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Abstract：
OBJECTIVE: Fetal magnetic resonance imaging (MRI) is broadly used as a method for assessing prognosis in congenital diaphragmatic hernia (CDH). In addition to the extent of lung hypoplasia, determined by measuring the lung volume, cardiac impairment due to pulmonary hypertension and left cardiac hypoplasia is decisive for the prognosis. The percentage area of left ventricle (pALV) describes the percentage of the inner area of the left ventricle in relation to the total area, whereas the mediastinal shift angle (MSA) quantifies the extent of cardiac displacement. The prognostic value of pALV and MSA should be evaluated in terms of survival, the need for extracorporeal membrane oxygenation (ECMO) therapy, and the development of chronic lung disease (CLD).
METHODS: In a total of 122 fetal MRIs, the MSA and pALV were measured retrospectively and complete outcome parameters were determined regarding survival for all 122 subjects, regarding ECMO therapy in 109 cases and about the development of CLD in 78 cases. The prognostic value regarding the endpoints was evaluated using logistic regression and ROC analysis.
RESULTS: The MSA was significantly higher in children who received ECMO therapy (p = 0.0054), as well as in children who developed CLD (p = 0.0018). ROC analysis showed an AUC of 0.68 for ECMO requirement and 0.77 with respect to CLD development. The pALV showed a tendency towards higher levels in children who received ECMO therapy (p = 0.0824). The MSA and the pALV had no significant effect on survival (MSA: p = 0.4293, AUC = 0.56; pALV: p = 0.1134, AUC = 0.57).
CONCLUSIONS: The MSA determined in fetal MRI is a suitable prognostic parameter for ECMO requirement and CLD development in CDH patients and can possibly be used as a supplement to the established parameters.
METHODS: In a total of 122 fetal MRIs, the MSA and pALV were measured retrospectively and complete outcome parameters were determined regarding survival for all 122 subjects, regarding ECMO therapy in 109 cases and about the development of CLD in 78 cases. The prognostic value regarding the endpoints was evaluated using logistic regression and ROC analysis.
RESULTS: The MSA was significantly higher in children who received ECMO therapy (p = 0.0054), as well as in children who developed CLD (p = 0.0018). ROC analysis showed an AUC of 0.68 for ECMO requirement and 0.77 with respect to CLD development. The pALV showed a tendency towards higher levels in children who received ECMO therapy (p = 0.0824). The MSA and the pALV had no significant effect on survival (MSA: p = 0.4293, AUC = 0.56; pALV: p = 0.1134, AUC = 0.57).
CONCLUSIONS: The MSA determined in fetal MRI is a suitable prognostic parameter for ECMO requirement and CLD development in CDH patients and can possibly be used as a supplement to the established parameters.
摘要：
目的：胎儿磁共振成像（MRI）被广泛用作评估先天性膈疝（CDH）预后的方法。除了肺发育不全的程度,通过测量肺体积来确定，肺动脉高压和左心发育不全导致的心脏损害是预后的决定性因素.左心室面积百分比（pALV）描述了左心室内部面积相对于总面积的百分比，而纵隔移位角(MSA)可量化心脏移位的程度。pALV和MSA的预后价值应根据生存率进行评估。需要体外膜氧合（ECMO）治疗，和慢性肺病（CLD）的发展。
方法：在总共122例胎儿MRI中，对所有122例受试者进行了MSA和pALV回顾性测量,并确定了关于生存的完整结局参数,关于ECMO治疗109例和CLD发展78例。使用逻辑回归和ROC分析评估关于终点的预后价值。
结果：接受ECMO治疗的儿童的MSA明显更高（p=0.0054），以及患有CLD的儿童（p=0.0018）。ROC分析显示ECMO需求的AUC为0.68，CLD发展的AUC为0.77。在接受ECMO治疗的儿童中，pALV显示出更高水平的趋势（p=0.0824）。MSA和pALV对存活没有显著影响(MSA:p=0.4293,AUC=0.56;pALV:p=0.1134,AUC=0.57)。
结论：在胎儿MRI中确定的MSA是CDH患者ECMO需求和CLD发展的合适预后参数，并且可能用作已建立参数的补充。
方法：在总共122例胎儿MRI中，对所有122例受试者进行了MSA和pALV回顾性测量,并确定了关于生存的完整结局参数,关于ECMO治疗109例和CLD发展78例。使用逻辑回归和ROC分析评估关于终点的预后价值。
结果：接受ECMO治疗的儿童的MSA明显更高（p=0.0054），以及患有CLD的儿童（p=0.0018）。ROC分析显示ECMO需求的AUC为0.68，CLD发展的AUC为0.77。在接受ECMO治疗的儿童中，pALV显示出更高水平的趋势（p=0.0824）。MSA和pALV对存活没有显著影响(MSA:p=0.4293,AUC=0.56;pALV:p=0.1134,AUC=0.57)。
结论：在胎儿MRI中确定的MSA是CDH患者ECMO需求和CLD发展的合适预后参数，并且可能用作已建立参数的补充。
