Mousa Abeer,  Perez Rachel,  Goncalves Luis

Final Pr. ID: Poster #: EDU-035

Congenital diaphragmatic hernia (CDH) is a life-threatening fetal anomaly characterized by herniation of abdominal contents into the thoracic cavity due to a defect in the diaphragm, most commonly left-sided. Accurate prenatal diagnosis and risk stratification are essential for guiding perinatal management, parental counseling, and prognostication. While ultrasound remains the first-line modality for initial detection, fetal MRI provides superior soft tissue contrast and volumetric assessment, offering critical additional information, particularly in complex or equivocal cases. This educational exhibit serves as a practical guide for radiologists interpreting fetal MRI for CDH. We review the typical imaging features of CDH on MRI, including identification of herniated organs, mediastinal shift, and assessment of the ipsilateral and contralateral lungs. Emphasis is placed on the standardized approach to measuring total and observed-to-expected lung volumes (o/e TLV), as well as lung area to head cicumference ratio (LHR), which serve as key prognostic markers. The exhibit also addresses the significance of liver position, stomach location, and diaphragmatic defect size, all of which correlate with postnatal outcomes and surgical complexity. We illustrate how MRI findings influence the clinical decision-making process, including eligibility for fetal intervention such as fetoscopic endoluminal tracheal occlusion (FETO). Radiologists play a vital role in the multidisciplinary care of these patients by providing accurate and reproducible measurements that impact prognosis and management. This exhibit aims to equip radiologists with the essential tools and knowledge required to confidently evaluate CDH on fetal MRI and contribute meaningfully to perinatal planning. Read More

Authors:  Mousa Abeer , Perez Rachel , Goncalves Luis

Keywords:  Fetal, Congenital Diaphragmatic Hernia, Lung

Didier Ryne,  Martin-saavedra Juan,  Sridharan Anush,  Larson Abby,  Coons Barbara,  Coleman Beverly,  Davey Marcus,  Hedrick Holly,  Flake Alan

Final Pr. ID: Paper #: 118

Assessment of fetal brain perfusion with contrast-enhanced ultrasound (CEUS) has not been performed in vivo in congenital diaphragmatic hernia (CDH). The development of the EXTra-uterine Environment for Neonatal Development allows investigation of CEUS and fetal brain perfusion parameters. The purpose of this study was to assess for aberrations in brain perfusion using CEUS in fetal lambs with CDH and correlate with cardiac output data. Read More

Authors:  Didier Ryne , Martin-saavedra Juan , Sridharan Anush , Larson Abby , Coons Barbara , Coleman Beverly , Davey Marcus , Hedrick Holly , Flake Alan

Keywords:  Congenital Diaphragmatic Hernia, Brain Perfusion, Contrast Enhanced Ultrasound

Hughes Jordan,  Chowdhary Anisa,  Walczak Edward,  Awan Baarkullah,  Jalili Mohammad

Final Pr. ID: Poster #: EDU-088

Fetal MRI is useful in the detection and evaluation of several fetal pulmonary abnormalities including congenital diaphragmatic hernia, pulmonary hypoplasia and pulmonary airway malformations. MRI offers a noninvasive modality that is complementary to ultrasound for detecting fetal abnormalities. Fetal MRI can also be beneficial in helping to establish the prognosis and assisting in perinatal management. One of the major advantages of MRI is that it allows the quantitative measurement of lung volume thereby providing the observed total fetal lung volume (TFLVo) which can be compared to expected total fetal lung volume. A ratio of observed to expected ratio can be calculated. This can be useful in prognosis and risk stratification, particularly in diaphragmatic hernias. MRI also has the advantage of excellent spatial resolution and evaluation of soft tissues structures that may be present above the diaphragm. In this exhibit we will provide several cases including congenital diaphragmatic hernia, congenital pulmonary airway malformation and bilateral pulmonary hypoplasia to illustrate the benefit and utility of fetal MRI for the evaluation of fetal thoracic abnormalities. Read More

