Use of magnetic resonance imaging in prenatal prognosis of the fetus with isolated left congenital diaphragmatic hernia

Teresa Victoria, Michael W. Bebbington, Enrico Danzer, Alan W. Flake, Mark P. Johnson, David Dinan, N. Scott Adzick, Holly L. Hedrick

Research output: Contribution to journalArticlepeer-review

78 Scopus citations

Abstract

Objectives: To investigate the prognostic value of magnetic resonance-calculated fetal lung volumes (FLV) in fetuses with isolated left congenital diaphragmatic hernia (L-CDH) who receive standardized prenatal and postnatal care at a single institution. Materials and methods: A retrospective review was undertaken to identify fetuses with isolated L-CDH between 2001 and 2010. Results: Eighty-five cases of isolated L-CDH were identified. The overall survival was 65% (55/85). Survival was 45% if there was 'liver up' (23/51) and 94% if there was 'liver down' (32/34). Univariate statistical analysis showed that 'liver up' (p=0.001), lung-to-head ratio (LHR) at diagnosis (p=0.009), observed/expected (O/E) LHR (p=0.01), total FLV (p=0.03), right LV (p=0.04), magnetic resonance imaging (MRI) observed versus expected (O/E) FLV (p=0.002), intrathoracic versus intraabdominal stomach (p=0.002), percentage of herniated liver (p=0.004), and postnatal extracorporeal membrane oxygenation use (p=0.001) are predictive of postnatal survival. Multivariate analysis of only prenatal factors showed that the most important determinants of postnatal outcome are percentage of herniated liver, presence of liver up, and MRI O/E FLV. Conclusion: Herniated intrathoracic liver expressed as 'liver up' or as percent herniated liver and MRI measurement of FLV expressed as a O/E ratio are strong prenatal indicators of postnatal survival.

Original languageEnglish
Pages (from-to)715-723
Number of pages9
JournalPrenatal Diagnosis
Volume32
Issue number8
DOIs
StatePublished - Aug 1 2012

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