Romain Corroenne , Leticia Benitez Quintanilla , Luis Delgadillo Chabolla , Ahmed A. Nassr , Roopali Donepudi , Alice King , Rebecca M. Johnson , Pamela Ketwaroo , Amy R. Mehollin-Ray , Jessian L. Munoz , Michael Belfort , Magdalena Sanz Cortes
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This study aimed to evaluate whether GA determined by first-trimester dating or fetal size at imaging affects the ability of O/E-TFLV to predict 6-month survival in fetuses with isolated left-sided CDH.</div></div><div><h3>Methods</h3><div>Retrospective cohort study of fetuses with isolated left-sided CDH. O/E-TFLV was calculated using GA based on CRL (O/E-TFLV<sub>GA</sub>) or fetal size-determined GA (O/E-TFLV<sub>EFW</sub>) at the time of MRI. Prediction of survival was evaluated using ROC curves and logistic regression analyses adjusting by CDH severity and liver herniation.</div></div><div><h3>Results</h3><div>Ninety-seven fetuses underwent third-trimester MRI, with seventy-nine (81 %) also having second-trimester MRI. At six months, 80/97 (82.5 %) were alive. No significant differences were observed between O/E-TFLV<sub>GA</sub> and O/E-TFLV<sub>EFW</sub> during the second (31.5[2–74]% vs. 31.7[2.5–86]%, p = 0.71) or third trimester (33.6[0.1–134.3]% vs. 31.7[8–105]%, p = 0.55). Higher O/E-TFLV<sub>GA</sub> and higher O/E-TFLV<sub>EFW</sub> were associated with higher chances of survival (Second trimester: O/E-TFLV<sub>GA</sub>: Odds Ratio 1.09 [95 %CI: 1.02–1.20], p = 0.04; O/E-TFLV<sub>EFW</sub>: 1.10[1.01–1.20], p = 0.04; Third trimester: O/E-TFLV<sub>GA</sub>: 1.06[1.02–1.16], p = 0.04; O/E-TFLV<sub>EFW</sub>: 1.03[1.01–1.09], p = 0.04). No significant differences were found in predictive accuracy between O/E-TFLV<sub>GA</sub> and O/E-TFLV<sub>EFW</sub> based on Area Under the Curve (AUC) analysis (Second trimester: p = 0.65; Third trimester: p = 0.72).</div></div><div><h3>Conclusion</h3><div>There were no difference in the prediction of survival in isolated left-sided CDH fetuses using O/E-TFLV regardless of the method used to calculate O/E-TFLV.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"307 ","pages":"Pages 241-246"},"PeriodicalIF":1.9000,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Prediction of survival in fetuses with left-sided congenital diaphragmatic hernia: Which method is better using MRI observed to expected total fetal lung volumes?\",\"authors\":\"Romain Corroenne , Leticia Benitez Quintanilla , Luis Delgadillo Chabolla , Ahmed A. Nassr , Roopali Donepudi , Alice King , Rebecca M. Johnson , Pamela Ketwaroo , Amy R. Mehollin-Ray , Jessian L. Munoz , Michael Belfort , Magdalena Sanz Cortes\",\"doi\":\"10.1016/j.ejogrb.2025.02.032\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Objective</h3><div>The Observed to Expected Total Fetal Lung Volume (O/E-TFLV) ratio, calculated using fetal MRI, is a common method to assess pulmonary hypoplasia severity in congenital diaphragmatic hernia (CDH). However, its accuracy may be affected by uncertain gestational age (GA), inaccurate pregnancy dating, or abnormal fetal growth. This study aimed to evaluate whether GA determined by first-trimester dating or fetal size at imaging affects the ability of O/E-TFLV to predict 6-month survival in fetuses with isolated left-sided CDH.</div></div><div><h3>Methods</h3><div>Retrospective cohort study of fetuses with isolated left-sided CDH. O/E-TFLV was calculated using GA based on CRL (O/E-TFLV<sub>GA</sub>) or fetal size-determined GA (O/E-TFLV<sub>EFW</sub>) at the time of MRI. Prediction of survival was evaluated using ROC curves and logistic regression analyses adjusting by CDH severity and liver herniation.</div></div><div><h3>Results</h3><div>Ninety-seven fetuses underwent third-trimester MRI, with seventy-nine (81 %) also having second-trimester MRI. At six months, 80/97 (82.5 %) were alive. No significant differences were observed between O/E-TFLV<sub>GA</sub> and O/E-TFLV<sub>EFW</sub> during the second (31.5[2–74]% vs. 31.7[2.5–86]%, p = 0.71) or third trimester (33.6[0.1–134.3]% vs. 31.7[8–105]%, p = 0.55). Higher O/E-TFLV<sub>GA</sub> and higher O/E-TFLV<sub>EFW</sub> were associated with higher chances of survival (Second trimester: O/E-TFLV<sub>GA</sub>: Odds Ratio 1.09 [95 %CI: 1.02–1.20], p = 0.04; O/E-TFLV<sub>EFW</sub>: 1.10[1.01–1.20], p = 0.04; Third trimester: O/E-TFLV<sub>GA</sub>: 1.06[1.02–1.16], p = 0.04; O/E-TFLV<sub>EFW</sub>: 1.03[1.01–1.09], p = 0.04). 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引用次数: 0
