OP22.03: Fetal brain MRI: novel classification and contribution to sonography (original) (raw)
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Fetal Lung Maturity Assessment With MRI Fetal Lung-to-Liver Signal-Intensity Ratio
American Journal of Roentgenology, 2013
E arly delivery because of fetal and maternal health concerns is steadily increasing in obstetric practice. According to the National Vital Statistics Report for 2006, 4.3 million births occurred in that year [1]. The rate of preterm births (before 37 weeks' gestation) increased to more than half a million, or 12.8% of all births. This was mostly due to a 25% increase in births at 34-36 weeks of gestation [1, 2]. According to data published by the Quint-Boenker Preemie Survival Foundation [3], infant survival is significantly dependent on gestational age at birth. For example, for infants born at 32-33 weeks, the survival rate is 98%, compared with those born at 25 weeks, who have a 50% survival rate. Sufficient fetal lung growth and maturation are key components in postnatal surviv
Proceedings in Obstetrics and Gynecology, 2020
The current study aims to compare the ultrasonographic evaluation of fetal lung Gray-level histogram width (GLHW) ratio with an amniotic fluid lamellar body count (LBC) in the prediction of fetal lung maturity. Methods: A prospective cohort study was conducted at a tertiary University Hospital in the period between May 1, 2017 and March 31, 2018. The study included pregnant women with a single fetus at ≥37 weeks of gestation scheduled for delivery by elective cesarean section (CS). Ultrasound evaluation was performed for assessment of the fetal lung to liver GLHW ratio to predict lung maturity. Lamellar body count was determined from an amniotic fluid sample obtained via amniotomy during CS. The lamellar body count for this sample was measured using a hematology analyzer. These data were further compared to Apgar scores at 1 and 5 minutes after delivery to assess the condition of the newborn immediately after birth, the degree of respiratory distress syndrome (RDS) and the need for resuscitation. Results: One hundred twenty women and their neonates were included in the study. There was a statistically significant decrease in the levels of both GLHW and LBC among those neonates that showed distressed respiration after Apgar testing as compared with those who did not show similar distress, with p-value <0.001. The Receiver Operating Characteristic Curve (ROC) for LBC levels in the prediction of respiratory distress shows the best cutoff point for LBC was found at ≤20214/μL with a sensitivity of 100.0%, specificity of 75.47% and area under the curve (AUC) of 88.4%. The ROC curve for GLWH levels in the prediction of respiratory distress shows the best cutoff point for GLWH was found at ≤0.93 with sensitivity of 100.0%, specificity of 84.91% and AUC of 97.1%. Conclusions: Ultrasonographic evaluation of GLHW of the fetal lung and liver is a noninvasive, inexpensive and time-efficient test for prediction of fetal lung maturity that has higher sensitivity and specificity.
Assessment of the Diagnostic Accuracy of the TDx-FLM II to Predict Fetal Lung Maturity
Background: Because respiratory distress syndrome (RDS) affects 1% of live births, accurate and rapid assessment of markers of fetal lung maturity is critical to clinicians in deciding whether to deliver a preterm infant. Our objective was to determine the optimal diagnostic cutoff value for the TDx-FLM II assay (Abbott Laboratories) for predicting clinically significant RDS. Methods: Amniotic fluid TDx-FLM II data were collected retrospectively over 4 years. Women were included in the study if they had delivered within 72 h of TDx-FLM II testing and both the mother and infant charts could be reviewed. Women who had been treated with steroids and delivered unaffected infants were excluded from the analysis. The diagnosis of RDS was defined as infants who either were treated with surfactant and/or were placed on a ventilator and/or required continuous positive airway pressure for >1 day. Results: A total of 185 women met all entry criteria (15 RDS, 170 non-RDS). A cutoff value for a mature result of >45 mg/g gave a sensitivity of 100% (95% confidence interval, 82-100%) and a specificity of 90% (95% confidence interval, 78 -89%). Conclusions: The TDx-FLM II appears to predict clinically significant RDS when a cutoff of >45 mg/g is used for mature results. Further studies will be required to confirm these findings.
