Advertisement

European Radiology

, Volume 20, Issue 4, pp 829–837 | Cite as

Assessment of lung development in isolated congenital diaphragmatic hernia using signal intensity ratios on fetal MR imaging

  • Csilla BalassyEmail author
  • Gregor Kasprian
  • Peter C. Brugger
  • Michael Weber
  • Bence Csapo
  • Christian Herold
  • Daniela Prayer
Pediatric

Abstract

Objectives

To investigate developmental changes in the apparently unaffected contralateral lung by using signal intensity ratios (SIR) and lung volumes (LV), and to search for correlation with clinical outcome.

Methods

Twenty-five fetuses (22–37 weeks’ gestation) were examined. Lung/liver signal intensity ratios (LLSIR) were assessed on T1-weighted and T2-weighted sequences for both lungs, then together with LV compared with age-matched controls of 91 fetuses by using the U test. Differences in LLSIRs and lung volumes were correlated with neonatal outcomes.

Results

LLSIRs in fetuses with congenital diaphragmatic hernia (CDH) were significantly higher in both lungs on T1-weighted images and significantly lower on T2-weighted images, compared with normals (p < 0.05), increasing on T2-weighted imaging and decreasing on T1-weighted imaging during gestation. Total LV were significantly smaller in the CDH group than in controls (p < 0.05). No significant differences in LLSIR of the two lungs were found. Outcomes correlated significantly with total LV, but not with LLSIR.

Conclusion

Changes in LLSIR seem to reflect developmental impairment in CDH; however, they provide no additional information in predicting outcome. LV remains the best indicator on fetal MR imaging of neonatal survival in isolated, left-sided CDH.

Keywords

Fetal MR imaging Signal intensities Congenital diaphragmatic hernia Fetal lung Structural changes 

