Fetal MRI lung volumes are predictive of perinatal outcomes in fetuses with congenital lung masses

Irving J. Zamora, Fariha Sheikh, Christopher I. Cassady, Oluyinka O. Olutoye, Amy R. Mehollin-Ray, Rodrigo Ruano, Timothy C. Lee, Stephen E. Welty, Michael A. Belfort, Cecilia G. Ethun, Michael E. Kim, Darrell L. Cass

Research output: Contribution to journalArticle

30 Scopus citations

Abstract

Purpose The purpose of this study was to evaluate fetal magnetic resonance imaging (MRI) as a modality for predicting perinatal outcomes and lung-related morbidity in fetuses with congenital lung masses (CLM). Methods The records of all patients treated for CLM from 2002 to 2012 were reviewed retrospectively. Fetal MRI-derived lung mass volume ratio (LMVR), observed/expected normal fetal lung volume (O/E-NFLV), and lesion-to-lung volume ratio (LLV) were calculated. Multivariate regression and receiver operating characteristic analyses were applied to determine the predictive accuracy of prenatal imaging. Results Of 128 fetuses with CLM, 93% (n = 118) survived. MRI data were available for 113 fetuses. In early gestation (< 26 weeks), MRI measurements of LMVR and LLV correlated with risk of fetal hydrops, mortality, and/or need for fetal intervention. In later gestation (> 26 weeks), LMVR, LLV, and O/E-NFLV correlated with neonatal respiratory distress, intubation, NICU admission and need for neonatal surgery. On multivariate regression, LMVR was the strongest predictor for development of fetal hydrops (OR: 6.97, 1.58-30.84; p = 0.01) and neonatal respiratory distress (OR: 12.38, 3.52-43.61; p ≤ 0.001). An LMVR > 2.0 predicted worse perinatal outcome with 83% sensitivity and 99% specificity (AUC = 0.94; p < 0.001). Conclusion Fetal MRI volumetric measurements of lung masses and residual normal lung are predictive of perinatal outcomes in fetuses with CLM. These data may assist in perinatal risk stratification, counseling, and resource utilization.

Original languageEnglish (US)
Pages (from-to)853-858
Number of pages6
JournalJournal of pediatric surgery
Volume49
Issue number6
DOIs
StatePublished - Jun 2014

Keywords

  • CCAM
  • CPAM
  • Congenital lung malformation
  • Fetal MRI
  • Fetal lung volumes
  • Perinatal outcomes
  • Risk stratification

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health

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    Zamora, I. J., Sheikh, F., Cassady, C. I., Olutoye, O. O., Mehollin-Ray, A. R., Ruano, R., Lee, T. C., Welty, S. E., Belfort, M. A., Ethun, C. G., Kim, M. E., & Cass, D. L. (2014). Fetal MRI lung volumes are predictive of perinatal outcomes in fetuses with congenital lung masses. Journal of pediatric surgery, 49(6), 853-858. https://doi.org/10.1016/j.jpedsurg.2014.01.012