Fetal MRI-Based Mediastinal Shift Angle (MSA) and Percentage Area of Left Ventricle (pALV) as Prognostic Parameters for Congenital Diaphragmatic Hernia
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 hyp...
| Main Authors: | , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2024-01-01
|
| Series: | Journal of Clinical Medicine |
| Subjects: | |
| Online Access: | https://www.mdpi.com/2077-0383/13/1/268 |
| _version_ | 1797358510874296320 |
|---|---|
| author | Greta Thater Lara Angermann Silviu-Viorel Virlan Christel Weiss Neysan Rafat Michael Boettcher Julia Elrod Tom Bayer Oliver Nowak Stefan O. Schönberg Meike Weis |
| author_facet | Greta Thater Lara Angermann Silviu-Viorel Virlan Christel Weiss Neysan Rafat Michael Boettcher Julia Elrod Tom Bayer Oliver Nowak Stefan O. Schönberg Meike Weis |
| author_sort | Greta Thater |
| collection | DOAJ |
| description | 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 (<i>p</i> = 0.0054), as well as in children who developed CLD (<i>p</i> = 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 (<i>p</i> = 0.0824). The MSA and the pALV had no significant effect on survival (MSA: <i>p</i> = 0.4293, AUC = 0.56; pALV: <i>p</i> = 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. |
| first_indexed | 2024-03-08T15:03:04Z |
| format | Article |
| id | doaj.art-17dd9d96c44e431298a1ec8c5475397e |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-08T15:03:04Z |
| publishDate | 2024-01-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-17dd9d96c44e431298a1ec8c5475397e2024-01-10T15:01:52ZengMDPI AGJournal of Clinical Medicine2077-03832024-01-0113126810.3390/jcm13010268Fetal MRI-Based Mediastinal Shift Angle (MSA) and Percentage Area of Left Ventricle (pALV) as Prognostic Parameters for Congenital Diaphragmatic HerniaGreta Thater0Lara Angermann1Silviu-Viorel Virlan2Christel Weiss3Neysan Rafat4Michael Boettcher5Julia Elrod6Tom Bayer7Oliver Nowak8Stefan O. Schönberg9Meike Weis10Department of Radiology and Nuclear Medicine, University Medical Center Mannheim, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, GermanyDepartment of Radiology and Nuclear Medicine, University Medical Center Mannheim, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, GermanyDepartment of Radiology and Nuclear Medicine, University Medical Center Mannheim, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, GermanyDepartment of Medical Statistics, Biomathematics and Information Processing, University Medical Center Mannheim, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, GermanyDepartment of Neonatology and Neonatal Intensive Care Medicine, Hospital Stuttgart, Kriegsbergstraße 60, 70174 Stuttgart, GermanyDepartment of Pediatric Surgery, University Medical Center Mannheim, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, GermanyDepartment of Pediatric Surgery, University Medical Center Mannheim, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, GermanyDepartment of Neonatology, University Medical Center Mannheim, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, GermanyDepartment of Obstetrics and Gynecology, University Medical Center Mannheim, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, GermanyDepartment of Radiology and Nuclear Medicine, University Medical Center Mannheim, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, GermanyDepartment of Radiology and Nuclear Medicine, University Medical Center Mannheim, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, GermanyObjective: 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 (<i>p</i> = 0.0054), as well as in children who developed CLD (<i>p</i> = 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 (<i>p</i> = 0.0824). The MSA and the pALV had no significant effect on survival (MSA: <i>p</i> = 0.4293, AUC = 0.56; pALV: <i>p</i> = 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.https://www.mdpi.com/2077-0383/13/1/268congenital diaphragmatic hernia (CDH)mediastinal shift angle (MSA)percentage area of left ventricle (pALV)prenatal diagnosis of CDHprognostic parameters CDHfetal MRI |
