Our Summary

This paper looks at how useful different types of scans are in preparing for surgery on babies with lung problems that are present at birth. The researchers looked at data from babies who had surgery to remove these lung problems at one hospital over roughly 9 years.

They found that MRI scans done before the baby is born can give useful information, but CT scans done after the baby is born can provide even clearer details. However, these CT scans also expose the baby to radiation.

The decision to remove these lung problems is controversial and depends on the type of problem. The researchers found that in most cases, the type of lung problem identified by the MRI and CT scans matched what was actually found during surgery.

However, sometimes the scans showed that the lung problem was being supplied by a blood vessel from the body’s main circulation (termed as systemic feeding vessel). Only about 38% of these cases were spotted by the MRI, while 88% were spotted by the CT scan.

In conclusion, if the MRI scan done before birth shows that the lung problem is being supplied by a systemic feeding vessel, then the CT scan done after birth isn’t really needed for planning the surgery. However, the CT scan was more accurate at spotting this than the MRI. There wasn’t a big difference between the types of lung problems predicted by the MRI and CT scans, but both types of scans sometimes differed from what was actually found during surgery.

FAQs

  1. What is the purpose of prenatal MRI and postnatal CT in the management of congenital lung lesions?
  2. How often do prenatal MRI and postnatal CT predictions match the final pathology in CLL resection cases?
  3. Is there any significant difference between the CLL type predicted from postnatal CT and that predicted by prenatal MRI?

Doctor’s Tip

A helpful tip a doctor might tell a patient about lung resection is to discuss the potential benefits and risks of prenatal MRI and postnatal CT imaging in preoperative decision-making. Prenatal MRI can provide valuable information about congenital lung lesions, while postnatal CT can offer further clarity but comes with the risk of radiation exposure. It is important to weigh the benefits of each imaging modality in order to make informed decisions about the best course of action for lung resection.

Suitable For

Patients who are typically recommended lung resection include those with congenital lung lesions (CLL), such as congenital pulmonary airway malformations (CPAM), that are causing symptoms or complications, such as recurrent infections, respiratory distress, or compression of surrounding structures. Additionally, patients with suspected lung cancer, lung infections, or lung nodules that are suspicious for malignancy may also be recommended for lung resection. Ultimately, the decision for lung resection is made on a case-by-case basis after careful evaluation of the patient’s medical history, imaging studies, and consultation with a multidisciplinary team of healthcare providers.

Timeline

  • Before lung resection:
  1. Patient undergoes prenatal MRI to define congenital lung lesions (CLL) for surgical management.
  2. Postnatal CT may be obtained for further clarity at the cost of radiation.
  3. Decision for resection is made based on the lesion identified, which remains controversial.
  4. Imaging studies are examined by pediatric radiologists with experience in prenatal CLL diagnosis.
  • After lung resection:
  1. Resection is performed before 6 months of age in 62% of patients.
  2. Pathologic CLL diagnosis is compared with prenatal MRI and postnatal CT findings.
  3. Eight patients had systemic feeding vessels, with varying detection rates on MRI and CT.
  4. Both prenatal MRI and postnatal CT had some level of discrepancy with pathology in predicting CLL type.
  5. CT was found to be redundant for preoperative planning if systemic feeding vessels were identified on prenatal MRI.
  6. Both imaging modalities had a specificity of 100% for detecting systemic feeding vessels.

What to Ask Your Doctor

  1. What is the specific type of lung lesion that has been identified?
  2. What are the risks and benefits of undergoing a lung resection for this particular lesion?
  3. How will the surgery be performed and what is the expected recovery time?
  4. Are there any alternative treatment options to consider?
  5. What are the potential complications associated with lung resection surgery?
  6. How likely is it that the lesion will recur after surgery?
  7. Will I need any additional imaging or tests before the surgery?
  8. How experienced is the surgical team in performing lung resection surgeries?
  9. What can I expect in terms of long-term outcomes and prognosis after the surgery?
  10. Are there any lifestyle changes or restrictions I should be aware of post-surgery?

Reference

Authors: Narayan RR, Abadilla N, Greenberg DR, Sylvester KG, Hintz SR, Barth RA, Bruzoni M. Journal: J Surg Res. 2019 Apr;236:68-73. doi: 10.1016/j.jss.2018.10.042. Epub 2018 Dec 7. PMID: 30694781