usfdУльтразвуковая и функциональная диагностикаUltrasound & Functional Diagnostics1607-07712408-9494RDS-Media Ltd.10.24835/1607-0771-2022-1-19-26usfd-24Research ArticleУльтразвуковая диагностика в акушерстве и гинекологииObstetrics and Gynecology UltrasoundПренатальное прогнозирование исходов врожденной диафрагмальной грыжи на основе трехмерной ультразвуковой морфометрии и оценки гистограмм легких плодаPrenatal prediction of outcomes in congenital diaphragmatic hernia based on fetal 3D/4D ultrasound lung morphometry and histogram analysis (a pilot study)ЧукановА. Н.ChukanovA. N.a.chukanov@tut.byГУО “Белорусская медицинская академия последипломного образования”Belarusian Medical Academy of Postgraduate Education202218012024011926Copyright © Чуканов А.Н., 20242024Чуканов А.Н.Chukanov A.N.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://usfd.rdsmedia.ru/jour/article/view/24

Цель: разработка критериев трехмерной ультразвуковой оценки состояния легких у плодов с врожденной диафрагмальной грыжей, которые впоследствии можно использовать для прогнозирования исходов. Материал и методы: проанализированы результаты ультразвукового исследования плодов с врожденной диафрагмальной грыжей (14 случаев) в сроках гестации 26-38 нед. По исходам данных беременностей плоды были разделены на две подгруппы: живые (n = 10) и умершие в раннем неонатальном периоде (n = 4). Ультразвуковое исследование проводилось на аппарате Voluson 730 Expert (GE Healthcare, США) с программным пакетом Virtual Organ Computer-aided AnaLysis (VOCAL) и возможностью получения гистограмм эхогенности при оценке массива трехмерной информации. Использовался объемный конвексный датчик, работающий в диапазоне частот 4-8,5 МГц. Оценивались соотношение объема контрлатерального легкого и длины окружности головы (1) и соотношение эхогенности ипси латерального и контрлатерального легких (2). Результаты: значения соотношения объема контрлатерального легкого и окружности головы в двух подгруппах достоверно различаются (P = 0,0047). Такой же уровень различия при сравнении двух подгрупп продемонстрировали значения соотношения эхогенности ипсилатерального и контрлатерального легких (P = 0,0047). Выводы: для прогнозирования летального исхода в раннем неонатальном периоде при врожденной диафрагмальной грыже возможно использование соотношения объема контрлатерального легкого и окружности головы (1) и соотношения эхогенности ипсилатерального и контрлатерального легких (2).

Objective: to develop 4D ultrasound criteria of lung assessment in fetuses with congenital diaphragmatic hernia, with potential use for outcomes prediction. Material and methods: the results of 4D ultrasound in fetuses with gestational age 26-38 weeks with congenital diaphragmatic hernia (14 cases) were analyzed. According to the pregnancy outcomes, the fetuses were divided into two subgroups: survived (n = 10) and deceased in the early neonatal period (n = 4). Ultrasound examinations performed with the use of Virtual Organ Computer-aided AnaLysis (VOCAL) and 4D Histogram software of Voluson 730 Expert (GE Healthcare, USA) with 4D convex transabdominal transducer (4-8.5 MHz). The fetal lung-to-head ratio (contralateral lung volume to head circumference ratio) (1) and lung-to-lung echogenicity ratio with histogram analyses (2) were evaluated. Results: the significant differences of fetal lung-to-head ratio and also in lung-to-lung echogenicity ratio with histogram analyses between the two groups were obtained (P = 0.0047). Conclusion: fetal lung-to-head ratio (1) and lung-to-lung echogenicity ratio with histogram analyses (2) are possible to use for early neonatal death prediction.

