胎儿MRI肺体积及纵隔偏移角预测左侧先天性膈疝预后的初步研究

Preliminary study on the value of fetal MRI lung volume and mediastinal shift angle for predicting prognosis of left congenital diaphragmatic hernia

目的探讨基于胎儿MRI测量的肺体积及纵隔偏移角(MSA)预测先天性膈疝(CDH)预后的价值。方法回顾性收集2016年9月至2022年1月在上海交通大学附属新华医院行胎儿MRI的左侧CDH胎儿。共65例,MRI检出CDH的孕周为29(26,35)周。基于胎儿MRI图像测量胎儿实际肺体积和MSA,并按胎龄计算实际/预期肺体积(o/eFLV)。收集患儿出生至出院相关临床数据,并根据患儿离院时预后分为存活组与死亡组,其中存活组54例、死亡组11例。采用独立样本t检验比较存活组与死亡组间o/eFLV和MSA的差异,绘制受试者操作特征曲线评价o/eFLV和MSA预测左侧CDH预后的价值。结果存活组o/eFLV为51.5%±18.3%,高于死亡组(27.8%±4.4%),差异有统计学意义(t=8.29,P<0.001)。存活组MSA为33.1°±1.2°,小于死亡组(41.8°±2.7°),差异有统计学意义(t=-11.15,P<0.001)。o/eFLV预测CDH存活或死亡的曲线下面积(AUC)为0.939(95%CI 0.851~0.983),截断值为33.8%,灵敏度为100%,特异度为88.9%。MSA的AUC为0.998(95%CI 0.941~1.000),截断值为37.2°,灵敏度为100%,特异度为98.2%。结论基于胎儿MRI测量的o/eFLV及MSA可有效预测左侧CDH胎儿预后。

Objective To explore the value of fetal lung volume and mediastinal shift angle(MSA)based on fetal MRI in predicting the prognosis of congenital diaphragmatic hernia(CDH).Methods Fetuses with left CDH that did fetal MRI in Xinhua Hospital Affiliated with Shanghai Jiao Tong University School of Medicine from September 2016 to January 2022 were retrospectively collected.There were 65 patients,and their gestational age was 29(26,35)weeks when they were diagnosed with left CDH by MRI.Observed fetal lung volume and MSA were measured based on fetal MRI,and observed/expected lung volume(o/eFLV)based on gestational age was calculated.The clinical data were collected from birth to discharge,and patients were divided into survival group and death group in case of prognosis at discharge,with 54 cases in the survival group and 11 cases in the death group.The student′s t test was used to compare the difference of o/eFLV and MSA between the survival group and the death group,and the receiver operating characteristic(ROC)curve was used to evaluate the value of o/eFLV and MSA in predicting the prognosis of left CDH.Results The o/eFLV of the survival group was 51.5%±18.3%,higher than that of the death group(27.8%±4.4%),and the difference was significant(t=8.29,P<0.001).The MSA of the survival group was 33.1°±1.2°,lower than that of the death group(41.8°±2.7°),and the difference was significant(t=-11.15,P<0.001).The area under the ROC curve(AUC)of o/eFLV to predict the fetal survival or death was 0.939(95%CI 0.851-0.983),the cutoff value was 33.8%,the sensitivity was 100%,the specificity was 88.9%.The AUC of MSA was 0.998(95%CI 0.941-1.000),the cutoff value was 37.2°,the sensitivity was 100%,the specificity was 98.2%.Conclusions The o/eFLV and MSA that were measured based on fetal MRI can effectively predict the fetus′s prognosis with left CDH.