Eur Radiol

. 2022 Sep 30.

 doi: 10.1007/s00330-022-09142-2. Online ahead of print. https://pubmed.ncbi.nlm.nih.gov/36180644/

Mediastinal shift angle (MSA) measurement with MRI: a simple and effective tool for prenatal risk stratification in fetuses with congenital diaphragmatic hernia

Wen Ding ^# 1, Yuanyuan Gu ^# 2, Huiying Wu ^# 3, Haiyu Wang ^# 3, Xiaochun Zhang ³, Hongying Wang ³, Li Huang ³, Rui Zhang ³, Qiuming He ⁴, Wei Zhong ⁴, Junjian Lv ⁵, Bo Xia ⁵, Guanglan Zhang ⁶, Shanshan Mei ⁶

Affiliations expand

• PMID: 36180644
• DOI: 10.1007/s00330-022-09142-2

Abstract

Objectives: To investigate the predictive value of mediastinal shift angle (MSA) in congenital diaphragmatic hernia (CDH).

Methods: A retrospective analysis was performed on 87 fetuses with prenatally diagnosed left-sided CDH (LCDH) and 88 controls. MSA was measured on magnetic resonance imaging (MRI). Lung area to head circumference ratio (LHR), ratio of the observed/expected LHR (O/E LHR), total fetal lung volume (TFLV), and observed/expected total fetal lung volume (O/E TFLV) were also measured. Correlation of MSA with pulmonary hypertension (PH), extracorporeal membrane oxygenation (ECMO) use, duration of hospitalization and survival in neonates with CDH was analyzed. Performance of MSA in prediction of postnatal outcomes was compared with LHR, O/E LHR, TFLV, and O/E TFLV.

Results: There were significant differences in MSA values not only between the CDH group and the control group but also in CDH patients with different survival outcomes. MSA was inversely correlated with O/E LHR, O/E TFLV, and TFLV. MSA, LHR, O/E LHR, TFLV, and O/E TFLV could all be used to predict survival of CDH patients. In addition, the receiver operating characteristic (ROC) curve showed that the test performance of MSA was similar to that of TFLV, O/E TFLV, and O/E LHR, but superior to that of LHR. MSA was also correlated with PH, need for ECMO support, and duration of hospitalization.

Conclusion: MRI measurement of MSA can provide various prognostic information for prenatally diagnosed LCDH, in addition to postnatal survival. The test performance of MSA is similar to TFLV, O/E TFLV, and O/E LHR.

Key points: • Mediastinal shift angle (MSA) can be measured quickly and reproducibly on MRI images. • MSA could provide more prognostic information other than postnatal survival for LCDH with good test performance. • MSA should be incorporated into prenatal risk stratification for LCDH to improve planning of postnatal management.

Keywords: Congenital diaphragmatic hernia; Extracorporeal membrane oxygenation; Magnetic resonance imaging; Mediastinal shift angle; Pulmonary hypertension.

© 2022. The Author(s), under exclusive licence to European Society of Radiology.