Top

Published in:

29-01-2024 | Fetal Magnetic Resonance Imaging | Original Article

Assessment of mediastinal shift angles in congenital pulmonary airway malformation: a new fetal magnetic resonance imaging indicator of congenital lung disease

Authors: Jun Tsukamoto, Osamu Miyazaki, Yuki Saito, Saho Irahara, Reiko Okamoto, Mikiko Miyasaka, Yoshiyuki Tsutsumi, Yushi Itoh, Haruhiko Sago, Yutaka Kanamori, Masashi Mikami, Yoshiko Hayashida, Takatoshi Aoki, Shunsuke Nosaka

Published in: Pediatric Radiology | Issue 5/2024

Abstract

Background

The mediastinal shift angle is a new fetal magnetic resonance imaging (MRI) index that is reportedly correlated with postnatal survival in fetuses with congenital diaphragmatic hernia. However, its correlation in patients with congenital pulmonary airway malformation (CPAM) has not been assessed.

Objective

This study aimed to establish a normal range for the right/left mediastinal shift angles, to evaluate the mediastinal shift angle in fetuses with CPAM, to compare the mediastinal shift angle with the CPAM volume ratio, and to evaluate the predictive value of the mediastinal shift angle measurements.

Materials and methods

To establish the normal range, we measured the mediastinal shift angle bilaterally in 124 fetuses without any lung abnormality (the control group). Subsequently, the mediastinal shift angle was measured in 32 fetuses pathologically diagnosed with CPAM. Moreover, the mediastinal shift angle and CPAM volume ratio were compared using fetal MRI.

Results

The mean values for the right/left mediastinal shift angles were 18.6°/26.3° and 39.2°/35.9° for control fetuses and fetuses with CPAM, respectively. The mediastinal shift angle and the CPAM volume ratio showed a positive statistical correlation. The area under the curve demonstrated high discriminatory accuracy for the mediastinal shift angle (0.76).

Conclusion

The mediastinal shift angle has potential to replace the CPAM volume ratio for evaluating the severity of CPAM in fetal MRI.

Graphical Abstract

Stocker JT (2002) Congenital pulmonary airway malformation- a new name for and an expanded classification of congenital cystic adenomatoid malformation of the lung. Histopathology 41:424–430

Sfakianaki AK, Copel JA (2012) Congenital cystic lesions of the lung: congenital cystic adenomatoid malformation and bronchopulmonary sequestration. Rev Obstet Gynecol 5:85–93. PMID: 22866187; PMCID: PMC3410507

Adzick NS, Harrison MR, Crombleholme TM, Flake AW, Howell LJ (1998) Fetal lung lesions: management and outcome. Am J Obstet Gynecol 179:884–889. https://doi.org/10.1016/s0002-9378(98)70183-8CrossRefPubMed

Adzick NS, Kitano Y (2003) Fetal surgery for lung lesions, congenital diaphragmatic hernia, and sacrococcygeal teratoma. Semin Pediatr Surg 12:154–167. https://doi.org/10.1016/S1055-8586(03)00030-1CrossRefPubMed

Quintero RA, Kontopoulos EV, Quintero LF, Landy DC, Gonzalez R, Chmait RH (2013) The observed vs. expected lung-to-head ratio does not correct for the effect of gestational age on the lung-to-head ratio. J Matern Fetal Neonatal Med 26:552–557. https://doi.org/10.3109/14767058.2012.736000CrossRefPubMed

Aspelund G, Fisher JC, Simpson LL, Stolar CJ (2012) Prenatal lung-head ratio: threshold to predict outcome for congenital diaphragmatic hernia. J Matern Fetal Neonatal Med 25:1011–1016. https://doi.org/10.3109/14767058.2011.608442CrossRefPubMed

Jani J, Nicolaides KH, Keller RL, Benachi A, Peralta CF, Favre R, Moreno O, Tibboel D, Lipitz S, Eggink A, Vaast P, Allegaert K, Harrison M, Deprest J (2007) Observed to expected lung area to head circumference ratio in the prediction of survival in fetuses with isolated diaphragmatic hernia. Ultrasound Obstet Gynecol 30:67–71. https://doi.org/10.1002/uog.4052CrossRefPubMed

Victoria T, Danzer E, Adzick NS (2013) Use of ultrasound and MRI for evaluation of lung volumes in fetuses with isolated left congenital diaphragmatic hernia. Semin Pediatr Surg 22:30–36. https://doi.org/10.1053/j.sempedsurg2012.10.006CrossRefPubMed

Savelli S, Bascetta S, Carducci C, Carnevale E, Caforio L, Romiti A, Tomà P (2020) Fetal MRI assessment of mediastinal shift angle in isolated left congenital diaphragmatic hernia: a new postnatal survival predictive tool? Prenat Diagn 40:136–141. https://doi.org/10.1002/pd.5619CrossRefPubMed

10.

