pathology (A.S.), Division of Paediatric Surgery, Department of Surgery (M.M.), and Department of Obstetrics and Gynaecology (J.B.), Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria; E. B. Singleton Department of Radiology, Texas Children's Hospital, Houston, Tex (A.R.M.R., C.C.C.); and Division of Anatomy and Developmental Biology, Karl Landsteiner University of Health Sciences, Krems, Austria (G.M.G.)
| | - Gregor Kasprian
- From the Department of Biomedical Imaging and Image-guided Therapy (F.P., A.H., M.W., H.P., D.P., G.K.), Center for Anatomy and Cell Biology (P.C.B.), Department of Pathology (A.S.), Division of Paediatric Surgery, Department of Surgery (M.M.), and Department of Obstetrics and Gynaecology (J.B.), Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria; E. B. Singleton Department of Radiology, Texas Children's Hospital, Houston, Tex (A.R.M.R., C.C.C.); and Division of Anatomy and Developmental Biology, Karl Landsteiner University of Health Sciences, Krems, Austria (G.M.G.)
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9
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Kunisaki SM, Saito JM, Fallat ME, St Peter SD, Lal DR, Johnson KN, Mon RA, Adams C, Aladegbami B, Bence C, Burns RC, Corkum KS, Deans KJ, Downard CD, Fraser JD, Gadepalli SK, Helmrath MA, Kabre R, Landman MP, Leys CM, Linden AF, Lopez JJ, Mak GZ, Minneci PC, Rademacher BL, Shaaban A, Walker SK, Wright TN, Hirschl RB. Development of a multi-institutional registry for children with operative congenital lung malformations. J Pediatr Surg 2020; 55:1313-1318. [PMID: 30879756 DOI: 10.1016/j.jpedsurg.2019.01.058] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 11/27/2018] [Accepted: 01/09/2019] [Indexed: 10/27/2022]
Abstract
INTRODUCTION The purpose of this study was to develop a multi-institutional registry to characterize the demographics, management, and outcomes of a contemporary cohort of children undergoing congenital lung malformation (CLM) resection. METHODS After central reliance IRB approval, a web-based, secure database was created to capture retrospective cohort data on pathologically-confirmed CLMs performed between 2009 and 2015 within a multi-institutional research collaborative. RESULTS Eleven children's hospitals contributed 506 patients. Among 344 prenatally diagnosed lesions, the congenital pulmonary airway malformation volume ratio was measured in 49.1%, and fetal MRI was performed in 34.3%. One hundred thirty-four (26.7%) children had respiratory symptoms at birth. Fifty-eight (11.6%) underwent neonatal resection, 322 (64.1%) had surgery at 1-12 months, and 122 (24.3%) had operations after 12 months. The median age at resection was 6.7 months (interquartile range, 3.6-11.4). Among 230 elective lobectomies performed in asymptomatic patients, thoracoscopy was successfully utilized in 102 (44.3%), but there was substantial variation across centers. The most common lesions were congenital pulmonary airway malformation (n = 234, 47.3%) and intralobar bronchopulmonary sequestration (n = 106, 21.4%). CONCLUSION This multicenter cohort study on operative CLMs highlights marked disease heterogeneity and substantial practice variation in preoperative evaluation and operative management. Future registry studies are planned to help establish evidence-based guidelines to optimize the care of these patients. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Shaun M Kunisaki
- Section of Pediatric Surgery, Department of Surgery, University of Michigan and Michigan Medicine, C.S. Mott Children's and Von Voigtlander Women's Hospital, Ann Arbor, MI, USA.
| | - Jacqueline M Saito
- Division of Pediatric Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Mary E Fallat
- Division of Pediatric Surgery, Hiram C. Polk, Jr., M.D. Department of Surgery, University of Louisville, Norton Children's Hospital, Louisville, KY, USA
| | - Shawn D St Peter
- Division of Pediatric Surgery, Department of Surgery, Children's Mercy Hospital, Kansas City, MO, USA
| | - Dave R Lal
- Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Kevin N Johnson
- Section of Pediatric Surgery, Department of Surgery, University of Michigan and Michigan Medicine, C.S. Mott Children's and Von Voigtlander Women's Hospital, Ann Arbor, MI, USA
| | - Rodrigo A Mon
- Section of Pediatric Surgery, Department of Surgery, University of Michigan and Michigan Medicine, C.S. Mott Children's and Von Voigtlander Women's Hospital, Ann Arbor, MI, USA
| | - Cheryl Adams
- Division of Pediatric Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Bola Aladegbami
- Division of Pediatric Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Christina Bence
- Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - R Cartland Burns
- Division of Pediatric Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Kristine S Corkum
- Division of Pediatric Surgery, Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Katherine J Deans
- Center for Surgical Outcomes Research, the Research Institute and Department of Surgery, Nationwide Children's Hospital, Ohio State University College of Medicine, Columbus, OH, USA
| | - Cynthia D Downard
- Division of Pediatric Surgery, Hiram C. Polk, Jr., M.D. Department of Surgery, University of Louisville, Norton Children's Hospital, Louisville, KY, USA
| | - Jason D Fraser
- Division of Pediatric Surgery, Department of Surgery, Children's Mercy Hospital, Kansas City, MO, USA
| | - Samir K Gadepalli
- Section of Pediatric Surgery, Department of Surgery, University of Michigan and Michigan Medicine, C.S. Mott Children's and Von Voigtlander Women's Hospital, Ann Arbor, MI, USA
| | - Michael A Helmrath
- Division of Pediatric Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Rashmi Kabre
- Division of Pediatric Surgery, Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Matthew P Landman
- Division of Pediatric Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Charles M Leys
- Division of Pediatric Surgery, Department of Surgery, University of Wisconsin, Madison, WI, USA
| | - Allison F Linden
- Section of Pediatric Surgery, Department of Surgery, Comer Children's Hospital, University of Chicago Medicine and Biological Sciences, Chicago, IL, USA
| | - Joseph J Lopez
- Center for Surgical Outcomes Research, the Research Institute and Department of Surgery, Nationwide Children's Hospital, Ohio State University College of Medicine, Columbus, OH, USA
| | - Grace Z Mak
- Section of Pediatric Surgery, Department of Surgery, Comer Children's Hospital, University of Chicago Medicine and Biological Sciences, Chicago, IL, USA
| | - Peter C Minneci
- Center for Surgical Outcomes Research, the Research Institute and Department of Surgery, Nationwide Children's Hospital, Ohio State University College of Medicine, Columbus, OH, USA
| | - Brooks L Rademacher
- Division of Pediatric Surgery, Department of Surgery, University of Wisconsin, Madison, WI, USA
| | - Aimen Shaaban
- Division of Pediatric Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Sarah K Walker
- Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Tiffany N Wright
- Division of Pediatric Surgery, Hiram C. Polk, Jr., M.D. Department of Surgery, University of Louisville, Norton Children's Hospital, Louisville, KY, USA
| | - Ronald B Hirschl
- Section of Pediatric Surgery, Department of Surgery, University of Michigan and Michigan Medicine, C.S. Mott Children's and Von Voigtlander Women's Hospital, Ann Arbor, MI, USA
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10
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Style CC, Mehollin-Ray AR, Verla MA, Olutoye OO, Lau PE, Johnson BL, King A, Keswani SG, Lee TC. Accuracy of prenatal and postnatal imaging for management of congenital lung malformations. J Pediatr Surg 2020; 55:844-847. [PMID: 32087934 DOI: 10.1016/j.jpedsurg.2020.01.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 01/25/2020] [Indexed: 01/12/2023]
Abstract
PURPOSE The purpose of this study was to compare the accuracy of prenatal and postnatal imaging modalities for evaluation and management of congenital lung malformations (CLMs). METHODS A retrospective review was performed of all fetuses evaluated for a CLM between December 2001 and January 2018. Pre and postnatal imaging findings, operative treatment, and patient outcomes were collected. Patients were included in analysis if they had fetal imaging (US and/or fetal MRI), a postnatal chest CT, and surgical pathology. RESULTS Over the study period, we identified 157 patients with prenatal imaging that also had a follow-up with postnatal chest CT at a median age of 2.1 [1.4, 3.2] months. Of these, 75% (n = 117) had surgical resection. Diagnostic accuracy (DA) for localization of unilobar lesions was 100% for pre- and postnatal imaging and 97% vs 98% for multilobar disease, respectively. On comparison for identification of aberrant vasculature and pathology prediction, pre- and postnatal imaging DAs were similar. However, postnatal CT had the highest specificity for diagnosing lesions overall (p < 0.05). CONCLUSION Prenatal imaging provides valuable information for counseling and possible fetal intervention. However, this study suggests that postnatal CT scan continues to provide important information for preoperative counseling and surgical management. TYPE OF STUDY Retrospective study. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Candace C Style
- Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX; Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX
| | - Amy R Mehollin-Ray
- Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX; Department of Radiology, Baylor College of Medicine, Houston, TX
| | - Mariatu A Verla
- Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX; Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX
| | - Oluyinka O Olutoye
- Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX; Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX; Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX
| | - Patricio E Lau
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX
| | - Brittany L Johnson
- Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX; Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX
| | - Alice King
- Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX; Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX
| | - Sundeep G Keswani
- Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX; Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX
| | - Timothy C Lee
- Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX; Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX.