пренатальная ультразвуковая диагностикасоотношение объема контрлатерального легкого и окружности головы плодасоотношение эхогенности ипсилатерального и контрлатерального легких плодапрогнозирование исходовврожденная диафрагмальная грыжаprenatal ultrasoundfetal lung-to-head ratiofetal lung-to-lung echogenicity ratio with histogram analysesprediction of outcomescongenital diaphragmatic herniaReferencesPiontelli A. Development of normal fetal movements. The first 25 weeks of gestation. Milan: Springer-Verlag, 2010, 133 p. https://doi.org/10.1007/978-88-470-1402-2Piontelli A. Development of normal fetal movements. The first 25 weeks of gestation. Milan: Springer-Verlag, 2010, 133 p. https://doi.org/10.1007/978-88-470-1402-2Reissland N., Kisilevsky B.S. (eds.) Fetal development. Research on brain and behavior, environmental influences, and emerging technologies. Springer International Publishing Switzerland, 2016, 492 p. https://doi.org/10.1007/978-3-319-22023-9Reissland N., Kisilevsky B.S. (eds.) Fetal development. Research on brain and behavior, environmental influences, and emerging technologies. Springer International Publishing Switzerland, 2016, 492 p. https://doi.org/10.1007/978-3-319-22023-9Bargy F., Beaudoin S., Barbet P. Fetal lung growth in congenital diaphragmatic hernia. Fetal Diagn. Ther. 2006; 21 (1): 39-44. https://doi.org/10.1159/000089046Bargy F., Beaudoin S., Barbet P. Fetal lung growth in congenital diaphragmatic hernia. Fetal Diagn. Ther. 2006; 21 (1): 39-44. https://doi.org/10.1159/000089046Gerards F.A., Twisk J.W., Bakker M., Barkhof F., van Vugt J.M. Fetal lung volume: three-dimensional ultrasonography compared with magnetic resonance imaging. Ultrasound Obstet. Gynecol. 2007; 29 (5): 533-536. https://doi.org/10.1002/uog.3931Gerards F.A., Twisk J.W., Bakker M., Barkhof F., van Vugt J.M. Fetal lung volume: three-dimensional ultrasonography compared with magnetic resonance imaging. Ultrasound Obstet. Gynecol. 2007; 29 (5): 533-536. https://doi.org/10.1002/uog.3931Szpinda M., Siedlaczek W., Szpinda A., Wozniak A., Mila-Kierzenkowska C., Wisniewski M. Volumetric growth of the lungs in human fetuses: an anatomical, hydrostatic and statistical study. Surg. Radiol. Anat. 2014; 36 (8): 813-820. https://doi.org/10.1007/s00276-014-1269-7Szpinda M., Siedlaczek W., Szpinda A., Wozniak A., Mila-Kierzenkowska C., Wisniewski M. Volumetric growth of the lungs in human fetuses: an anatomical, hydrostatic and statistical study. Surg. Radiol. Anat. 2014; 36 (8): 813-820. https://doi.org/10.1007/s00276-014-1269-7Khan A.A., Furey E.A., Bailey A.A., Xi Y., Schindel D.T., Santiago-Munoz P.C., Twickler D.M. Fetal liver and lung volume index of neonatal survival with congenital diaphragmatic hernia. Pediatr. Radiol. 2021; 51 (9): 1637-1644. https://doi.org/10.1007/s00247-021-05049-0Khan A.A., Furey E.A., Bailey A.A., Xi Y., Schindel D.T., Santiago-Munoz P.C., Twickler D.M. Fetal liver and lung volume index of neonatal survival with congenital diaphragmatic hernia. Pediatr. Radiol. 2021; 51 (9): 1637-1644. https://doi.org/10.1007/s00247-021-05049-0Jani J., Peralta C.F., Van Schoubroeck D., Deprest J., Nicolaides K.H. Relationship between lung-to-head ratio and lung volume in normal fetuses and fetuses with diaphragmatic hernia. Ultrasound Obstet. Gynecol. 2006; 27 (5): 545-550. https://doi.org/10.1002/uog.2735Jani J., Peralta C.F., Van Schoubroeck D., Deprest J., Nicolaides K.H. Relationship between lung-to-head ratio and lung volume in normal fetuses and fetuses with diaphragmatic hernia. Ultrasound Obstet. Gynecol. 