Prediction of chronic lung disease, survival and need for ECMO therapy in infants with congenital diaphragmatic hernia: Additional value of fetal MRI measurements?
Prediction of chronic lung disease, survival and need for ECMO therapy in infants with congenital diaphragmatic hernia: Additional value of fetal MRI measurements?
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DOI：
10.1016/j.ejrad.2011.02.060
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发表时间：
2012-05-01
影响因子：
3.3
通讯作者：
van den Hout, L.
中科院分区：
文献类型：
--
作者：
Schaible, T.;Buesing, K. A.;van den Hout, L.
前言：超声测量的肺/头比(LHR)和MRI测量的胎儿肺体积(FLV)均可用于预测先天性横隔疝(CDH)患儿的存活率和体外体膜氧合(ECMO)的必要性。这项研究的目的是确定除了标准的LHR超声测量外，MRI测量的FLV是否能更好地预测慢性肺部疾病、第28天前的死亡率和是否需要体外循环。材料和方法：2002年1月至2008年12月出生的单侧孤立性CDH患者符合纳入条件。LHR和FLV以观察值和期望值(O/E、LHR和O/E FLV)表示。进行单因素和多因素分析。构建受试者工作特征曲线，计算曲线下面积(AUC)以确定预测值。结果：90例患者进入分析。联合测量O/E LHR和O/E FLV对预测慢性肺部疾病(AUC=0.83和AUC=0.87)和是否需要ECMO治疗(AUC=0.77和AUC=0.81)比单独测量O/E LHR的标准超声更好。与单独测量O/E LHR(AUC=0.89)相比，联合测量O/E LHR和O/E FLV并不能改善早期死亡率的预测(AUC=0.90)。肝脏位于胸腔内的位置与早期死亡率(p<；0.001)、慢性肺部疾病(p=0.007)和需要体外循环治疗(p=0.001)的风险独立相关。讨论：联合测量O/E LHR和O/E FLV可以更好地预测慢性肺部疾病和是否需要体外循环治疗。仅通过测量O/E LHR可以很好地预测早期死亡率。结论：额外的MRI测量的临床相关性可能还有待商榷。(C)2011爱思唯尔爱尔兰有限公司。保留所有权利。
Introduction: The lung-to-head ratio (LHR), measured by ultrasound, and the fetal lung volume (FLV), measured by MRI, are both used to predict survival and need for extra corporeal membrane oxygenation (ECMO) in infants with congenital diaphragmatic hernia (CDH). The aim of this study is to determine whether MRI measurements of the FLV, in addition to standard ultrasound measurements of the LHR, give better prediction of chronic lung disease, mortality by day 28 and need for ECMO.Materials and methods: Patients with unilateral isolated CDH born between January 2002 and December 2008 were eligible for inclusion. LHR and FLV were expressed as observed-to-expected values (O/E LHR and O/E FLV). Univariate and multivariate analyses were performed. Receiver operating characteristic curves were constructed and areas under the curve (AUC) were calculated to determine predictive values.Results: 90 patients were included in the analysis. Combined measurement of the O/E LHR and O/E FLV gave a slightly better prediction of chronic lung disease (AUC = 0.83 and AUC = 0.87) and need for ECMO therapy (AUC = 0.77 and AUC = 0.81) than standard ultrasound measurements of the O/E LHR alone. Combined measurement of the O/E LHR and O/E FLV did not improve prediction of early mortality (AUC = 0.90) compared to measurement of the O/E LHR alone (AUC = 0.89). An intrathoracal position of the liver was independently associated with a higher risk of early mortality (p < 0.001), chronic lung disease (p = 0.007) and need for ECMO therapy (p = 0.001).Discussion: Chronic lung disease and need for ECMO therapy are slightly better predicted by combined measurement of the O/E LHR and the O/E FLV. Early mortality is very well predicted by measurement of the O/E LHR alone.Conclusion: Clinical relevance of additional MRI measurements may be debated. (C) 2011 Elsevier Ireland Ltd. All rights reserved.