Authors:  Hughes Jordan , Chowdhary Anisa , Walczak Edward , Awan Baarkullah , Jalili Mohammad

Keywords:  MR, Congenital Diaphragmatic Hernia, Pulmonary Hypoplasia

Stern Joseph,  Ramirez Suarez Karen,  Victoria Teresa,  Otero Hansel

Final Pr. ID: Poster #: CR-033

Hepatopulmonary fusion (HPF) is a very rare type of right-sided congenital diaphragmatic hernia (CDH) with a reported prevalence of 3 in 1000 right-sided CDH cases. By June 2020, less than 50 cases have been reported in the literature. Out of 147 patients with right CDH managed at our institution, we found only one case (0.68%) of HPF, which is presented here.

HPF is typically not identified preoperatively, and the presence of HPF changes the operative management. It has been reported that a large right CDH without leftward cardiomediastinal shift and atelectatic lung adherent to the liver are imaging features of HPF.

This patient was a full-term, newborn girl with a normal prenatal course who developed respiratory distress immediately after birth. Chest radiograph at birth demonstrated a right CDH. On day four of life, the patient underwent surgical repair of right CDH. During the procedure, hepatopulmonary fusion involving the cephalad portion of the liver was discovered. The lung and liver could not be separated safely so the diaphragmatic defect was closed around the portion of the liver that extended into the thorax. Postoperative CT angiography of the chest and abdomen demonstrated no abnormal vascular communication between the lungs and liver; however, anomalies of systemic veins were identified. Follow-up chest radiograph at 9 months of age demonstrated a large right CDH that did not include bowel or right-sided colon and was without leftward mediastinal deviation. Concurrent contrast-enhanced CT images of the thorax at this time confirm the right CDH with herniated liver occupying most of the right hemothorax and expected rightward traction of the liver vasculature. However, no significant leftward mediastinal deviation was noted. A small amount of atelectatic lung overlying the liver was also noted, another imaging sign expected with HPF. Last follow-up at age 4, patient was thriving with normal growth and development. Read More

Authors:  Stern Joseph , Ramirez Suarez Karen , Victoria Teresa , Otero Hansel

Keywords:  Hepatopulmonary Fusion, Congenital diaphragmatic hernia, CTA

Perdomo-luna Camilo,  Park Paul,  Bridgemohan Abigael,  Riera Luis,  Kvist Ola,  Duron Vincent

Final Pr. ID: Poster #: SCI-027

Fetal MRI is increasingly used in congenital diaphragmatic hernia (CDH) cases for enhanced anatomical imaging and prognostic assessment. Radiomics allows extraction of complex quantitative data that may enhance prediction capabilities beyond standard lung volume measurements. This investigation sought to determine which radiomic characteristics distinguish normal fetal lungs from those affected by CDH. Read More

Authors:  Perdomo-luna Camilo , Park Paul , Bridgemohan Abigael , Riera Luis , Kvist Ola , Duron Vincent

Keywords:  Lung, Fetal MRI, Congenital Diaphragmatic Hernia

Alford Raphael,  Rubesova Erika,  Halabi Safwan,  Blumenfeld Yair,  Hintz Susan,  Barth Richard

Final Pr. ID: Poster #: SCI-049

The purpose of this study is to determine the reliability of sonographic (US) lung measurements compared with Fetal MR in fetuses with congenital diaphragmatic hernia. The sonographic lung head ratio (LHR) is a widely used prognostic tool in CDH, but can be difficult to obtain due to shifted mediastinum and fetal position. To our knowledge, comparison of MRI measured LHR with US has not been previously reported. Read More

Authors:  Alford Raphael , Rubesova Erika , Halabi Safwan , Blumenfeld Yair , Hintz Susan , Barth Richard

Keywords:  Congenital diaphragmatic hernia, Lung head ratio, LHR, Fetal MRI, Lung volumes