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11
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Vincent M, Karolak JA, Deutsch G, Gambin T, Popek E, Isidor B, Szafranski P, Le Caignec C, Stankiewicz P. Clinical, Histopathological, and Molecular Diagnostics in Lethal Lung Developmental Disorders. Am J Respir Crit Care Med 2020; 200:1093-1101. [PMID: 31189067 DOI: 10.1164/rccm.201903-0495tr] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Lethal lung developmental disorders are a rare but important group of pediatric diffuse lung diseases presenting with neonatal respiratory failure. On the basis of histopathological appearance at lung biopsy or autopsy, they have been termed: alveolar capillary dysplasia with misalignment of the pulmonary veins, acinar dysplasia, congenital alveolar dysplasia, and other unspecified primary pulmonary hypoplasias. However, the histopathological continuum in these lethal developmental disorders has made accurate diagnosis challenging, which has implications for recurrence risk. Over the past decade, genetic studies in infants with alveolar capillary dysplasia with misalignment of the pulmonary veins have revealed the causative role of the dosage-sensitive FOXF1 gene and its noncoding regulatory variants in the distant lung-specific enhancer at chromosome 16q24.1. In contrast, the molecular bases of acinar dysplasia and congenital alveolar dysplasia have remained poorly understood. Most recently, disruption of the TBX4-FGF10-FGFR2 epithelial-mesenchymal signaling pathway has been reported in patients with these lethal pulmonary dysplasias. Application of next-generation sequencing techniques, including exome sequencing and whole-genome sequencing, has demonstrated their complex compound inheritance. These data indicate that noncoding regulatory elements play a critical role in lung development in humans. We propose that for more precise lethal lung developmental disorder diagnosis, a diagnostic pathway including whole-genome sequencing should be implemented.
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Affiliation(s)
- Marie Vincent
- Service de Genetique Medicale, Centre Hospitalier Universitaire de Nantes, Nantes, France.,Institut National de la Santé et de la Recherche Médicale, Centre National de la Recherche Scientifique, Université de Nantes, L'institut du Thorax, Nantes, France
| | - Justyna A Karolak
- Department of Molecular and Human Genetics and.,Department of Genetics and Pharmaceutical Microbiology, Poznan University of Medical Sciences, Poznan, Poland
| | - Gail Deutsch
- Department of Pathology, Seattle Children's Hospital, Seattle, Washington
| | - Tomasz Gambin
- Department of Molecular and Human Genetics and.,Department of Medical Genetics, Institute of Mother and Child, Warsaw, Poland; and.,Institute of Computer Science, Warsaw University of Technology, Warsaw, Poland
| | - Edwina Popek
- Department of Pathology and Immunology, Baylor College of Medicine, Houston, Texas
| | - Bertrand Isidor
- Service de Genetique Medicale, Centre Hospitalier Universitaire de Nantes, Nantes, France.,Institut National de la Santé et de la Recherche Médicale, Centre National de la Recherche Scientifique, Université de Nantes, L'institut du Thorax, Nantes, France
| | | | - Cedric Le Caignec
- Service de Genetique Medicale, Centre Hospitalier Universitaire de Nantes, Nantes, France
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12
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Anderson JN, Girsen AI, Hintz SR, El-Sayed YY, Davis AS, Barth RA, Halabi S, Hazard FK, Sylvester KG, Bruzoni M, Blumenfeld YJ. Obstetric and neonatal outcomes in pregnancies complicated by fetal lung masses: does final histology matter? . J Matern Fetal Neonatal Med 2019; 34:3662-3668. [PMID: 31722592 DOI: 10.1080/14767058.2019.1689559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Purpose: Fetal lung masses complicate approximately 1 in 2000 live births. Our aim was to determine whether obstetric and neonatal outcomes differ by final fetal lung mass histology.Materials and methods: A review of all pregnancies complicated by a prenatally diagnosed fetal lung mass between 2009 and 2017 at a single academic center was conducted. All cases included in the final analysis underwent surgical resection and histology diagnosis was determined by a trained pathologist. Clinical data were obtained from review of stored electronic medical records which contained linked maternal and neonatal records. Imaging records included both prenatal ultrasound and magnetic resonance imaging. Fisher's exact test was used for categorical variables and the Kruskal-Wallis test was used for continuous variables. The level of significance was p<.05.Results: Of 61 pregnancies complicated by fetal lung mass during the study period, 45 cases underwent both prenatal care and postnatal resection. Final histology revealed 10 cases of congenital pulmonary airway malformation (CPAM) type 1, nine cases of CPAM type 2, and 16 cases of bronchopulmonary sequestration. There was no difference in initial, maximal, or final CPAM volume ratio between groups, with median final CPAM volume ratio of 0.6 for CPAM type 1, 0.7 for CPAM type 2, and 0.3 for bronchopulmonary sequestration (p = .12). There were no differences in any of the maternal or obstetric outcomes including gestational age at delivery and mode of delivery between the groups. The primary outcome of neonatal respiratory distress was not statistically different between groups (p = .66). Median neonatal length of stay following delivery ranged from 3 to 4 days, and time to postnatal resection was similar as well, with a median of 126 days for CPAM type 1, 122 days for CPAM type 2, and 132 days for bronchopulmonary sequestration (p = .76).Conclusions: In our cohort, there was no significant association between histologic lung mass subtypes and any obstetric or neonatal morbidity including respiratory distress.
