MRI Lung Volume Prediction of ECMO and Mortality in Congenital Diaphragmatic Hernia

Objectives: This study evaluated fetal MRI lung measurements with ECMO use and survival of prenatally diagnosed CDH. Methods: Retrospective chart review of 113 patients from 01/2012-12/2023 with prenatally diagnosed congenital diaphragmatic hernias. Lung measurements from prenatal MRIs, infant ECMO use, and survival were analyzed to determine optimal cut-off value for outcome prediction. Results: Patients were categorized as mild (10.1%, n = 11), moderate (34.3%, n = 37), and severe (55.6%, n = 60). Mortality was 29.2% (n = 33), and 52.2% (n = 59) required ECMO. Patients undergoing FETO (n = 11) were excluded from statistical analysis. Median change in total lung volume, ipsilateral lung, and contralateral lung from early to late gestation MRI was 15.1 mL (IQR: 9.3-21.7), 1.5 mL (IQR: 0.1-3.1), and 13.4 mL (IQR: 8.1-18.34), respectively. Optimal cut-off values, sensitivity, specificity, positive predictive value, and negative predictive value were calculated for each volume parameter in terms of predicting ECMO use and mortality. Ipsilateral and contralateral lung growth below the cut-off significantly predicted ECMO use (p < 0.05). There was no significance for any cut-offs predicting mortality. Conclusion: Lung volume growth measured by MRI in prenatally diagnosed CDH may be a useful predictor of ECMO use and mortality.