Prenatal assessment and prediction in CDH: for what purpose?

Area of Science:

• Medical Imaging
• Fetal Medicine
• Neonatology

Background:

• Congenital diaphragmatic hernia (CDH) diagnosis is typically prenatal.
• Accurate assessment is critical for prognosis, parental counseling, and treatment planning.
• Pulmonary hypoplasia is the primary prognostic indicator, assessed via ultrasound and MRI (e.g., lung-to-head ratio, total fetal lung volume).

Purpose of the Study:

• To critically review current prenatal imaging methods for CDH.
• To highlight the strengths and limitations of existing prognostic markers.
• To emphasize the need for improved, standardized, and predictive imaging parameters.

Main Methods:

• Review of current literature on prenatal imaging for CDH.
• Evaluation of established parameters like observed-to-expected lung-to-head ratio and total fetal lung volume.
• Discussion of limitations including inability to predict associated complications and inter-center variability.

Main Results:

• Prenatal imaging parameters like lung-to-head ratio are primary predictors of neonatal outcome.
• Current markers do not predict critical complications such as persistent pulmonary hypertension of neonates or cardiac dysfunction.
• Proposed new imaging parameters lack sufficient validation and standardization for widespread clinical use.

Conclusions:

• Improved understanding of CDH pathophysiology is needed.
• Development of standardized, reproducible, and predictive imaging markers is essential.
• Refined prognostic tools will optimize fetal therapy selection and improve neonatal outcomes.