Beth A. Furey MD, BEng, Presenter: Nothing to Disclose

April Alexander Bailey MD, Abstract Co-Author: Nothing to Disclose

Kevin Worley MD, Abstract Co-Author: Nothing to Disclose

Patricia Santiago-Munoz MD, Abstract Co-Author: Nothing to Disclose

Jodi S Dashe MD, Abstract Co-Author: Nothing to Disclose

Diane Mary Twickler MD, Abstract Co-Author: Nothing to Disclose

To evaluate the percentage of fetal lung and liver occupied in the thorax with MRI as predictors of survival in fetuses with congenital diaphragmatic hernias (CDH).

A retrospective review of fetuses with the diagnosis of isolated CDH referred for fetal MR from July 2001 to December 2013 was performed. Observed lung volume and intrathoracic liver (“liver-up”) volume to expected lung volume ratios were calculated using region of interest (ROI) measurements, and compared to neonatal survival. Data stratified for gestational age (GA) at the time of MR examination (≤ 28 weeks vs. > 28 weeks) was also compared. Wilcoxon rank sum tests were used for individual significance of lung volume and liver-up ratios in determining neonatal survival. Logistic regression was used for predicting neonatal survival.

To date, 48 MR examinations of fetuses with isolated CDH who had neonatal outcomes available have been included. Newborns who survived the neonatal period had significantly larger observed to expected lung volume ratios [median 0.25 (Q1 = 0.17, Q3 = 0.42) vs. 0.13 (Q1 = 0.10, Q3 = 0.20) p=0.0004] and smaller liver-up to lung volume ratios [median 0.08 (Q1 = 0, Q3 = 0.16) vs. 0.27 (Q1 = 0.19, Q3 = 0.41), p=0.0002] than the non-survivors. Measurements of observed to expected lung volume ratios obtained at a GA of ≤ 28 weeks were less predictive [median 0.42 (Q1 = 0.17, Q3 = 0.43)vs. 0.16 (Q1 = 0.10, Q3 = 0.27), p=0.0474] than GA > 28 weeks [median 0.25 (Q1 = 0.17, Q3 = 0.33) vs. 0.13 (Q1 = 0.08, Q3 = 0.16), p=0.0031]; measurements of liver-up to expected lung volume ratio obtained at a GA of ≤ 28 weeks were also less predictive [median 0.11 (Q1 = 0, Q3 = 0.16) vs. 0.22 (Q1 = 0.16, Q3 = 0.35), p=0.0356] compared to GA > 28 weeks [median 0.05 (Q1 = 0, Q3 = 0.16) vs. 0.35 (Q1 = 0.20, Q3 = 0.45), p=0.0004]. Both remained statistically significant. A logistic regression analysis was generated for survival with area under the curve (AUC) based on both MR volumes and GA = 0.9304 [95% CI: 0.8654, 0.9954].

The fetal MR combination of liver-up and lung volume ratios in conjunction with gestational age at the time of study can assign an index which may be helpful in predicting survival of fetuses with CDH.

Accurate prediction of survival in fetuses with CDH by MR measurements of lung and liver-up volumes is important for antenatal parental counseling and decisions for neonatal care.

Furey, B, Bailey, A, Worley, K, Santiago-Munoz, P, Dashe, J, Twickler, D, MRI of Fetal Congenital Diaphragmatic Hernias: Liver and Lung Volume Index of Neonatal Survival.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14045531.html