European Radiology, 2007
To purpose of this paper is to study the relation between normal lung maturation signal and changes in intensity ratios (SIR) and to determine which magnetic resonance imaging sequence provides the strongest correlation of normal lung SIs with gestational age. 126 normal singleton pregnancies (20-37 weeks) were examined with a 1.5 Tesla unit. Mean SIs for lungs, liver, and gastric fluid were assessed on six different sequences, and SIRs of lung/liver (LLSIR) and lung/gastric fluid (LGSIR) were correlated with gestational age for each sequence. To evaluate the feasibility of SIRs in the prediction of the state of the lung maturity, accuracy of the predicted SIRs (D*) was measured by calculating relative residuals (D*−D)/ D for each sequence. LLSIRs showed significant changes in every sequence (p<0.05), while LGSIRs only on two sequences. Significant differences were shown for the mean of absolute residuals for both LLSIRs (p<0.001) and for LGSIRs (p=0.003). Relative residuals of LLSIRs were significantly smaller on T1-weighted sequence, whereas they were significantly higher for LGSIRs on FLAIR sequence. Fetal liver seems to be adequate reference for the investigation of lung maturation. T1-weighted sequence was the most accurate for the measurement of the lung SIs; thus, we propose to determine LLSIR on T1-weighted sequence when evaluating lung development.
A New Method for Assessment of Fetal Lung Maturity
BJOG: An International Journal of Obstetrics and Gynaecology, 1976
A new method for evaluation of fetal lung maturity in utero is described. The method is based on the fluorescence polarization (P) of the lipids in the amniotic fluid after labelling with a special dye. Tests performed with 49 amniotic fluid samples drawn from 33 pregnancies clearly demonstrated a decrease in P during gestation which correlated with the increase in the lecithin/sphingomyelin ratio (L/S) in the fluid. During gestation the P value at 24 "C decreased steadily from about 0.4 to 0.2 and the value of P (24 "C)= 0.310 has been tentatively chosen as the threshold above which respiratory distress syndrome may develop. The described method, which requires a specially designed instrument, offers a series of important advantages over the presently available methods. It is simple, rapid, highly accurate and reproducible, and independent of amniotic fluid volume. The P value reflects the microviscosity in the whole lipid assembly of amniotic fluid and is not confined specifically to lecithin.
Standard Normal Fetal Lung Volume by MRI Measurement
Iranian Journal of Radiology
Background: Pulmonary hypoplasia is a significant decrease in lung volume by any cause in comparison to the normal volume for gestational age. Objectives: To evaluate the application of prenatal magnetic resonance imaging in order to predict pulmonary hypoplasia, measurement of fetal lung volume (FLV) was aimed to establish a reference data in normal fetuses. Patients and Methods: Three hundred forty two fetuses with abnormal ultrasound findings underwent fast spin-echo T2-weighted MR imaging at a single tertiary care hospital (Shahid Faghihi Hospital, Shiraz, Iran). Data of 241 fetuses at 18-36 weeks' gestation without thoracic malformations were obtained for a FLV normative curve. To acquire a best-fit formula for the mean total fetal lung volume based on each gestational week with 95% confidence interval (CI), we used the regression model applied by Rypens et al. This resulted in a formula calculating the expected fetal lung volume based on gestational age. A one-sample t-test was also carried out to compare the mean total fetal lung volume at each gestational week with the expected mean total fetal lung volume predicted by the formula by Rypens et al., Meyers et al., and Osada et al. Results: Normal FLV increased with gestational age as the spread of values. The expected fetal lung volume was derived from the following formula: Fetal lung volume (mL) = 0.002 × (gestational age [GA] 2.913), in which GA is gestational weeks. FLV in our population had a more consistent correlation with Japanese fetuses than European or American fetuses. Conclusion: In fetuses with normal lungs, FLV distribution against gestational age is simply measured prenatally with MR imaging. A single universal formula might not be suitable for fetuses worldwide. In our region, acquired data were more consistent with Asian normal values.
