Prenatal MR imaging of congenital diaphragmatic hernias: association of MR fetal lung volume with the need for postnatal prosthetic patch repair.

[congenital diaphragmatic hernia]

To assess whether the need for postnatal prosthetic patch repair of the diaphragmatic defect in neonates with a congenital diaphragmatic hernia (CDH ) is associated with the antenatal measured observed -to -expected magnetic resonance fetal lung volume (o /e MR-FLV ).The o /e MR-FLV was calculated in 247 fetuses with isolated CDH . Logistic regression analysis was used to assess the prognostic value of the individual o /e MR-FLV for association with the need for postnatal patch repair .Seventy -seven percent (77 %) of patients with a CDH (190 /247 ) required prosthetic patch repair and the defect was closed primarily in 23 % (57 /247 ). Patients requiring a patch had a significantly lower o /e MR-FLV (27 .7 ± 10 .2 %) than patients with primary repair (40 .8 ± 13 .8 %, p < 0 .001 , AUC = 0 .786 ). With an o /e MR-FLV of 20 %, 92 % of the patients required patch repair , compared to only 24 % with an o /e MR-FLV of 60 %. The need for a prosthetic patch was further influenced by the fetal liver position (herniation /no herniation ) as determined by magnetic resonance imaging (MRI ; p < 0 .001 ). Fetal liver position , in addition to the o /e MR-FLV , improves prognostic accuracy (AUC = 0 .827 ).Logistic regression analysis based on the o /e MR-FLV is useful for prenatal estimation of the prosthetic patch requirement in patients with a CDH . In addition to the o /e MR-FLV , the position of the liver as determined by fetal MRI helps improve prognostic accuracy .• The o /e MR-FLV is associated with the need for postnatal patch repair in CDH . • The need for a patch is associated with a significantly lower o /e MR-FLV (p < 0 .001 ). • The patch requirement is also influenced by fetal liver position . • Fetal liver position , in addition to the o /e MR-FLV , improves prognostic accuracy . • CDH -fetuses with a high probability for patch requirement can be identified prenatally .