Stomach position versus liver-to-thoracic volume ratio in left-sided congenital diaphragmatic hernia

J Matern Fetal Neonatal Med. 2015 Jan;28(2):190-5. doi: 10.3109/14767058.2014.906576. Epub 2014 Apr 25.


Objective: To describe a new grading method for stomach position (SP) in fetuses with left-sided congenital diaphragmatic hernia (L-CDH) using ultrasound and to correlate SP to liver position and to liver-to-thoracic cavity volume ratio (LiTR) using magnetic resonance imaging.

Methods: SP were graded at the level of the 4-chamber view as following: grade 1-to-4 for stomach not visualised, visualised anteriorly at the apex of the heart, stomach showing abdominal structures anteriorly and stomach with its larger part posterior to the level of the atrial-ventricular heart valves, respectively. The LiTR was calculated and correlated to SP using the Mann-Whitney U test.

Results: Seventy-four fetuses were included. Median LiTR for grade 1 SP was 0% and was not different from median LiTR for grade 2 SP (0%, p=NS). Median LiTR for grade 3 SP was 14.9% and was significantly higher than for grade 2 SP (p<0.001). Similarly, median LiTR for grade 4 SP was 20.7% and was significantly higher than for grade 3 SP (p<0.05). When SP was grade 1 or 2, liver was intra-abdominal in 21 (84%) out of 25 fetuses while it was always intrathoracic for SP 3 or 4.

Conclusion: In L-CDH, SP as described represents a simple indirect measurement of intrathoracic position and quantification of liver.

Keywords: Diaphragmatic hernia; magnetic resonance imaging; quantification of liver; stomach grading; stomach position.

MeSH terms

  • Female
  • Fetus / pathology
  • Gestational Age
  • Hernias, Diaphragmatic, Congenital / classification
  • Hernias, Diaphragmatic, Congenital / diagnostic imaging
  • Hernias, Diaphragmatic, Congenital / pathology*
  • Humans
  • Liver / diagnostic imaging
  • Liver / embryology
  • Liver / pathology*
  • Lung / diagnostic imaging
  • Lung / embryology
  • Lung / pathology
  • Magnetic Resonance Imaging
  • Organ Size
  • Pregnancy
  • Prenatal Diagnosis / methods*
  • Retrospective Studies
  • Stomach / diagnostic imaging
  • Stomach / embryology
  • Stomach / pathology*
  • Thoracic Cavity / diagnostic imaging
  • Thoracic Cavity / embryology
  • Thoracic Cavity / pathology*
  • Ultrasonography, Prenatal