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Affiliation(s)
- Jill N Anderson
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Anna I Girsen
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Susan R Hintz
- Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Stanford, CA, USA.,Fetal and Pregnancy Health Program, Lucile Packard Children's Hospital, Palo Alto, CA, USA
| | - Yasser Y El-Sayed
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Stanford University School of Medicine, Stanford, CA, USA.,Fetal and Pregnancy Health Program, Lucile Packard Children's Hospital, Palo Alto, CA, USA
| | - Alexis S Davis
- Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Stanford, CA, USA.,Fetal and Pregnancy Health Program, Lucile Packard Children's Hospital, Palo Alto, CA, USA
| | - Richard A Barth
- Fetal and Pregnancy Health Program, Lucile Packard Children's Hospital, Palo Alto, CA, USA.,Department of Radiology, Division of Pediatric Radiology, Stanford University School of Medicine, Stanford, CA, USA
| | - Safwan Halabi
- Fetal and Pregnancy Health Program, Lucile Packard Children's Hospital, Palo Alto, CA, USA.,Department of Radiology, Division of Pediatric Radiology, Stanford University School of Medicine, Stanford, CA, USA
| | - Florette K Hazard
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Karl G Sylvester
- Fetal and Pregnancy Health Program, Lucile Packard Children's Hospital, Palo Alto, CA, USA.,Department of Surgery, Division of Pediatric Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Matias Bruzoni
- Fetal and Pregnancy Health Program, Lucile Packard Children's Hospital, Palo Alto, CA, USA.,Department of Surgery, Division of Pediatric Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Yair J Blumenfeld
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Stanford University School of Medicine, Stanford, CA, USA.,Fetal and Pregnancy Health Program, Lucile Packard Children's Hospital, Palo Alto, CA, USA
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13
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Kane SC, Ancona E, Reidy KL, Palma-Dias R. The Utility of the Congenital Pulmonary Airway Malformation-Volume Ratio in the Assessment of Fetal Echogenic Lung Lesions: A Systematic Review. Fetal Diagn Ther 2019; 47:171-181. [PMID: 31593968 DOI: 10.1159/000502841] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 08/21/2019] [Indexed: 11/19/2022]
Abstract
Although relatively uncommon, the incidence of fetal echogenic lung lesions - a heterogeneous group of anomalies that includes congenital pulmonary airway malformations (CPAM) and bronchopulmonary sequestrations (BPS) - has increased recently. Two decades ago, the CPAM-volume ratio (CVR) was first described as a tool to predict the development of hydrops, with this outcome found to be unlikely in fetuses with CVRs of ≤1.6 cm2. Since then, no clear international consensus has evolved as to the optimal CVR thresholds for the prediction of fetal/neonatal outcomes. This systematic review aimed to assess all original research studies that reported on the predictive utility of the CVR. Potentially relevant papers were identified through searching for citations of the paper that originally described the CVR, in addition to keyword searches of electronic databases. Fifty-two original research papers were included in the final review. Of these, 34 used the CVR for descriptive purposes only, 5 assessed the validity of established thresholds in different populations, and 13 proposed new thresholds. The evidence identified in this review would suggest that a threshold much lower than 1.6 cm2 is likely to be of greater utility in most populations for many outcomes of perinatal relevance. For neonatal outcomes (mostly respiratory compromise at birth), a CVR on the initial ultrasound scan ranging from 0.5 to 1.0 cm2 appears to have the greatest predictive value. Although a number of studies concurred that 1.6 cm2 was a useful threshold for the prediction of hydrops, many others were unable to assess this due to the rarity of this complication. For this reason, thresholds as low as 0.4 cm2 may be more useful for the prediction of a broader range of fetal concerns, including mediastinal shift and fluid collections. Further large-scale studies are required to determine the true utility of this well-established index.
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Affiliation(s)
- Stefan C Kane
- Pregnancy Research Centre, Department of Maternal Fetal Medicine, The Royal Women's Hospital, Parkville, Victoria, Australia, .,Ultrasound Services, Pauline Gandel Women's Imaging Centre, The Royal Women's Hospital, Parkville, Victoria, Australia, .,The University of Melbourne, Department of Obstetrics and Gynaecology, Parkville, Victoria, Australia,
| | - Emanuele Ancona
- Pregnancy Research Centre, Department of Maternal Fetal Medicine, The Royal Women's Hospital, Parkville, Victoria, Australia.,Ultrasound Services, Pauline Gandel Women's Imaging Centre, The Royal Women's Hospital, Parkville, Victoria, Australia.,Obstetrics and Gynaecology Unit, Department of Women's and Children's Health, The University of Padua, Padua, Italy
| | - Karen L Reidy
- Pregnancy Research Centre, Department of Maternal Fetal Medicine, The Royal Women's Hospital, Parkville, Victoria, Australia.,Ultrasound Services, Pauline Gandel Women's Imaging Centre, The Royal Women's Hospital, Parkville, Victoria, Australia
| | - Ricardo Palma-Dias
- Pregnancy Research Centre, Department of Maternal Fetal Medicine, The Royal Women's Hospital, Parkville, Victoria, Australia.,Ultrasound Services, Pauline Gandel Women's Imaging Centre, The Royal Women's Hospital, Parkville, Victoria, Australia.,The University of Melbourne, Department of Obstetrics and Gynaecology, Parkville, Victoria, Australia
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14
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Didier RA, DeBari SE, Oliver ER, Gebb JS, Howell LJ, Hedrick HL, Adzick NS, Coleman BG. Secondary Imaging Findings Aid in Prenatal Diagnosis and Characterization of Congenital Diaphragmatic Hernia: Role of an Abnormal Orientation of Vascular Structures and Gallbladder Position. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:1449-1456. [PMID: 30244484 DOI: 10.1002/jum.14823] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 08/23/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To determine whether an abnormal orientation of the abdominal or hepatic vasculature and an abnormal gallbladder position on prenatal ultrasound (US) imaging are associated with intrathoracic liver herniation and postnatal outcomes in cases of congenital diaphragmatic hernia (CDH). METHODS Children who underwent prenatal US examinations and postnatal CDH repair at our institution were eligible. Prenatal US images were reviewed, and the orientation of the superior mesenteric artery (SMA) and hepatic veins as well as gallbladder position were recorded. Findings were correlated with prenatal US measurements (lung-to-head ratio and calculated observed-to-expected lung-to-head ratio) and postnatal outcomes, including intrathoracic liver herniation, an extracorporeal membrane oxygenation (ECMO) requirement, and mortality. RESULTS A total of 175 patients met inclusion criteria. The SMA was shown in 168 cases and had a cephalad orientation in 95.4% (161 of 168), which was not associated with outcome measures and represented bowel herniation. A cephalad orientation of the hepatic veins was identified in 52.6% (90 of 171) and was associated with intrathoracic liver herniation, an ECMO requirement, and mortality (P < .01). In right-sided CDH, the gallbladder was intrathoracic in 91.3% (21 of 23). In left-sided CDH, an abnormal gallbladder position was seen in 51.3% (76/152) and was associated with intrathoracic liver herniation, an ECMO requirement, mortality, and lower lung-to-head ratio and observed-to-expected lung-to-head ratio values. When combined, abnormal hepatic vein and gallbladder positions showed good sensitivity and specificity in predicting intrathoracic liver herniation (area under the curve, 0.93). CONCLUSIONS Abnormal SMA, hepatic vein, and gallbladder positions can be used to improve prenatal characterization of CDH. Accurate depiction of these structures on prenatal US images may aid in patient counseling and postnatal management.
