Different volumetric indices of lungs in fetuses with congenital diaphragmatic hernia by three-dimensional ultrasonography

Abstract

Objective: To evaluate the potential of different lung measurements using threedimensionalultrasonography (3DUS) to predict perinatal outcome in cases of isolated congenital diaphragmatic hernia (CDH). Study design: Fifty-five fetuses presenting isolated CDH were prospectively evaluated by 3DUS between January 2002 and May 2007. Observed/expectedtotal, contralateral and ipsilateral fetal lung volume ratios TFLV, CFLV and IFLV, respectively) were calculated using the VOCALTM technique and ultrassonographic fetal total lung volume to body weight ratio (US-FLW). These lung measurements were compared to one another and to perinatal outcomes: perinatal deaths, severe pulmonary hypoplasia (PH) and pulmonary arterial hypertension (PAH). Results: Perinatal death occurred in 31 of 55 infants (56.4%), severe PH in 37 of 55 infants (67.3%) and PAH in 38 of 54 (excluding one death in utero) of neonates (70.4%). Severe PH and PAH occurred simultaneously in 35 (63.0%) of 54 infants. Good correlations between all lung volumetric ratios were observed. O/e-TotFLV, o/e-ContFLVand US-FLW correlated statistically with perinatal deaths; o/e-TotFLV, o/e-IpsiFLV and USFLWwith postnatal diagnosis of severe PH; while only o/e-TotFLH correlated statistically with postnatal diagnosis of PAH. The accuracies of o/e-TotFLV, o/e-ContFLV, o/e-IpsiFLV andUS-FLW in predicting perinatal deaths were 83.6%, 72.7%, 67.3% and 76.4%, respectively. Conclusion: O/e-TotFLV using 3D-US appeared to be the most accurate predictor of perinatal deaths as it can predict both PH and PAH.