Abstract：
OBJECTIVE: To evaluate the impact of the timing of MRI on the prediction of survival and morbidity in patients with CDH, and whether serial measurements have a beneficial value.
METHODS: This retrospective cohort study was conducted in two perinatal centers, in Germany and Italy. It included 354 patients with isolated CDH having at least one fetal MRI. The severity was assessed with the observed-to-expected total fetal lung volume (o/e TFLV) measured by two experienced double-blinded operators. The cohort was divided into three groups according to the gestational age (GA) at which the MRI was performed (< 27, 27-32, and > 32 weeks\' gestation [WG]). The accuracy for the prediction of survival at discharge and morbidity was analyzed with receiver operating characteristic (ROC) curves. Multiple logistic regression analyses and propensity score matching examined the population for balance. The effect of repeated MRI was evaluated in ninety-seven cases.
RESULTS: There were no significant differences in the prediction of survival when the o/e TFLV was measured before 27, between 27 and 32, and after 32 WG (area under the curve [AUC]: 0.77, 0.79, and 0.77, respectively). After adjustment for confounding factors, it was seen, that GA at MRI was not associated with survival at discharge, but the risk of mortality was higher with an intrathoracic liver position (adjusted odds ratio [aOR]: 0.30, 95% confidence interval [95%CI] 0.12-0.78), lower GA at birth (aOR 1.48, 95%CI 1.24-1.78) and lower o/e TFLV (aOR 1.13, 95%CI 1.06-1.20). ROC curves showed comparable prediction accuracy for the different timepoints in pregnancy for pulmonary hypertension, the need of extracorporeal membrane oxygenation, and feeding aids. Serial measurements revealed no difference in change rate of the o/e TFLV according to survival.
CONCLUSIONS: The timing of MRI does not affect the prediction of survival rate or morbidity as the o/e TFLV does not change during pregnancy. Clinicians could choose any gestational age starting mid second trimester for the assessment of severity and counseling.
METHODS: This retrospective cohort study was conducted in two perinatal centers, in Germany and Italy. It included 354 patients with isolated CDH having at least one fetal MRI. The severity was assessed with the observed-to-expected total fetal lung volume (o/e TFLV) measured by two experienced double-blinded operators. The cohort was divided into three groups according to the gestational age (GA) at which the MRI was performed (< 27, 27-32, and > 32 weeks\' gestation [WG]). The accuracy for the prediction of survival at discharge and morbidity was analyzed with receiver operating characteristic (ROC) curves. Multiple logistic regression analyses and propensity score matching examined the population for balance. The effect of repeated MRI was evaluated in ninety-seven cases.
RESULTS: There were no significant differences in the prediction of survival when the o/e TFLV was measured before 27, between 27 and 32, and after 32 WG (area under the curve [AUC]: 0.77, 0.79, and 0.77, respectively). After adjustment for confounding factors, it was seen, that GA at MRI was not associated with survival at discharge, but the risk of mortality was higher with an intrathoracic liver position (adjusted odds ratio [aOR]: 0.30, 95% confidence interval [95%CI] 0.12-0.78), lower GA at birth (aOR 1.48, 95%CI 1.24-1.78) and lower o/e TFLV (aOR 1.13, 95%CI 1.06-1.20). ROC curves showed comparable prediction accuracy for the different timepoints in pregnancy for pulmonary hypertension, the need of extracorporeal membrane oxygenation, and feeding aids. Serial measurements revealed no difference in change rate of the o/e TFLV according to survival.
CONCLUSIONS: The timing of MRI does not affect the prediction of survival rate or morbidity as the o/e TFLV does not change during pregnancy. Clinicians could choose any gestational age starting mid second trimester for the assessment of severity and counseling.
摘要：
目的：评估MRI检查时机对CDH患者生存率和发病率预测的影响。以及串行测量是否具有有益的价值。
方法：这项回顾性队列研究在两个围产期中心进行，在德国和意大利。它包括354名具有至少一个胎儿MRI的孤立CDH患者。通过两名经验丰富的双盲操作员测量的观察到的预期的胎儿肺总体积（o/eTFLV）来评估严重程度。根据进行MRI检查的胎龄（GA）（<27、27-32和>32周[WG]），该队列分为三组。使用受试者工作特征（ROC）曲线分析了出院时生存率和发病率预测的准确性。多元逻辑回归分析和倾向评分匹配检查了人群的平衡。在97例患者中评估了重复MRI的效果。
结果：当在27日、27日和32日和32日WG后测量o/eTFLV时（曲线下面积[AUC]：分别为0.77、0.79和0.77），生存预测没有显著差异。在对混杂因素进行调整后，它被看到了，MRI的GA与出院时的生存率无关，但是胸内肝脏位置的死亡风险更高（调整后的优势比[aOR]：0.30，95％置信区间[95CI]0.12-0.78），出生时GA较低（aOR1.48，95CI1.24-1.78）和o/eTFLV较低（aOR1.13，95CI1.06-1.20）。ROC曲线显示妊娠不同时间点肺动脉高压的预测准确性相当，体外膜氧合的需要，和喂养艾滋病。连续测量显示，根据生存率，o/eTFLV的变化率没有差异。
结论：MRI的时机不影响生存率或发病率的预测，因为o/eTFLV在怀孕期间没有变化。临床医生可以选择从中期妊娠开始的任何胎龄来评估严重程度和咨询。
方法：这项回顾性队列研究在两个围产期中心进行，在德国和意大利。它包括354名具有至少一个胎儿MRI的孤立CDH患者。通过两名经验丰富的双盲操作员测量的观察到的预期的胎儿肺总体积（o/eTFLV）来评估严重程度。根据进行MRI检查的胎龄（GA）（<27、27-32和>32周[WG]），该队列分为三组。使用受试者工作特征（ROC）曲线分析了出院时生存率和发病率预测的准确性。多元逻辑回归分析和倾向评分匹配检查了人群的平衡。在97例患者中评估了重复MRI的效果。
结果：当在27日、27日和32日和32日WG后测量o/eTFLV时（曲线下面积[AUC]：分别为0.77、0.79和0.77），生存预测没有显著差异。在对混杂因素进行调整后，它被看到了，MRI的GA与出院时的生存率无关，但是胸内肝脏位置的死亡风险更高（调整后的优势比[aOR]：0.30，95％置信区间[95CI]0.12-0.78），出生时GA较低（aOR1.48，95CI1.24-1.78）和o/eTFLV较低（aOR1.13，95CI1.06-1.20）。ROC曲线显示妊娠不同时间点肺动脉高压的预测准确性相当，体外膜氧合的需要，和喂养艾滋病。连续测量显示，根据生存率，o/eTFLV的变化率没有差异。
结论：MRI的时机不影响生存率或发病率的预测，因为o/eTFLV在怀孕期间没有变化。临床医生可以选择从中期妊娠开始的任何胎龄来评估严重程度和咨询。