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Affiliation(s)
- Ryne A Didier
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Center for Fetal Diagnosis and Therapy, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Suzanne E DeBari
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Center for Fetal Diagnosis and Therapy, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Edward R Oliver
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Center for Fetal Diagnosis and Therapy, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Juliana S Gebb
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Center for Fetal Diagnosis and Therapy, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Lori J Howell
- Center for Fetal Diagnosis and Therapy, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Holly L Hedrick
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Center for Fetal Diagnosis and Therapy, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - N Scott Adzick
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Center for Fetal Diagnosis and Therapy, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Beverly G Coleman
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Center for Fetal Diagnosis and Therapy, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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15
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Normal values of the resistivity index of the pericallosal artery with and without compression of the anterior fontanelle. Pediatr Radiol 2019; 49:646-651. [PMID: 30712160 DOI: 10.1007/s00247-019-04347-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 11/07/2018] [Accepted: 01/16/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Resistivity index (RI) of the pericallosal artery as is commonly measured during head ultrasound (US) examination in neonates. Some studies have shown that RI measured with gentle compression of the fontanelle provides additional information in cases of neonatal brain anomalies. OBJECTIVE The purpose of this study was to establish normal RI values with and without compression in a large population of neonates with normal cranial ultrasound as a function of gestational age. MATERIALS AND METHODS The authors of this retrospective study reviewed the RI of 323 infants with normal gray-scale cranial US and with a gestational age ranging 26-42 weeks. We conducted the exams both with and without compression of the anterior fontanelle and we studied changes in RI depending on gestational age, gender and type of delivery. RESULTS Infants with a gestational age of more than 35 weeks tended to have a lower RI (P=0.011). The compression of the anterior fontanelle emphasized the change in RI with increasing gestational age, with higher gestational ages having a lower RI (P<0.001). The results concerning the percentage change between baseline RI and RI with compression showed that infants with higher gestational ages have a smaller percentage change in RI (P=0.002). CONCLUSION We established the normal values for RI from 26 weeks to 42 weeks of gestation. The results of the study show the importance of taking the gestational age into consideration when evaluating the RI.
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Sharma S. Progress in Fetal Surgery: A Buoyant Start or Watchful Reluctance? Perspectives for India. J Indian Assoc Pediatr Surg 2019; 24:1-3. [PMID: 30686880 PMCID: PMC6322186 DOI: 10.4103/jiaps.jiaps_84_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
- Shilpa Sharma
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
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17
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Schierz IAM, Giuffrè M, Piro E, Leone MC, Pinello G, Corsello G. Clinical cardiac assessment in newborns with prenatally diagnosed intrathoracic masses. Ital J Pediatr 2018; 44:98. [PMID: 30134984 PMCID: PMC6106891 DOI: 10.1186/s13052-018-0543-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 08/13/2018] [Indexed: 11/17/2022] Open
Abstract
Background Congenital space-occupying thoracic malformations and diaphragmatic hernia have in common pulmonary hypoplasia. Our study aims to assess cardiac involvement during post-natal adaptation. Methods A retrospective study was carried out on newborns with prenatally diagnosed intrathoracic mass. Gathering for respiratory distress syndrome (RDS), 35 neonates were compared for clinical course, cardiovascular enzymes, ECG, and ultrasound. Results The analysis revealed a high left heart defect rate in patients with severe RDS, without being influenced by the laterality. Ultrasound or laboratory assessment did not detect altered cardiac dimension or cardiomyopathy. Solely ECG signs of right ventricular strain were found. Increased QT-dispersion, T-wave and cardiac variability alterations in the first hours were all expression of non-specific cardiac repolarization disorders but predict worse outcome. Conclusions Although RDS is the predominant symptom, slight cardiac dysfunctions should be recognized for prompt treatment. Conventional examinations for postnatal adaption should be integrated by complementary investigations.
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18
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Fetal Lung Volumes by MRI: Normal Weekly Values From 18 Through 38 Weeks' Gestation. AJR Am J Roentgenol 2018; 211:432-438. [PMID: 29894217 DOI: 10.2214/ajr.17.19469] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The purpose of this study is to establish normal total fetal lung volume reference ranges from 18 to 38 weeks' gestation at 1-week intervals. MATERIALS AND METHODS A retrospective analysis of 665 patients who underwent fetal MRI at two tertiary fetal centers from 2001 to 2013 was performed. Total fetal lung volume was measured in at least two planes, either manually or using a 3D workstation. The mean, median, SD, minimum, maximum, and lower and upper quartiles for total fetal lung volume were determined per gestational week. A t test was used to compare our values to previously reported values. A new formula to calculate total fetal lung volume derived from our data was created using a regression model. Comparisons between total fetal lung volume obtained by different imaging planes and manual versus semiautomatic calculation were also performed. RESULTS The mean normal total fetal lung volume showed a weekly increase from 18 through 35 weeks' gestation. Means were compared with the expected total fetal lung volume generated by the Rypens formula, showing statistically significant lower mean total fetal lung volume from week 19 to week 22 (p < 0.05). Comparison between our data-derived total fetal lung volume formula and the Rypens formula showed very similar values at every gestational age. No difference in total fetal lung volume was seen when comparing imaging planes or manual versus semiautomatic methods. CONCLUSION Measured mean total fetal lung volume values at 19-22 weeks are significantly lower than those predicted by the Rypens formula. Therefore, we propose preferential use of our values for prenatal counseling and delivery planning.
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19
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Leblanc C, Baron M, Desselas E, Phan MH, Rybak A, Thouvenin G, Lauby C, Irtan S. Congenital pulmonary airway malformations: state-of-the-art review for pediatrician's use. Eur J Pediatr 2017; 176:1559-1571. [PMID: 29046943 DOI: 10.1007/s00431-017-3032-7] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 09/30/2017] [Accepted: 10/04/2017] [Indexed: 02/06/2023]
Abstract
UNLABELLED Congenital pulmonary airway malformations or CPAM are rare developmental lung malformations, leading to cystic and/or adenomatous pulmonary areas. Nowadays, CPAM are diagnosed prenatally, improving the prenatal and immediate postnatal care and ultimately the knowledge on CPAM pathophysiology. CPAM natural evolution can lead to infections or malignancies, whose exact prevalence is still difficult to assess. The aim of this "state-of-the-art" review is to cover the recently published literature on CPAM management whether the pulmonary lesion was detected during pregnancy or after birth, the current indications of surgery or surveillance and finally its potential evolution to pleuro-pulmonary blastoma. CONCLUSION Surgery remains the cornerstone treatment of symptomatic lesions but the postnatal management of asymptomatic CPAM remains controversial. There are pros and cons of surgical resection, as increasing rate of infections over time renders the surgery more difficult after months or years of evolution, as well as risk of malignancy, though exact incidence is still unknown. What is known: • Congenital pulmonary airway malformations (CPAM) are rare developmental lung malformations mainly antenatally diagnosed. • While the neonatal management of symptomatic CPAM is clear and includes prompt surgery, controversies remain for asymptomatic CPAM due to risk of infections and malignancies. What is new: • Increased rate of infection over time renders the surgery more difficult after months or years of evolution and pushes for recommendation of early elective surgery. • New molecular or pathological pathways may help in the distinction of type 4 CPAM from type I pleuropulmonary blastoma.
