Mediastinal shift angle (MSA) measurement with MRI: a simple and effective tool for prenatal risk stratification in fetuses with congenital diaphragmatic hernia,European Radiology

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Mediastinal shift angle (MSA) measurement with MRI: a simple and effective tool for prenatal risk stratification in fetuses with congenital diaphragmatic hernia
European Radiology ( IF 4.7 ) Pub Date : 2022-09-30 , DOI: 10.1007/s00330-022-09142-2
Wen Ding ₁ , Yuanyuan Gu ₂ , Huiying Wu ₃ , Haiyu Wang ₃ , Xiaochun Zhang ₃ , Hongying Wang ₃ , Li Huang ₃ , Rui Zhang ₃ , Qiuming He ₄ , Wei Zhong ₄ , Junjian Lv ₅ , Bo Xia ₅ , Guanglan Zhang ₆ , Shanshan Mei ₆

Affiliation

Objectives

To investigate the predictive value of mediastinal shift angle (MSA) in congenital diaphragmatic hernia (CDH).

Methods

A retrospective analysis was performed on 87 fetuses with prenatally diagnosed left-sided CDH (LCDH) and 88 controls. MSA was measured on magnetic resonance imaging (MRI). Lung area to head circumference ratio (LHR), ratio of the observed/expected LHR (O/E LHR), total fetal lung volume (TFLV), and observed/expected total fetal lung volume (O/E TFLV) were also measured. Correlation of MSA with pulmonary hypertension (PH), extracorporeal membrane oxygenation (ECMO) use, duration of hospitalization and survival in neonates with CDH was analyzed. Performance of MSA in prediction of postnatal outcomes was compared with LHR, O/E LHR, TFLV, and O/E TFLV.

Results

There were significant differences in MSA values not only between the CDH group and the control group but also in CDH patients with different survival outcomes. MSA was inversely correlated with O/E LHR, O/E TFLV, and TFLV. MSA, LHR, O/E LHR, TFLV, and O/E TFLV could all be used to predict survival of CDH patients. In addition, the receiver operating characteristic (ROC) curve showed that the test performance of MSA was similar to that of TFLV, O/E TFLV, and O/E LHR, but superior to that of LHR. MSA was also correlated with PH, need for ECMO support, and duration of hospitalization.

Conclusion

MRI measurement of MSA can provide various prognostic information for prenatally diagnosed LCDH, in addition to postnatal survival. The test performance of MSA is similar to TFLV, O/E TFLV, and O/E LHR.

Key Points

• Mediastinal shift angle (MSA) can be measured quickly and reproducibly on MRI images.

• MSA could provide more prognostic information other than postnatal survival for LCDH with good test performance.

• MSA should be incorporated into prenatal risk stratification for LCDH to improve planning of postnatal management.

中文翻译：

MRI 纵隔偏移角 (MSA) 测量：一种简单有效的先天性膈疝胎儿产前风险分层工具

目标

探讨纵隔移位角（MSA）对先天性膈疝（CDH）的预测价值。

方法

对 87 例产前诊断为左侧 CDH (LCDH) 的胎儿和 88 例对照进行了回顾性分析。MSA 是在磁共振成像 (MRI) 上测量的。还测量了肺面积与头围比 (LHR)、观察到的/预期的 LHR 的比率 (O/E LHR)、胎儿肺总容积 (TFLV) 和观察到的/预期的胎儿肺总容积 (O/E TFLV)。分析了 CDH 新生儿 MSA 与肺动脉高压 (PH)、体外膜肺氧合 (ECMO) 使用、住院时间和存活率的相关性。将 MSA 在预测产后结果方面的表现与 LHR、O/E LHR、TFLV 和 O/E TFLV 进行了比较。

结果

MSA 值不仅在 CDH 组与对照组之间存在显着差异，而且在具有不同生存结果的 CDH 患者中也存在显着差异。MSA 与 O/E LHR、O/E TFLV 和 TFLV 呈负相关。MSA、LHR、O/E LHR、TFLV 和 O/E TFLV 均可用于预测 CDH 患者的生存。此外，接受者操作特征（ROC）曲线显示MSA的测试性能与TFLV、O/E TFLV和O/E LHR相似，但优于LHR。MSA 还与 PH、ECMO 支持需求和住院时间相关。