{Reference Type}: Journal Article
{Title}: Relative Mediastinal Displacement Index (RMDI): A Prenatal MRI Indicator of Adverse Events in Fetuses With Isolated Left Congenital Diaphragmatic Hernia.
{Author}: Wu F;Chen Y;Zhang X;Li Y;Chen Z;Liu Z;Dai W;Yang C;Liu H;
{Journal}: J Magn Reson Imaging
{Volume}: 0
{Issue}: 0
{Year}: 2024 Mar 5
{Factor}: 5.119
{DOI}: 10.1002/jmri.29329
{Abstract}: BACKGROUND: Extracorporeal membrane oxygenation (ECMO), has partly improved congenital diaphragmatic hernia (CDH) outcomes, yet the overall morbidity and mortality remain high. Existing prenatal indicators for CDH fetuses are operator-dependent, time-consuming, or less accurate, a new simple and accurate indicator to indicate adverse events in CDH patients is needed.
OBJECTIVE: To propose and assess the association of a new MRI parameter, the relative mediastinal displacement index (RMDI), with adverse events including in-hospital deaths or the need for ECMO in fetuses with isolated left CDH (iLCDH).
METHODS: Retrospective analysis.
METHODS: One hundred thirty-nine fetuses were included in the iLCDH group (24 with adverse events and 115 without) and 257 fetuses were included in the control group from two centers in Guangzhou.
UNASSIGNED: 3.0 T, T2WI-TRUFI; 1.5 T, T2WI-FIESTA.
RESULTS: Three operators independently measured the → DL $$ \underset{\mathrm{DL}}{\to } $$ , → DR $$ \underset{\mathrm{DR}}{\to } $$ , and DH on the axial images. The calculation formula of the RMDI was ( → DL $$ \underset{\mathrm{DL}}{\to } $$ + → DR $$ \underset{\mathrm{DR}}{\to } $$ )/DH .
METHODS: The independent sample t test, Mann-Whitney U test, Chi-square test, Chi-square test continuity correction, Fisher's test, linear regression analysis, logistic regression analysis, intraclass correlation coefficient, receiver operating characteristic curve analysis, and Delong test. A P value <0.05 was considered statistically significant.
RESULTS: The RMDI did not change with gestational age in the iLCDH group (with [P = 0.189] and without [P = 0.567] adverse events) and the control group (P = 0.876). There were significant differences in RMDI between the iLCDH group (0.89 [0.65, 1.00]) and the control group (-0.23 [-0.34, -0.16]). In the iLCDH group, RMDI was the only indicator left for indicating adverse events, and the best cutoff value was 1.105. Moreover, there was a significant difference in diagnostic accuracy between the RMDI (AUC = 0.900) and MSA (AUC = 0.820), LHR (AUC = 0.753), o/e LHR (AUC = 0.709), and o/e TFLV (AUC = 0.728), respectively.
CONCLUSIONS: The RMDI is expected to be a simple and accurate tool for indicating adverse events in fetuses with iLCDH.
METHODS: 4 TECHNICAL EFFICACY: Stage 1.