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Affiliation(s)
- Claire Leblanc
- Department of Pediatric Pulmonology, APHP Hôpital Armand Trousseau, Paris, France
| | - Marguerite Baron
- Department of Pediatric Pulmonology, APHP Hôpital Armand Trousseau, Paris, France
| | - Emilie Desselas
- Department of Pediatric Pulmonology, APHP Hôpital Armand Trousseau, Paris, France
| | - Minh Hanh Phan
- Department of Pediatric Pulmonology, APHP Hôpital Armand Trousseau, Paris, France
| | - Alexis Rybak
- Department of Pediatric Pulmonology, APHP Hôpital Armand Trousseau, Paris, France
| | - Guillaume Thouvenin
- Department of Pediatric Pulmonology, APHP Hôpital Armand Trousseau, Paris, France.,UPMC Univ Paris 06, Centre de Recherche St Antoine Inserm UMRS.938, Sorbonne Universités, Paris, France
| | - Clara Lauby
- Department of Pediatric Pulmonology, APHP Hôpital Armand Trousseau, Paris, France
| | - Sabine Irtan
- UPMC Univ Paris 06, Centre de Recherche St Antoine Inserm UMRS.938, Sorbonne Universités, Paris, France. .,Department of Pediatric Surgery, APHP Hôpital Armand Trousseau, 26 avenue du Dr Arnold Netter, 75012, Paris, France.
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20
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Abstract
Fetal MRI is a level III diagnostic tool performed subsequently a level II prenatal ultrasound (US), in cases of inconclusive ultrasonographic diagnosis or when a further investigation is required to confirm or improve the diagnosis, to plan an appropriate pregnancy management. Fetal MRI plays an increasingly important role in the prenatal diagnosis of fetal neck, chest and abdominal malformations, even if its role has been amply demonstrated, especially, in the field of fetal CNS anomalies. Due to its multiparametricity and multiplanarity, MRI provides a detailed evaluation of the whole fetal respiratory, gastrointestinal and genitourinary systems, especially on T2-weighted (W) images, with a good tissue contrast resolution. In the evaluation of the digestive tract, T1-W sequences are very important in relation to the typical hyperintensity of the large intestine, due to the presence of meconium. The objective of this review is to focus on the application of fetal MRI in neck, chest and abdominal diseases.
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21
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Kane SC, Da Silva Costa F, Crameri JA, Reidy KL, Kaganov H, Palma-Dias R. Antenatal assessment and postnatal outcome of fetal echogenic lung lesions: a decade’s experience at a tertiary referral hospital. J Matern Fetal Neonatal Med 2017; 32:703-709. [DOI: 10.1080/14767058.2017.1388367] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Stefan C. Kane
- Department of Maternal Fetal Medicine, Pregnancy Research Centre, The Royal Women’s Hospital, Parkville, Australia
- Department of Obstetrics and Gynecology, The University of Melbourne, The Royal Women’s Hospital, Parkville, Australia
- Pauline Gandel Women’s Imaging Centre, The Royal Women’s Hospital, Parkville, Australia
| | - Fabrício Da Silva Costa
- Department of Obstetrics and Gynecology, The University of Melbourne, The Royal Women’s Hospital, Parkville, Australia
- Monash Ultrasound for Women, Clayton, Victoria, Australia
- Perinatal Services, Monash Medical Centre, Monash Health, Clayton, Victoria, Australia
| | - Joseph A. Crameri
- Department of Paediatric and Neonatal Surgery, The Royal Children’s Hospital, Parkville, Victoria, Australia
| | - Karen L. Reidy
- Department of Maternal Fetal Medicine, Pregnancy Research Centre, The Royal Women’s Hospital, Parkville, Australia
- Pauline Gandel Women’s Imaging Centre, The Royal Women’s Hospital, Parkville, Australia
| | - Helen Kaganov
- Maternity Services, Werribee Mercy Hospital, Werribee, Victoria, Australia
| | - Ricardo Palma-Dias
- Department of Obstetrics and Gynecology, The University of Melbourne, The Royal Women’s Hospital, Parkville, Australia
- Pauline Gandel Women’s Imaging Centre, The Royal Women’s Hospital, Parkville, Australia
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22
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Alansary A, Rajchl M, McDonagh SG, Murgasova M, Damodaram M, Lloyd DFA, Davidson A, Rutherford M, Hajnal JV, Rueckert D, Kainz B. PVR: Patch-to-Volume Reconstruction for Large Area Motion Correction of Fetal MRI. IEEE TRANSACTIONS ON MEDICAL IMAGING 2017; 36:2031-2044. [PMID: 28880160 PMCID: PMC6051489 DOI: 10.1109/tmi.2017.2737081] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 06/07/2017] [Accepted: 08/01/2017] [Indexed: 05/23/2023]
Abstract
In this paper, we present a novel method for the correction of motion artifacts that are present in fetal magnetic resonance imaging (MRI) scans of the whole uterus. Contrary to current slice-to-volume registration (SVR) methods, requiring an inflexible anatomical enclosure of a single investigated organ, the proposed patch-to-volume reconstruction (PVR) approach is able to reconstruct a large field of view of non-rigidly deforming structures. It relaxes rigid motion assumptions by introducing a specific amount of redundant information that is exploited with parallelized patchwise optimization, super-resolution, and automatic outlier rejection. We further describe and provide an efficient parallel implementation of PVR allowing its execution within reasonable time on commercially available graphics processing units, enabling its use in the clinical practice. We evaluate PVR's computational overhead compared with standard methods and observe improved reconstruction accuracy in the presence of affine motion artifacts compared with conventional SVR in synthetic experiments. Furthermore, we have evaluated our method qualitatively and quantitatively on real fetal MRI data subject to maternal breathing and sudden fetal movements. We evaluate peak-signal-to-noise ratio, structural similarity index, and cross correlation with respect to the originally acquired data and provide a method for visual inspection of reconstruction uncertainty. We further evaluate the distance error for selected anatomical landmarks in the fetal head, as well as calculating the mean and maximum displacements resulting from automatic non-rigid registration to a motion-free ground truth image. These experiments demonstrate a successful application of PVR motion compensation to the whole fetal body, uterus, and placenta.
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23
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Seravalli V, Jelin EB, Miller JL, Tekes A, Vricella L, Baschat AA. Fetoscopic tracheal occlusion for treatment of non-isolated congenital diaphragmatic hernia. Prenat Diagn 2017; 37:1046-1049. [PMID: 28891233 DOI: 10.1002/pd.5139] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 07/26/2017] [Accepted: 08/06/2017] [Indexed: 11/05/2022]
Abstract
Fetoscopic endotracheal occlusion (FETO) is a prenatal treatment that may increase survival in severe congenital diaphragmatic hernia (CDH). In the USA, FETO is offered for isolated severe left-sided CDH in the context of an FDA-approved feasibility study. FETO in non-isolated cases of severe CDH is only performed with a compassionate use exemption from US regulatory bodies. Anomalies frequently associated with CDH include congenital cystic lesions of the lung and cardiac defects. We describe two cases of non-isolated severe left-sided CDH that underwent prenatal FETO, survived after birth and underwent postnatal surgical repair. The potential benefit of FETO in this setting is discussed. © 2017 John Wiley & Sons, Ltd.
