Fetal Lung Volume in Congenital Diaphragmatic Hernia: Association of Prenatal MR Imaging Findings with Postnatal Chronic Lung Disease
Fetal Lung Volume in Congenital Diaphragmatic Hernia: Association of Prenatal MR Imaging Findings with Postnatal Chronic Lung Disease
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DOI：
10.1148/radiol.12111512
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发表时间：
2013-03-01
期刊：
影响因子：
19.7
通讯作者：
Buesing, Karen A.
中科院分区：
文献类型：
--
作者：
Debus, Angelika;Hagelstein, Claudia;Buesing, Karen A.
目的：根据产前磁共振（MR）测量的胎儿肺体积（FLV）与预期肺体积（FLV）比值的结果，评估先天性膈疝（CDH）存活婴儿的慢性肺病（CLD）是否与肺发育不良相关。材料和方法：该研究获得了机构审查委员会的批准，放弃了先前对前瞻性研究给予知情同意的患者对本回顾性审查的知情同意。计算了172例CDH胎儿在MR成像中观察到的FLV与预期FLV的比值。在产后第28天，需要补充氧气暗示CLD的诊断。在第56天，CLD患者根据他们对氧气的需求被分为三组-轻度、中度或重度CLD。Logistic回归分析被用来评估与CLD.Results的出生后发展相关的个体预测值与预期FLV的比值：CLD的儿童被发现有显着较小的预测值与预期FLV的比值在MR成像比婴儿没有CLD（P < .001）。CLD分级显示轻度CLD患者与中度（P = .012）或重度（P = .007）CLD患者之间的预期FLV比存在显著差异。当预测值与预期值之比为5%时，99%的CDH患者发生CLD，而当预测值与预期值之比为50%时，发生CLD的胎儿不到5%。围产期，CLD的发展和分级进一步受到体外膜肺氧合（ECMO）（P <0.001）和分娩时胎龄（P = 0.009）的影响。结论：CDH存活婴儿的CLD表现与产前确定的预期FLV比相关。早期新生儿治疗决策也可以基于这个比例。在围产期，ECMO要求和分娩时的胎龄有助于进一步提高CLD的估计概率。(C)RSNA，2012年
Purpose: To assess whether chronic lung disease (CLD) in surviving infants with congenital diaphragmatic hernia (CDH) is associated with lung hypoplasia on the basis of the results of antenatal observed-to-expected fetal lung volume (FLV) ratio measurement at magnetic resonance (MR) imaging.Materials and Methods: The study received approval from the institutional review board, with waiver of informed consent for this retrospective review from patients who had previously given informed consent for prospective studies. The ratio of observed to expected FLV at MR imaging was calculated in 172 fetuses with CDH. At postpartum day 28, the need for supplemental oxygen implicated the diagnosis of CLD. At day 56, patients with CLD were assigned to one of three groups-those with mild, moderate, or severe CLD-according to their demand for oxygen. Logistic regression analysis was used to assess the prognostic value of the individual observed-to-expected FLV ratio for association with postnatal development of CLD.Results: Children with CLD were found to have significantly smaller observed-to-expected FLV ratios at MR imaging than infants without CLD (P < .001). Grading of CLD revealed significant differences in observed-to-expected FLV ratio between patients with mild CLD and those with moderate (P = .012) or severe (P = .007) CLD. For an observed-toexpected FLV ratio of 5%, 99% of patients with CDH developed CLD, compared with less than 5% of fetuses with an observed-to-expected FLV ratio of 50%. Perinatally, development and grade of CLD were further influenced by the need for extracorporeal membrane oxygenation (ECMO) (P < .001) and gestational age at delivery (P = .009).Conclusion: Manifestation of CLD in surviving infants with CDH is associated with the prenatally determined observed-toexpected FLV ratio. Early neonatal therapeutic decisions can additionally be based on this ratio. Perinatally, ECMO requirement and gestational age at delivery are useful in further improving the estimated probability of CLD. (C) RSNA, 2012