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European Radiology
Published in: European Radiology 1/2015

01-01-2015 | Pediatric

Prenatal MR imaging of congenital diaphragmatic hernias: association of MR fetal lung volume with the need for postnatal prosthetic patch repair

Authors: Claudia Hagelstein, Katrin Zahn, Meike Weidner, Christel Weiss, Stefan O. Schoenberg, Thomas Schaible, Karen A. Büsing, K. Wolfgang Neff

Published in: European Radiology | Issue 1/2015

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Abstract

Objective

To assess whether the need for postnatal prosthetic patch repair of the diaphragmatic defect in neonates with a congenital diaphragmatic hernia (CDH) is associated with the antenatal measured observed-to-expected magnetic resonance fetal lung volume (o/e MR-FLV).

Methods

The o/e MR-FLV was calculated in 247 fetuses with isolated CDH. Logistic regression analysis was used to assess the prognostic value of the individual o/e MR-FLV for association with the need for postnatal patch repair.

Results

Seventy-seven percent (77 %) of patients with a CDH (190/247) required prosthetic patch repair and the defect was closed primarily in 23 % (57/247). Patients requiring a patch had a significantly lower o/e MR-FLV (27.7 ± 10.2 %) than patients with primary repair (40.8 ± 13.8 %, p < 0.001, AUC = 0.786). With an o/e MR-FLV of 20 %, 92 % of the patients required patch repair, compared to only 24 % with an o/e MR-FLV of 60 %. The need for a prosthetic patch was further influenced by the fetal liver position (herniation/no herniation) as determined by magnetic resonance imaging (MRI; p < 0.001). Fetal liver position, in addition to the o/e MR-FLV, improves prognostic accuracy (AUC = 0.827).

Conclusion

Logistic regression analysis based on the o/e MR-FLV is useful for prenatal estimation of the prosthetic patch requirement in patients with a CDH. In addition to the o/e MR-FLV, the position of the liver as determined by fetal MRI helps improve prognostic accuracy.