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Affiliation(s)
- Viola Seravalli
- Center for Fetal Therapy, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Eric B Jelin
- Department of Pediatric Surgery, Johns Hopkins Bloomberg Children's Center and Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jena L Miller
- Center for Fetal Therapy, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Aylin Tekes
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Pediatric Radiology and Pediatric Neuroradiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Luca Vricella
- Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ahmet A Baschat
- Center for Fetal Therapy, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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24
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Zirpoli S, Munari AM, Rustico M, Bulfamante G, Lista G, Spaccini L, Cesaretti C. Fetal-MRI prenatal diagnosis of severe bilateral lung hypoplasia: alveolar capillary dysplasia case report. J Prenat Med 2017; 10:15-19. [PMID: 28725341 DOI: 10.11138/jpm/2016.10.3.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Alveolar capillary dysplasia with misalignment of pulmonary veins (ACD/MPV) is a rare and lethal developmental disorder of the lung that affect both acinar structure and the intrinsic pulmonary vasculature. We report prenatal and postnatal imaging with histopathological findings of this rare condition. We, first, describe MR imaging features and discuss its role in prenatal imaging.
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Affiliation(s)
- Salvatore Zirpoli
- Pediatric Radiology and Neuroradiology, Children's Hospital V. Buzzi, Milan, Italy
| | | | - Mariangela Rustico
- Unit of Prenatal Diagnosis and Fetal Surgery, Children's Hospital V. Buzzi, Milan, Italy
| | - Gaetano Bulfamante
- Department of Health Sciences, San Paolo Hospital, University of Milan, Milan, Italy
| | - Gianluca Lista
- Division of Neonatology, Children's Hospital V. Buzzi, Milan, Italy
| | - Luigina Spaccini
- Clinical Genetics Service, Children's Hospital V. Buzzi, Milan, Italy
| | - Claudia Cesaretti
- Medical Genetics Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
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25
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Prayer D, Malinger G, Brugger PC, Cassady C, De Catte L, De Keersmaecker B, Fernandes GL, Glanc P, Gonçalves LF, Gruber GM, Laifer-Narin S, Lee W, Millischer AE, Molho M, Neelavalli J, Platt L, Pugash D, Ramaekers P, Salomon LJ, Sanz M, Timor-Tritsch IE, Tutschek B, Twickler D, Weber M, Ximenes R, Raine-Fenning N. ISUOG Practice Guidelines: performance of fetal magnetic resonance imaging. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2017; 49:671-680. [PMID: 28386907 DOI: 10.1002/uog.17412] [Citation(s) in RCA: 128] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 01/07/2017] [Accepted: 01/13/2017] [Indexed: 06/07/2023]
Affiliation(s)
- D Prayer
- Division of Neuroradiology and Musculoskeletal Radiology, Department of Radiology, Medical University of Vienna, Vienna, Austria
| | - G Malinger
- Division of Ultrasound in Obstetrics & Gynecology, Lis Maternity Hospital, Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - P C Brugger
- Division of Anatomy, Center for Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria
| | - C Cassady
- Texas Children's Hospital and Fetal Center, Houston, TX, USA
| | - L De Catte
- Department of Obstetrics & Gynecology, University Hospitals Leuven, Leuven, Belgium
| | - B De Keersmaecker
- Department of Obstetrics & Gynecology, University Hospitals Leuven, Leuven, Belgium
| | - G L Fernandes
- Fetal Medicine Unit, Department of Obstetrics, ABC Medicine University, Santo Andre, Brazil
| | - P Glanc
- Departments of Radiology and Obstetrics & Gynecology, University of Toronto and Sunnybrook Research Institute, Obstetrical Ultrasound Center, Department of Medical Imaging, Body Division, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - L F Gonçalves
- Fetal Imaging, William Beaumont Hospital, Royal Oak and Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - G M Gruber
- Division of Anatomy, Center for Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria
| | - S Laifer-Narin
- Division of Ultrasound and Fetal MRI, Columbia University Medical Center - New York Presbyterian Hospital, New York, NY, USA
| | - W Lee
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Pavilion for Women, Houston, TX, USA
| | - A-E Millischer
- Radiodiagnostics Department, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes, Paris, France
| | - M Molho
- Diagnostique Ante Natal, Service de Neuroradiologie, CHU Sud Réunion, St Pierre, La Réunion, France
| | - J Neelavalli
- Department of Radiology, Wayne State University School of Medicine, Detroit, MI, USA
| | - L Platt
- Department of Obstetrics and Gynecology, David Geffen School of Medicine, Los Angeles, CA, USA
| | - D Pugash
- Department of Radiology, University of British Columbia, Vancouver, Canada
- Department of Obstetrics and Gynecology, BC Women's Hospital, Vancouver, Canada
| | - P Ramaekers
- Prenatal Diagnosis, Department of Obstetrics and Gynecology, Ghent University Hospital, Ghent, Belgium
| | - L J Salomon
- Department of Obstetrics, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes, Paris, France
| | - M Sanz
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Pavilion for Women, Houston, TX, USA
| | - I E Timor-Tritsch
- Division of Obstetrical & Gynecological Ultrasound, NYU School of Medicine, New York, NY, USA
| | - B Tutschek
- Department of Obstetrics & Gynecology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany and Prenatal Zurich, Zürich, Switzerland
| | - D Twickler
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - M Weber
- Division of Neuroradiology and Musculoskeletal Radiology, Department of Radiology, Medical University of Vienna, Vienna, Austria
| | - R Ximenes
- Fetal Medicine Foundation Latin America, Centrus, Campinas, Brazil
| | - N Raine-Fenning
- Department of Child Health, Obstetrics & Gynaecology, School of Medicine, University of Nottingham and Nurture Fertility, The Fertility Partnership, Nottingham, UK
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26
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Girsen AI, Hintz SR, Sammour R, Naqvi A, El-Sayed YY, Sherwin K, Davis AS, Chock VY, Barth RA, Rubesova E, Sylvester KG, Chitkara R, Blumenfeld YJ. Prediction of neonatal respiratory distress in pregnancies complicated by fetal lung masses. Prenat Diagn 2017; 37:266-272. [PMID: 28061000 DOI: 10.1002/pd.5002] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 12/21/2016] [Accepted: 12/29/2016] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The objective of this article is to evaluate the utility of fetal lung mass imaging for predicting neonatal respiratory distress. METHOD Pregnancies with fetal lung masses between 2009 and 2014 at a single center were analyzed. Neonatal respiratory distress was defined as intubation and mechanical ventilation at birth, surgery before discharge, or extracorporeal membrane oxygenation (ECMO). The predictive utility of the initial as well as maximal lung mass volume and congenital pulmonary airway malformation volume ratio by ultrasound (US) and magnetic resonance imaging (MRI) was analyzed. RESULTS Forty-seven fetal lung mass cases were included; of those, eight (17%) had respiratory distress. The initial US was performed at similar gestational ages in pregnancies with and without respiratory distress (26.4 ± 5.6 vs 22.3 ± 3 weeks, p = 0.09); however, those with respiratory distress had higher congenital volume ratio at that time (1.0 vs 0.3, p = 0.01). The strongest predictors of respiratory distress were maximal volume >24.0 cm3 by MRI (100% sensitivity, 91% specificity, 60% positive predictive value, and 100% negative predictive value) and maximal volume >34.0 cm3 by US (100% sensitivity, 85% specificity, 54% positive predictive value, and 100% negative predictive value). CONCLUSION Ultrasound and MRI parameters can predict neonatal respiratory distress, even when obtained before 24 weeks. Third trimester parameters demonstrated the best positive predictive value. © 2017 John Wiley & Sons, Ltd.
