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Rosales JP, Flores MEY. Ultrasonographic measurement of mediastinal shift angle for the prediction of postnatal survival in fetuses with isolated left congenital diaphragmatic hernia. Int J Gynaecol Obstet 2024; 165:474-479. [PMID: 38189145 DOI: 10.1002/ijgo.15348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 12/15/2023] [Accepted: 12/18/2023] [Indexed: 01/09/2024]
Abstract
OBJECTIVE The main objective of the study was to determine if ultrasonographic measurement of mediastinal shift angle (MSA) can predict postnatal survival in fetuses with isolated left congenital diaphragmatic hernia (CDH). This relatively new technique may be used to enhance antenatal prediction of survival in fetuses with CDH. METHODS A retrospective cross-sectional study was conducted at the Philippine Children's Medical Center involving 16 cases with prenatally diagnosed isolated left CDH and 60 controls with normal fetuses. The cases with prenatally diagnosed isolated left CDH were allocated into two groups: Group A (survivors) and group B (non-survivors). For all fetuses (study and control groups), MSA was determined independently by two operators. The diagnostic capacity of MSA was assessed using the receiver operating characteristic curve. RESULTS The mean MSA for the control group was 17.18°. Among CDH cases, the mean MSA was 33.04° and 37.57° for survivors and non-survivors, respectively. Results showed that MSA significantly predicted the probability of neonatal survival status (OR = 0.46, P = 0.021). The best cutoff score of MSA based on the receiver operating characteristic curve was 33.80° with 87.50% sensitivity and specificity. CONCLUSION MSA has the potential to enhance antenatal prediction of survival in fetuses with CDH and may serve as a guide in prenatal counseling and evaluation of the need for in-utero treatment or postnatal procedures.
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Affiliation(s)
- Jacel P Rosales
- Section of Perinatology, Philippine Children's Medical Center, Quezon City, Philippines
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Wang X, Shi Q, Pan W, Wang W, Wu W, Liu M, Xie W, Wang X, Wang J. Mediastinal Shift Angle in Fetal MRI Is Associated With Prognosis, Severity, and Cardiac Underdevelopment in Left Congenital Diaphragmatic Hernia. Front Pediatr 2022; 10:907724. [PMID: 35799694 PMCID: PMC9253291 DOI: 10.3389/fped.2022.907724] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 05/20/2022] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Fetal MRI has played an essential role in the evaluation and management of congenital diaphragmatic hernia (CDH). We aimed to investigate whether the mediastinal shift angle (MSA) value was associated with the prognosis and the severity of left CDH and explore the relationship between the MSA value and fetal and neonatal cardiac structures and functions. METHODS From January 2012 to December 2020, the fetal MSA values of left CDH in our institution were retrospectively measured. Other prenatal parameters and clinical outcomes of them are collected. We also measured the fetal and postnatal echocardiography parameters to analyze linear correlation with MSA values. RESULTS A total of 94 patients with left CDH were included. MSA was significantly higher in the deceased group than in the survived group [((38.3 ± 4.7)° vs. 32.3 ± 5.3)°, p < 0.001]. The MSA value of the high-risk defect group [CDH Study Group (CDHSG) C/D type] was significantly higher than that of the low-risk defect group [CDHSG A/B type; (36.0 ± 4.9)° vs. (30.1 ± 4.8)°, p < 0.001]. The AUC for severity was 0.766 (95% CI, 0.661-0.851, p < 0.0001) and the best cut-off value for MSA was 30.7°. Higher MSA correlates with decreased fetal Z-score of left ventricle (LV) width, the diameter of the mitral valve (MV), peak velocity of MV and tricuspid valve (TV), and neonatal LV end-diastolic diameter (LVEDD) and velocity of tricuspid regurgitation (TR; p < 0.05). CONCLUSION A high MSA value can effectively predict high-risk defects and high mortality of left CDH. The higher the MSA value, the worse the neonatal conditions, the respiratory and cardiovascular prognosis. The MSA values could reflect the level of left heart underdevelopment, including decreased dimensions and diastolic dysfunction of the left ventricle.