References

  1. 1.
    Harrison MR, Adzik NS, Estes JM, Howell LJ (1994) A prospective study of the outcome for fetuses with diaphragmatic hernia. JAMA 271:382–384CrossRefPubMedGoogle Scholar
  2. 2.
    Langham MR Jr, Kays DW, Ledbetter DJ, Frentzen B, Sanford LL, Richards DS (1996) Congenital diaphragmatic hernia. Epidemiology and outcome. Clin Perinatol 23:671–688PubMedGoogle Scholar
  3. 3.
    Gucciardo L, Deprest J, Done’ E et al (2008) Prediction of outcome in isolated congenital diaphragmatic hernia and its consequences for fetal therapy. Best Pract Res Clin Obstet Gynaecol 22:123–138CrossRefPubMedGoogle Scholar
  4. 4.
    Doné E, Gucciardo L, Van Mieghem T et al (2008) Prenatal diagnosis, prediction of outcome and in utero therapy of isolated congenital diaphragmatic hernia. Prenat Diagn 28:581–591CrossRefPubMedGoogle Scholar
  5. 5.
    Jani J, Cannie M, Done E et al (2007) Relationship between lung area at ultrasound examination and lung volume assessment with magnetic resonance imaging in isolated congenital diaphragmatic hernia. Ultrasound Obstet Gynecol 30:855–860CrossRefPubMedGoogle Scholar
  6. 6.
    Jani JC, Cannie M, Peralta CF, Deprest JA, Nicolaides KH, Dymarkowski S (2007) Lung volumes in fetuses with congenital diaphragmatic hernia: comparison of 3D US and MR imaging assessments. Radiology 244:575–582CrossRefPubMedGoogle Scholar
  7. 7.
    Neff KW, Kilian AK, Schaible T, Schütz EM, Büsing KA (2007) Prediction of mortality and need for neonatal extracorporeal membrane oxygenation in fetuses with congenital diaphragmatic hernia: logistic regression analysis based on MRI fetal lung volume measurements. AJR Am J Roentgenol 189:1307–1311CrossRefPubMedGoogle Scholar
  8. 8.
    Kilian AK, Schaible T, Hofmann V, Brade J, Neff KW, Büsing KA (2009) Congenital diaphragmatic hernia: predictive value of MRI relative lung-to-head ratio compared with MRI fetal lung volume and sonographic lung-to-head ratio. AJR Am J Roentgenol 192:153–158CrossRefPubMedGoogle Scholar
  9. 9.
    Tanigaki S, Miyakoshi K, Tanaka M et al (2004) Pulmonary hypoplasia: prediction with use of ratio of MR imaging-measured fetal lung volume to US-estimated fetal body weight. Radiology 232:767–772CrossRefPubMedGoogle Scholar
  10. 10.
    Mahieu-Caputo D, Sonigo P, Dommergues M et al (2001) Fetal lung volume measurement by magnetic resonance imaging in congenital diaphragmatic hernia. BJOG 108:863–868CrossRefPubMedGoogle Scholar
  11. 11.
    Balassy C, Kasprian G, Brugger PC et al (2007) MRI investigation of normal fetal lung maturation using signal intensities on different imaging sequences. Eur Radiol 17:835–842CrossRefPubMedGoogle Scholar
  12. 12.
    Balassy C, Kasprian G, Brugger PC et al (2008) Diffusion-weighted MR imaging of the normal fetal lung. Eur Radiol 18:700–706CrossRefPubMedGoogle Scholar
  13. 13.
    Brewerton LJ, Chari RS, Liang Y, Bhargava R (2005) Fetal lung-to-liver signal intensity ratio at MR imaging: development of a normal scale and possible role in predicting pulmonary hypoplasia in utero. Radiology 235:1005–1010CrossRefPubMedGoogle Scholar
  14. 14.
    Keller TM, Rake A, Michel SC, Seifert B, Wisser J, Marincek B, Kubik-Huch RA (2004) MR assessment of fetal lung development using lung volumes and signal intensities. Eur Radiol 14:984–989CrossRefPubMedGoogle Scholar
  15. 15.
    Nakamura Y, Yamamoto I, Fukuda S, Hashimoto T (1991) Pulmonary acinar development in diaphragmatic hernia. Arch Pathol Lab Med 115:372–376PubMedGoogle Scholar
  16. 16.
    George DK, Cooney TP, Chiu BK, Thurlbeck WM (1987) Hypoplasia and immaturity of the terminal lung unit (acinus) in congenital diaphragmatic hernia. Am Rev Respir Dis 136:947–950PubMedGoogle Scholar
  17. 17.
