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Fetal Lung-to-Liver Signal Intensity Ratio at MR Imaging: Development of a Normal Scale and Possible Role in Predicting Pulmonary Hypoplasia in Utero¹

¹ From the University of Alberta Medical School, Edmonton, Alberta, Canada (L.J.B.), and the Departments of Obstetrics and Gynaecology (R.S.C.), Statistical and Mathematical Sciences (Y.L.), Radiology and Diagnostic Imaging (R.B.), and Pediatrics (R.B.), University of Alberta, 2A2.42 Walter C. Mackenzie Health Sciences Centre, 8440 112 St, Edmonton, AB, Canada T6G 2B7. Received February 13, 2004; revision requested April 20; revision received June 10; accepted July 21. Supported by a grant from the Royal Alexandra Hospital Foundation Research Fund and the Dr M. E. Ledingham Memorial Research Award. Address correspondence to R.B. (e-mail: rbhargav@cha.ab.ca).

View larger version (151K): [in a new window]   Figure 1. Coronal half-Fourier single-shot turbo spin-echo MR image (1100/68, 4-mm section thickness, 30 x 30-cm field of view, 218 x 256 matrix) of fetus at 28 weeks gestation shows regions of interest in lung (upper region of interest) and liver (lower region of interest) from which LLSIR was calculated. Areas chosen in each organ were homogeneous and free of organ borders and vascular structures.

View larger version (29K): [in a new window]   Figure 2. Scatter plot of LLSIR for normal lungs. Mean curve (solid line) and 95% prediction interval (dotted lines) for each gestational age are shown and are based on mixed-effects statistical model. LLSIR increases with age, likely because of increased lung fluid retained within the lung as lung spaces develop.

View larger version (30K): [in a new window]   Figure 3. Graph shows LLSIR for hypoplastic lungs compared with normal LLSIR range. = hypoplastic lungs associated with oligohydramnios. + = hypoplastic lungs not associated with oligohydramnios. Data on hypoplastic lungs from Kuwashima et al (10) () are included for comparison. At 25 weeks and beyond, all LLSIRs for hypoplastic lungs are outside the lower bound.