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30-08-2023 | ECMO | Paediatric

Prenatal MRI assessment of mediastinal shift angle as a feasible and effective risk stratification tool in isolated right-sided congenital diaphragmatic hernia

Authors: Wen Ding, Yuanyuan Gu, Haiyu Wang, Huiying Wu, Xiaochun Zhang, Rui Zhang, Hongying Wang, Li Huang, Junjian Lv, Bo Xia, Wei Zhong, Qiuming He, Longlong Hou

Published in: European Radiology | Issue 3/2024

Abstract

Objectives

To develop a mediastinal shift angle (MSA) measurement method applicable to right-sided congenital diaphragmatic hernia (RCDH) in fetal MRI and to validate the predictive value of MSA in RCDH.

Methods

Twenty-seven fetuses with isolated RCDH and 53 controls were included in our study. MSA was measured on MRI axial image at the level of four-chamber view of the fetal heart. The angle between the sagittal midline landmark line and the left boundary landmark line touching tangentially the lateral wall of the left ventricle was used to quantify MSA for RCDH. Appropriate statistical analyses were performed to determine whether MSA can be regarded as a valid predictive tool for postnatal outcomes. Furthermore, predictive performance of MSA was compared with that of lung area to head circumference ratio (LHR), observed/expected LHR (O/E LHR), total fetal lung volume (TFLV), and observed/expected TFLV (O/E TFLV).

Results

MSA was significantly higher in the RCDH group than in the control group. MSA, LHR, O/E LHR, TFLV, and O/E TFLV were all correlated with postnatal survival, pulmonary hypertension (PH), and extracorporeal membrane oxygenation (ECMO) therapy (p < 0.05). Value of the AUC demonstrated good predictive performance of MSA for postnatal survival (0.901, 95%CI: (0.781–1.000)), PH (0.828, 95%CI: (0.661–0.994)), and ECMO therapy (0.813, 95%CI: (0.645–0.980)), which was similar to O/E TFLV but slightly better than TFLV, O/E LHR, and LHR.

Conclusions

We developed a measurement method of MSA for RCDH for the first time and demonstrated that MSA could be used to predict postnatal survival, PH, and ECMO therapy in RCDH.

Clinical relevance statement

Newly developed MRI assessment method of fetal MSA in RCDH offers a simple and effective risk stratification tool for patients with RCDH.

Key Points

• We developed a measurement method of mediastinal shift angle for right-sided congenital diaphragmatic hernia for the first time and demonstrated its feasibility and reproducibility.

• Mediastinal shift angle can predict more prognostic information other than survival in right-sided congenital diaphragmatic hernia with good performance.

• Mediastinal shift angle can be used as a simple and effective risk stratification tool in right-sided congenital diaphragmatic hernia to improve planning of postnatal management.

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Title: Prenatal MRI assessment of mediastinal shift angle as a feasible and effective risk stratification tool in isolated right-sided congenital diaphragmatic hernia
Authors: Wen Ding
Yuanyuan Gu
Haiyu Wang
Huiying Wu
Xiaochun Zhang
Rui Zhang
Hongying Wang
Li Huang
Junjian Lv
Bo Xia
Wei Zhong
Qiuming He
Longlong Hou
Publication date: 30-08-2023
Publisher: Springer Berlin Heidelberg
Keywords: ECMO
ECMO
Pulmonary Hypertension
Pulmonary Hypertension
Diaphragmatic Hernia
Diaphragmatic Hernia
Fetal Magnetic Resonance Imaging
Pulmonary Hypertension
Pulmonary Hypertension
Published in: European Radiology / Issue 3/2024
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-023-10178-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Prenatal MRI assessment of mediastinal shift angle as a feasible and effective risk stratification tool in isolated right-sided congenital diaphragmatic hernia

Abstract

Objectives

Methods

Results

Conclusions

Clinical relevance statement

Key Points

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusions

Clinical relevance statement

Key Points

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