Observational Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Feb 6, 2021; 9(4): 822-829
Published online Feb 6, 2021. doi: 10.12998/wjcc.v9.i4.822
Usefulness of prenatal magnetic resonance imaging in differential diagnosis of fetal congenital cystic adenomatoid malformation and bronchopulmonary sequestration
Zhi Li, Yi-Dan Lv, Rong Fang, Xu Li, Zhi-Qin Luo, Ling-Hong Xie, Ling Zhu
Zhi Li, Zhi-Qin Luo, Department of Radiology, Huzhou Maternity & Child Health Care Hospital, Huzhou 313000, Zhejiang Province, China
Yi-Dan Lv, Department of Endocrinology, Huzhou Central Hospital, Affiliated Central Hospital of Huzhou University, Huzhou 313000, Zhejiang Province, China
Rong Fang, Ling-Hong Xie, Prenatal Diagnosis Center, Huzhou Maternity & Child Health Care Hospital, Huzhou 313000, Zhejiang Province, China
Xu Li, Center of Imaging Diagnosis, Anhui Provincial Children’s Hospital, Hefei 230000, Anhui Province, China
Ling Zhu, Department of Ultrasound, Huzhou Maternity & Child Health Care Hospital, Huzhou 313000, Zhejiang Province, China
Author contributions: Li Z, Lv YD, Fang R, and Li X prepared the manuscript; Luo ZQ, Xie LH, and Zhu L critically revised the intellectual content and gave final approval of the manuscript.
Supported by Huzhou Science and Technology Plan of Zhejiang Province, No. 2018GYB75.
Institutional review board statement: This study was approved by the Ethics Committee of Huzhou Maternity & Child Health Care Hospital and Anhui Provincial Children’s Hospital.
Informed consent statement: The clinical data used in this study were anonymous.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to report.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Yi-Dan Lv, BSc, Associate Chief Nurse, Department of Endocrinology, Huzhou Central Hospital, Affiliated Central Hospital of Huzhou University, No. 198 Hongqi Road, Huzhou 313000, Zhejiang Province, China. doctorhu163@163.com
Received: October 9, 2020
Peer-review started: October 9, 2020
First decision: November 29, 2020
Revised: December 4, 2020
Accepted: December 11, 2020
Article in press: December 11, 2020
Published online: February 6, 2021
Abstract
BACKGROUND

Congenital cystic adenomatoid malformation (CCAM) and bronchopulmonary sequestration (BPS) are the most common lung diseases in fetuses. There are differences in the prognosis and treatment of CCAM and BPS, and the clinical diagnosis and treatment plan is usually prepared prior to birth. Therefore, it is quite necessary to make a clear diagnosis before delivery. CCAM and BPS have similar imaging features, and the differentiation mainly relies on the difference in supply vessels. However, it is hard to distinguish them due to invisible supplying vessels on some images.

AIM

To explore the application value of magnetic resonance imaging (MRI) in the differential diagnosis of fetal CCAM and BPS.

METHODS

Data analysis for 32 fetuses with CCAM and 14 with BPS diagnosed by prenatal MRI at Huzhou Maternal and Child Health Care Hospital and Anhui Provincial Children’s Hospital from January 2017 to January 2020 was performed to observe the source blood vessels of lesions and their direction. Pathological confirmation was completed through CT examination and/or operations after birth.

RESULTS

After birth, 31 cases after birth were confirmed to be CCAM, and 15 were confirmed to be BPS. The CCAM group consisted of 21 macrocystic cases and 10 microcystic cases. In 18 cases, blood vessels were visible in lesions. Blood supply of the pulmonary artery could be traced in eight cases, and in 10 cases, only vessels running from the midline to the lateral down direction were observed. No lesions were found in four macrocystic cases and one microcystic case with CCAM through CT after birth; two were misdiagnosed by MRI, and three were misdiagnosed by prenatal ultrasonography. The BPS group consisted of 12 intralobar cases and three extralobar cases. Blood vessels were visible in lesions of nine cases, in four of which, the systemic circulation blood supply could be traced, and in five of which, only vessels running from the midline to the lateral up direction were observed. Three were misdiagnosed by MRI, and four were misdiagnosed by prenatal ultrasonography.

CONCLUSION

CCAM and BPS can be clearly diagnosed based on the origin of blood vessels, and correct diagnosis can be made according to the difference in the direction of the blood vessels, but it is hard distinguish microcystic CCAM and BPS without supplying vessels. In some CCAM cases, mainly the macrocystic ones, the lesions may disappear after birth.

Keywords: Congenital cystic adenomatoid malformation, Bronchopulmonary sequestration, Magnetic resonance imaging, Differential diagnosis, Fetuses, Congenital

Core Tip: Congenital cystic adenomatoid malformation (CCAM) and broncho-pulmonary sequestration (BPS) can be clearly diagnosed based on the origin of blood vessels, and correct diagnosis can be made according to the difference in the direction of the blood vessels, but it is hard to distinguish microcystic CCAM and BPS without supplying vessels. In some CCAM cases, mainly the macrocystic ones, the lesions may disappear after birth.