Assessment of fetal lung volumes and liver herniation with magnetic resonance imaging in congenital diaphragmatic hernia

OBJECTIVE: We evaluated the use of fetal magnetic resonance imaging in pred icting outcomes after ultrasonographic diagnosis of left-sided congenital d iaphragmatic hernia. STUDY DESIGN: Forty-one pregnant women carrying fetuses with congenital dia phragmatic hernia underwent 43 magnetic resonance imaging scans. Lung volum es were calculated by summing the areas on 6-mm axial sections. The presenc e or absence of liver herniation was noted. A liver/diaphragm ratio was obt ained by using the distances from the superior aspect of the liver and the diaphragmatic remnant to the apex of the chest. RESULTS: Mean gestational age was 26 weeks and overall survival was 59%. Ne ither right, left, nor total lung volume measurements were predictive of su rvival. Liver herniation into the left side of the chest was predictive of outcome at P < .05. The liver/diaphragm ratio was predictive of outcome at P = .03. CONCLUSION: Fetal magnetic resonance imaging permits calculation of lung vo lumes, but these volumes are not predictive of outcome. However, both the p resence of liver herniation and the volume of liver within the chest, as re flected by the liver/diaphragm ratio, help predict outcome in left-sided co ngenital diaphragmatic hernia.