Abstract
Ultrasonography (US) is the screening method of choice for the evaluation of the fetal airway and chest. It is safe, inexpensive and easily performed. Advances in US technique including higher resolution transducers, Doppler and 3D/4D imaging have allowed for improved assessment of the congenital thoracic masses. The assessment of the fetal chest by US, however, is operator dependent and evaluation may be limited due to fetal position, maternal obesity, overlying bone and/or oligohydramnios. Ultrasound evaluation is sensitive in the diagnosis of many prenatal lung lesions but has low specificity. Magnetic resonance imaging (MRI) is an alternative modality that uses no ionizing radiation, has excellent tissue contrast, a large field of view, is not limited by obesity or overlying bone and can image the fetus in multiple planes regardless of fetal lie. Faster scanning techniques allow studies to be performed without sedation in the second and third trimester with minimal motion artifact. Fetal MRI helps confirm the presence of masses identified by US, can delineate anatomy such as the trachea not visualized by US and may demonstrate additional subtle anomalies. Advances in US and MRI have improved our ability to accurately diagnose fetal airway and chest anomalies and furthered our understanding of the evolution of fetal lung lesions.
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References
Kline-Fath BM. Is prenatal sonography accurate in identification of Congenital lung lesions? Scientific paper presented at SPR, Boston, MA. April 15; 2010.
Breysem L, Bosmans H, Dymarkowski S, et al. The value of fast MR imaging as an adjunct to ultrasound in prenatal diagnosis. Eur Radiol. 2003;13:1538–48.
Quinn TM, Hubbard AM, Adzick NS. Prenatal MRI enhance fetal diagnosis. J Pediatr Surg. 1998;33:553–8.
Bulas DI. Fetal magnetic resonance imaging as a complement to fetal ultrasonography. Ultrasound Q. 2007;23(1):3–22.
Aite L, Zaccara A, Trucchi A, et al. When uncertainty generates more anxiety than severity: the prenatal experience with cystic adenomatoid malformation of the lung. J Perinat Med. 2009;37:539–42.
Ruano R, Joubin L, Abry MC, et al. Anomogram of fetal lung volumes estimated by 3D US using the roataional technique (virtual organ computer aided analysis). J Ultrasound Med. 2006;35:701–9.
Harmath A, Csaba A, Hauzman E, et al. Congenital lung malformations in the second trimester: prenatal ultrasound diagnosis and pathologic findings. J Clin Ultrasound. 2007;35(5):250–5.
Lecompte B, Hadden H, Coste K, et al. Hyperechoic congenital lung lesions in a non-selected population: from prenatal detection till perinatal management. Prenat Diagn. 2009;29:1222–30.
Ankerman T, Oppermann HC, Engler S, et al. Congenital masses of the lung, cystic adenomatoid malformation versus congenital lobar emphysema: prenatal diagnosis and implications for postnatal treatment. J Ultrasound Med. 2004;23:1379–84.
Johnson AM, Hubbard AM. Congenital anomalies of the fetal/neonatal chest. Semin Roentgenol. 2004;39:197–214.
Coakley FV, Glenn OA, Qayyam A, et al. Fetal MRI: a developing technique for the developing patient. AJR. 2004;182:243–52.
Prayer D, Brugger PC, Prayer L. Fetal MRI: techniques and protocols. Pediatr Radiol. 2004;34:685–93.
Baker PN, Johnson IR, Harvey PR, et al. A three year follow up children imaged in utero with echoplanar magnetic resonance. Am J Obstet Gynecol. 1994;170:32–3.
De Wilde JP, Rivers AW, Price DU, et al. A review of the current use of magnetic resonance imaging in pregnancy and safety implications for the fetus. Prog Biophys Mol Biol. 2005;87:335.
Yip YP, Capriotti C, Tlagala SL, et al. Effects of MR exposure at 1.5 T on early embryonic development of the chick. J Magn Reson Imaging. 1994;4:742–8.
Yip YP, Capriotti C, Yip JW. Effects of MR exposure on axonal outgrowth in the sympathetic nervous system of the chick. J Magn Reson Imaging. 1995;5:457–62.
Vadeyar SH, Moore RJ, Strachan BK, et al. Effect of fetal magnetic resonance imaging on fetal heart rate patterns. Am J Obstet Gynecol. 2000;182:666–9.
Mevissen M, Buntenkotter S, Loscher W. Effect of static and time varying magnetic field on reproduction and fetal development in rats. Teratology. 1994;50:229–37.
