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

25 Citations (Scopus)

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 - Jan 1 2014
Externally publishedYes

Fingerprint

Fetus
Magnetic Resonance Imaging
Lung
Hydrops Fetalis
Intubation
ROC Curve
Area Under Curve
Counseling
Morbidity
Sensitivity and Specificity
Pregnancy

Keywords

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

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health

Cite this

Zamora, I. J., Sheikh, F., Cassady, C. I., Olutoye, O. O., Mehollin-Ray, A. R., Ruano, R., ... 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

Fetal MRI lung volumes are predictive of perinatal outcomes in fetuses with congenital lung masses. / Zamora, Irving J.; Sheikh, Fariha; Cassady, Christopher I.; Olutoye, Oluyinka O.; Mehollin-Ray, Amy R.; Ruano, Rodrigo; Lee, Timothy C.; Welty, Stephen E.; Belfort, Michael A.; Ethun, Cecilia G.; Kim, Michael E.; Cass, Darrell L.

In: Journal of Pediatric Surgery, Vol. 49, No. 6, 01.01.2014, p. 853-858.

Research output: Contribution to journalArticle

Zamora, IJ, Sheikh, F, Cassady, CI, Olutoye, OO, Mehollin-Ray, AR, Ruano, R, Lee, TC, Welty, SE, Belfort, MA, Ethun, CG, Kim, ME & Cass, DL 2014, 'Fetal MRI lung volumes are predictive of perinatal outcomes in fetuses with congenital lung masses', Journal of Pediatric Surgery, vol. 49, no. 6, pp. 853-858. https://doi.org/10.1016/j.jpedsurg.2014.01.012
Zamora, Irving J. ; Sheikh, Fariha ; Cassady, Christopher I. ; Olutoye, Oluyinka O. ; Mehollin-Ray, Amy R. ; Ruano, Rodrigo ; Lee, Timothy C. ; Welty, Stephen E. ; Belfort, Michael A. ; Ethun, Cecilia G. ; Kim, Michael E. ; Cass, Darrell L. / Fetal MRI lung volumes are predictive of perinatal outcomes in fetuses with congenital lung masses. In: Journal of Pediatric Surgery. 2014 ; Vol. 49, No. 6. pp. 853-858.
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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.",
keywords = "CCAM, Congenital lung malformation, CPAM, Fetal lung volumes, Fetal MRI, Perinatal outcomes, Risk stratification",
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T1 - Fetal MRI lung volumes are predictive of perinatal outcomes in fetuses with congenital lung masses

AU - Zamora, Irving J.

AU - Sheikh, Fariha

AU - Cassady, Christopher I.

AU - Olutoye, Oluyinka O.

AU - Mehollin-Ray, Amy R.

AU - Ruano, Rodrigo

AU - Lee, Timothy C.

AU - Welty, Stephen E.

AU - Belfort, Michael A.

AU - Ethun, Cecilia G.

AU - Kim, Michael E.

AU - Cass, Darrell L.

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N2 - 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.

AB - 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.

KW - CCAM

KW - Congenital lung malformation

KW - CPAM

KW - Fetal lung volumes

KW - Fetal MRI

KW - Perinatal outcomes

KW - Risk stratification

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