Timothy W Ng1,2, Yin Xi1, David Schindel3, Angela Beavers1, Patricia Santiago-Munoz4, April A Bailey1,4, Diane M Twickler1,4. 1. 1 Department of Radiology, The University of Texas Southwestern Medical Center, Dallas, TX. 2. 2 Present: Department of Radiology, Fontana Medical Center, Southern California Permanente Group, 9961 Sierra Avenue, Fontana, CA 92335. 3. 3 Department of Surgery, The University of Texas Southwestern Medical Center, Dallas, TX. 4. 4 Department of Obstetrics and Gynecology, The University of Texas Southwestern Medical Center, Dallas, TX.
Abstract
OBJECTIVE: The purpose of this study is to determine which MRI parameters of fetal head and neck masses predict high-morbidity neonatal outcomes, including ex utero intrapartum treatment (EXIT) procedure. MATERIALS AND METHODS: This retrospective study (2004-2016) included parameters of polyhydramnios (based on largest vertical pocket), mass effect on the trachea, mass midline extension, and morphologic grade and size of masses. The morbid cohort included those requiring an EXIT procedure, difficult intubation at delivery, or lethal outcome. Predictive modeling with a multivariable logistic regression and ROC analysis was then performed. RESULTS: Of 36 fetuses, five were delivered by EXIT procedures, there was one neonatal death within 12 hours after delivery, and another neonate required multiple intubation attempts. The remaining 29 fetuses were delivered at outside institutions with no interventions or neonatal morbidity. The largest vertical pocket and mass effect on the trachea were selected as independent predictors by the logistic regression. The cross-validated ROC AUC was 0.951 (95% CI, 0.8795-1). CONCLUSION: The largest vertical pocket measurement and mass effect on the trachea were the most contributory MRI parameters that predicted significant morbidity in fetuses with masses of the face and neck, along with other significant parameters. These parameters predict significant morbid neonatal outcomes, including the need for EXIT procedures.
OBJECTIVE: The purpose of this study is to determine which MRI parameters of fetal head and neck masses predict high-morbidity neonatal outcomes, including ex utero intrapartum treatment (EXIT) procedure. MATERIALS AND METHODS: This retrospective study (2004-2016) included parameters of polyhydramnios (based on largest vertical pocket), mass effect on the trachea, mass midline extension, and morphologic grade and size of masses. The morbid cohort included those requiring an EXIT procedure, difficult intubation at delivery, or lethal outcome. Predictive modeling with a multivariable logistic regression and ROC analysis was then performed. RESULTS: Of 36 fetuses, five were delivered by EXIT procedures, there was one neonatal death within 12 hours after delivery, and another neonate required multiple intubation attempts. The remaining 29 fetuses were delivered at outside institutions with no interventions or neonatal morbidity. The largest vertical pocket and mass effect on the trachea were selected as independent predictors by the logistic regression. The cross-validated ROC AUC was 0.951 (95% CI, 0.8795-1). CONCLUSION: The largest vertical pocket measurement and mass effect on the trachea were the most contributory MRI parameters that predicted significant morbidity in fetuses with masses of the face and neck, along with other significant parameters. These parameters predict significant morbid neonatal outcomes, including the need for EXIT procedures.
Authors: Nada Mufti; Michael Ebner; Premal Patel; Michael Aertsen; Trevor Gaunt; Paul D Humphries; Fonteini Emmananouella Bredaki; Richard Hewitt; Colin Butler; Magdalena Sokolska; Giles S Kendall; David Atkinson; Tom Vercauteren; Sebastien Ourselin; Pranav P Pandya; Jan Deprest; Andrew Melbourne; Anna L David Journal: OTO Open Date: 2021-10-25