2006; 27 (5): 545-550. https://doi.org/10.1002/uog.2735Keijzer R., Puri P. Congenital diaphragmatic hernia. Semin. Pediatr. Surg. 2010; 19 (3): 180-185. https://doi.org/10.1053/j.sempedsurg.2010.03.001Keijzer R., Puri P. Congenital diaphragmatic hernia. Semin. Pediatr. Surg. 2010; 19 (3): 180-185. https://doi.org/10.1053/j.sempedsurg.2010.03.001Beck A.P., Araujo Junior E., Leslie A.T., Camano L., Moron A.F. Assessment of fetal lung maturity by ultrasound: objective study using gray-scale histogram. J. Matern. Fetal Neonatal Med. 2015; 28 (6): 617-622. https://doi.org/10.3109/14767058.2014.927862Beck A.P., Araujo Junior E., Leslie A.T., Camano L., Moron A.F. Assessment of fetal lung maturity by ultrasound: objective study using gray-scale histogram. J. Matern. Fetal Neonatal Med. 2015; 28 (6): 617-622. https://doi.org/10.3109/14767058.2014.927862Khalifa Y.E.A., Aboulghar M.M., Hamed S.T., Tomerak R.H., Asfour A.M., Kamal E.F. Prenatal prediction of respiratory distress syndrome by multimodality approach using 3D lung ultrasound, lung-to-liver intensity ratio tissue histogram and pulmonary artery Doppler assessment of fetal lung maturity. Br. J. Radiol. 2021; 94 (1128): 20210577. https://doi.org/10.1259/bjr.20210577Khalifa Y.E.A., Aboulghar M.M., Hamed S.T., Tomerak R.H., Asfour A.M., Kamal E.F. Prenatal prediction of respiratory distress syndrome by multimodality approach using 3D lung ultrasound, lung-to-liver intensity ratio tissue histogram and pulmonary artery Doppler assessment of fetal lung maturity. Br. J. Radiol. 2021; 94 (1128): 20210577. https://doi.org/10.1259/bjr.20210577Yamoto M., Iwazaki T., Takeuchi K., Sano K., Fukumoto K., Takahashi T., Nomura A., Ooyama K., Sekioka A., Yamada Y., Urushihara N. The fetal lung-to-liver signal intensity ratio on magnetic resonance imaging as a predictor of outcomes from isolated congenital diaphragmatic hernia. Pediatr. Surg. Int. 2018 Feb; 34 (2): 161-168. https://doi.org/10.1007/s00383-017-4184-2Yamoto M., Iwazaki T., Takeuchi K., Sano K., Fukumoto K., Takahashi T., Nomura A., Ooyama K., Sekioka A., Yamada Y., Urushihara N. The fetal lung-to-liver signal intensity ratio on magnetic resonance imaging as a predictor of outcomes from isolated congenital diaphragmatic hernia. Pediatr. Surg. Int. 2018 Feb; 34 (2): 161-168. https://doi.org/10.1007/s00383-017-4184-2Maeda K., Utsu M., Yamamoto N., Serizawa M. Echogenicity of fetal lung and liver quantified by the grey-level histogram width. Ultrasound Med. Biol. 1999; 25 (2): 201-208. https://doi.org/10.1016/s0301-5629(98)00160-4Maeda K., Utsu M., Yamamoto N., Serizawa M. Echogenicity of fetal lung and liver quantified by the grey-level histogram width. Ultrasound Med. Biol. 1999; 25 (2): 201-208. https://doi.org/10.1016/s0301-5629(98)00160-4Чуканов А.Н. Комплексный подход к совершенствованию дородовой диагностики врожденных аномалий развития. Минск: БелМАПО, 2020. 308 с.Чуканов А.Н. Комплексный подход к совершенствованию дородовой диагностики врожденных аномалий развития. Минск: БелМАПО, 2020. 308 с.Senat M.V., Bouchghoul H., Stirnemann J., Vaast P., Boubnova J., Begue L., Carricaburu E., Sartor A., Jani J., Benachi A., Bouyer J.; Center for Rare Diseases: Congenital Diaphragmatic Hernia. Prognosis of isolated congenital diaphragmatic hernia using lung-area-to-head-circumference ratio: variability across centers in a national perinatal network. Ultrasound Obstet. Gynecol. 