Standardization of sonographic lung-to-head ratio measurements in isolated congenital diaphragmatic hernia: Impact on the reproducibility and efficacy to predict outcomes

Ingrid Schwach Werneck Britto, Nicolas Sananes, Oluyinka O. Olutoye, Darrell L. Cass, Haleh Sangi-Haghpeykar, Timothy C. Lee, Christopher I. Cassady, Amy Mehollin-Ray, Stephen Welty, Caraciolo Fernandes, Michael A. Belfort, Wesley Lee, Rodrigo Ruano

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11 Scopus citations

Abstract

Objectives - The purpose of this study was to evaluate the impact of standardization of the lung-to-head ratio measurements in isolated congenital diaphragmatic hernia on prediction of neonatal outcomes and reproducibility. Methods - We conducted a retrospective cohort study of 77 cases of isolated congenital diaphragmatic hernia managed in a single center between 2004 and 2012. We compared lung-to-head ratio measurements that were performed prospectively in our institution without standardization to standardized measurements performed according to a defined protocol. Results - The standardized lung-to-head ratio measurements were statistically more accurate than the nonstandardized measurements for predicting neonatal mortality (area under the receiver operating characteristic curve, 0.85 versus 0.732; P =.003). After standardization, there were no statistical differences in accuracy between measurements regardless of whether we considered observed-to-expected values (P >.05). Standardization of the lung-to-head ratio did not improve prediction of the need for extracorporeal membrane oxygenation (P >.05). Both intraoperator and interoperator reproducibility were good for the standardized lung-to-head ratio (intraclass correlation coefficient, 0.98 [95% confidence interval, 0.97-0.99]; bias, 0.02 [limits of agreement, -0.11 to +0.15], respectively). Conclusions - Standardization of lung-to-head ratio measurements improves prediction of neonatal outcomes. Further studies are needed to confirm these results and to assess the utility of standardization of other prognostic parameters.

Original languageEnglish (US)
Pages (from-to)1721-1727
Number of pages7
JournalJournal of Ultrasound in Medicine
Volume34
Issue number10
DOIs
StatePublished - Jan 1 2015
Externally publishedYes

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Keywords

  • Congenital diaphragmatic hernia
  • Fetal lung
  • Lung-to-head ratio
  • Obstetric ultrasound
  • Pulmonary hypoplasia
  • Standardization

ASJC Scopus subject areas

  • Radiological and Ultrasound Technology
  • Radiology Nuclear Medicine and imaging

Cite this

Britto, I. S. W., Sananes, N., Olutoye, O. O., Cass, D. L., Sangi-Haghpeykar, H., Lee, T. C., Cassady, C. I., Mehollin-Ray, A., Welty, S., Fernandes, C., Belfort, M. A., Lee, W., & Ruano, R. (2015). Standardization of sonographic lung-to-head ratio measurements in isolated congenital diaphragmatic hernia: Impact on the reproducibility and efficacy to predict outcomes. Journal of Ultrasound in Medicine, 34(10), 1721-1727. https://doi.org/10.7863/ultra.15.14.11064