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Affiliation(s)
- Xueyao Wang
- Department of Pediatric Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qi Shi
- Department of Pediatric Cardiology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Weihua Pan
- Department of Pediatric Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Weipeng Wang
- Department of Pediatric Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wenjie Wu
- Department of Pediatric Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ming Liu
- Department of Radiology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wei Xie
- Department of Pediatric Intensive Care Unit, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xinyun Wang
- Department of Radiology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jun Wang
- Department of Pediatric Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Romiti A, Viggiano M, Savelli S, Salvi S, Vicario R, Vassallo C, Valfrè L, Tomà P, Bonito M, Lanzone A, Bagolan P, Caforio L. Comparison of mediastinal shift angles obtained with ultrasound and magnetic resonance imaging in fetuses with isolated left sided congenital diaphragmatic hernia. J Matern Fetal Neonatal Med 2020; 35:269-274. [PMID: 31973612 DOI: 10.1080/14767058.2020.1716714] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objectives: To compare ultrasound (US) and magnetic resonance imaging (MRI) in the assessment of mediastinal shift angles (MSAs) in fetuses affected by isolated left congenital diaphragmatic hernia (CDH). The use of MRI-MSA and US-MSA as prognostic factor for postnatal survival in fetal left CDH was also explored.Methods: This was an observational study of 29 fetuses with prenatally diagnosed isolated left CDH, assessed with both US and MRI examinations between January 2015 and December 2018. The US-MSA measurements performed within 2 weeks from the MRI assessment were considered for the analysis. The primary outcome was the postnatal survival rate.Results: No significant difference between US and MRI MSAs was detected (p = .419). Among the 29 cases, there were 21 alive infants, for an overall postnatal survival rate of 72.41%. After stratifying for postnatal survival, the best cutoffs with the highest discriminatory power in terms of sensibility and specificity were 42.1° for the US-MSA and 39.1° for the MRI-MSA. The performance of MRI-MSA in predicting postnatal survival was close to that of US-MSA in terms of sensitivity (62.5 versus 50.0%), specificity (80.9 versus 90.5%), positive predictive value (55.6 versus 66.7%), negative predictive value (85.0 versus 82.6%) and accuracy (75.9 versus 79.3%). There was no statistically significant difference between the two modalities (p > .05 for all).Conclusions: MRI and US can be interchangeably used for the assessment of MSA in prenatally diagnosed isolated left CDH. Moreover, MSA measured by both US and MRI was confirmed to be correlated with perinatal outcome in terms of survival.
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Affiliation(s)
- Anita Romiti
- Department of Medical and Surgical Neonatology, Fetal Medicine and Surgery Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Milena Viggiano
- Department of Medical and Surgical Neonatology, Fetal Medicine and Surgery Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Sara Savelli
- Department of Diagnostic Imaging, Pediatric Radiology, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Silvia Salvi
- Department of Medical and Surgical Neonatology, Fetal Medicine and Surgery Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy.,Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, UOC di Patologia Ostetrica, Fondazione Policlinico Universitario "A Gemelli" IRCCS, Rome, Italy
| | - Roberta Vicario
- Department of Medical and Surgical Neonatology, Fetal Medicine and Surgery Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Chiara Vassallo
- Department of Medical and Surgical Neonatology, Fetal Medicine and Surgery Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy.,Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, UOC di Patologia Ostetrica, Fondazione Policlinico Universitario "A Gemelli" IRCCS, Rome, Italy
| | - Laura Valfrè
- Department of Medical and Surgical Neonatology, Neonatal Surgery Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Paolo Tomà
- Department of Diagnostic Imaging, Pediatric Radiology, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Marco Bonito
- Department of Obstetrics and Gynecology, San Pietro Fatebenefratelli Hospital, Rome, Italy
| | - Antonio Lanzone
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, UOC di Patologia Ostetrica, Fondazione Policlinico Universitario "A Gemelli" IRCCS, Rome, Italy.,Istituto di Clinica Ostetrica e Ginecologica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Pietro Bagolan
- Department of Medical and Surgical Neonatology, Fetal Medicine and Surgery Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy.,Department of Medical and Surgical Neonatology, Neonatal Surgery Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Leonardo Caforio
- Department of Medical and Surgical Neonatology, Fetal Medicine and Surgery Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
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