Volumetric assessment of normal fetal lungs using three-dimensional ultrasound

We attempted to construct normal reference centiles of fetal lung volume (LV) for clinical application by using three-dimensional (3-D) ultrasound (US) during normal gestation. A prospective study was performed on 195 healthy fetuses with gestational age (GA) ranging from 20 to 40 weeks for the assessment of fetal LV using a 3-D US volume scanner with a mixture of cross-sectional and serial measurements. Polynomial regression analysis was calculated to find the best-fit model between GA, right lung volume (RLV), left lung volume (LLV) and total lung volume (TLV). In addition, common fetal growth parameters, such as biparietal diameter (BPD), occipitofrontal diameter (OFD), head circumference (HCi), abdominal circumference (ACi), femur length (FL) and estimated fetal weight (EFW) were also measured to demonstrate the correlations between RLV, LLV, TLV and these parameters. Our results showed that RLV, LLV and TLV were highly correlated with GA. Using GA as the independent variable and RLV, LLV and TLV as the dependent variable, the best-fit regression equations were: RLV (mL) = 0.067 GA(2) - 1.2464 GA + 2.7825 (r = 0.95, n = 173, p < 0.0001), LLV (mL) = 0.0573 GA(2) - 1.599 GA + 12.454 (r = 0.95, n = 159, p < 0.0001) and TLV (mL) = 0.1263 GA(2) - 2.982 GA + 17.448 (r = 0.96, n = 152, p < 0.0001). For clinical use, a chart of normal growth centiles of fetal LV in utero was then calculated based on this equation. Furthermore, RLV, LLV and TLV were also highly correlated with the common fetal growth parameters during normal gestation (all p < 0.0001). In conclusion, the 3-D US nomograms of the fetal lung volume established in this study can be utilized as useful references in prenatal detection of fetal pulmonary pathologic status and relevant abnormalities.