Claudia Hagelstein MD, Presenter: Nothing to Disclose

Stefan Burger-Scheidlin, Abstract Co-Author: Nothing to Disclose

Meike Weidner, Abstract Co-Author: Nothing to Disclose

Thomas Schaible, Abstract Co-Author: Nothing to Disclose

Christel Weiss, Abstract Co-Author: Nothing to Disclose

Stefan Oswald Schoenberg MD, PhD, Abstract Co-Author: Institutional research agreement, Siemens AG

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

To separately evaluate the ipsi- and contralateral observed-to-expected MR fetal lung volume (o/e MR-FLV) in fetuses with congenital diaphragmatic hernia (CDH) and to assess the prognostic accuracy of the o/e MR-FLV regarding neonatal survival, extracorporeal membrane oxygenation (ECMO) requirement and development of a chronic lung disease (CLD).

Using T2-weighted HASTE imaging, the o/e MR-FLV ipsi- and contralateral to the diaphragmatic defect was separately calculated and evaluated in 107 fetuses with isolated CDH between 20 and 39 weeks gestation. To assess the prognostic value of the o/e MR-FLV for association with neonatal survival, ECMO requirement, and development of CLD receiver operating characteristics (ROC) analysis and logistic regression analysis were performed.

Total o/e MR-FLV of both lungs in fetuses with a left-sided CDH (n=97) was 31.9±13.7% and 22.8±7.4 in patients with a right-sided CDH (n=10; p=0.004). Fetuses with a right-sided CDH showed a significantly lower o/e MR-FLV of the ipsilateral lung (4.8±2.9%) when compared to the ipsilateral o/e MR-FLV in fetuses with a left-sided hernia (9.9±10.0%; p=0.001). Regarding the contralateral o/e MR-FLV, there was no statistically significant difference between left-sided (49.2±18.8%) and right-sided hernias (45.7±15.0%; p=0.573). Total and contralateral o/e MR-FLV revealed significant differences regarding neonatal survival (total p<0.001; contralateral p<0.001), ECMO requirement (total p<0.001; contralateral p<0.001), and development of CLD (total p<0.001; contralateral p<0.001). Compared to the total o/e MR-FLV, the contralateral o/e MR-FLV showed a slightly higher prognostic accuracy regarding survival (AUC=0.859 vs. 0.825) and development of CLD (AUC=0.734 vs. 0.732) and a very similar prognostic accuracy regarding ECMO requirement (AUC=0.805 vs. 0.826).

Both lungs, ipsi- and contralateral to the diaphragmatic defect in patients with CDH showed a reduced fetal lung volume as compared to healthy controls. Beside the total o/e MR-FLV, the contralateral o/e MR-FLV is a highly reliable prenatal predictor for neonatal outcome.

Separate evaluation of the ipsi- and contralateral o/e MR-FLV has the potential to improve prenatal prediction of neonatal survival, ECMO requirement and development of CLD in CDH patients.

Hagelstein, C, Burger-Scheidlin, S, Weidner, M, Schaible, T, Weiss, C, Schoenberg, S, Neff, W, Prenatal MR Imaging in Congenital Diaphragmatic Hernia: Separate Evaluation of the Ipsi- and Contralateral MR Fetal Lung Volume.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14045541.html