The MRI findings of the right-sided fetal lung can be used to predict postnatal mortality and the requirement for extracorporeal membrane oxygenation in isolated left-sided congenital diaphragmatic hernia
The MRI findings of the right-sided fetal lung can be used to predict postnatal mortality and the requirement for extracorporeal membrane oxygenation in isolated left-sided congenital diaphragmatic hernia
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DOI：
10.1203/pdr.0b013e3180676cdb
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发表时间：
2007-07-01
影响因子：
3.6
通讯作者：
Kojima, Seiji
中科院分区：
文献类型：
--
作者：
Hayakawa, Masahiro;Seo, Takahiko;Kojima, Seiji
我们评估了胎儿肺磁共振成像(MRI)表现与出生后死亡率之间是否存在相关性，以及对产前诊断的孤立性左侧先天性隔膜疝(CDH)婴儿进行体外膜氧合(ECMO)治疗的要求。21例妊娠合并CDH的孕妇行30次MRI扫描，测量右侧胎儿肺体积(FLV)。在对照组中，进行了回归分析，以将FLV与胎龄联系起来。这产生了一个公式，使得能够计算预期的右肺体积(ERFLV)。在CDH患者中，右侧观察到的FLV/ERFLV(=%RFLV)与出生后死亡率和是否需要ECMO进行比较。此外，我们还研究了MRI上的肺形态(是否存在完整的肺基线)与出生后死亡率之间的关系。死亡者的%RFLV显著低于存活者。在幸存者中，需要ECMO的婴儿的%RFLV显著低于不需要ECMO的婴儿。死亡者和存活者中分别有3例(38%)和13例(100%)完全存在肺基线。在孤立的左侧CDH中，%RFLV不仅是出生后死亡率的良好预测指标，而且也是ECMO需求的良好预测指标。
We evaluated whether a correlation existed between fetal pulmonary magnetic resonance imaging (MRI) findings and postnatal mortality, as well as the requirements for extracorporeal membrane oxygenation (ECMO) in infants with prenatally diagnosed, isolated left-sided congenital diaphragmatic hernia (CDH). Twenty-one pregnant women carrying fetuses with CDH underwent 30 MRI scans, and the right-sided fetal lung volume (FLV) was measured. In the control, a regression analysis was performed to associate FLV with gestational age. This yielded a formula that enabled the calculation of the expected right fetal lung volume (ERFLV). In cases with CDH, the right-sided observed FLV/ERFLV (= %RFLV) was compared with both the postnatal mortality and whether ECMO was required. Additionally, we investigated the relationship between the lung shape on MRI (whether there was a complete pulmonary baseline present) and postnatal mortality. The %RFLV was significantly lower in nonsurvivors compared with survivors. Among survivors, the %RFLV was significantly lower in infants who required ECMO compared with those who did not. The pulmonary baseline was completely present in 3 (38%) and 13 (100%) of the nonsurvivors and survivors, respectively. In isolated left-sided CDH, the %RFLV is a good predictor not only of postnatal mortality but also of the requirement for ECMO.