Values and validity of fetal parameters by ultrasound and Doppler as markers of fetal lung maturity
Egyptian Journal of Radiology and Nuclear Medicine
Background In this study, we combined ultrasound and Doppler parameters to conclude the most accurate and applicable method for fetal lung maturity assessment. Thepurpose is to reduce risk of neonatal respiratory distress by assessment of fetal lung maturity through ultrasound and Doppler instead of amniocentesis. Results A total of 120 women were included. The ultrasound examination was performed at a gestational age ranging between 30 and 37 weeks and delivery occurred within 72 h from ultrasound. After birth, 19 fetuses were diagnosed with RDS. The ultrasound parameters assessed for fetal lung maturity showed varying sensitivity and specificity but presence of proximal tibial epiphyses showed the highest sensitivity (91%) and specificity (95%) followed by the presence of distal femoral epiphyses with 90% sensitivity and 84% specificity. The placental grade III maturity showed a sensitivity of 81% and 74% specificity followed by the presence of the amniotic fluid free-floating par...
Fetal MRI lung volumes are predictive of perinatal outcomes in fetuses with congenital lung masses
Journal of Pediatric Surgery, 2014
The purpose of this study was to evaluate fetal magnetic resonance imaging (MRI) as a modality for predicting perinatal outcomes and lung-related morbidity in fetuses with congenital lung masses (CLM). Methods: The records of all patients treated for CLM from 2002 to 2012 were reviewed retrospectively. Fetal MRI-derived lung mass volume ratio (LMVR), observed/expected normal fetal lung volume (O/E-NFLV), and lesion-to-lung volume ratio (LLV) were calculated. Multivariate regression and receiver operating characteristic analyses were applied to determine the predictive accuracy of prenatal imaging. Results: Of 128 fetuses with CLM, 93% (n = 118) survived. MRI data were available for 113 fetuses. In early gestation (b 26 weeks), MRI measurements of LMVR and LLV correlated with risk of fetal hydrops, mortality, and/or need for fetal intervention. In later gestation (N26 weeks), LMVR, LLV, and O/E-NFLV correlated with neonatal respiratory distress, intubation, NICU admission and need for neonatal surgery. On multivariate regression, LMVR was the strongest predictor for development of fetal hydrops (OR: 6.97, 1.58-30.84; p = 0.01) and neonatal respiratory distress (OR: 12.38, 3.52-43.61; p ≤ 0.001). An LMVR N 2.0 predicted worse perinatal outcome with 83% sensitivity and 99% specificity (AUC = 0.94; p b 0.001). Conclusion: Fetal MRI volumetric measurements of lung masses and residual normal lung are predictive of perinatal outcomes in fetuses with CLM. These data may assist in perinatal risk stratification, counseling, and resource utilization.
American Journal of Obstetrics and Gynecology, 2011
We sought to develop a gestational age-independent sonographic parameter to characterize lung growth. STUDY DESIGN: Reported descriptors of lung growth, including lungto-head circumference (HC) ratio (LHR) and observed/expected LHR, were examined. A new index, the quantitative lung index (QLI) was derived using published data on HC and the area of the base of the right lung.
MRI of normal and pathological fetal lung development
European Journal of Radiology, 2006
Normal fetal lung development is a complex process influenced by mechanical and many biochemical factors. In addition to ultrasound, fetal magnetic resonance imaging (MRI) constitutes a new method to investigate this process in vivo during the second and third trimester. The techniques of MRI volumetry, assessment of signal intensities, and MRI spectroscopy of the fetal lung have been used to analyze this process and have already been applied clinically to identify abnormal fetal lung growth. Particularly in conditions such as oligohydramnios and congenital diaphragmatic hernia (CDH), pulmonary hypoplasia may be the cause of neonatal death. A precise diagnosis and quantification of compromised fetal lung development may improve post-and perinatal management. The main events in fetal lung development are reviewed and MR volumetric data from 106 normal fetuses, as well as different examples of pathological lung growth, are provided.