European Radiology

, Volume 23, Issue 5, pp 1299–1305

Liver-to-thoracic volume ratio: use at MR imaging to predict postnatal survival in fetuses with isolated congenital diaphragmatic hernia with or without prenatal tracheal occlusion

  • Mieke M. Cannie
  • Anne-Gaël Cordier
  • Jocelyne De Laveaucoupet
  • Stéphanie Franchi-Abella
  • Maud Cagneaux
  • Olivier Prodhomme
  • Marie-Victoire Senat
  • Mostafa Mokhtari
  • Vinciane Vlieghe
  • Dorota Nowakowska
  • Alexandra Benachi
  • Jacques C. Jani



To evaluate the relationship of the liver-to-thoracic volume ratio (LiTR) by MRI with postnatal survival in foetuses with isolated congenital diaphragmatic hernia (CDH).


In 30 conservatively managed CDH foetuses and in 31 who underwent fetoscopic endoluminal tracheal occlusion (FETO), logistic regression analysis was used to investigate the effect on postnatal survival of the observed-to-expected (O/E) ratio of total foetal lung volume (TFLV), LiTR, gestational age at delivery, CDH side, intrathoracic position of the liver and, for those who underwent FETO, gestational age at FETO and occlusion period. For 19 foetuses undergoing FETO, a post-FETO MRI was available. The proportionate increase in O/E ratio of TFLV at 3–8 weeks after FETO was compared with the pre-FETO value and correlated with pre-FETO LiTR using linear regression analysis.


For conservatively managed foetuses, only LiTR provided a significant prediction of postnatal survival. For foetuses undergoing FETO, LiTR and gestational age at delivery provided a significant independent prediction of postnatal survival. There was a significant inverse association between lung response and pre-FETO LiTR.


In foetuses with CDH with/without FETO treatment, the LiTR is predictive of postnatal survival at discharge. In foetuses treated with FETO, LiTR is predictive of post-FETO lung response.

Key Points

Congenital diaphragmatic hernia is usually managed conservatively before surgery soon after delivery

Fetoscopic endoluminal tracheal occlusion (FETO) has been introduced for severely affected foetuses

In conservatively managed CDH, the liver-to-thoracic volume ratio (LiTR) predicted postnatal survival best.

In severe CDH with prenatal FETO, LiTR also helped predict postnatal survival.

LiTR should be integrated into the prenatal decision-making for foetuses with CDH.


Liver-to-thoracic volume ratio Diaphragmatic hernia Magnetic resonance imaging Tracheal occlusion Lung response 


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Copyright information

© European Society of Radiology 2012

Authors and Affiliations

  • Mieke M. Cannie
    • 1
    • 3
  • Anne-Gaël Cordier
    • 4
  • Jocelyne De Laveaucoupet
    • 5
  • Stéphanie Franchi-Abella
    • 6
  • Maud Cagneaux
    • 9
  • Olivier Prodhomme
    • 10
  • Marie-Victoire Senat
    • 7
  • Mostafa Mokhtari
    • 8
  • Vinciane Vlieghe
    • 11
  • Dorota Nowakowska
    • 12
  • Alexandra Benachi
    • 4
  • Jacques C. Jani
    • 2
  1. 1.Department of RadiologyUniversity Hospital BrugmannBrusselsBelgium
  2. 2.Department of Obstetrics and GynecologyFetal Medicine and Treatment Unit, University Hospital BrugmannBrusselsBelgium
  3. 3.Department of RadiologyUZ Brussel, Vrije Universiteit BrusselBrusselsBelgium
  4. 4.Department of Obstetrics and Gynecology and Centre de Maladie Rare: Hernie de Coupole DiaphragmatiqueHôpital Antoine Béclère, APHP, Université Paris SudParisFrance
  5. 5.Department of RadiologyHôpital Antoine Béclère, APHP, Université Paris SudParisFrance
  6. 6.Department of Pediatric RadiologyHôpital Kremlin Bicètre, APHP, Université Paris SudLe Kremlin BicètreFrance
  7. 7.Department of Obstetrics and GynecologyHôpital Kremlin Bicètre, APHP, Université Paris SudLe Kremlin BicètreFrance
  8. 8.Department of NeonatologyHôpital Kremlin Bicètre, APHP, Université Paris SudLe Kremlin BicètreFrance
  9. 9.Department of Pediatric and Fœtal RadiologyHôpital Femme Mère Enfant, Université Claude Bernard Lyon ILyonFrance
  10. 10.Department of Pediatric RadiologyMontpellier University HospitalMontpellierFrance
  11. 11.Department of NeonatologyHôpital Universitaire des Enfants Reine FabiolaBrusselsBelgium
  12. 12.Department of Fetal-Maternal Medicine and GynecologyMedical University and the Research Institute Polish Mother’s Memorial HospitalLodzPoland

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