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The novel fetal MRI O/E CLV versus O/E LHR in predicting prognosis in congenital diaphragmatic hernias: can we teach an old dog new tricks?

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A Correction to this article was published on 15 October 2021

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Abstract

Purpose

In congenital diaphragmatic hernia (CDH), ultrasound (U/S) measurements of the contralateral lung commonly provide the observed-to-expected lung-to-head ratio (O/E LHR) and are used to determine the severity of pulmonary hypoplasia. Fetal magnetic resonance imaging (MRI) measurement of the observed-to-expected total lung volume (O/E TLV) has been used as an adjunct to O/E LHR in predicting outcomes. Since O/E LHR only measures the contralateral lung, we sought to investigate if MRI measurements of the contralateral lung volume (O/E CLV) can accurately predict outcomes in CDH. We hypothesize that O/E CLV is a better predictor of CDH outcomes than O/E LHR.

Methods

We identified all infants with a prenatal diagnosis of CDH at our fetal center who had both MRI and U/S measurements. Using lung volume ratios of right–left 55:45, we calculated O/E CLV from O/E TLV. We used receiver-operating characteristic (ROC) curves to calculate the area under the curve (AUC) to compare the predictive accuracy of O/E CLV to O/E LHR for ECMO support, as well as survival to both discharge and 1 year.

Results

Seventy-four patients had complete prenatal imaging with 39% requiring ECMO support. The median O/E CLV was 48.0% and the median O/E LHR was 42.3%. O/E CLV was a better predictor of the need for ECMO support (AUC 0.81 vs. 0.74). O/E CLV was a better predictor of survival to discharge (AUC 0.84 vs. 0.64) and 1-year survival (AUC 0.83 vs. 0.63) than O/E LHR.

Conclusion

O/E LHR is a well-validated standard for predicting outcomes and guiding prenatal counseling in CDH. We provide evidence that fetal MRI measurements of the contralateral lung volume corrected for gestational age were more accurate in predicting the need for ECMO and survival. Future prospective studies validating O/E CLV regarding outcomes and ECMO utilization are warranted.

Level of evidence

Level III, retrospective comparative study.

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Author notes

  1. Mariana L. Meyers and Ahmed Marwan are co-senior authors.

Authors and Affiliations

  1. Division of Pediatric Surgery, Children’s Hospital Colorado, Aurora, CO, USA

    Ryan Phillips, Niti Shahi, Stephen Niemiec, Sarah Ogle, Shannon Acker & Ahmed Marwan

  2. Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA

    Ryan Phillips, Niti Shahi, Stephen Niemiec, Sarah Ogle & Shannon Acker

  3. Center for Research in Outcomes for Children’s Surgery, Center for Children’s Surgery, University of Colorado School of Medicine, Aurora, CO, USA

    Maxene Meier

  4. Colorado Fetal Care Center, Colorado Institute of Maternal and Fetal Health, Anschutz Medical Center, University of Colorado Denver, Denver, USA

    Jason Gien, Kenneth W. Liechty, Mariana L. Meyers & Ahmed Marwan

  5. Department of Pediatrics, Division of Neonatology, University of Colorado School of Medicine, Aurora, CO, USA

    Jason Gien, Kenneth W. Liechty & Ahmed Marwan

Authors
  1. Ryan Phillips
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Correspondence to Ryan Phillips.

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None of the authors has a conflict of interest to disclose.

Ethical approval

All of the procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

The study was evaluated and approved by the Colorado Multiple Institution Review Board (COMIRB), and a waiver of informed consent was obtained due to the retrospective nature of the study.

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Phillips, R., Shahi, N., Meier, M. et al. The novel fetal MRI O/E CLV versus O/E LHR in predicting prognosis in congenital diaphragmatic hernias: can we teach an old dog new tricks?. Pediatr Surg Int 37, 1499–1504 (2021). https://doi.org/10.1007/s00383-021-04936-9

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  • DOI: https://doi.org/10.1007/s00383-021-04936-9

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