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Liver-to-thoracic volume ratio: use at MR imaging to predict postnatal survival in fetuses with isolated congenital diaphragmatic hernia with or without prenatal tracheal occlusion |
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| Authors: | Mieke M. Cannie Anne-Gaël Cordier Jocelyne De Laveaucoupet Stéphanie Franchi-Abella Maud Cagneaux Olivier Prodhomme Marie-Victoire Senat Mostafa Mokhtari Vinciane Vlieghe Dorota Nowakowska Alexandra Benachi Jacques C. Jani |
| Affiliation: | 1. Department of Radiology, University Hospital Brugmann, Brussels, Belgium 3. Department of Radiology, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium 4. Department of Obstetrics and Gynecology and Centre de Maladie Rare: Hernie de Coupole Diaphragmatique, H?pital Antoine Béclère, APHP, Université Paris Sud, Paris, France 5. Department of Radiology, H?pital Antoine Béclère, APHP, Université Paris Sud, Paris, France 6. Department of Pediatric Radiology, H?pital Kremlin Bicètre, APHP, Université Paris Sud, Le Kremlin Bicètre, France 9. Department of Pediatric and F?tal Radiology, H?pital Femme Mère Enfant, Université Claude Bernard Lyon I, Lyon, France 10. Department of Pediatric Radiology, Montpellier University Hospital, Montpellier, France 7. Department of Obstetrics and Gynecology, H?pital Kremlin Bicètre, APHP, Université Paris Sud, Le Kremlin Bicètre, France 8. Department of Neonatology, H?pital Kremlin Bicètre, APHP, Université Paris Sud, Le Kremlin Bicètre, France 11. Department of Neonatology, H?pital Universitaire des Enfants Reine Fabiola, Brussels, Belgium 12. Department of Fetal-Maternal Medicine and Gynecology, Medical University and the Research Institute Polish Mother’s Memorial Hospital, Lodz, Poland 2. Department of Obstetrics and Gynecology, Fetal Medicine and Treatment Unit, University Hospital Brugmann, Place A. Van Gehuchten 4, 1020, Brussels, Belgium |
| Abstract: | ObjectiveTo evaluate the relationship of the liver-to-thoracic volume ratio (LiTR) by MRI with postnatal survival in foetuses with isolated congenital diaphragmatic hernia (CDH).MethodsIn 30 conservatively managed CDH foetuses and in 31 who underwent fetoscopic endoluminal tracheal occlusion (FETO), logistic regression analysis was used to investigate the effect on postnatal survival of the observed-to-expected (O/E) ratio of total foetal lung volume (TFLV), LiTR, gestational age at delivery, CDH side, intrathoracic position of the liver and, for those who underwent FETO, gestational age at FETO and occlusion period. For 19 foetuses undergoing FETO, a post-FETO MRI was available. The proportionate increase in O/E ratio of TFLV at 3–8 weeks after FETO was compared with the pre-FETO value and correlated with pre-FETO LiTR using linear regression analysis.ResultsFor conservatively managed foetuses, only LiTR provided a significant prediction of postnatal survival. For foetuses undergoing FETO, LiTR and gestational age at delivery provided a significant independent prediction of postnatal survival. There was a significant inverse association between lung response and pre-FETO LiTR.ConclusionIn foetuses with CDH with/without FETO treatment, the LiTR is predictive of postnatal survival at discharge. In foetuses treated with FETO, LiTR is predictive of post-FETO lung response.Key Points? Congenital diaphragmatic hernia is usually managed conservatively before surgery soon after delivery ? Fetoscopic endoluminal tracheal occlusion (FETO) has been introduced for severely affected foetuses ? In conservatively managed CDH, the liver-to-thoracic volume ratio (LiTR) predicted postnatal survival best. ? In severe CDH with prenatal FETO, LiTR also helped predict postnatal survival. ? LiTR should be integrated into the prenatal decision-making for foetuses with CDH. |
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