Prenatal ultrasound-and MRI-based imaging predictors of respiratory symptoms at birth for congenital lung malformations

Background: Congenital lung malformations (CLM) are rare developmental anomalies of the fetal lung with a minority of patients exhibiting symptoms around the time of birth. Although ultrasound re-mains the gold standard, fetal MRI has recently been incorporated as an adjunct imaging modality in the workup and prenatal counseling of patients with CLM as it is thought to more accurately delineate lesion boundaries and diagnose lesion type. We evaluate what prenatal variables correlate with postnatal respiratory symptoms.Methods: We performed a retrospective review of patients with prenatal diagnosis of CLM treated at our institution between 2006-2020. Fetal ultrasound and magnetic resonance imaging (MRI) parameters including maximal congenital pulmonary airway malformation volume ratio (CVR), absolute cyst volume, and observed to expected normal fetal lung volume (O/E NFLV) were correlated with outcomes includ-ing postnatal respiratory symptoms, need for supplementary oxygen or mechanical ventilation, delay in tolerating full feeds, resection in the neonatal period.Results: Our study included 111 patients, all of whom underwent fetal ultrasound with 64 patients addi-tionally undergoing fetal MRI. Postnatal respiratory symptoms were noted in 22.5% of patients, 19.8% re-quired supplemental oxygen, 2.7% mechanical ventilation and two patients requiring urgent resection. Ul-trasound parameters including absolute cyst volume and maximal CVR correlated with need for mechan-ical ventilation (p = 0.034 and p = 0.024, respectively) and for urgent resection (p = 0.018 and p = 0.023, re-spectively) and had a marginal association with postnatal respiratory symptoms (p = 0.050 and p = 0.052). Absolute cyst volume became associated with postnatal respiratory symptoms (p = 0.017) after multivari-able analysis controlling for maternal steroid administration and gestational age. O/E NFLV did not corre-late with perinatal outcomes.Conclusion: We have found that ultrasound-based measurements correlate with postnatal respiratory symptoms, while MRI derived O/E NFLV does not. Further studies are needed to elucidate the role of MRI in the prenatal workup of congenital lung malformations. Type of Study: Study of Diagnostic Test.Level of Evidence: Level I.(c) 2022 Elsevier Inc. All rights reserved.