Key ultrasound predictors in the prenatal assessment of congenital pulmonary airway malformation: a single-center experience
BackgroundThis study assesses the sensitivity and specificity of congenital pulmonary airway malformation (CPAM) Volume Ratio (CVR) in predicting the need for fetal therapy (FT) and explores the role of additional ultrasound indicators, including the Observed/Expected Lung to Head Ratio (O/E LHR) an...
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Frontiers Media S.A.
2025-05-01
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| Series: | Frontiers in Pediatrics |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fped.2025.1555539/full |
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| author | Isabella Fabietti Alice Novak Alice Novak Laura Valfrè Chiara Vassallo Domenico Umberto De Rose Milena Viggiano Andrea Conforti Chiara Iacusso Marco Bonito Pietro Bagolan Pietro Bagolan Leonardo Caforio |
| author_facet | Isabella Fabietti Alice Novak Alice Novak Laura Valfrè Chiara Vassallo Domenico Umberto De Rose Milena Viggiano Andrea Conforti Chiara Iacusso Marco Bonito Pietro Bagolan Pietro Bagolan Leonardo Caforio |
| author_sort | Isabella Fabietti |
| collection | DOAJ |
| description | BackgroundThis study assesses the sensitivity and specificity of congenital pulmonary airway malformation (CPAM) Volume Ratio (CVR) in predicting the need for fetal therapy (FT) and explores the role of additional ultrasound indicators, including the Observed/Expected Lung to Head Ratio (O/E LHR) and Mediastinal Angle Shift (MSA), in improving FT prediction.MethodsWe retrospectively studied all CPAM cases referred to our Center from 2018 to 2022. FT was provided at any CVR value in cases of hydrops, rapid lesion growth, or polyhydramnios. The worst CVR, O/E LHR, and MSA values between 20 and 28 weeks of gestation were analyzed.ResultsAmong 62 CPAM cases, 56.4% right-sided and 43.5% left-sided. Hydrops occurred in 5 cases, all right-sided. FT was required in 14 cases (11 receiving steroids and 3 thoraco-amniotic shunt). CVR was significantly higher in the FT group compared to the non-FT group (p < 0.0001), with an optimal cut-off of 1.25 (Sn 100%; Sp 89.6%) for predicting FT. The O/E LHR was significantly lower in the FT group (mean 44.8 vs. 58.3; p = 0.0046, AUC 0.75), with a Sn of 84% and Sp of 62%. MSA was significantly higher in the FT compared to the non-FT group (p < 0.0001), with a threshold of 13.3° providing high Sn (92.8%) and Sp (89.3%) for predicting FT.ConclusionsCVR is the most reliable predictor of the need for FT, even at lower thresholds. MSA can effectively complement CVR in predicting FT, and using multiple parameters may improve parental counseling and identify cases needing closer monitoring. |
| format | Article |
| id | doaj-art-667fb3a25145471386b3ff14bbbfc33c |
| institution | OA Journals |
| issn | 2296-2360 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Pediatrics |
| spelling | doaj-art-667fb3a25145471386b3ff14bbbfc33c2025-08-20T02:31:44ZengFrontiers Media S.A.Frontiers in Pediatrics2296-23602025-05-011310.3389/fped.2025.15555391555539Key ultrasound predictors in the prenatal assessment of congenital pulmonary airway malformation: a single-center experienceIsabella Fabietti0Alice Novak1Alice Novak2Laura Valfrè3Chiara Vassallo4Domenico Umberto De Rose5Milena Viggiano6Andrea Conforti7Chiara Iacusso8Marco Bonito9Pietro Bagolan10Pietro Bagolan11Leonardo Caforio12Clinical Area of Fetal, Neonatal and Cardiological Sciences and Research Area of Perinatal Medicine – “Bambino Gesù” Children's Hospital IRCCS, Rome, ItalyClinical Area of Fetal, Neonatal and Cardiological Sciences and Research Area of Perinatal Medicine – “Bambino Gesù” Children's Hospital IRCCS, Rome, ItalyObstetrics and Gynecology Unit, Maternal and Child Department, San Pietro Fatebenefratelli Hospital, Rome, ItalyClinical Area of Fetal, Neonatal and Cardiological Sciences and Research Area of Perinatal Medicine – “Bambino Gesù” Children's Hospital IRCCS, Rome, ItalyClinical Area of Fetal, Neonatal and Cardiological Sciences and Research Area of Perinatal Medicine – “Bambino Gesù” Children's Hospital IRCCS, Rome, ItalyClinical Area of Fetal, Neonatal and Cardiological Sciences