Concordance of MRI, CT, and Surgical Pathology in Prenatally Diagnosed Lung Lesions

This study quantified the concordance of pre- and post-natal imaging and pathology diagnoses of fetal lung lesions. Retrospective review of patients seen at a single Fetal Center from 2014-2024. 138 patients with prenatally diagnosed lung lesions were identified. Patients with an associated congenital diaphragmatic hernia (n=7) and patients with neither postnatal imaging nor surgical pathology (n=11) were excluded. 86.7% had postnatal imaging; of these, 79.8% had postnatal CT findings consistent with prenatal imaging. 68.3% had surgical resection at our institution. The remaining patients had surgery elsewhere or did not pursue resection of the lesion. Of those 82 patients, 90.2% had a pathologic diagnosis concordant with their prenatal MRI and 97.1% had a pathologic diagnosis concordant with postnatal CT. The most common case of discordance between pre- and post-natal imaging was bronchial atresia (71.4%, 15/21) which was originally called a CPAM/BPS/hybrid lesion on prenatal imaging. The most striking case of discordance between imaging and pathology was a pleuropulmonary blastoma initially called a CPAM on prenatal MRI. Congenital lung lesions may evolve during pregnancy, highlighting the value of postnatal imaging to further characterize the lesions and assess the appropriateness of patients for surgical resection.