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Prenatal MR imaging of congenital diaphragmatic hernias: association of MR fetal lung volume with the need for postnatal prosthetic patch repair

  • Pediatric
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Abstract

Objective

To assess whether the need for postnatal prosthetic patch repair of the diaphragmatic defect in neonates with a congenital diaphragmatic hernia (CDH) is associated with the antenatal measured observed-to-expected magnetic resonance fetal lung volume (o/e MR-FLV).

Methods

The o/e MR-FLV was calculated in 247 fetuses with isolated CDH. Logistic regression analysis was used to assess the prognostic value of the individual o/e MR-FLV for association with the need for postnatal patch repair.

Results

Seventy-seven percent (77 %) of patients with a CDH (190/247) required prosthetic patch repair and the defect was closed primarily in 23 % (57/247). Patients requiring a patch had a significantly lower o/e MR-FLV (27.7 ± 10.2 %) than patients with primary repair (40.8 ± 13.8 %, p < 0.001, AUC = 0.786). With an o/e MR-FLV of 20 %, 92 % of the patients required patch repair, compared to only 24 % with an o/e MR-FLV of 60 %. The need for a prosthetic patch was further influenced by the fetal liver position (herniation/no herniation) as determined by magnetic resonance imaging (MRI; p < 0.001). Fetal liver position, in addition to the o/e MR-FLV, improves prognostic accuracy (AUC = 0.827).

Conclusion

Logistic regression analysis based on the o/e MR-FLV is useful for prenatal estimation of the prosthetic patch requirement in patients with a CDH. In addition to the o/e MR-FLV, the position of the liver as determined by fetal MRI helps improve prognostic accuracy.

Key Points

• The o/e MR-FLV is associated with the need for postnatal patch repair in CDH.

• The need for a patch is associated with a significantly lower o/e MR-FLV (p < 0.001).

• The patch requirement is also influenced by fetal liver position.

• Fetal liver position, in addition to the o/e MR-FLV, improves prognostic accuracy.

• CDH-fetuses with a high probability for patch requirement can be identified prenatally.

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Abbreviations

AUC:

area under the curve

aMR-FLV:

absolute MR-FLV

CDH:

congenital diaphragmatic hernia

ECMO:

extracorporeal membrane oxygenation

FLV:

fetal lung volume

HASTE:

half-Fourier acquired single-shot turbo spin-echo

LHR:

lung-to-head ratio

o/e LHR:

observed-to-expected LHR

o/e MR-FLV:

observed-to-expected MR-FLV

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Acknowledgments

The scientific guarantor of this publication is Prof. Dr. K. Wolfgang Neff. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. One of the authors has significant statistical expertise: (Dr. Christel Weiß, Department of Medical Statistics and Biomathematics, University Medical Center Mannheim, University of Heidelberg, Germany). Institutional Review Board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study. Some study subjects or cohorts have been previously reported in studies of our study group. None of the previously published studies put focus on the need for prosthetic patch repair as a clinical endpoint. Methodology: retrospective, diagnostic or prognostic study, performed at one institution.

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Authors and Affiliations

  1. Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany

    Claudia Hagelstein, Meike Weidner, Stefan O. Schoenberg, Karen A. Büsing & K. Wolfgang Neff

  2. Department of Pediatric Surgery, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany

    Katrin Zahn

  3. Department of Medical Statistics and Biomathematics, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany

    Christel Weiss

  4. Department of Pediatrics, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany

    Thomas Schaible

Authors
  1. Claudia Hagelstein
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  2. Katrin Zahn
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  3. Meike Weidner
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  4. Christel Weiss
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  8. K. Wolfgang Neff
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Correspondence to Claudia Hagelstein.

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Hagelstein, C., Zahn, K., Weidner, M. et al. Prenatal MR imaging of congenital diaphragmatic hernias: association of MR fetal lung volume with the need for postnatal prosthetic patch repair. Eur Radiol 25, 258–266 (2015). https://doi.org/10.1007/s00330-014-3410-8

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  • DOI: https://doi.org/10.1007/s00330-014-3410-8

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