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Q&A

Fetus

Poster Session 2

(372) Comparison of ultrasound and magnetic resonance imaging in predicting congenital diaphragmatic hernia (CDH) outcomes

Tuesday, February 13, 2024
3:30 PM – 5:00 PM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Objective:

Optimal imaging for CDH includes observed to expected lung-to-head ratio (O/E LHR) by ultrasound (US), and percent predicted lung volume (PPLV) by magnetic resonance imaging (MRI), but data for sensitivity of one modality over the other is lacking. Our primary objective was to determine whether MRI or US derived prognostic factors are best at predicting need for extracorporeal membrane oxygenation (ECMO) at early and late gestational age. Secondary outcomes included survival to discharge, length of neonatal intensive care unit stay (NLOS), ventilator days (VD), and inhaled nitric oxide duration (iNOD).

Study Design:

This retrospective study included CDH affected fetuses managed at a single fetal care center from 2013-2022 who had 2 sets of fetal MRI and US performed between 21w0d-27w6d and 32w0d-37w6d. Prenatal, and neonatal data were obtained from the electronic medical record. Those with right sided CDH, other major anomalies, < 34 weeks gestational age at birth, multiple gestations, and genetic syndromes were excluded.  The relationship between prenatal prognostic factors and neonatal outcomes was described using spearman and pearson correlations with p value of < 0.05 taken as significant. We compared the sensitivity of MRI and US derived measures using univariate logistic regression.

Results:

Of 141 fetuses, 52 met inclusion criteria. 48 neonates survived to discharge (92%) and 20 required ECMO (38%). Lower PPLV and O/E LHR values were significantly correlated with need for ECMO, increased NLOS, longer VD, and longer iNOD at both time points (p values < 0.05). There were no significant differences at both time points in the AUCROC for PPLV vs O/E LHR for ECMO, predicting survival, increased NLOS, and increased VD (p values >0.05)

Conclusion:

MRI PPLV and US O/E LHR derived prognostic factors are clinically useful in predicting CDH severity. We found no advantage of one modality over the other, even when compared at two different time points in predicting need for ECMO and other neonatal outcomes.