RESUMO
BACKGROUND: Extracorporeal membrane oxygenation (ECMO), has partly improved congenital diaphragmatic hernia (CDH) outcomes, yet the overall morbidity and mortality remain high. Existing prenatal indicators for CDH fetuses are operator-dependent, time-consuming, or less accurate, a new simple and accurate indicator to indicate adverse events in CDH patients is needed. PURPOSE: To propose and assess the association of a new MRI parameter, the relative mediastinal displacement index (RMDI), with adverse events including in-hospital deaths or the need for ECMO in fetuses with isolated left CDH (iLCDH). STUDY TYPE: Retrospective analysis. SUBJECTS: One hundred thirty-nine fetuses were included in the iLCDH group (24 with adverse events and 115 without) and 257 fetuses were included in the control group from two centers in Guangzhou. FIELD STRENGTH/SEQUENCE: 3.0 T, T2WI-TRUFI; 1.5 T, T2WI-FIESTA. ASSESSMENT: Three operators independently measured the â DL $$ \underset{\mathrm{DL}}{\to } $$ , â DR $$ \underset{\mathrm{DR}}{\to } $$ , and DH on the axial images. The calculation formula of the RMDI was ( â DL $$ \underset{\mathrm{DL}}{\to } $$ + â DR $$ \underset{\mathrm{DR}}{\to } $$ )/DH . STATISTICAL TESTS: The independent sample t test, Mann-Whitney U test, Chi-square test, Chi-square test continuity correction, Fisher's test, linear regression analysis, logistic regression analysis, intraclass correlation coefficient, receiver operating characteristic curve analysis, and Delong test. A P value <0.05 was considered statistically significant. RESULTS: The RMDI did not change with gestational age in the iLCDH group (with [P = 0.189] and without [P = 0.567] adverse events) and the control group (P = 0.876). There were significant differences in RMDI between the iLCDH group (0.89 [0.65, 1.00]) and the control group (-0.23 [-0.34, -0.16]). In the iLCDH group, RMDI was the only indicator left for indicating adverse events, and the best cutoff value was 1.105. Moreover, there was a significant difference in diagnostic accuracy between the RMDI (AUC = 0.900) and MSA (AUC = 0.820), LHR (AUC = 0.753), o/e LHR (AUC = 0.709), and o/e TFLV (AUC = 0.728), respectively. DATA CONCLUSION: The RMDI is expected to be a simple and accurate tool for indicating adverse events in fetuses with iLCDH. EVIDENCE LEVEL: 4 TECHNICAL EFFICACY: Stage 1.
RESUMO
BACKGROUND: Although quantitative computed tomography (CT) has been used to analyze the lungs of patients with confirmed diagnoses of acute respiratory distress syndrome (ARDS), there are few reports to show the diagnosis during the early stage of ARDS. Using a canine model and quantitative CT, we aimed to develop an oleic acid (OA) induced ARDS regarding the early stage of ARDS that could improve in the early diagnosis of ARDS. METHODS: Fourteen healthy beagle dogs underwent CT. Their lung tissue was manually partitioned into four compartments, i.e., non-aerated, poorly aerated, normally aerated, and hyper-aerated lung compartments. The mean CT attenuation value Hounsfield unit (HU), tissue mass (g), residual volume (ml), and percentage of lung area were automatically determined for each lung compartment and compared between groups by receiver operating characteristic curve (ROC) analyses using area under curve (AUC). The optimized cut-off point for each parameter was determined by Youden's index. RESULTS: Regarding lung compartments during the expiratory phase, the percentage of non-aerated lung area in the ARDS group was higher vs. controls at all time points (T1 to T6). CT attenuation values for the ARDS group increased with time during both respiratory phases compared with controls. During both respiratory phases, tissue mass within the ARDS group significantly increased compared with controls at T3-T6. CONCLUSIONS: Quantitative CT analysis can detect ARDS at an early stage with high sensitivity and specificity, providing a minimum of assistance in the early diagnosis of ARDS.
