| Prenatal prediction of survival in isolated diaphragmatic hernia using observed to expected total fetal lung volume determined by magnetic resonance imaging based on either gestational age or fetal body volume. | |
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MedLine Citation:
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PMID: 18792417 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVES: To compare the predictive value of the prenatal observed to expected (o/e) lung volume as measured by fetal magnetic resonance imaging (MRI), based on an algorithm using either the gestational age or fetal body volume (FBV), for neonatal survival of fetuses with isolated congenital diaphragmatic hernia (CDH). METHODS: We included 53 fetuses with a prenatal diagnosis of isolated CDH, 26 without and 27 with prenatal tracheal occlusion, who were assessed by fetal MRI, liveborn after 32 weeks, and in whom follow-up until discharge from the neonatal care unit was available. Measurements of lung volumes were expressed as a percentage of the appropriate mean (o/e total fetal lung volume (TFLV) x 100) either for gestational age or for FBV. Measurements of FBV were expressed as a percentage of the appropriate mean (o/e FBV x 100) for gestation. Fetuses with prenatal intervention were all assessed > or = 24 h after balloon removal. Regression analysis was used to examine the effect on postnatal survival of either o/e TFLV based on gestational age or based on FBV, gestation at delivery, side of CDH, intrathoracic position of the liver and prenatal intervention. Receiver-operating characteristics (ROC) curves were constructed for the prediction of survival by o/e TFLV based on gestational age and o/e TFLV based on FBV, for all fetuses, as well as for those with o/e FBV between 90 and 110% and those with values beyond that range. A power calculation for the number of fetuses needed to show a difference between the ROC curves was performed. RESULTS: Regression analysis demonstrated that o/e TFLV based on gestational age and on FBV were the only independent predictors of postnatal survival. The area under the ROC curve for prediction of postnatal survival from the o/e TFLV based on gestational age was 0.811, and for that based on FBV it was 0.868 (P < 0.001 for both). For fetuses with o/e FBV between 90 and 110%, and those with values < 90% and > 110%, the area for measurements based on gestational age was 0.895 and 0.733, respectively; when based on FBV it was 0.906 and 0.833 (P < 0.01 for all). A minimum of 273 patients would be needed to provide a probability of 90% of detecting a difference between the areas under both ROC curves. CONCLUSIONS: In fetuses with isolated CDH, lung volume as measured by fetal MRI was significantly correlated with survival. Prediction tended to be better by o/e TFLV based on FBV rather than gestational age. The difference in the prediction of survival between o/e TFLV based on FBV or gestational age was dependent on fetal biometry. |
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Authors:
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M Cannie; J Jani; J Meersschaert; K Allegaert; E Done'; G Marchal; J Deprest; S Dymarkowski |
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Publication Detail:
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Type: Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology Volume: 32 ISSN: 1469-0705 ISO Abbreviation: Ultrasound Obstet Gynecol Publication Date: 2008 Oct |
Date Detail:
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Created Date: 2008-09-30 Completed Date: 2009-03-03 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 9108340 Medline TA: Ultrasound Obstet Gynecol Country: England |
Other Details:
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Languages: eng Pagination: 633-9 Citation Subset: IM |
Affiliation:
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Department of Radiology, University Hospital Gasthuisberg, Leuven, Belgium. |
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Algorithms Area Under Curve Cross-Sectional Studies False Positive Reactions Fetal Diseases* / diagnosis, mortality Fetal Organ Maturity Gestational Age Hernia, Diaphragmatic* / congenital, diagnosis, mortality Humans Infant, Newborn Lung / embryology Lung Volume Measurements / methods Magnetic Resonance Imaging Prenatal Diagnosis / methods* Prospective Studies Survival Analysis |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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