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Assessment of mediastinal shift angles in congenital pulmonary airway malformation: a new fetal magnetic resonance imaging indicator of congenital lung disease

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Abstract

Background

The mediastinal shift angle is a new fetal magnetic resonance imaging (MRI) index that is reportedly correlated with postnatal survival in fetuses with congenital diaphragmatic hernia. However, its correlation in patients with congenital pulmonary airway malformation (CPAM) has not been assessed.

Objective

This study aimed to establish a normal range for the right/left mediastinal shift angles, to evaluate the mediastinal shift angle in fetuses with CPAM, to compare the mediastinal shift angle with the CPAM volume ratio, and to evaluate the predictive value of the mediastinal shift angle measurements.

Materials and methods

To establish the normal range, we measured the mediastinal shift angle bilaterally in 124 fetuses without any lung abnormality (the control group). Subsequently, the mediastinal shift angle was measured in 32 fetuses pathologically diagnosed with CPAM. Moreover, the mediastinal shift angle and CPAM volume ratio were compared using fetal MRI.

Results

The mean values for the right/left mediastinal shift angles were 18.6°/26.3° and 39.2°/35.9° for control fetuses and fetuses with CPAM, respectively. The mediastinal shift angle and the CPAM volume ratio showed a positive statistical correlation. The area under the curve demonstrated high discriminatory accuracy for the mediastinal shift angle (0.76).

Conclusion

The mediastinal shift angle has potential to replace the CPAM volume ratio for evaluating the severity of CPAM in fetal MRI.

Graphical Abstract

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Data availability

The datasets generated and/or analyzed in the current study are available from the corresponding author on reasonable request.

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Acknowledgements

We thank Junko Ihara, Taizou Somemori, Keisuke Asano, Masaya Fujiyoshi, Ryota Hiura, and Kasumi Watanabe, MRI technologists at the National Center for Child Health and Development.

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Authors and Affiliations

  1. Department of Radiology, National Center for Child Health and Development, Tokyo, Japan

    Jun Tsukamoto, Osamu Miyazaki, Yuki Saito, Saho Irahara, Reiko Okamoto, Mikiko Miyasaka, Yoshiyuki Tsutsumi & Shunsuke Nosaka

  2. Department of Radiology, University of Occupational and Environmental Health School of Medicine, 1-1 Iseigaoka, Yahatanishi-Ku, Kitakyushu, Fukuoka, 807-8555, Japan

    Jun Tsukamoto, Yoshiko Hayashida & Takatoshi Aoki

  3. Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan

    Yushi Itoh & Haruhiko Sago

  4. Division of Surgery, Department of Surgical Specialties, National Center for Child Health and Development, Tokyo, Japan

    Yutaka Kanamori

  5. Department of Data Science, Clinical Research Center, Biostatistics Unit, National Center for Child Health and Development, Tokyo, Japan

    Masashi Mikami

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  1. Jun Tsukamoto
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  2. Osamu Miyazaki
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Contributions

O.M., Y.S., S.I., R.O., M.M., Y.T., Y.I., H.S․, Y.K., Y.H., T.A., and S.N. conceived, supervised, and supported the study. J.T., O.M., and M.M. collated and analyzed the data, performed the statistical analysis, and drafted the initial manuscript. J.T. and O.M. interpreted the images. J.T., O.M., and T.A. edited the manuscript. All authors have reviewed and approved the final manuscript.

Corresponding author

Correspondence to Jun Tsukamoto.

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Tsukamoto, J., Miyazaki, O., Saito, Y. et al. Assessment of mediastinal shift angles in congenital pulmonary airway malformation: a new fetal magnetic resonance imaging indicator of congenital lung disease. Pediatr Radiol 54, 715–724 (2024). https://doi.org/10.1007/s00247-024-05852-5

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  • DOI: https://doi.org/10.1007/s00247-024-05852-5

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