Shellock FG, Kanal E. Policies, guidelines and recommendations for MR imaging safety and patient management. JMRI. 1991;1:97–101.
United Nations Scientific Committee on the effects of atomic radiation. Ionizing radiation levels and effects. 1972 report to the General Assembly Vol 2 Effects New York, NY; 1972
Hand JW, Li Y, Thomas EL, et al. Prediction of specific absorption rate in mother and fetus associated with MRI examinations during pregnancy. Magn Reson Med. 2006;55:883–93.
Frates MC, Kumar AJ, Benson CB, et al. Fetal anomalies: comparison of MR imaging and US for diagnosis. Radiology. 2004;232:398–404.
Levine D, Barnewolt CE, Mehta TS, et al. Fetal thoracic abnormalities: MR imaging. Radiology. 2003;228:379–88.
Kunisaki SM, Fauza DO, Barnewolt CE, et al. Exutero intrapartum treatment with placement of extracorporeal membrane oxygenation for fetal thoracic masses. J Pediatr Surg. 2007;42(2):420–5.
Daltro P, Werner H, Gasparetto TD, et al. Congenital chest malformations: a multimodality approach with emphasis on fetal MR Imaging. Radiographics. 2010;30:385–95.
Curran PF, Jelin EB, Rand L, et al. Prenatal steroids for microcystic congenital cystic adenomatoid malformations. J Pediatr Surg. 2010;45:145–50.
Azizkhan RG, Crombleholme TM. Congenital cystic lung disease: contemporary antenatal and postnatal management. Pediatr Surg Int. 2008;24:643–57.
Adzick NS. Management of fetal lung lesions. Clin Perinatol. 2009;36:363–76.
Kumar AN. Perinatal management of common neonatal thoracic lesions. Indian J Pediatr. 2008;75:931–7.
Bush A, Hogg J, Chitty LS. Cystic lung lesions – prenatal diagnosis and management. Prenat Diagn. 2008;28:604–11.
Cavoretto P, Molina F, Poggi S, et al. Prenatal diagnosis and outcome of echogenic fetal lung lesions. Ultrasound Obstet Gynecol. 2008;32:769–83.
Stocker TJ, Manewell JE, Drake RM. Congenital cystic adenomatoid malformation of the lung: classification and morphologic spectrum. Hum Pathol. 1977;8:155–71.
Crombleholme TM, Coleman B, Hedrick H, et al. Cystic adenomatoid malformation volume ratio predicts outcome in prenatally diagnosed cystic adenomatoid malformation of the lung. J Pediatr Surg. 2002;37(3):331–8.
Mann S, Wilson RD, Bebbington MW, et al. Antenatal diagnosis and management of congenital cystic adenomatoid malformation. Semin Fetal Neonatal Med. 2007;12:477–81.
Coleman BG, Adzick NS, Crombleholme TM, et al. Fetal therapy: state of the art. J Ultrasound Med. 2002;21:1257–88.
Morris LM, Lim FY, Livingston JC, et al. High-risk fetal congenital pulmonary airway malformations have a variable response to steroids. J Pediatr Surg. 2009;2004:60–5.
Kunisaki SM, Barnewolt CE, Estroff JA, et al. Large fetal congenital cystic adenomatoid malformations: growth trends and patient survival. J Pediatr Surg. 2007;42(2):404–10.
Knox EM, Kilby MD, Martin WL, et al. In-utero pulmonary drainage in the management of primary hydrothorax and congenital cystic lung lesion: a systematic review. Ultrasound Obstet Gynecol. 2006;28:726–34.
Fortunato S, Lombardo S, Dantrell J. Intrauterine laser ablation of a fetal cystic adenomatoid malformation with hydrops: the application of minimally invasive surgical techniques to fetal surgery. Am J Obstet Gynecol. 1997;177:S84.
Adzick NS. Open fetal surgery for life-threatening fetal anomalies. Semin Fetal Neonatal Med. 2009; (epub ahead of print).
Bermudez C, Perez-Wulff J, Arcadipane M, et al. Percutaneous fetal sclerotherapy for congenital cystic adenomatoid malformation of the lung. Fetal Diagn Ther. 2008;24:237–40.
Marshall KW, Blane CE, Teitelbaum DH, et al. Congenital cystic adenomatoid malformation: impact of prenatal diagnosis and changing strategies in the treatment of the asymptomatic patient. AJR. 2000;175:1551–4.
