478: Imaging before 24 weeks gestation can predict neonatal respiratory morbidity in pregnancies complicated by fetal lung masses

Abstract

To evaluate the utility of imaging before 24 weeks for predicting adverse neonatal respiratory morbidity in pregnancies with fetal lung masses. A retrospective analysis of pregnancies complicated by fetal lung masses between 2009 and 2016 at a single center was performed. Cases with ultrasound (US) and magnetic resonance imaging (MRI) performed before 24 weeks gestation were included. US and MRI measurements were used to calculate the congenital pulmonary airway malformation (CPAM) volume and CPAM volume ratio (CVR). Adverse neonatal respiratory outcome was defined as need for any of the following: intubation and mechanical ventilation at birth, surgery before discharge, or extracorporeal membrane oxygenation (ECMO). The sensitivity, specificity, positive and negative predictive value of both US and MRI were determined. ROC curves were calculated as well. 41 cases with initial US imaging performed at <24 weeks gestation were identified. Of those, 35 also had an initial MRI performed at before 24 weeks. 6 cases (15% of those with US <24 weeks) had an adverse respiratory outcome at birth (5 intubation and mechanical ventilation, 4 surgery before discharge, and 1 ECMO). Additionally, there was one case of intrauterine fetal demise, and one neonatal death which were excluded from the analysis. When analyzing all imaging parameters, the strongest predictors of adverse respiratory outcomes were lesion CVR by MRI ≥0.68 (79% specificity, 83% sensitivity, 45% positive predictive value, 96% negative predictive value) and volume by MRI ≥12.8 cm3 (79% specificity, 83% sensitivity, 45% positive predictive value, 96% negative predictive value). Whereas, CVR by US ≥0.31 (50% specificity, 100% sensitivity 24%, positive predictive value, 100% negative predictive value) and volume by US ≥11.8 cm3 (75% specificity, 80% sensitivity, 33% positive predictive value, 96% negative predictive value) were weaker predictors. MRI lesion volume had an AUC of 0.82 and MRI CVR had an AUC of 0.83. CVR and lesion volume by MRI calculated before 24 weeks gestational age were the strongest imaging predictors of adverse neonatal respiratory outcomes. MRI should be considered in cases of fetal lung masses in order to optimize delivery planning and multidisciplinary care coordination.View Large Image Figure ViewerDownload Hi-res image Download (PPT)