BackgroundExtracorporeal membrane oxygenation (ECMO), has partly improved congenital diaphragmatic hernia (CDH) outcomes, yet the overall morbidity and mortality remain high. Existing prenatal indicators for CDH fetuses are operator‐dependent, time‐consuming, or less accurate, a new simple and accurate indicator to indicate adverse events in CDH patients is needed.PurposeTo propose and assess the association of a new MRI parameter, the relative mediastinal displacement index (RMDI), with adverse events including in‐hospital deaths or the need for ECMO in fetuses with isolated left CDH (iLCDH).Study TypeRetrospective analysis.SubjectsOne hundred thirty‐nine fetuses were included in the iLCDH group (24 with adverse events and 115 without) and 257 fetuses were included in the control group from two centers in Guangzhou.Field Strength/Sequence3.0 T, T2WI‐TRUFI; 1.5 T, T2WI‐FIESTA.AssessmentThree operators independently measured the , , and DH on the axial images. The calculation formula of the RMDI was ( + )/DH.Statistical TestsThe independent sample t test, Mann–Whitney U test, Chi‐square test, Chi‐square test continuity correction, Fisher's test, linear regression analysis, logistic regression analysis, intraclass correlation coefficient, receiver operating characteristic curve analysis, and Delong test. A P value <0.05 was considered statistically significant.ResultsThe RMDI did not change with gestational age in the iLCDH group (with [P = 0.189] and without [P = 0.567] adverse events) and the control group (P = 0.876). There were significant differences in RMDI between the iLCDH group (0.89 [0.65, 1.00]) and the control group (−0.23 [−0.34, −0.16]). In the iLCDH group, RMDI was the only indicator left for indicating adverse events, and the best cutoff value was 1.105. Moreover, there was a significant difference in diagnostic accuracy between the RMDI (AUC = 0.900) and MSA (AUC = 0.820), LHR (AUC = 0.753), o/e LHR (AUC = 0.709), and o/e TFLV (AUC = 0.728), respectively.Data ConclusionThe RMDI is expected to be a simple and accurate tool for indicating adverse events in fetuses with iLCDH.Evidence Level4Technical EfficacyStage 1

中文翻译：

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相对纵隔位移指数 (RMDI)：孤立性左侧先天性膈疝胎儿不良事件的产前 MRI 指标

背景体外膜肺氧合（ECMO）部分改善了先天性膈疝（CDH）的结局，但总体发病率和死亡率仍然很高。现有的 CDH 胎儿产前指标依赖于操作员、耗时或不太准确，需要一种新的简单而准确的指标来指示 CDH 患者的不良事件。目的提出并评估新的 MRI 参数（相对纵隔）的关联位移指数 (RMDI)，不良事件包括院内死亡或孤立性左 CDH (iLCDH) 胎儿需要 ECMO。研究类型回顾性分析。受试者 iLCDH 组包括 139 名胎儿（24 名胎儿发生不良事件）广州两个中心的115个胎儿和257个胎儿被纳入对照组。Field Strength/Sequence3.0 T，T2WI-TRUFI；1.5 T、T2WI-FIESTA.评估三名操作员独立测量 、 和 DH在轴向图像上。RMDI的计算公式为(+)/DH.统计检验独立样本t测试，曼-惠特尼U检验、卡方检验、卡方检验连续性校正、Fisher 检验、线性回归分析、Logistic 回归分析、组内相关系数、受试者工作特征曲线分析和 Delong 检验。A磷值<0.05被认为具有统计学意义。结果iLCDH组中RMDI不随胎龄而变化（[磷= 0.189] 并且没有 [磷= 0.567] 不良事件）和对照组（磷= 0.876）。iLCDH 组 (0.89 [0.65, 1.00]) 和对照组 (−0.23 [−0.34, -0.16]) 之间的 RMDI 存在显着差异。在iLCDH组中，RMDI是唯一指示不良事件的指标，最佳截断值为1.105。此外，RMDI (AUC = 0.900) 和 MSA (AUC = 0.820)、LHR (AUC = 0.753)、o/e LHR (AUC = 0.709) 和 o/e TFLV (AUC) 之间的诊断准确性存在显着差异。 = 0.728），分别。数据结论 RMDI 有望成为指示 iLCDH 胎儿不良事件的简单而准确的工具。证据级别 4 技术功效阶段 1