Vijayaraghavan SB, Rao PS, Selvarasu CD, et al. Prenatal sonographic features of intralobar bronchopulmonary sequestration. J Ultrasound Med. 2003;22:541–4.
Sepulveda W. Perinatal imaging in bronchopulmonary sequestration. J Ultrasound Med. 2009;28:89–94.
Zeidan S, Gorincour G, Potier A, et al. Congenital lung malformation: evaluation of prenatal and postnatal radiologic findings. Respirology. 2009;14:1005–11.
Witlox RS, Lopriore E, Rikkers-Mutsaerts ER, et al. Single-needle laser treatment with drainage of hydrothorax in fetal bronchopulmonary sequestration with hydrops. Ultrasound Obstet Gynecol. 2009;34:355–7.
Oepkes D, Devlieger R, Lopriore E, et al. Successful ultrasound-guided laser treatment of fetal hydrops caused by pulmonary sequestration. Ultrasound Obstet Gynecol. 2007;29:457–9.
Ruano R, de A Pimenta EJ, Marques da Silva M, et al. Percutaneous intrauterine laser ablation of the abnormal vessel in pulmonary sequestration with hydrops at 29 weeks’ gestation. J Ultrasound Med. 2007;26:1235–41.
Becmeur F, Horta-Geraud P, Donato L, et al. Pulmonary sequestrations: prenatal ultrasound diagnosis, treatment and outcome. J Pediatr Surg. 1998;33:492–6.
Seo T, Ando H, Kaneko K, et al. Two cases of prenatally diagnosed congenital lobar emphysema caused by lobar bronchial atresia. J Pediatr Surg. 2006;41:E17–20.
Pariente G, Aviram M, Landau D, et al. Prenatal diagnosis of congenital lobar emphysema: case report and review of the literature. J Ultrasound Med. 2009;28:1081–4.
Peranteau WH, Merchant AM, Hedrick HL, et al. Prenatal Course and postnatal management of peripheral bronchial atresia: association with congenital cystic adenomatoid malformation of the lung. Fetal Diagn Ther. 2008;24:190–6.
Aubard Y, Derouineau I, Aubard V, et al. Primary fetal hydrothorax: a literature review and proposed antenatal clinical strategy. Fetal Diagn Ther. 1998;13:325–33.
Chaoui R, Kalache K, Tennstedt C, et al. Pulmonary arterial Doppler velocimetry in fetuses with lung hypoplasia. Eur J Obstet Gynecol Repord Biol. 1999;84:179–85.
Keller TM, Rake A, Michel SC, Seifert B, et al. MR assessment of fetal lung development using lung volumes and signal intensities. Eur Radiol. 2004;14(6):984–9.
Osada H, Kaku K, Masuda K, Iitsuka Y, Seki K, Sekiya S. Quantitative and qualitative evaluations of fetal lung with MR imaging. Radiology. 2004;231:887–92.
Tanigaki S, Miyakoshi K, Tanaka M, et al. Pulmonary hypoplasia: prediction with use of ratio of MRI measured fetal lung volume to US estimated fetal body weight. Radiology. 2004;232:767–72.
Ward VL, Nishino M, Hatabu H, et al. Fetal lung volume measurements: determination with MR imaging – effect of various factors. Radiology. 2006;240(1):187–93.
Williams G, Coakley FV, Qayyum A, et al. Fetal relative lung volume: quantification by using prenatal MR imaging lung volumetry. Radiology. 2004;233:457–62.
Keller TM, Rake A, Michel SC, Seifert B, Wisser J, et al. MR assessment of fetal lung development using lung volumes and signal intensities. Eur Radiol. 2004;14(6):984–9.
Kuwashima S, Nishimura G, Limura F, et al. Low intensity fetal lungs on MRI may suggest the diagnosis of pulmonary hypoplasia. Pediatr Radiol. 2001;31:669–72.
Zaretsky M, Ramus R, McIntire D, et al. MR calculation of lung volumes to predict outcome in fetuses with genitourinary abnormalities. Am J Roentgenol. 2005;185(5):1328–34.
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Bulas, D., Egloff, A. (2012). Fetal Imaging of the Chest. In: Cleveland, R. (eds) Imaging in Pediatric Pulmonology. Springer, Boston, MA. https://doi.org/10.1007/978-1-4419-5872-3_18
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