Research: Assessment of the fetal lungs in utero

Am J Obstet Gynecol MFM

. 2022 Jul 17;100693.

 doi: 10.1016/j.ajogmf.2022.100693. Online ahead of print.

Assessment of the fetal lungs in utero

Carla L Avena-Zampieri 1Jana Hutter 2Mary Rutherford 2Anna Milan 3Megan Hall 1Alexia Egloff 2David F A Lloyd 2Surabhi Nanda 4Anne Greenough 5Lisa Story 6

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Antenatal diagnosis of abnormal pulmonary development has improved significantly over recent years due to progress in imaging techniques. 2D ultrasound is the mainstay of investigation of pulmonary pathology during pregnancy, providing good prognostication in conditions such as congenital diaphragmatic hernia; however, it is less validated in other high-risk groups such as congenital pulmonary airway malformation or preterm premature rupture of the membrane. 3D assessment of lung volume/size is now possible using ultrasound or magnetic resonance imaging; however, the use of these techniques is still limited, due to unpredictable fetal motion and such tools have again been inadequately validated in high-risk populations other than congenital diaphragmatic hernia. The advent of advanced, functional magnetic resonance imaging techniques such as diffusion and T2* imaging as well as development of post-processing pipelines which facilitate motion correction, have enabled not only more accurate evaluation of pulmonary size, but also assessment of tissue microstructure and perfusion. In the future, fetal magnetic resonance imaging may have an increasing role, in the prognostication of pulmonary abnormalities as well as monitoring current and future antenatal therapies to enhance lung development. This review aims to examine the current imaging methods available to assess antenatal lung development and outline possible future directions.

Keywords: Fetal; MRI; Pulmonary development; Ultrasound.

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