Romiti A, Viggiano M, Savelli S, Salvi S, Vicario R, Vassallo C, Valfrè L, Tomà P, Bonito M, Lanzone A, Bagolan P, Caforio L (2022) Comparison of mediastinal shift angles obtained with ultrasound and magnetic resonance imaging in fetuses with isolated left sided congenital diaphragmatic hernia. J Matern Fetal Neonatal Med 35:269–274. https://doi.org/10.1080/14767058.2020.1716714CrossRefPubMed

11.

Amodeo I, Borzani I, Corsani G, Pesenti N, Raffaeli G, Macchini F, Condò V, Persico N, Ghirardello S, Colnaghi M, Mosca F, Cavallaro G (2022) Fetal MRI mediastinal shift angle and respiratory and cardiovascular pharmacological support in newborns with congenital diaphragmatic hernia. Eur J Pediatr 181:323–334. https://doi.org/10.1007/s00431-021-04207-8CrossRefPubMed

12.

Romiti A, Viggiano M, Conforti A, Valfré L, Ravà L, Ciofi Degli Atti M, Bagolan P, Caforio L (2020) Ultrasonographic assessment of mediastinal shift angle (MSA) in isolated left congenital diaphragmatic hernia for the prediction of postnatal survival. J Matern Fetal Neonatal Med 33:1330–1335. https://doi.org/10.1080/14767058.2018.1517329CrossRefPubMed

13.

Crombleholme TM, Coleman B, Hedrick H, Liechty K, Howell L, Flake AW, Johnson M, Adzick NS (2002) Cystic adenomatoid malformation volume ratio predicts outcome in prenatally diagnosed cystic adenomatoid malformation of the lung. J Pediatr Surg 37:331–338. https://doi.org/10.1053/jpsu.2002.30832CrossRefPubMed

14.

Cass DL, Olutoye OO, Cassady CI, Moise KJ, Johnson A, Papanna R, Lazar DA, Ayres NA, Belleza-Bascon B (2011) Prenatal diagnosis and outcome of fetal lung masses. J Pediatr Surg 46:292–298. https://doi.org/10.1016/j.jpedsurg.2010.11.004CrossRefPubMed

15.

Adzick NS, Flake AW, Crombleholme TM (2003) Management of congenital lung lesions. Semin Pediatr Surg 12:10–16. https://doi.org/10.1053/spsu.2003.50002CrossRefPubMed

16.

Di Prima FA, Bellia A, Inclimona G, Grasso F, Teresa M, Cassaro MN (2012) Antenatally diagnosed congenital cystic adenomatoid malformations (CCAM): research review. J Prenat Med 6:22–30PubMedPubMedCentral

Title: Assessment of mediastinal shift angles in congenital pulmonary airway malformation: a new fetal magnetic resonance imaging indicator of congenital lung disease
Authors: Jun Tsukamoto
Osamu Miyazaki
Yuki Saito
Saho Irahara
Reiko Okamoto
Mikiko Miyasaka
Yoshiyuki Tsutsumi
Yushi Itoh
Haruhiko Sago
Yutaka Kanamori
Masashi Mikami
Yoshiko Hayashida
Takatoshi Aoki
Shunsuke Nosaka
Publication date: 29-01-2024
Publisher: Springer Berlin Heidelberg
Keywords: Fetal Magnetic Resonance Imaging
Magnetic Resonance Imaging
Magnetic Resonance Imaging
Diaphragmatic Hernia
Diaphragmatic Hernia
Published in: Pediatric Radiology / Issue 5/2024
Print ISSN: 0301-0449
Electronic ISSN: 1432-1998
DOI: https://doi.org/10.1007/s00247-024-05852-5

2024 ASCO Annual Meeting

Springer Medicine

Assessment of mediastinal shift angles in congenital pulmonary airway malformation: a new fetal magnetic resonance imaging indicator of congenital lung disease

Abstract

Background

Objective

Materials and methods

Results

Conclusion

Graphical Abstract

2024 ASCO Annual Meeting

Springer Medicine

Abstract

Background

Objective

Materials and methods

Results

Conclusion

Graphical Abstract

Please log in to get access to this content

Other articles of this Issue 5/2024

Current and emerging 3D visualization technologies in radiology

Pulmonary lesions in early response assessment in pediatric Hodgkin lymphoma: prevalence and possible implications for initial staging

Using MRI derived observed to expected total lung volume to predict lethality in fetal skeletal dysplasia

Evaluation of claims data from a commercial value-based insurance product shows pediatric imaging is not a major driver of overall or pediatric healthcare expenditures

Predicting event-free survival after induction of remission in high-risk pediatric neuroblastoma: combining 123I-MIBG SPECT-CT radiomics and clinical factors

Correction to: Positron emission tomography in the diagnosis and management of primary pediatric lung tumors