The role of magnetic resonance imaging in the diagnosis and prognostic evaluation of fetuses with congenital diaphragmatic hernia

Eur J Pediatr. 2022 Sep;181(9):3243-3257. doi: 10.1007/s00431-022-04540-6. Epub 2022 Jul 7.


In recent years, magnetic resonance imaging (MRI) has largely increased our knowledge and predictive accuracy of congenital diaphragmatic hernia (CDH) in the fetus. Thanks to its technical advantages, better anatomical definition, and superiority in fetal lung volume estimation, fetal MRI has been demonstrated to be superior to 2D and 3D ultrasound alone in CDH diagnosis and outcome prediction. This is of crucial importance for prenatal counseling, risk stratification, and decision-making approach. Furthermore, several quantitative and qualitative parameters can be evaluated simultaneously, which have been associated with survival, postnatal course severity, and long-term morbidity.

Conclusion: Fetal MRI will further strengthen its role in the near future, but it is necessary to reach a consensus on indications, methodology, and data interpretation. In addition, it is required data integration from different imaging modalities and clinical courses, especially for predicting postnatal pulmonary hypertension. This would lead to a comprehensive prognostic assessment.

What is known: • MRI plays a key role in evaluating the fetal lung in patients with CDH. • Prognostic assessment of CDH is challenging, and advanced imaging is crucial for a complete prenatal assessment and counseling.

What is new: • Fetal MRI has strengthened its role over ultrasound due to its technical advantages, better anatomical definition, superior fetal lung volume estimation, and outcome prediction. • Imaging and clinical data integration is the most desirable strategy and may provide new MRI applications and future research opportunities.

Keywords: Congenital diaphragmatic hernia; Liver herniation percentage; Liver-to-thoracic volume ratio; Mediastinal shift angle; Observed/expected total fetal lung volume; Pulmonary hypertension; Survival; Total fetal lung volume.

Publication types

  • Review

MeSH terms

  • Female
  • Fetus / pathology
  • Hernias, Diaphragmatic, Congenital* / diagnostic imaging
  • Humans
  • Lung / diagnostic imaging
  • Lung / pathology
  • Lung Volume Measurements / methods
  • Magnetic Resonance Imaging / methods
  • Pregnancy
  • Prognosis
  • Retrospective Studies
  • Ultrasonography, Prenatal / methods