Discordance between Fetal Ultrasound and MRI to Predict Severity in Congenital Diaphragmatic Hernia.

INTRODUCTION

Prenatal ultrasound (US) and MRI guide the diagnosis and management of congenital diaphragmatic hernia (CDH). A challenge arises when one imaging modality suggests a moderate case and the other a severe case ("discordant severe CDH"). We aimed to analyze newborn outcomes for this group.

METHODS

We reviewed all left-sided CDH cases at our fetal care center from 2012 to 2023. Discordant severe was defined as severe by either US (trace observed-to-expected lung-to-head ratio ≤25%) or MRI (percent predicted lung volume ≤15%) and moderate by the other. Concordant severe and concordant moderate groups were defined as both US and MRI predicting the same severity. Primary outcomes were rate of extracorporeal membrane oxygenation (ECMO) cannulation and survival to discharge.

RESULTS

We identified 35 concordant moderate, 21 discordant severe, and 11 concordant severe CDH cases. Compared to the concordant moderate group, the discordant severe group had significantly higher ECMO cannulation rates and significantly lower survival to discharge. No significant differences were found between concordant severe and discordant severe groups.

CONCLUSION

Outcomes for discordant severe CDH are similar to concordant severe, suggesting teams should rely on the imaging modality that predicts the more severe categorization in the setting of discordant severe CDH.