    Kuwashima S, Nishimura G, Iimura F, Kohno T, Watanabe H, Kohno A, Fujioka M (2001) Low-intensity fetal lungs on MRI may suggest the diagnosis of pulmonary hypoplasia. Pediatr Radiol 31:669–672CrossRefPubMedGoogle Scholar
  18. 18.
    Levine D, Barnewolt CE, Mehta TS, Trop I, Estroff J, Wong G (2003) Fetal thoracic abnormalities: MR imaging. Radiology 228:379–388CrossRefPubMedGoogle Scholar
  19. 19.
    Osada H, Kaku K, Masuda K, Iitsuka Y, Seki K, Sekiya S (2004) Quantitative and qualitative evaluations of fetal lung with MR imaging. Radiology 231:887–892CrossRefPubMedGoogle Scholar
  20. 20.
    Matsushita M, Ishii K, Tamura M, Takahashi Y, Kamura T, Takakuwa K, Tanaka K (2008) Perinatal magnetic resonance fetal lung volumetry and fetal lung-to-liver signal intensity ratio for predicting short outcome in isolated congenital diaphragmatic hernia and cystic adenomatoid malformation of the lung. J Obstet Gynaecol Res 34:162–167CrossRefPubMedGoogle Scholar
  21. 21.
    Kasprian G, Balassy C, Brugger PC, Prayer D (2006) MRI of normal and pathological fetal lung development. Eur J Radiol 57:261–270CrossRefPubMedGoogle Scholar
  22. 22.
    Jani J, Cannie M, Sonigo P (2008) Value of prenatal magnetic resonance imaging in the prediction of postnatal outcome in fetuses with diaphragmatic hernia. Ultrasound Obstet Gynecol 32:793–799CrossRefPubMedGoogle Scholar
  23. 23.
    Cannie M, Jani J, Meersschaert J et al (2008) Prenatal prediction of survival in isolated diaphragmatic hernia using observed to expected total fetal lung volume determined by magnetic resonance imaging based on either gestational age or fetal body volume. Ultrasound Obstet Gynecol 32:633–639CrossRefPubMedGoogle Scholar
  24. 24.
    Cannie MM, Jani JC, Van Kerkhove F et al (2008) Fetal body volume at MR imaging to quantify total fetal lung volume: normal ranges. Radiology 247:197–203CrossRefPubMedGoogle Scholar
  25. 25.
    Stege G, Fenton A, Jaffray B (2003) Nihilism in the 1990s: the true mortality of congenital diaphragmatic hernia. Pediatrics 112:532–535CrossRefPubMedGoogle Scholar
  26. 26.
    Colvin J, Bower C, Dickinson JE, Sokol J (2005) Outcomes of congenital diaphragmatic hernia: a population-based study in Western Australia. Pediatrics 116:e356–e363CrossRefPubMedGoogle Scholar
  27. 27.
    Askenazi SS, Perlman M (1979) Pulmonary hypoplasia: lung weight and radial alveolar count as criteria of diagnosis. Arch Dis Child 54:614–618CrossRefPubMedGoogle Scholar
  28. 28.
    Emery JL, Mithal A (1960) The number of alveoli in the terminal respiratory unit of man during late intrauterine life and childhood. Arch Dis Child 35:544–547CrossRefPubMedGoogle Scholar
  29. 29.
    Reale FR, Esterly JR (1973) Pulmonary hypoplasia: a morphometric study of the lungs of infants with diaphragmatic hernia, anencephaly, and renal malformations. Pediatrics 51:91–96PubMedGoogle Scholar
  30. 30.
    Kitagawa M, Hislop A, Boyden EA, Reid L (1971) Lung hypoplasia in congenital diaphragmatic hernia. A quantitative study of airway, artery, and alveolar development. Br J Surg 58:342–346CrossRefPubMedGoogle Scholar
  31. 31.
    Areechon W, Eid L (1963) Hypoplasia of lung with congenital diaphragmatic hernia. Br Med J 1:230–233CrossRefPubMedGoogle Scholar
  32. 32.
    Ting A, Glick PL, Wilcox DT, Holm BA, Gil J, DiMaio M (1998) Alveolar vascularization of the lung in a lamb model of congenital diaphragmatic hernia. Am J Respir Crit Care Med 157:31–34PubMedGoogle Scholar
  33. 33.
    Naeye RL, Shochat SJ, Whitman V, Maisels MJ (1976) Unsuspected pulmonary vascular abnormalities associated with diaphragmatic hernia. Pediatrics 58:902–906PubMedGoogle Scholar
  34. 34.
    O’Toole SJ, Irish MS, Holm BA, Glick PL (1996) Pulmonary vascular abnormalities in congenital diaphragmatic hernia. Clin Perinatol 23:781–794PubMedGoogle Scholar
  35. 35.
