Fetal lung volume measurement by magnetic resonance imaging in congenital diaphragmatic hernia

BJOG. 2001 Aug;108(8):863-8. doi: 10.1111/j.1471-0528.2001.00184.x.


Objective: To study the potential for prenatal magnetic resonance imaging to predict pulmonary hypoplasia in congenital diaphragmatic hernia.

Design: Prospective observational study.

Setting: Tertiary care centre.

Participants: Thirteen cases of congenital diaphragmatic hernia (11 left, 2 right) without associated anomalies and 74 controls.

Methods: Measurements by magnetic resonance imaging of fetal lung volume were achieved. In the control fetuses, a regression analysis was performed to associate fetal lung volume with gestational age. This yielded a formula allowing calculation of the expected fetal lung volume as a function of gestational age. In the cases with congenital diaphragmatic hernia, the observed/expected fetal lung volume ratio was compared with perinatal outcome.

Main outcome measures: Neonatal mortality and pulmonary hypoplasia, which was defined as lung/body weight ratios less than 0.012.

Results: The expected fetal lung volume was derived from the following formula: Fetal lung volume (mL) = exp (1.24722 + 0.08939 x gestational age in weeks). The observed/expected fetal lung volume ratio was significantly lower in congenital diaphragmatic hernia (median: 0.31, range: 0.06-0.63), than in controls (median: 0.99, range: 0.42-1.94). This ratio was significantly less in the infants with congenital diaphragmatic hernia who died (median: 0.26, range: 0.06-0.63) compared with those who survived (median: 0.46, range: 0.35-0.56). The observed: expected fetal lung volume ratio was significantly correlated with the post mortem lung: body weight ratio.

Conclusion: In isolated congenital diaphragmatic hernia, fetal lung volume measurement by magnetic resonance imaging is a potential predictor of pulmonary hypoplasia and postnatal outcome. Further studies are required to establish the clinical value of magnetic resonance imaging for the prenatal assessment of fetal lungs.

MeSH terms

  • Case-Control Studies
  • Female
  • Fetal Diseases / diagnosis*
  • Hernia, Diaphragmatic / diagnosis
  • Hernias, Diaphragmatic, Congenital*
  • Humans
  • Hyperplasia / diagnosis
  • Lung / pathology*
  • Lung Volume Measurements / methods
  • Magnetic Resonance Imaging / methods
  • Pilot Projects
  • Pregnancy
  • Pregnancy Outcome
  • Prenatal Diagnosis / methods
  • Prospective Studies