Key Points

• The o/e MR-FLV is associated with the need for postnatal patch repair in CDH.
• The need for a patch is associated with a significantly lower o/e MR-FLV (p < 0.001).
• The patch requirement is also influenced by fetal liver position.
• Fetal liver position, in addition to the o/e MR-FLV, improves prognostic accuracy.
• CDH-fetuses with a high probability for patch requirement can be identified prenatally.
Literature
1.
Ackerman KG, Pober BR (2007) Congenital diaphragmatic hernia and pulmonary hypoplasia: new insights from developmental biology and genetics. Am J Med Genet C: Semin Med Genet 145C:105–108CrossRef
2.
Lally KP, Lally PA, Lasky RE et al (2007) Defect size determines survival in infants with congenital diaphragmatic hernia. Pediatrics 120:e651–e657PubMedCrossRef
3.
Jani J, Cannie M, Sonigo P et al (2008) Value of prenatal magnetic resonance imaging in the prediction of postnatal outcome in fetuses with diaphragmatic hernia. Ultrasound Obstet Gynecol 32:793–799PubMedCrossRef
4.
Kilian AK, Schaible T, Hofmann V, Brade J, Neff KW, Busing KA (2009) Congenital diaphragmatic hernia: predictive value of MRI relative lung-to-head ratio compared with MRI fetal lung volume and sonographic lung-to-head ratio. AJR Am J Roentgenol 192:153–158PubMedCrossRef
5.
Jani JC, Peralta CF, Nicolaides KH (2012) Lung-to-head ratio: a need to unify the technique. Ultrasound Obstet Gynecol 39:2–6PubMedCrossRef
6.
Busing KA, Kilian AK, Schaible T, Debus A, Weiss C, Neff KW (2008) Reliability and validity of MR image lung volume measurement in fetuses with congenital diaphragmatic hernia and in vitro lung models. Radiology 246:553–561PubMedCrossRef
7.
Paek BW, Coakley FV, Lu Y et al (2001) Congenital diaphragmatic hernia: prenatal evaluation with MR lung volumetry–preliminary experience. Radiology 220:63–67PubMedCrossRef
8.
Ward VL, Nishino M, Hatabu H et al (2006) Fetal lung volume measurements: determination with MR imaging–effect of various factors. Radiology 240:187–193PubMedCrossRef
9.
Sola JE, Bronson SN, Cheung MC, Ordonez B, Neville HL, Koniaris LG (2010) Survival disparities in newborns with congenital diaphragmatic hernia: a national perspective. J Pediatr Surg 45:1336–1342PubMedCrossRef
10.
Waag KL, Loff S, Zahn K et al (2008) Congenital diaphragmatic hernia: a modern day approach. Semin Pediatr Surg 17:244–254PubMedCrossRef
11.
Romao RL, Nasr A, Chiu PP, Langer JC (2012) What is the best prosthetic material for patch repair of congenital diaphragmatic hernia? Comparison and meta-analysis of porcine small intestinal submucosa and polytetrafluoroethylene. J Pediatr Surg 47:1496–1500PubMedCrossRef
12.
de Buys Roessingh AS, Dinh-Xuan AT (2009) Congenital diaphragmatic hernia: current status and review of the literature. Eur J Pediatr 168:393–406PubMedCrossRef
13.
Chiu P, Hedrick HL (2008) Postnatal management and long-term outcome for survivors with congenital diaphragmatic hernia. Prenat Diagn 28:592–603PubMedCrossRef
14.
Jaillard SM, Pierrat V, Dubois A et al (2003) Outcome at 2 years of infants with congenital diaphragmatic hernia: a population-based study. Ann Thorac Surg 75:250–256PubMedCrossRef
15.
Gallot D, Boda C, Ughetto S et al (2007) Prenatal detection and outcome of congenital diaphragmatic hernia: a French registry-based study. Ultrasound Obstet Gynecol 29:276–283PubMedCrossRef
16.
Grushka JR, Laberge JM, Puligandla P, Skarsgard ED, Canadian Pediatric Surgery N (2009) Effect of hospital case volume on outcome in congenital diaphragmatic hernia: the experience of the Canadian Pediatric Surgery Network. J Pediatr Surg 44:873–876PubMedCrossRef
17.
Busing KA, Kilian AK, Schaible T, Dinter DJ, Neff KW (2008) MR lung volume in fetal congenital diaphragmatic hernia: logistic regression analysis–mortality and extracorporeal membrane oxygenation. Radiology 248:233–239PubMedCrossRef
18.
Busing KA, Kilian AK, Schaible T, Endler C, Schaffelder R, Neff KW (2008) MR relative fetal lung volume in congenital diaphragmatic hernia: survival and need for extracorporeal membrane oxygenation. Radiology 248:240–246PubMedCrossRef
19.
Debus A, Hagelstein C, Kilian AK, et al (2012) Fetal Lung Volume in Congenital Diaphragmatic Hernia: Association of Prenatal MR Imaging Findings with Postnatal Chronic Lung Disease. Radiology
20.
Kilian AK, Busing KA, Schuetz EM, Schaible T, Neff KW (2009) Fetal MR lung volumetry in congenital diaphragmatic hernia (CDH): prediction of clinical outcome and the need for extracorporeal membrane oxygenation (ECMO). Klin Padiatr 221:295–301PubMedCrossRef
21.
Neff KW, Kilian AK, Schaible T, Schutz EM, Busing KA (2007) Prediction of mortality and need for neonatal extracorporeal membrane oxygenation in fetuses with congenital diaphragmatic hernia: logistic regression analysis based on MRI fetal lung volume measurements. AJR Am J Roentgenol 189:1307–1311PubMedCrossRef
22.
Rypens F, Metens T, Rocourt N et al (2001) Fetal lung volume: estimation at MR imaging-initial results. Radiology 219:236–241PubMedCrossRef
23.
Reiss I, Schaible T, van den Hout L et al (2010) Standardized postnatal management of infants with congenital diaphragmatic hernia in Europe: the CDH EURO Consortium consensus. Neonatology 98:354–364PubMedCrossRef
24.
25.
Brindle ME, Brar M, Skarsgard ED (2011) Patch repair is an independent predictor of morbidity and mortality in congenital diaphragmatic hernia. Pediatr Surg Int 27:969–974PubMedCrossRef
26.
Jani JC, Benachi A, Nicolaides KH et al (2009) Prenatal prediction of neonatal morbidity in survivors with congenital diaphragmatic hernia: a multicenter study. Ultrasound Obstet Gynecol Off J Int Soc Ultrasound Obstet Gynecol 33:64–69CrossRef
27.
Loff S, Wirth H, Jester I et al (2005) Implantation of a cone-shaped double-fixed patch increases abdominal space and prevents recurrence of large defects in congenital diaphragmatic hernia. J Pediatr Surg 40:1701–1705PubMedCrossRef
28.
Tsao K, Lally KP (2011) Surgical management of the newborn with congenital diaphragmatic hernia. Fetal Diagn Ther 29:46–54PubMedCrossRef
29.
Jawaid WB, Qasem E, Jones MO, Shaw NJ, Losty PD (2013) Outcomes following prosthetic patch repair in newborns with congenital diaphragmatic hernia. Br J Surg 100:1833–1837PubMedCrossRef
30.
Tsai J, Sulkowski J, Adzick NS, Hedrick HL, Flake AW (2012) Patch repair for congenital diaphragmatic hernia: is it really a problem? J Pediatr Surg 47:637–641PubMedCrossRef
31.
Ruano R, Lazar DA, Cass DL et al (2014) Fetal lung volume and quantification of liver herniation by magnetic resonance imaging in isolated congenital diaphragmatic hernia. Ultrasound Obstet Gynecol 43:662–669PubMedCrossRef
32.
Wright T, Filbrun A, Bryner B, Mychaliska G (2014) Predictors of early lung function in patients with congenital diaphragmatic hernia. J Pediatr Surg 49:882–885PubMedCrossRef
33.
Valfre L, Braguglia A, Conforti A et al (2011) Long term follow-up in high-risk congenital diaphragmatic hernia survivors: patching the diaphragm affects the outcome. J Pediatr Surg 46:52–56PubMedCrossRef
34.
St Peter SD, Valusek PA, Tsao K, Holcomb GW 3rd, Ostlie DJ, Snyder CL (2007) Abdominal complications related to type of repair for congenital diaphragmatic hernia. J Surg Res 140:234–236PubMedCrossRef
35.
Ba'ath ME, Jesudason EC, Losty PD (2007) How useful is the lung-to-head ratio in predicting outcome in the fetus with congenital diaphragmatic hernia? A systematic review and meta-analysis. Ultrasound Obstet Gynecol 30:897–906PubMedCrossRef
36.
Jani J, Nicolaides KH, Keller RL et al (2007) Observed to expected lung area to head circumference ratio in the prediction of survival in fetuses with isolated diaphragmatic hernia. Ultrasound Obstet Gynecol 30:67–71PubMedCrossRef
Metadata
Title
Prenatal MR imaging of congenital diaphragmatic hernias: association of MR fetal lung volume with the need for postnatal prosthetic patch repair
Authors
Claudia Hagelstein
Katrin Zahn
Meike Weidner
Christel Weiss
Stefan O. Schoenberg
Thomas Schaible
Karen A. Büsing
K. Wolfgang Neff
Publication date
01-01-2015
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 1/2015
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-014-3410-8

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