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Affiliation(s)
- Anna I Girsen
- Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Susan R Hintz
- Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Stanford, CA, USA.,Fetal and Pregnancy Health Program, Lucile Packard Children's Hospital, Palo Alto, CA, USA
| | - Rami Sammour
- Fetal Medicine Research Institute, King's College University Hospital, London, UK
| | | | - Yasser Y El-Sayed
- Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Stanford University School of Medicine, Stanford, CA, USA.,Fetal and Pregnancy Health Program, Lucile Packard Children's Hospital, Palo Alto, CA, USA
| | - Katie Sherwin
- Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Alexis S Davis
- Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Stanford, CA, USA.,Fetal and Pregnancy Health Program, Lucile Packard Children's Hospital, Palo Alto, CA, USA
| | - Valerie Y Chock
- Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Stanford, CA, USA.,Fetal and Pregnancy Health Program, Lucile Packard Children's Hospital, Palo Alto, CA, USA
| | - Richard A Barth
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA.,Fetal and Pregnancy Health Program, Lucile Packard Children's Hospital, Palo Alto, CA, USA
| | - Erika Rubesova
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA.,Fetal and Pregnancy Health Program, Lucile Packard Children's Hospital, Palo Alto, CA, USA
| | - Karl G Sylvester
- Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA.,Fetal and Pregnancy Health Program, Lucile Packard Children's Hospital, Palo Alto, CA, USA
| | - Ritu Chitkara
- Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Stanford, CA, USA.,Fetal and Pregnancy Health Program, Lucile Packard Children's Hospital, Palo Alto, CA, USA
| | - Yair J Blumenfeld
- Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Stanford University School of Medicine, Stanford, CA, USA.,Fetal and Pregnancy Health Program, Lucile Packard Children's Hospital, Palo Alto, CA, USA
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27
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Weisstanner C, Gruber GM, Brugger PC, Mitter C, Diogo MC, Kasprian G, Prayer D. Fetal MRI at 3T-ready for routine use? Br J Radiol 2017; 90:20160362. [PMID: 27768394 PMCID: PMC5605013 DOI: 10.1259/bjr.20160362] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Fetal MR now plays an important role in the clinical work-up of pregnant females. It is performed mainly at 1.5 T. However, the desire to obtain a more precise fetal depiction or the fact that some institutions have access only to a 3.0 T scanner has resulted in a growing interest in performing fetal MR at 3.0 T. The aim of this article was to provide a reference for the use of 3.0 T MRI as a prenatal diagnostic method.
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Affiliation(s)
- Christian Weisstanner
- 1 Division of Neuro- and Musculoskeletal Radiology, Department of Radiology, Medical University of Vienna, Vienna, Austria
- 2 Institute for Diagnostic and Interventional Neuroradiology, Inselspital, University of Bern, Bern, Switzerland
| | - Gerlinde M Gruber
- 3 Center of Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria
| | - Peter C Brugger
- 3 Center of Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria
| | - Christan Mitter
- 1 Division of Neuro- and Musculoskeletal Radiology, Department of Radiology, Medical University of Vienna, Vienna, Austria
| | - Mariana C Diogo
- 4 Neuroradiology Department, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
| | - Gregor Kasprian
- 1 Division of Neuro- and Musculoskeletal Radiology, Department of Radiology, Medical University of Vienna, Vienna, Austria
| | - Daniela Prayer
- 1 Division of Neuro- and Musculoskeletal Radiology, Department of Radiology, Medical University of Vienna, Vienna, Austria
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28
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Abstract
Historically, the gold standard for the treatment of congenital malformations has been planned delivery at tertiary care center with attempted post-natal repair or amelioration of the lesion. Over the last few decades however, rapid advances in imaging and instrumentation technology combined with superior knowledge of fetal pathophysiology has led to the development of novel intrauterine interventions for most common fetal anomalies. Great success has already been seen the treatment of previous devastating anomalies such as myelomeningocele (MMC), congenital cystic malformations of the lung, twin-twin transfusion, and sacrococcygeal teratomas. Although still limited, these innovative techniques have unique potential to improve outcomes in the most devastating fetal anomalies.
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Affiliation(s)
- Kathryn M Maselli
- Department of Surgery, Medstar Georgetown University Hospital, Washington DC 20007, USA
| | - Andrea Badillo
- Division of Pediatric Surgery, Children's National Medical Center, Washington DC 20010, USA
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Durell J, Thakkar H, Gould S, Fowler D, Lakhoo K. Pathology of asymptomatic, prenatally diagnosed cystic lung malformations. J Pediatr Surg 2016; 51:231-5. [PMID: 26653945 DOI: 10.1016/j.jpedsurg.2015.10.061] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 10/30/2015] [Indexed: 12/26/2022]
Abstract
AIM The management of asymptomatic congenital cystic lung malformations is controversial. Arguments for excision of asymptomatic lesions are the potential for infection and malignancy. Following antenatal detection, our institute performs a CT at 1month, clinic follow-up by 3months to discuss the controversial management, and offers surgery by 6months of age. We investigated the histopathology of asymptomatic lesions to determine whether there was evidence of subclinical infection or malignancy. METHODS A retrospective review of prospectively collected antenatal congenital cystic lung malformations more than a 10year period (2005-2014) was conducted. Information was gathered from the antenatal registry and histopathology reports. Infection was defined by the presence of microabscesses or neutrophil/macrophage infiltration, as per histopathological criteria. MAIN RESULTS From the cohort of 99 patients, the study focused on 69 asymptomatic lesions. These cases comprised 34 congenital pulmonary airway malformations (CPAM), 15 pulmonary sequestrations (PS), and 20 hybrid lesions. Eighteen cases (26%) had microscopic disease - 16 cases of infection and 2 tumors. The infectious cases comprised 7 with microabscesses and 9 with neutrophil/macrophage infiltration. There were two cases of tumors, namely pleuropulmonary blastoma. These tumors were followed up by the oncology team with regular imaging until 3years of age and clinical review thereafter. CONCLUSION Twenty-six percent of antenatally detected, asymptomatic cystic lung malformations demonstrated either subclinical infection or malignancy. This information can be used for counseling parents and determining the method of treatment.
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Affiliation(s)
- Jonathan Durell
- Department of Paediatric Surgery, Oxford University Hospitals, John Radcliffe Hospital, Headley Way, Oxford, United Kingdom OX3 9DU
| | - Hemanshoo Thakkar
- Department of Paediatric Surgery, Oxford University Hospitals, John Radcliffe Hospital, Headley Way, Oxford, United Kingdom OX3 9DU
| | - Steve Gould
- Department of Histopathology, Oxford University Hospitals, John Radcliffe Hospital, Headley Way, Oxford, United Kingdom OX3 9DU
| | - Darren Fowler
- Department of Histopathology, Oxford University Hospitals, John Radcliffe Hospital, Headley Way, Oxford, United Kingdom OX3 9DU
| | - Kokila Lakhoo
- Department of Paediatric Surgery, Oxford University Hospitals, John Radcliffe Hospital, Headley Way, Oxford, United Kingdom OX3 9DU.
