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© 2008 by the American Institute of Ultrasound in Medicine
J Ultrasound Med 27:707-713 • 0278-4297

The Lung-to-Thorax Transverse Area Ratio at Term and Near Term Correlates With Survival in Isolated Congenital Diaphragmatic Hernia

Kiyomi Tsukimori, MD, PhD, Kouji Masumoto, MD, PhD, Seiichi Morokuma, MD, PhD, Takazumi Yoshimura, MD, Tomoaki Taguchi, MD, PhD, Toshiro Hara, MD, PhD, Yoshiro Sakaguchi, MD, PhD, Shosuke Takahashi, MD, PhD, Norio Wake, MD, PhD and Sachiyo Suita, MD, PhD

Departments of Obstetrics and Gynecology (K.T., S.M., T.Y., N.W.), Pediatric Surgery (K.M., T.T., S.S.), Pediatrics (T.H.), and Anesthesiology (Y.S., S.T.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.

Address correspondence to Kiyomi Tsukimori, MD, PhD, Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kyushu University, Maidashi 3-1-1, Higashi-ku, Fukuoka 812, Japan. E-mail: tsuki{at}med.kyushu-u.ac.jp

Objective. The purpose of this study was to determine how well liver position, the lung area-to-head circumference (L/H) ratio, and the lung-to-thorax transverse area (L/T) ratio predicted the need for extra-corporeal membrane oxygenation (ECMO) and survival in fetuses with isolated congenital diaphragmatic hernia (CDH). Methods. Antenatal records of 25 fetuses with isolated left-sided CDH who were born by cesarean delivery under fetal stabilization at this institution were reviewed. The latest determinations of the L/H and L/T ratios before birth (between 34 and 38 weeks’ gestation) were compared on the basis of the cutoff points for mortality: less than 1.0 versus 1.0 or greater for the L/H ratio and 0.08 or less versus greater than 0.08 for the L/T ratio. Outcome measures assessed were survival (discharge to home) and the need for ECMO. Results. Overall survival was 64% (16/25). Postnatal survival in fetuses with an L/T ratio of 0.08 or less was statistically lower than in those with an L/T ratio of greater than 0.08 (33% versus 81%; P = .0308). The percentage requiring ECMO in the group with an L/T ratio of 0.08 or less was also higher than that of the group with an L/T ratio of greater than 0.08, but the difference was not statistically significant (67% versus 25%; P = .0872). Neither the L/H ratio nor herniation of the fetal liver into the chest affected survival or the need for ECMO. Conclusions. In fetuses with isolated CDH at term or near term, the L/T ratio may be a better predictor of outcome than the L/H ratio or liver herniation.

Key Words: congenital diaphragmatic hernia • lung area-to-head circumference ratio • lung hypoplasia • lung-to-thorax transverse area ratio • sonography

Abbreviations: CDH, congenital diaphragmatic hernia • ECMO, extra-corporeal membrane oxygenation • L/H, lung area-to-head circumference • L/T, lung-to-thorax transverse area • NO, nitric oxide • SaO2, oxygen saturation

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