BJOG
. 2025 Dec 22.
doi: 10.1111/1471-0528.70120. Online ahead of print. https://pubmed.ncbi.nlm.nih.gov/41424179/
Qualitative Assessment of Foetal Lung Size in Left Congenital Diaphragmatic Hernia Using Ultrasound and MRI: A Retrospective Cohort Study
Shiri Shinar 1, Dilkash Kajal 2, Sarah Johnson 2, Anna Otvodenko 1, Seungwoo Lee 3, Priscilla P L Chiu 4, Johannes Keunen 1, Tim Van Mieghem 1, Greg Ryan 1, Prakesh S Shah 3 5, Nimrah Abbasi 1
Affiliations Expand
- PMID: 41424179
- DOI: 10.1111/1471-0528.70120
Abstract
Objective: To evaluate the reliability of qualitative foetal lung size assessments on ultrasound (US) and MRI in left congenital diaphragmatic hernia (CDH) and their correlation with quantitative metrics and neonatal mortality.
Design: Retrospective cohort study.
Setting: Single tertiary center, 2008-2020.
Population: A total of 103 cases of prenatally diagnosed isolated left CDH underwent postnatal active care.
Methods: Two independent reviewers performed qualitative foetal lung size assessments on US and MRI. Interrater agreement was assessed, and correlations were determined between qualitative assessments, quantitative metrics (observed-to-expected lung-to-head ratio [o/e LHR] and observed-to-expected total Foetal lung volume [o/e TFLV]), and neonatal mortality.
Main outcome measures: Interrater agreement and correlation between qualitative and quantitative assessments of lung size and neonatal mortality.
Results: A total of 74 cases with both US and MRI imaging were included. Interrater agreement for qualitative lung size assessment was strong for US (weighted kappa: 0.80, 95% CI 0.68-0.93) and moderate for MRI (Cohen’s kappa: 0.48, 95% CI 0.30-0.66). Both modalities showed a strong correlation between qualitative and quantitative lung size assessments. On US, qualitative and quantitative assessments had similar associations with neonatal mortality (Spearman’s correlation: 0.44 for each reviewer vs. 0.49). On MRI, quantitative metrics correlated more strongly with neonatal mortality than qualitative assessment (Cramér’s V: 0.44 vs. 0.34-0.35).
Conclusions: Qualitative foetal lung size assessment, by US more so than MRI, is a reliable and reproducible tool that correlates with established quantitative metrics and neonatal mortality. These findings support its role as a complementary method for prenatal risk stratification in left CDH.
Keywords: CDH; MRI; congenital diaphragmatic hernia; correlation; foetal lungs; neonatal mortality; pulmonary hypoplasia; qualitative; ultrasound.
© 2025 The Author(s). BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd.
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