Prospective analysis of the prognostic value of prenatal MRI measurement of cystic volume ratio in fetal congenital cystic adenomatoid malformation.

BACKGROUND

The cystic volume ratio (CVR) has been used to predict the prognosis of fetal lung disease, but most of them are reported on ultrasound. The purpose of this study was to investigate the prognostic value of prenatal magnetic resonance imaging (MRI) measurement of CVR in fetal congenital cystic adenomatoid malformation (CCAM).

METHODS

To collect follow-up data on postnatally confirmed CCAM fetuses. According to the size of CVR, they were divided into a CVR ≥1.26 group and a CVR <1.26 group. The lesions were divided into macrocystic (diameter ≥5 mm) and microcystic (diameter <5 mm) types according to the size of cysts in the lesions. The collected contents also included the location of the lesions, prenatal symptoms, postpartum clinical prognosis, and pregnancy outcomes.

RESULTS

In all, 51 cases were collected. Of these, 11 were placed into the CVR ≥1.26 group, and 40 were placed into the CVR <1.26 group; meanwhile 34 were classified as macrocystic lesions and 17 as microcystic lesions; 7 cases involved a terminated pregnancy. In the CVR ≥1.26 group, 81.82% (9/11) and 36.36% (4/11) had displacement of large vessels/heart and increased amniotic fluid, respectively; meanwhile, in the CVR <1.26 group, these phenomena occurred in 35.00% (14/40) and 2.50% (1/40) of cases (P=0.006, 0.010). Additionally, 83.33% (5/6) of live infants in the CVR ≥1.26 group had dyspnea, a significantly higher proportion than the 21.05% (8/38) in the CVR <1.26 group (P=0.011). Moreover, 45.45% (5/11) of the cases in the CVR ≥1.26 group were terminated pregnancies, a significantly higher proportion than the 5.26% (2/38) in the CVR <1.26 group (P=0.001). Finally, the CVR of macrocystic lesions was 0.55 (0.34-1.31), which was significantly greater than the 0.34 (0.17-0.57) of microcystic lesions (P=0.022). Logistical regression analysis identified that CVR is an independent factor associated with the postpartum prognosis of CCAM.

CONCLUSIONS

Prenatal symptoms and postpartum prognosis were worse than CVR <1.26 when fetal CVR ≥1.26 measured by prenatal MRI; and the measurement of CVR of CCAM through prenatal MRI has considerable practical value in prenatal consultation, evaluation, and postpartum treatment.