Value of prenatal magnetic resonance imaging in the prediction of postnatal outcome in fetuses with diaphragmatic hernia

Ultrasound Obstet Gynecol. 2008 Nov;32(6):793-9. doi: 10.1002/uog.6234.


Objectives: To investigate the potential value of antenatally determined total fetal lung volume (TFLV) by magnetic resonance imaging (MRI) in the prediction of the postnatal survival in congenital diaphragmatic hernia (CDH).

Methods: We examined fetuses with isolated CDH, in which MRI was used at 22-38 weeks of gestation to measure TFLV and assess intrathoracic herniation of abdominal viscera, that were liveborn after 30 weeks of gestation and had postnatal follow-up until death or discharge from hospital. Regression analysis was used to investigate the effect on survival of gestational age at diagnosis, observed to expected (o/e) TFLV, intrathoracic herniation of the liver, side of CDH, gestational age at MRI, institution, year and gestational age at delivery. In 76 fetuses measurements of o/e TFLV and the lung area to head circumference ratio (LHR) were performed within 2 weeks of each other; in these cases o/e TFLV and o/e LHR were compared for their prediction of postnatal survival.

Results: In the 148 cases that fulfilled the entry criteria, multiple regression analysis demonstrated that significant predictors of survival were the presence or absence of intrathoracic herniation of the liver and o/e TFLV. The area under the receiver-operating characteristics curves for prediction of postnatal survival from o/e TFLV was 0.786 (standard error, 0.059; P < 0.001) and that from o/e LHR was 0.743 (standard error, 0.069; P = 0.001).

Conclusions: In the assessment of fetuses with CDH, MRI-based o/e TFLV is useful in the prediction of postnatal survival.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Biometry
  • Cephalometry
  • Female
  • Gestational Age
  • Hernia, Diaphragmatic / diagnosis*
  • Hernia, Diaphragmatic / mortality
  • Hernias, Diaphragmatic, Congenital*
  • Humans
  • Hypertension, Pulmonary / congenital
  • Hypertension, Pulmonary / diagnosis*
  • Hypertension, Pulmonary / mortality
  • Infant, Newborn
  • Lung Volume Measurements
  • Magnetic Resonance Imaging*
  • Male
  • Predictive Value of Tests
  • Pregnancy
  • ROC Curve
  • Regression Analysis
  • Retrospective Studies
  • Ultrasonography, Prenatal