| spellingShingle | Greta Thater Lara Angermann Silviu-Viorel Virlan Christel Weiss Neysan Rafat Michael Boettcher Julia Elrod Tom Bayer Oliver Nowak Stefan O. Schönberg Meike Weis Fetal MRI-Based Mediastinal Shift Angle (MSA) and Percentage Area of Left Ventricle (pALV) as Prognostic Parameters for Congenital Diaphragmatic Hernia Journal of Clinical Medicine congenital diaphragmatic hernia (CDH) mediastinal shift angle (MSA) percentage area of left ventricle (pALV) prenatal diagnosis of CDH prognostic parameters CDH fetal MRI |
| title | Fetal MRI-Based Mediastinal Shift Angle (MSA) and Percentage Area of Left Ventricle (pALV) as Prognostic Parameters for Congenital Diaphragmatic Hernia |
| title_full | Fetal MRI-Based Mediastinal Shift Angle (MSA) and Percentage Area of Left Ventricle (pALV) as Prognostic Parameters for Congenital Diaphragmatic Hernia |
| title_fullStr | Fetal MRI-Based Mediastinal Shift Angle (MSA) and Percentage Area of Left Ventricle (pALV) as Prognostic Parameters for Congenital Diaphragmatic Hernia |
| title_full_unstemmed | Fetal MRI-Based Mediastinal Shift Angle (MSA) and Percentage Area of Left Ventricle (pALV) as Prognostic Parameters for Congenital Diaphragmatic Hernia |
| title_short | Fetal MRI-Based Mediastinal Shift Angle (MSA) and Percentage Area of Left Ventricle (pALV) as Prognostic Parameters for Congenital Diaphragmatic Hernia |
| title_sort | fetal mri based mediastinal shift angle msa and percentage area of left ventricle palv as prognostic parameters for congenital diaphragmatic hernia |
| topic | congenital diaphragmatic hernia (CDH) mediastinal shift angle (MSA) percentage area of left ventricle (pALV) prenatal diagnosis of CDH prognostic parameters CDH fetal MRI |
| url | https://www.mdpi.com/2077-0383/13/1/268 |
| work_keys_str_mv | AT gretathater fetalmribasedmediastinalshiftanglemsaandpercentageareaofleftventriclepalvasprognosticparametersforcongenitaldiaphragmatichernia AT laraangermann fetalmribasedmediastinalshiftanglemsaandpercentageareaofleftventriclepalvasprognosticparametersforcongenitaldiaphragmatichernia AT silviuviorelvirlan fetalmribasedmediastinalshiftanglemsaandpercentageareaofleftventriclepalvasprognosticparametersforcongenitaldiaphragmatichernia AT christelweiss fetalmribasedmediastinalshiftanglemsaandpercentageareaofleftventriclepalvasprognosticparametersforcongenitaldiaphragmatichernia AT neysanrafat fetalmribasedmediastinalshiftanglemsaandpercentageareaofleftventriclepalvasprognosticparametersforcongenitaldiaphragmatichernia AT michaelboettcher fetalmribasedmediastinalshiftanglemsaandpercentageareaofleftventriclepalvasprognosticparametersforcongenitaldiaphragmatichernia AT juliaelrod fetalmribasedmediastinalshiftanglemsaandpercentageareaofleftventriclepalvasprognosticparametersforcongenitaldiaphragmatichernia AT tombayer fetalmribasedmediastinalshiftanglemsaandpercentageareaofleftventriclepalvasprognosticparametersforcongenitaldiaphragmatichernia AT olivernowak fetalmribasedmediastinalshiftanglemsaandpercentageareaofleftventriclepalvasprognosticparametersforcongenitaldiaphragmatichernia AT stefanoschonberg fetalmribasedmediastinalshiftanglemsaandpercentageareaofleftventriclepalvasprognosticparametersforcongenitaldiaphragmatichernia AT meikeweis fetalmribasedmediastinalshiftanglemsaandpercentageareaofleftventriclepalvasprognosticparametersforcongenitaldiaphragmatichernia |