Reproducibility of Liver-to-Thorax Area Ratio Ultrasound Measurements in Congenital Diaphragmatic Hernia

Victoria Arruga Novoa y Novoa, Laura F. Sutton, Allan E. Neis, Amber M. Marroquin, Tracey M. Coleman, Kathleen A. Praska, Tamara A. Freimund, Krystal L. Ruka, Vicki L. Warzala, Haleh Sangi-Haghpeykar, Rodrigo Ruano

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Objectives: The aim of this study was to investigate the reproducibility of a standardized method to assess the ultrasound liver-to-thoracic area ratio in fetuses with congenital diaphragmatic hernia. Methods: We selected 24 images of 9 fetuses diagnosed with left-sided at our institution between January 2010 and December 2017. Eight operators (1 maternal-fetal medicine specialist and 7 sonographers) reviewed the selected images and assessed the ultrasound liver-to-thoracic area ratio according to a standardized protocol. We evaluated the correlation between operators using the intraclass correlation coefficient and compared agreement between the sonographers and a physician with experience in measuring the ultrasound liver-to-thoracic area ratio using a Bland-Altman analysis. Results: Good intraoperator reproducibility was observed for the standardized ultrasound liver-to-thoracic area ratio (intraclass correlation coefficient, 0.78). Good agreement among sonographers and the physician was also observed for the standardized measurements (bias, 0.01; precision, 0.03; limits of agreement, –0.05 to + 0.07). Conclusions: We demonstrated that good intraoperator and interoperator reproducibility of ultrasound liver-to-thoracic area ratio assessment is feasible after standardizing the method in our center.

Original languageEnglish (US)
Pages (from-to)1477-1482
Number of pages6
JournalJournal of Ultrasound in Medicine
Issue number6
StatePublished - Jun 2019


  • congenital diaphragmatic hernia
  • fetal lungs
  • fetal therapy
  • fetoscopic tracheal occlusion
  • liver-to-thoracic area
  • obstetrics
  • prenatal diagnosis
  • pulmonary hypoplasia
  • ultrasound

ASJC Scopus subject areas

  • Radiological and Ultrasound Technology
  • Radiology Nuclear Medicine and imaging


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