MRI and three dimensional ultrasonography in the assessment of pulmonary hypoplasia in fetuses with urinary tract anomalies

Abstract Purpose To analyze the correlation and agreement between three dimensional (3D) US and MRI in the assessment of pulmonary volumes of fetuses with different types of urinary tract malformations (UTM) and high-risk of pulmonary hypoplasia (PH). Patients and methods Thirty-nine fetuses with various UTM, at risk for PH were involved in this cross-sectional study. 3D volume US data sets of the fetal lungs were acquired. The right, left and total lung volumes were calculated separately using the virtual organ computer-aided analysis (VOCAL) method with a 30° rotation. MRI of fetal lung was obtained with assessment of signal intensity and lung volumetry. Comparison between mean lung volumes was performed using unpaired t test. Agreement between the 3D-US and MRI methods was done using Cohen kappa test. Results Good agreement was detected between the two methods (Kappa = 0.629, p  = 0.001). The measured lung volumes by 3D-US were smaller than those measured by MRI ( p  u003e 0.05, non-significant). MRI showed greater specificity, PPV and diagnostic accuracy (100% each) than 3D-US (50%, 88.9% and 90% respectively). Conclusion There is a good concordance between 3D-US and MRI in the evaluation of PH in fetuses with UTM. MRI could be reserved for borderline cases of pulmonary hypoplasia and the difficult diagnostic situations.