Diffusion Tensor Imaging of Fetuses With Congenital Diaphragmatic Hernia

Objective: To evaluate differences in diffusion tensor imaging (DTI) parameters in the brain between fetuses with congenital diaphragmatic hernia (CDH) and age-matched controls. Method: This retrospective IRB-approved study included fetal MRIs for CDH and gestational age (GA) matched controls with lung pathology other than CDH with normal fetal brains. Fetal DTI data were acquired in 15 noncollinear diffusion-weighting directions with the b-value at 600 s/mm2 (1 b0). Slice-to-volume registration (SVR) was employed to correct for motion artifact. Results: Twenty-eight controls (27.3 ± 4.1 weeks GA) and 26 CDH (28.1 ± 4.2 weeks GA) fetuses were included. Fractional anisotropy (FA) values were significantly higher (p < 0.05) in CDH fetuses relative to controls in 12 of 50 white matter (WM) regions examined based on ANCOVA controlling for GA. After controlling for GA, sex, and CDH side, FA values in the CDH fetuses had a significant positive correlation with observed-to-expected lung volumes in 20 of 50 WM regions and with percent predicted lung volumes in 29 of 50 WM regions. Conclusion: Our data demonstrate evidence of microstructural differences based on DTI indices in the brain between CDH fetuses and age-matched controls along with correlation with the degree of pulmonary hypoplasia.