and Research Area of Perinatal Medicine – “Bambino Gesù” Children's Hospital IRCCS, Rome, ItalyClinical Area of Fetal, Neonatal and Cardiological Sciences and Research Area of Perinatal Medicine – “Bambino Gesù” Children's Hospital IRCCS, Rome, ItalyClinical Area of Fetal, Neonatal and Cardiological Sciences and Research Area of Perinatal Medicine – “Bambino Gesù” Children's Hospital IRCCS, Rome, ItalyClinical Area of Fetal, Neonatal and Cardiological Sciences and Research Area of Perinatal Medicine – “Bambino Gesù” Children's Hospital IRCCS, Rome, ItalyObstetrics and Gynecology Unit, Maternal and Child Department, San Pietro Fatebenefratelli Hospital, Rome, ItalyClinical Area of Fetal, Neonatal and Cardiological Sciences and Research Area of Perinatal Medicine – “Bambino Gesù” Children's Hospital IRCCS, Rome, ItalyDepartment of Systems Medicine, University of Rome “Tor Vergata”, Rome, ItalyClinical Area of Fetal, Neonatal and Cardiological Sciences and Research Area of Perinatal Medicine – “Bambino Gesù” Children's Hospital IRCCS, Rome, ItalyBackgroundThis study assesses the sensitivity and specificity of congenital pulmonary airway malformation (CPAM) Volume Ratio (CVR) in predicting the need for fetal therapy (FT) and explores the role of additional ultrasound indicators, including the Observed/Expected Lung to Head Ratio (O/E LHR) and Mediastinal Angle Shift (MSA), in improving FT prediction.MethodsWe retrospectively studied all CPAM cases referred to our Center from 2018 to 2022. FT was provided at any CVR value in cases of hydrops, rapid lesion growth, or polyhydramnios. The worst CVR, O/E LHR, and MSA values between 20 and 28 weeks of gestation were analyzed.ResultsAmong 62 CPAM cases, 56.4% right-sided and 43.5% left-sided. Hydrops occurred in 5 cases, all right-sided. FT was required in 14 cases (11 receiving steroids and 3 thoraco-amniotic shunt). CVR was significantly higher in the FT group compared to the non-FT group (p < 0.0001), with an optimal cut-off of 1.25 (Sn 100%; Sp 89.6%) for predicting FT. The O/E LHR was significantly lower in the FT group (mean 44.8 vs. 58.3; p = 0.0046, AUC 0.75), with a Sn of 84% and Sp of 62%. MSA was significantly higher in the FT compared to the non-FT group (p < 0.0001), with a threshold of 13.3° providing high Sn (92.8%) and Sp (89.3%) for predicting FT.ConclusionsCVR is the most reliable predictor of the need for FT, even at lower thresholds. MSA can effectively complement CVR in predicting FT, and using multiple parameters may improve parental counseling and identify cases needing closer monitoring.https://www.frontiersin.org/articles/10.3389/fped.2025.1555539/fullcongenital pulmonary airway malformationCPAMCVRO/E LHRMSAfetal surgery |
| spellingShingle | Isabella Fabietti Alice Novak Alice Novak Laura Valfrè Chiara Vassallo Domenico Umberto De Rose Milena Viggiano Andrea Conforti Chiara Iacusso Marco Bonito Pietro Bagolan Pietro Bagolan Leonardo Caforio Key ultrasound predictors in the prenatal assessment of congenital pulmonary airway malformation: a single-center experience Frontiers in Pediatrics congenital pulmonary airway malformation CPAM CVR O/E LHR MSA fetal surgery |
| title | Key ultrasound predictors in the prenatal assessment of congenital pulmonary airway malformation: a single-center experience |
| title_full | Key ultrasound predictors in the prenatal assessment of congenital pulmonary airway malformation: a single-center experience |
| title_fullStr | Key ultrasound predictors in the prenatal assessment of congenital pulmonary airway malformation: a single-center experience |
| title_full_unstemmed | Key ultrasound predictors in the prenatal assessment of congenital pulmonary airway malformation: a single-center experience |
| title_short | Key ultrasound predictors in the prenatal assessment of congenital pulmonary airway malformation: a single-center experience |
| title_sort | key ultrasound predictors in the prenatal assessment of congenital pulmonary airway malformation a single center experience |
| topic | congenital pulmonary airway malformation CPAM CVR O/E LHR MSA fetal surgery |
| url | https://www.frontiersin.org/articles/10.3389/fped.2025.1555539/full |
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