Two-dimensional ultrasound examination for assessment of the degree of liver herniation into the chest in fetuses with congenital diaphragmatic hernia
DOI:
https://doi.org/10.15574/PP.2019.80.10Keywords:
congenital diaphragmatic hernia, liver herniationAbstract
Purpose — to develop a method for assessing the degree of liver herniation into the chest in fetuses with congenital diaphragmatic hernia by two-dimensional ultrasound examination, to determine cut-off values and to propose a working clinical classification of the degrees liver herniation.Patients and methods. Analysis of ultrasound data of fetuses as patients with isolated congenital diaphragmatic hernia and known postnatal clinical outcome. Measurement of lungs' and herniated liver areas were performed in a standard cross section of fetal thorax, at the level of a four-chamber view, liver-to-lung area ratio was calculated dividing the area of liver by the lungs area. Comparison of data in groups according to postnatal clinical outcome was performed using Student's t-test, determination of cut-off by ROC analysis, calculation of operative characteristics of diagnostic test using contingency tables.
Results. In 92.9% there was a left diaphragmatic hernia, in 7.1% — right. The mean term of prenatal evaluation was 32.5±6.2 weeks of gestation (range — 20–38 weeks). Among newborns, 35.7% (n=10) were operated and survived, and 64.3% died (n=18). The mean liver-to-lung area ratio in the group with favorable outcome was 0,798±0,325 (range — 0,432–1,326), in the group with neonatal death — 2,153±0,931 (range — 1,176–5,276), the difference was statistically significant (p<0.001). An optimal cut-off value 1.2 was identified, with best operational characteristics (sensitivity — 94.4%, specificity — 90.0%, accuracy — 92.85%). A working clinical classification of liver herniation degrees was proposed: a) index <1.0 — mild liver herniation (100% survival rate); b) index 1.0–1.5 — significant (survival rate — 50%), c) index >1.5 — severe (survival rate — 0%).
Conclusions. Liver-to-lung area ratio can be a new tool for quantitative assessment of the degree of liver herniation into the chest in fetuses with congenital diaphragmatic hernia by two-dimensional ultrasound. It can be used in complex with other markers for prediction of neonatal outcome and planning management of pregnancy, delivery and specialized help to neonate.The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of SI «Institute of Pediatrics, Obstetrics and Gynecology named of academician O.M. Lukyanova of the NAMS of Ukraine». The informed consent of the patient was obtained for conducting the studies.
No conflict of interest were declared by the authors.
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