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Comparison of ultrasound and magnetic resonance imaging parameters in predicting survival in isolated left‐sided congenital diaphragmatic hernia
Author(s) -
Bebbington M.,
Victoria T.,
Danzer E.,
Moldenhauer J.,
Khalek N.,
Johnson M.,
Hedrick H.,
Adzick N. S.
Publication year - 2014
Publication title -
ultrasound in obstetrics and gynecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.202
H-Index - 141
eISSN - 1469-0705
pISSN - 0960-7692
DOI - 10.1002/uog.13271
Subject(s) - medicine , receiver operating characteristic , congenital diaphragmatic hernia , ultrasound , magnetic resonance imaging , nuclear medicine , logistic regression , area under the curve , diaphragmatic breathing , radiology , prenatal diagnosis , fetus , pregnancy , pathology , alternative medicine , biology , genetics
Objective To compare test characteristics of ultrasound‐ and magnetic resonance imaging ( MRI )‐derived parameters in predicting newborn survival in cases of isolated left‐sided congenital diaphragmatic hernia ( CDH ) . Methods This was a retrospective study involving 85 fetuses with an isolated left CDH . All had detailed prenatal evaluation, prenatal care, delivery and postnatal care at a single institution. Ultrasound images were reviewed to allow calculation of the lung‐to‐head ratio ( LHR ) and the observed/expected LHR (O/E- LHR ), and MRI images were reviewed to determine the observed/expected total lung volume (O/E- TLV ) and the percent herniated liver (% HL ). Univariable logistic regression was used to evaluate each parameter for its ability to predict survival. Receiver–operating characteristics ( ROC ) curves were constructed and test characteristics were determined for each parameter as a predictor of survival . Results The overall survival for all fetuses included was 65%. Pseudo ‐ R 2 values for all parameters were similar and were statistically significant as predictors of survival, with %HL having the highest pseudo ‐ R 2 , of 0.28. ROC curve analysis showed ultrasound‐determined parameters (LHR and O/E-LHR) to have a similar area under the curve (AUC), of 0.70, whilst MRI parameters (O/E-TLV and %HL) had AUC values of 0.82 and 0.84, respectively. At ROC‐curve‐determined cut‐off values, MRI parameters had better test characteristics than did ultrasound parameters. At a standardized 5% false‐positive rate, %HL performed best, with a sensitivity of 0.54 and a specificity of 0.95. At clinically employed cut‐off values, sensitivity was similar for all parameters but MRI parameters provided the best combination of sensitivity and specificity, as evidenced by better likelihood ratios . Conclusions A variety of measures have been proposed as antenatal predictors of survival in CDH. Ultrasound parameters function at a similar level, whereas MRI‐determined parameters appear to offer better predictive value. Copyright © 2013 ISUOG. Published by John Wiley & Sons Ltd .