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J Ultrasound Med. 2015 Oct;34(10):1721-7. doi: 10.7863/ultra.15.14.11064. Epub 2015 Aug 25.

Standardization of Sonographic Lung-to-Head Ratio Measurements in Isolated Congenital Diaphragmatic Hernia: Impact on the Reproducibility and Efficacy to Predict Outcomes.

Author information

1
Texas Children's Fetal Center, Houston, Texas USA (I.S.W.B., N.S., O.O.O., D.L.C., T.C.L., C.I.C., A.M.-R., S.W., C.F., M.A.B., W.L., R.R.); and Department of Obstetrics and Gynecology (I.S.W.B., N.S., H.S.-H., M.A.B., W.L., R.R.), Michael E. DeBakey Department of Surgery (O.O.O., D.L.C., T.C.L.), Department of Radiology (C.I.C., A.M.-R.), and Department of Pediatrics, Section of Neonatology (S.W., C.F.), Baylor College of Medicine, Houston, Texas USA.
2
Texas Children's Fetal Center, Houston, Texas USA (I.S.W.B., N.S., O.O.O., D.L.C., T.C.L., C.I.C., A.M.-R., S.W., C.F., M.A.B., W.L., R.R.); and Department of Obstetrics and Gynecology (I.S.W.B., N.S., H.S.-H., M.A.B., W.L., R.R.), Michael E. DeBakey Department of Surgery (O.O.O., D.L.C., T.C.L.), Department of Radiology (C.I.C., A.M.-R.), and Department of Pediatrics, Section of Neonatology (S.W., C.F.), Baylor College of Medicine, Houston, Texas USA. ruano@bcm.edu rodrigoruano@hotmail.com.

Abstract

OBJECTIVES:

The purpose of this study was to evaluate the impact of standardization of the lung-to-head ratio measurements in isolated congenital diaphragmatic hernia on prediction of neonatal outcomes and reproducibility.

METHODS:

We conducted a retrospective cohort study of 77 cases of isolated congenital diaphragmatic hernia managed in a single center between 2004 and 2012. We compared lung-to-head ratio measurements that were performed prospectively in our institution without standardization to standardized measurements performed according to a defined protocol.

RESULTS:

The standardized lung-to-head ratio measurements were statistically more accurate than the nonstandardized measurements for predicting neonatal mortality (area under the receiver operating characteristic curve, 0.85 versus 0.732; P = .003). After standardization, there were no statistical differences in accuracy between measurements regardless of whether we considered observed-to-expected values (P > .05). Standardization of the lung-to-head ratio did not improve prediction of the need for extracorporeal membrane oxygenation (P> .05). Both intraoperator and interoperator reproducibility were good for the standardized lung-to-head ratio (intraclass correlation coefficient, 0.98 [95% confidence interval, 0.97-0.99]; bias, 0.02 [limits of agreement, -0.11 to +0.15], respectively).

CONCLUSIONS:

Standardization of lung-to-head ratio measurements improves prediction of neonatal outcomes. Further studies are needed to confirm these results and to assess the utility of standardization of other prognostic parameters.

KEYWORDS:

congenital diaphragmatic hernia; fetal lung; lung-to-head ratio; obstetric ultrasound; pulmonary hypoplasia; standardization

PMID:
26307118
DOI:
10.7863/ultra.15.14.11064
[Indexed for MEDLINE]

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