摘要
目的利用胎儿MRI计算胎儿肺总容积（O/E-TFLV），是评估先天性膈疝肺发育不全严重程度的常用方法。然而，其准确性可能受到不确定的胎龄（GA），不准确的妊娠日期，或胎儿生长异常的影响。本研究旨在评估早期妊娠期测定的GA或成像时胎儿大小是否会影响O/E-TFLV预测孤立性左侧CDH胎儿6个月生存率的能力。方法对孤立性左侧CDH胎儿进行回顾性队列研究。O/E-TFLV采用基于MRI时CRL （O/E-TFLVGA）或胎儿大小确定GA （O/E-TFLVEFW）的遗传算法计算。采用ROC曲线和经CDH严重程度和肝疝调整的logistic回归分析评估生存预测。结果97例妊娠晚期进行MRI检查，其中79例（81%）妊娠中期也进行MRI检查。6个月时，80/97（82.5%）存活。O/E-TFLVGA和O/E-TFLVEFW在妊娠中期（31.5[2-74]%比31.7[2.5-86]%,p = 0.71）和妊娠晚期（33.6[0.1-134.3]%比31.7[8-105]%,p = 0.55）无显著差异。较高的O/E-TFLVGA和较高的O/E-TFLVEFW与较高的生存机会相关(妊娠中期：O/E-TFLVGA：优势比1.09 [95% CI: 1.02-1.20], p = 0.04；O/E-TFLVEFW: 1.10[1.01-1.20], p = 0.04；妊娠晚期：O/E-TFLVGA: 1.06[1.02-1.16], p = 0.04；O/E-TFLVEFW: 1.03[1.01-1.09], p = 0.04)。基于曲线下面积（AUC）分析，O/E-TFLVGA和O/E-TFLVEFW的预测准确性无显著差异(妊娠中期：p = 0.65；妊娠晚期：p = 0.72)。结论不论采用何种方法计算O/E-TFLV，对离体左侧CDH胎儿的生存预测均无差异。
Prediction of survival in fetuses with left-sided congenital diaphragmatic hernia: Which method is better using MRI observed to expected total fetal lung volumes?
Objective
The Observed to Expected Total Fetal Lung Volume (O/E-TFLV) ratio, calculated using fetal MRI, is a common method to assess pulmonary hypoplasia severity in congenital diaphragmatic hernia (CDH). However, its accuracy may be affected by uncertain gestational age (GA), inaccurate pregnancy dating, or abnormal fetal growth. This study aimed to evaluate whether GA determined by first-trimester dating or fetal size at imaging affects the ability of O/E-TFLV to predict 6-month survival in fetuses with isolated left-sided CDH.
Methods
Retrospective cohort study of fetuses with isolated left-sided CDH. O/E-TFLV was calculated using GA based on CRL (O/E-TFLVGA) or fetal size-determined GA (O/E-TFLVEFW) at the time of MRI. Prediction of survival was evaluated using ROC curves and logistic regression analyses adjusting by CDH severity and liver herniation.
Results
Ninety-seven fetuses underwent third-trimester MRI, with seventy-nine (81 %) also having second-trimester MRI. At six months, 80/97 (82.5 %) were alive. No significant differences were observed between O/E-TFLVGA and O/E-TFLVEFW during the second (31.5[2–74]% vs. 31.7[2.5–86]%, p = 0.71) or third trimester (33.6[0.1–134.3]% vs. 31.7[8–105]%, p = 0.55). Higher O/E-TFLVGA and higher O/E-TFLVEFW were associated with higher chances of survival (Second trimester: O/E-TFLVGA: Odds Ratio 1.09 [95 %CI: 1.02–1.20], p = 0.04; O/E-TFLVEFW: 1.10[1.01–1.20], p = 0.04; Third trimester: O/E-TFLVGA: 1.06[1.02–1.16], p = 0.04; O/E-TFLVEFW: 1.03[1.01–1.09], p = 0.04). No significant differences were found in predictive accuracy between O/E-TFLVGA and O/E-TFLVEFW based on Area Under the Curve (AUC) analysis (Second trimester: p = 0.65; Third trimester: p = 0.72).
Conclusion
There were no difference in the prediction of survival in isolated left-sided CDH fetuses using O/E-TFLV regardless of the method used to calculate O/E-TFLV.
期刊介绍：
The European Journal of Obstetrics & Gynecology and Reproductive Biology is the leading general clinical journal covering the continent. It publishes peer reviewed original research articles, as well as a wide range of news, book reviews, biographical, historical and educational articles and a lively correspondence section. Fields covered include obstetrics, prenatal diagnosis, maternal-fetal medicine, perinatology, general gynecology, gynecologic oncology, uro-gynecology, reproductive medicine, infertility, reproductive endocrinology, sexual medicine and reproductive ethics. The European Journal of Obstetrics & Gynecology and Reproductive Biology provides a forum for scientific and clinical professional communication in obstetrics and gynecology throughout Europe and the world.
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