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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

European Radiology volume 23, pages 1299–1305 (2013)Cite this article

Abstract

Objective

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).

Methods

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.

Results

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.

Conclusion

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.

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Authors and Affiliations

  1. Department of Radiology, University Hospital Brugmann, Brussels, Belgium

    Mieke M. Cannie

  2. Department of Obstetrics and Gynecology, Fetal Medicine and Treatment Unit, University Hospital Brugmann, Place A. Van Gehuchten 4, 1020, Brussels, Belgium

    Jacques C. Jani

  3. Department of Radiology, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium

    Mieke M. Cannie

  4. Department of Obstetrics and Gynecology and Centre de Maladie Rare: Hernie de Coupole Diaphragmatique, Hôpital Antoine Béclère, APHP, Université Paris Sud, Paris, France

    Anne-Gaël Cordier & Alexandra Benachi

  5. Department of Radiology, Hôpital Antoine Béclère, APHP, Université Paris Sud, Paris, France

    Jocelyne De Laveaucoupet

  6. Department of Pediatric Radiology, Hôpital Kremlin Bicètre, APHP, Université Paris Sud, Le Kremlin Bicètre, France

    Stéphanie Franchi-Abella

  7. Department of Obstetrics and Gynecology, Hôpital Kremlin Bicètre, APHP, Université Paris Sud, Le Kremlin Bicètre, France

    Marie-Victoire Senat

  8. Department of Neonatology, Hôpital Kremlin Bicètre, APHP, Université Paris Sud, Le Kremlin Bicètre, France

    Mostafa Mokhtari

  9. Department of Pediatric and Fœtal Radiology, Hôpital Femme Mère Enfant, Université Claude Bernard Lyon I, Lyon, France

    Maud Cagneaux

  10. Department of Pediatric Radiology, Montpellier University Hospital, Montpellier, France

    Olivier Prodhomme

  11. Department of Neonatology, Hôpital Universitaire des Enfants Reine Fabiola, Brussels, Belgium

    Vinciane Vlieghe

  12. Department of Fetal-Maternal Medicine and Gynecology, Medical University and the Research Institute Polish Mother’s Memorial Hospital, Lodz, Poland

    Dorota Nowakowska

Authors
  1. Mieke M. Cannie
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  2. Anne-Gaël Cordier
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  3. Jocelyne De Laveaucoupet
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  4. Stéphanie Franchi-Abella
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  5. Maud Cagneaux
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  6. Olivier Prodhomme
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  7. Marie-Victoire Senat
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  8. Mostafa Mokhtari
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  9. Vinciane Vlieghe
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  10. Dorota Nowakowska
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  11. Alexandra Benachi
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  12. Jacques C. Jani
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Corresponding author

Correspondence to Jacques C. Jani.

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Cannie, M.M., Cordier, AG., De Laveaucoupet, J. et al. 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. Eur Radiol 23, 1299–1305 (2013). https://doi.org/10.1007/s00330-012-2709-6

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  • DOI: https://doi.org/10.1007/s00330-012-2709-6

Keywords

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