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Rubesova E. Why do we need more data on MR volumetric measurements of the fetal lung? Pediatr Radiol 2016; 46:167-71. [PMID: 26829947 DOI: 10.1007/s00247-015-3521-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2015] [Revised: 10/03/2015] [Accepted: 11/23/2015] [Indexed: 01/31/2023]
Abstract
Fetal lung hypoplasia is associated with a series of congenital anomalies, particularly the congenital diaphragmatic hernia. Evaluation of the severity of the lung hypoplasia is important for parental counseling, assessment of prognosis and planning of postnatal management. Although a large number of studies have been performed to measure fetal lung volumes in order to predict outcome, there are little data on fetuses younger than 24 weeks of gestation, the age when parental counseling is crucial if termination is considered. Few studies have evaluated prognosis of lung hypoplasia in fetuses with congenital chest anomalies other than congenital diaphragmatic hernia. We review the studies on measurements of the fetal lung volumes by MRI.
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Affiliation(s)
- Erika Rubesova
- Pediatric Radiology, Lucile Packard Children's Hospital at Stanford, Stanford University, 725 Welch Road, Stanford, CA, 94305, USA.
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31
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Euser AG, Meyers ML, Zaretsky MV, Crombleholme TM. Comparison of congenital pulmonary airway malformation volume ratios calculated by ultrasound and magnetic resonance imaging. J Matern Fetal Neonatal Med 2015; 29:3172-7. [DOI: 10.3109/14767058.2015.1118038] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Anna G. Euser
- Colorado Institute for Maternal and Fetal Health, Children’s Hospital of Colorado, Aurora, CO, USA,
- Department of Obstetrics and Gynecology, University of Colorado Denver, Aurora, CO, USA,
| | - Mariana L. Meyers
- Colorado Institute for Maternal and Fetal Health, Children’s Hospital of Colorado, Aurora, CO, USA,
- Department of Radiology, University of Colorado Denver, Aurora, CO, USA, and
| | - Michael V. Zaretsky
- Colorado Institute for Maternal and Fetal Health, Children’s Hospital of Colorado, Aurora, CO, USA,
- Department of Obstetrics and Gynecology, University of Colorado Denver, Aurora, CO, USA,
| | - Timothy M. Crombleholme
- Colorado Institute for Maternal and Fetal Health, Children’s Hospital of Colorado, Aurora, CO, USA,
- Department of Surgery, Children’s Hospital of Colorado, Aurora, CO, USA
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Abstract
The controversy surrounding the management of congenital lung malformations (CLMs) centre on how best to manage the increasing population of asymptomatic antenatally detected infants. Should elective surgery be offered? Or is a "watch-and-wait" policy safe? This will be addressed in this review by examining the reported complications of surgery, the risk of symptom development if lesions are left in situ and whether this may alter surgical outcomes, and importantly whether there is any long-term risk of malignancy that can be negated by surgical resection in infancy.
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Affiliation(s)
- Michael Stanton
- Department of Paediatric Surgery, University Hospital Southampton, Tremona Road, Southampton SO16 6YD, UK.
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33
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Vanishing fetal lung malformations: Prenatal sonographic characteristics and postnatal outcomes. J Pediatr Surg 2015; 50:978-82. [PMID: 25805010 DOI: 10.1016/j.jpedsurg.2015.03.025] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Accepted: 03/10/2015] [Indexed: 12/24/2022]
Abstract
BACKGROUND/PURPOSE The purpose of this study was to examine the natural history and outcomes of prenatally diagnosed lung masses that appear to undergo complete regression before birth. METHODS An IRB-approved retrospective review was performed on 100 consecutive fetuses with a congenital lung malformation at a single fetal center. Prenatal and postnatal imaging as well as outcomes of vanishing fetal masses was analyzed and compared to those with persistent fetal masses. RESULTS Seventeen lesions (17%) became sonographically undetectable at 35.3 ± 2.3 weeks gestation. Vanishing fetal masses were associated with microcystic disease (100% vs. 69%, p=0.005) and a low initial congenital pulmonary airway malformation volume ratio (CVR; 0.31 ± 0.35 vs. 0.70 ± 0.66, p=0.002) when compared to those with persistent fetal lesions. Based on postnatal CT imaging and pathology data, 10.3% of all fetal masses completely regressed. The positive predictive value and negative predictive value of prenatal ultrasound for detecting lung malformations in late gestation were 96% and 43%, respectively. All infants with vanishing fetal lesions were asymptomatic at birth and were more likely to be managed nonoperatively (75% vs. 22%, p<0.0001) when compared to infants with persistent fetal masses. CONCLUSIONS Vanishing lung lesions late in gestation are relatively common and are associated with a low CVR and microcystic disease.
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Lyons K, Cassady C, Mehollin-Ray A, Krishnamurthy R. Current Role of Fetal Magnetic Resonance Imaging in Body Anomalies. Semin Ultrasound CT MR 2015; 36:310-23. [PMID: 26296482 DOI: 10.1053/j.sult.2015.05.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Fetal MR body applications have become more common in recent years as both in utero therapies, including fetoscopic surgery, and improvements in perinatal care have increased the demand for precise antenatal anatomic detail. This article discusses the variety of fast imaging sequences available to the fetal imager and describes their applications to both common and unusual congenital pathologies, including of the neck, chest, abdomen/pelvis and musculoskeletal systems.
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Affiliation(s)
- Karen Lyons
- EB Singleton Department of Diagnostic Radiology, Texas Children׳s Hospital, Baylor College of Medicine, Houston, TX
| | - Christopher Cassady
- EB Singleton Department of Diagnostic Radiology, Texas Children׳s Hospital, Baylor College of Medicine, Houston, TX.
| | - Amy Mehollin-Ray
- EB Singleton Department of Diagnostic Radiology, Texas Children׳s Hospital, Baylor College of Medicine, Houston, TX
| | - Rajesh Krishnamurthy
- EB Singleton Department of Diagnostic Radiology, Texas Children׳s Hospital, Baylor College of Medicine, Houston, TX
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Rayburn WF, Jolley JA, Simpson LL. Advances in ultrasound imaging for congenital malformations during early gestation. ACTA ACUST UNITED AC 2015; 103:260-8. [PMID: 25820190 DOI: 10.1002/bdra.23353] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Revised: 11/18/2014] [Accepted: 11/27/2014] [Indexed: 12/29/2022]
Abstract
BACKGROUND With refinement in ultrasound technology, detection of fetal structural abnormalities has improved and there have been detailed reports of the natural history and expected outcomes for many anomalies. The ability to either reassure a high-risk woman with normal intrauterine images or offer comprehensive counseling and offer options in cases of strongly suspected lethal or major malformations has shifted prenatal diagnoses to the earliest possible gestational age. METHODS When indicated, scans in early gestation are valuable in accurate gestational dating. Stricter sonographic criteria for early nonviability guard against unnecessary intervention. Most birth defects are without known risk factors, and detection of certain malformations is possible in the late first trimester. RESULTS The best time for a standard complete fetal and placental scan is 18 to 20 weeks. In addition, certain soft anatomic markers provide clues to chromosomal aneuploidy risk. Maternal obesity and multifetal pregnancies are now more common and further limit early gestation visibility. CONCLUSION Other advanced imaging techniques during early gestation in select cases of suspected malformations include fetal echocardiography and magnetic resonance imaging.
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Affiliation(s)
- William F Rayburn
- Divisions of Maternal-Fetal Medicine, Departments of Obstetrics and Gynecology, University of New Mexico, Albuquerque, New Mexico
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