The image analysis of prenatal ultrasound and MRI of fetal right congenital diaphragmatic hernia / 中华医学超声杂志（电子版）

ABSTRACT

Objective To summarize the image features of prenatal ultrasound and MRI of fetal right congenital diaphragmatic hernia (CDH). Methods Between June 2007 and December 2014, eight fetuses with suspicious right pleural abnormalities diagnosed by conventional prenatal ultrasound received MRI examination within 24 to 48 hours after ultrasonography at Shanghai Children′s Medical Center. The imaging sequences included steady-state free-precession (SSFP) sequence, single-shot turbo spin echo (SSTSE) sequence and T1-weighted imaging (T1WI) sequence. Prenatal ultrasound and MRI findings were compared with postnatal imaging diagnoses, surgery or autopsy. The image features of prenatal ultrasound and MRI of fetal right CDH were analyzed. Results Among the eight cases of fetal prenatal ultrasound, 7 cases presented right pleural abnormal heterogeneous echo, 1 case showed right pleural effusion. Fetal prenatal MRI showed seven cases of right-sided pleural abnormalities, included a portion of the liver in 2 cases, a portion of the bowel in 2 cases, a portion of the liver and the bowel in 3 cases. One case was with bilateral pleural abnormalities, the liver and the bowel in right thoracic cavity, a portion of the bowel in left thoracic cavity. Prenatal ultrasound and MRI findings were compared with postnatal upper gastrointestinal tract barium contrast, enhanced chest CT, surgery or autopsy. Prenatal ultrasound correctly diagnosed 4 cases of fetal right CHD, misdiagnosed right CHD as right pleural mass in 2 cases, missed 1 case of right CHD, and misdiagnosed 1 case of bilateral CHD as right CHD. MRI correctly diagnosed 7 cases of fetal right CHD and 1 case of bilateral CHD. Conclusions Prenatal ultrasound couldn′t identify the detailed contents herniated into the fetal thoracic cavity of right CDH, especially when the liver herniated into the fetal thoracic cavity. However, prenatal MRI could clearly show the hernia contents in the fetal thoracic cavity, and make the correct diagnosis of fetal right CHD as well as the hernia contents in the fetal thoracic cavity. Both SSFSE and T1WI sequences can distinguish detailed contents herniated into the thoracic cavity.