Comparison of fetal lung area to head circumference ratio with lung volume in the prediction of postnatal outcome in diaphragmatic hernia

Objectives: To compare prediction of postnatal survival in isolated diaphragmatic hernia by prenatal two-dimensional (2D) versus three-dimensional (3D) sonographic assessment of the contralateral lung. Methods: The lung area to head circumference ratio (LHR) of the contralateral lung was measured and expressed as a percentage of the normal mean for gestation (O/E) in 47 fetuses with isolated diaphragmatic hernia at 26 (range, 21-36) weeks of gestation. The lung area was measured by tracing the limits of the lungs (LHR trace) and by multiplying the longest diameter by its perpendicular (LHR diameters). The contralateral lung volume was measured by the Virtual Organ Computer-Aided anaLysis method and the O/E was calculated. Regression analysis was used to determine the significance of the LHRs and volume in the prediction of postnatal survival. Results: The survival rate was 59.6% (28 of 47). There were significant associations between O/E LHR trace and O/E LHR diameters, and between each O/E LHR and O/E volume, but multiple regression analysis demonstrated that significant prediction of survival was provided only by O/E LHR trace and intrathoracic herniation of the liver. Conclusions: In diaphragmatic hernia prenatal prediction of postnatal outcome is better by 2D measurement of LHR trace than it is by 3D measurement of lung volume.