A. Kristina Kilian, Presenter: Nothing to Disclose

Karen Annet Busing MD, Abstract Co-Author: Nothing to Disclose

Thomas Schaible, Abstract Co-Author: Nothing to Disclose

Valeska Hofmann, Abstract Co-Author: Nothing to Disclose

Wolfgang Neff MD, PhD, Abstract Co-Author: Nothing to Disclose

In patients with CDH prognosis is terminated routinely by calculating the lung-to-head ratio (LHR) in ultrasound by indirect measurement of lung area. Aim of this study was to determine a new MR-based LHR by direct measurement of fetal lung volume (FLV) with regard to survival and need for extracorporeal membrane oxygenation (ECMO) in fetuses with CDH in comparison to ultrasound-based LHR-measurement as gold standard.

In addition to ultrasound examination 100 fetuses with CDH underwent MRI (3D HASTE-imaging, 1.5 T Magnetom Sonata and Avanto, Siemens, Erlangen, Germany) for measurement of FLV and head circumference (HC) and biparietal diameter (BPD) within 24-38 weeks gestation. Based on logistic regression analysis mortality rate and necessity of ECMO was calculated by calculating the prenatal FLV/HC and FLV/BPD in MRI. Findings were correlated with ultrasound-based LHR.

71/100 fetuses with CDH survived, 44/100 required ECMO, 20/44 (45.5%) of children with ECMO died. All fetuses revealed a FLV/HC-ratio of 5.95 ± 2.8 and a FLV/BPD-ratio of 2.05 ± 0.97. Prognostic value of MR-based LHR was superior to us-based LHR in survival (p=0.0003 vs. p=0.02) and in necessity of ECMO (p=0.0016 vs. p=0.0898). There was no statistically difference of FLV/HC or FLV/BPD.

FLV/HC and FLV/BPD based an direct MR-FLV-measurement is predictive of outcome in fetuses with CDH concerning survival and requirement of ECMO reveales a better prognostic value of survival and necessity of ECMO in fetuses with CDH than gold standard ultrasound-based LHR. On beside routinely ultrasound, LHR measurement in MRI should be performed for predicting postnatal outcome in fetuses with CDH.

FLV/HC and FLV/BPD based an direct MR-FLV-measurement is predictive of outcome in fetuses with CDH and reveales a better prognostic value than gold standard ultrasound-based LHR.

Kilian, A, Busing, K, Schaible, T, Hofmann, V, Neff, W, Congenital Diaphragmatic Hernia (CDH): Predicting Outcome with a New MR-based Lung-to-Head Ratio in Comparison to Ultrasound-based Lung-to-Head Ratio as Gold Standard.  Radiological Society of North America 2007 Scientific Assembly and Annual Meeting, November 25 - November 30, 2007 ,Chicago IL. http://archive.rsna.org/2007/5008652.html