2018; 51 (2): 208-213. https://doi.org/10.1002/uog.17463Senat M.V., Bouchghoul H., Stirnemann J., Vaast P., Boubnova J., Begue L., Carricaburu E., Sartor A., Jani J., Benachi A., Bouyer J.; Center for Rare Diseases: Congenital Diaphragmatic Hernia. Prognosis of isolated congenital diaphragmatic hernia using lung-area-to-head-circumference ratio: variability across centers in a national perinatal network. Ultrasound Obstet. Gynecol. 2018; 51 (2): 208-213. https://doi.org/10.1002/uog.17463Cruz-Martinez R., Molina-Giraldo S., Etchegaray A., Ventura W., Pavon-Gomez N., Gil-Guevara E., Villalobos-Gomez R., Luna-Garcia J., Gamez-Varela A., Martinez-Rodriguez M., Lopez-Briones H., Chavez-Gonzalez E.; Latin American CDH Study Group. Prediction of neonatal survival according to lung-to-head ratio in fetuses with right congenital diaphragmatic hernia (CDH): A multicentre study from the Latin American CDH Study Group registry. Prenat. Diagn. 2022; 42 (3): 357-363. https://doi.org/10.1002/pd.6070Cruz-Martinez R., Molina-Giraldo S., Etchegaray A., Ventura W., Pavon-Gomez N., Gil-Guevara E., Villalobos-Gomez R., Luna-Garcia J., Gamez-Varela A., Martinez-Rodriguez M., Lopez-Briones H., Chavez-Gonzalez E.; Latin American CDH Study Group. Prediction of neonatal survival according to lung-to-head ratio in fetuses with right congenital diaphragmatic hernia (CDH): A multicentre study from the Latin American CDH Study Group registry. Prenat. Diagn. 2022; 42 (3): 357-363. https://doi.org/10.1002/pd.6070Abbasi N., Ryan G., Johnson A., Cortes M.S., Sangi-Haghpeykar H., Ye X.Y., Shah P.S., Benachi A., Saada J., Ruano R.; NAFTNet. Reproducibility of fetal lung-to-head ratio in left diaphragmatic hernia across the North American Fetal Therapy Network (NAFTNet). Prenat. Diagn. 2019; 39 (3): 188-194. https://doi.org/10.1002/pd.5413Abbasi N., Ryan G., Johnson A., Cortes M.S., Sangi-Haghpeykar H., Ye X.Y., Shah P.S., Benachi A., Saada J., Ruano R.; NAFTNet. Reproducibility of fetal lung-to-head ratio in left diaphragmatic hernia across the North American Fetal Therapy Network (NAFTNet). Prenat. Diagn. 2019; 39 (3): 188-194. https://doi.org/10.1002/pd.5413Achiron R., Strauss S., Seidman D.S., Lipitz S., Mashiach S., Goldman B. Fetal lung hyperechogenicity: prenatal ultrasonographic diagnosis, natural history and neonatal outcome. Ultrasound Obstet. Gynecol. 1995; 6 (1): 40-42. https://doi.org/10.1046/j.1469-0705.1995.06010040.xAchiron R., Strauss S., Seidman D.S., Lipitz S., Mashiach S., Goldman B. Fetal lung hyperechogenicity: prenatal ultrasonographic diagnosis, natural history and neonatal outcome. Ultrasound Obstet. Gynecol. 1995; 6 (1): 40-42. https://doi.org/10.1046/j.1469-0705.1995.06010040.xCavoretto P., Molina F., Poggi S., Davenport M., Nicolaides K.H. Prenatal diagnosis and outcome of echogenic fetal lung lesions. Ultrasound Obstet. Gynecol. 2008; 32 (6): 769-783. https://doi.org/10.1002/uog.6218Cavoretto P., Molina F., Poggi S., Davenport M., Nicolaides K.H. Prenatal diagnosis and outcome of echogenic fetal lung lesions. Ultrasound Obstet. Gynecol. 2008; 32 (6): 769-783. https://doi.org/10.1002/uog.6218Achiron R., Hegesh J., Yagel S. Fetal lung lesions: a spectrum of disease. New classification based on pathogenesis, two-dimensional and color Doppler ultrasound. Ultrasound Obstet. Gynecol. 2004; 24 (2): 107-114. https://doi.org/10.1002/uog.1110Achiron R., Hegesh J., Yagel S. Fetal lung lesions: a spectrum of disease. New classification based on pathogenesis, two-dimensional and color Doppler ultrasound. Ultrasound Obstet. Gynecol. 2004; 24 (2): 107-114. https://doi.org/10.1002/uog.1110

The authors declare that there are no conflicts of interest present.