EP06.34: O/E LHR at ultrasound versus observed‐to‐expected total fetal lung volume at MR imaging in the prediction of survival in fetuses with left‐sided congenital diaphragmatic hernia

To assess the value of observed-to-expected (O/E) lung area to head circumference ratio (LHR) at ultrasound versus total fetal lung volume (TFLV) at MRI and compare them for the prediction of postnatal survival in fetuses with left-sided congenital diaphragmatic hernia (CDH). This was a multicentre retrospective study including fetuses with CDH who had ultrasound and MRI examination and were expectantly managed in Mannheim in Germany and in 5 other European centres. All MRI lung volumes were measured by two blinded operators. Multiple logistic regression analyses examined the effect on survival of various perinatal variables including the centre. In left-sided CDH and intrathoracic herniation of the liver, for patients from Mannheim and those from other European centres separately, receiver operating characteristic (ROC) curves compared O/E TFLV and O/E LHR in the prediction of postnatal survival. 309 patients were included from Mannheim and 116 from the 5 other European centres. Survival rates were lower in left-sided CDH (odds ratio (OR) 0.349; p = 0.033), those with intrathoracic liver (OR 0.297; p = 0.001), and higher with bigger O/E TFLV (OR 1.123; p < 0.001), advanced gestational age at birth (OR 1.294; p = 0.013) and when born Mannheim (OR 7.560; p =< 0.001). In Mannheim, in left-sided CDH with intrathoracic liver, pairwise comparison of ROC curves showed no significant difference (0.025, p = 0.610) between the areas under the ROC curves for the prediction of postnatal survival between O/E TFLV and O/E LHR whereas there was a significant difference (0.056, p = 0.033) in other European centres. In fetuses with left-sided CDH, the predictive value of postnatal survival of O/E TFLV at MR imaging and O/E-LHR at ultrasound is similar in Mannheim but O/E TFLV has a better predictive value compared to O/E LHR in the five other European centers. One explanation could be the significantly higher survival rate of infants with CDH born in Mannheim compared to those managed in other centres.