    Hassett MJ, Glick PL, Karamanoukian HL, Rossman JE, Wilcox DT, Azizkhan RG (1995) Pathophysiology of congenital diaphragmatic hernia. XVI: Elevated pulmonary collagen in the lamb model of congenital diaphragmatic hernia. J Pediatr Surg 30:1191–1194CrossRefPubMedGoogle Scholar
  36. 36.
    Wigglesworth JS, Desai R, Guerrini P (1981) Fetal lung hypoplasia: biochemical and structural variations and their possible significance. Arch Dis Child 56:606–615CrossRefPubMedGoogle Scholar
  37. 37.
    Sullivan KM, Hawgood S, Flake AW, Harrison MR, Adzick NS (1994) Amniotic fluid phospholipid analysis in the fetus with congenital diaphragmatic hernia. J Pediatr Surg 29:1020–1023CrossRefPubMedGoogle Scholar
  38. 38.
    Hisanaga S, Shimokawa H, Kashiwabara Y, Maesato S, Nakano H (1984) Unexpectedly low lecithin/sphingomyelin ratio associated with fetal diaphragmatic hernia. Am J Obstet Gynecol 149:905–906PubMedGoogle Scholar
  39. 39.
    IJsselstijn H, Zimmermann LJ, Bunt JE, de Jongste JC, Tibboel D (1998) Prospective evaluation of surfactant composition in bronchoalveolar lavage fluid of infants with congenital diaphragmatic hernia and of age-matched controls. Crit Care Med 26:573–580CrossRefPubMedGoogle Scholar
  40. 40.
    Boucherat O, Benachi A, Chailley-Heu B, Franco-Montoya ML, Elie C, Martinovic J, Bourbon JR (2007) Surfactant maturation is not delayed in human fetuses with diaphragmatic hernia. PLoS Med 31(4):e237CrossRefGoogle Scholar
  41. 41.
    Witters I, Legius E, Moerman P, Deprest J, Van Schoubroeck D, Timmerman D, Van Assche FA, Fryns JP (2001) Associated malformations and chromosomal anomalies in 42 cases of prenatally diagnosed diaphragmatic hernia. Am J Med Genet 103:278–282CrossRefPubMedGoogle Scholar
  42. 42.
    Fauza DO, Wilson JM (1994) Congenital diaphragmatic hernia and associated anomalies: their incidence, identification, and impact on prognosis. J Pediatr Surg 29:1113–1117CrossRefPubMedGoogle Scholar
  43. 43.
    Albanese CT, Lopoo J, Goldstein RB, Filly RA, Feldstein VA, Calen PW, Jennings RW, Farrell JA, Harrison MR (1998) Fetal liver position and perinatal outcome for congenital diaphragmatic hernia. Prenat Diagn 18:1138–1142CrossRefPubMedGoogle Scholar
  44. 44.
    Cannie M, Jani J, Chaffiotte C, Vaast P, Deruelle P, Houfflin-Debarge V, Dymarkowski S, Deprest J (2008) Quantification of intrathoracic liver herniation by magnetic resonance imaging and prediction of postnatal survival in fetuses with congenital diaphragmatic hernia. Ultrasound Obstet Gynecol 32:627–632CrossRefPubMedGoogle Scholar
  45. 45.
    Worley KC, Dashe JS, Barber RG, Megison SM, McIntire DD, Twickler DM (2009) Fetal magnetic resonance imaging in isolated diaphragmatic hernia: volume of herniated liver and neonatal outcome. Am J Obstet Gynecol 200(3):318.e1–318.e6. doi: 10.1016/j.ajog.2008.10.008 CrossRefGoogle Scholar
  46. 46.
    Coakley FV, Lopoo JB, Lu Y, Hricak H, Albanese CT, Harrison MR, Filly RA (2000) Normal and hypoplastic fetal lungs: volumetric assessment with prenatal single-shot rapid acquisition with relaxation enhancement MR imaging. Radiology 216:107–111PubMedGoogle Scholar
  47. 47.
    Paek BW, Coakley FV, Lu Y et al (2001) Congenital diaphragmatic hernia: prenatal evaluation with MR lung volumetry—preliminary experience. Radiology 220:63–67PubMedGoogle Scholar

Copyright information

© European Society of Radiology 2009

Authors and Affiliations

  • Csilla Balassy
    • 1
    Email author
  • Gregor Kasprian
    • 1
  • Peter C. Brugger
    • 2
  • Michael Weber
    • 1
  • Bence Csapo
    • 3
  • Christian Herold
    • 1
  • Daniela Prayer
    • 1
  1. 1.Department of RadiologyMedical University of ViennaViennaAustria
  2. 2.Centre of Anatomy and Cell BiologyMedical University of ViennaViennaAustria
  3. 3.Department of Obstetrics and GyneocologyMedical University of ViennaViennaAustria

Personalised recommendations