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European Radiology

Erschienen in:

01.02.2015 | Pediatric

The contribution of fetal MR imaging to the assessment of oesophageal atresia

verfasst von: V. Hochart, P. Verpillat, C. Langlois, C. Garabedian, J. Bigot, V. Houfflin Debarge, R. Sfeir, F. E. Avni

Erschienen in: European Radiology | Ausgabe 2/2015

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Abstract

Objective

Present challenges are to improve the diagnosis rate of oesophageal atresia (OA) and evaluate as completely as possible a fetus affected by OA, specifically the type of OA and the length of the gap. Our aim was to evaluate the accuracy of fetal MR imaging (fMRI) for diagnosis of OA.

Methods

We reviewed fMRI performed because of sonographic suspicion of an OA. The signs reviewed included stomach size, “pouch sign”, bowing of the trachea and visualization of the lower oesophageal lumen. The fetuses were assigned by consensus as having or not having EA, as well as having a tracheaoesophageal fistula (TOF). All findings were correlated with postnatal data. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated.

Results

Se, Sp, PPV and NPV of the technique were respectively 91 %, 100 %, 100 % and 88 %. The presence of the pouch sign yielded corresponding values of 82 %, 100 %, 100 % and 78 %. Mid-tracheal bowing was correlated positively with EA. The type of atresia was correctly evaluated in 90 % of patients.

Conclusion

fMRI is useful for the diagnosis of EA through the visualization of the oesophageal pouch or through associated signs such as tracheal bowing. Visualization of the lower oesophageal lumen seems to be a good sign of TEF.

Key Points

• Challenges are to improve the prenatal diagnosis of EA and associated malformations.

• fMRI is able to diagnose EA through demonstration of the pouch sign.

• Tracheal bowing is a promising indirect sign of EA.

• Tracheoesophageal fistula can also be suspected thanks to fMRI.

• Obstetrical US, fMRI and fetal CT are complementary for assessing associated malformations.

Spitz L (2006) Esophageal atresia. Lessons I have learned in a 40-year experience. J Pediatr Surg 41:1635–1640PubMedCrossRef

Vogt E (1929) Congenital esophageal atresia. AJR 22:463–465

Ladd WE (1944) The surgical treatment of esophageal atresia and tracheoesophageal fistulas. NEJM 230:625–637CrossRef

Felix JF, de Jong EM, Torfs CP, de Klein A, Rottier RJ, Tibboel D (2009) Genetic and environmental factors in the etiology of esophageal atresia and/or tracheoesophageal fistula: an overview of the current concepts. Birt Defects Res A Clin Mol Teratol 85:747–754CrossRef

Oddsberg J, Lu Y, Lagergren J (2010) Maternal diabetes and risk of esophageal atresia. J Pediatr Surg 45:2004–2008PubMedCrossRef

Källén B, Finnström O, Lindam A, Nilsson E, Nygren K-G, Otterblad PO (2010) Congenital malformations in infants born after in vitro fertilization in Sweden. Birth Defects Res A Clin Mol Teratol 88:137–143PubMed

Sfeir R, Bonnard A, Khen-Dunlop N et al (2013) Esophageal atresia: data from a national cohort. J Pediatr Surg 48:1664–1669PubMedCrossRef

Sfeir R, Michaud L, Salleron J, Gottrand F (2013) Epidemiology of esophageal atresia. Dis Esophagus 26:354–355PubMedCrossRef

Pedersen RN, Calzolari E, Husby S, Garne E, EUROCAT Working group (2012) Oesophageal atresia: prevalence, prenatal diagnosis and associated anomalies in 23 European regions. Arch Dis Child 97:227–232PubMedCrossRef

10.

Stringer MD, McKenna KM, Goldstein RB, Filly RA, Adzick NS, Harrison MR (1995) Prenatal diagnosis of esophageal atresia. J Pediatr Surg 30:1258–1263PubMedCrossRef

11.

Houben CH, Curry JI (2008) Current status of prenatal diagnosis, operative management and outcome of esophageal atresia/tracheo-esophageal fistula. Prenat Diagn 28:667–675PubMedCrossRef

12.

Brantberg A, Blaas H-GK, Haugen SE, Eik-Nes SH (2007) Esophageal obstruction-prenatal detection rate and outcome. Ultrasound Obstet Gynecol 30:180–187PubMedCrossRef

13.

Shulman A, Mazkereth R, Zalel Y et al (2002) Prenatal identification of esophageal atresia: the role of ultrasonography for evaluation of functional anatomy. Prenat Diagn 22:669–674PubMedCrossRef

14.

Kalache KD, Chaoui R, Mau H, Bollmann R (1998) The upper neck pouch sign: a prenatal sonographic marker for esophageal atresia. Ultrasound Obstet Gynecol 11:138–140PubMedCrossRef

15.

Has R, Günay S, Topuz S (2004) Pouch sign in prenatal diagnosis of esophageal atresia. Ultrasound Obstet Gynecol 23:523–524PubMedCrossRef

16.

Quarello E, Saada J, Desbriere R, Rousseau V, De Lagausie P, Benachi A (2011) Prenatal diagnosis and evaluation of defect length in esophageal atresia using direct and indirect (tracheal print) signs. Ultrasound Obstet Gynecol 38:225–228PubMedCrossRef

17.

Langer JC, Hussain H, Khan A et al (2001) Prenatal diagnosis of esophageal atresia using sonography and magnetic resonance imaging. J Pediatr Surg 36:804–807PubMedCrossRef

18.

Houfflin-Debarge V, Bigot J (2011) Ultrasound and MRI prenatal diagnosis of esophageal atresia: effect on management. J Pediatr Gastroenterol Nutr 52(Suppl 1):S9–S11PubMedCrossRef

19.

Salomon LJ, Sonigo P, Ou P, Ville Y, Brunelle F (2009) Real-time fetal magnetic resonance imaging for the dynamic visualization of the pouch in esophageal atresia. Ultrasound Obstet Gynecol 34:471–474PubMedCrossRef

20.

Chittmittrapap S, Spitz L, Kiely EM, Brereton RJ (1989) Oesophageal atresia and associated anomalies. Arch Dis Child 64:364–368PubMedCentralPubMedCrossRef

21.

Choudhury SR, Ashcraft KW, Sharp RJ, Murphy JP, Snyder CL, Sigalet DL (1999) Survival of patients with esophageal atresia: influence of birth weight, cardiac anomaly, and late respiratory complications. J Pediatr Surg 34:70–73, discussion 74PubMedCrossRef

22.

Revel MP, Pons JC, Lelaidier C, Fournet P, Vial M, Musset D (1993) Magnetic resonance imaging of the fetus: a study of 20 cases performed without curarization. Prenat Diagn 13:775–799PubMedCrossRef

23.

Brugger PC, Weber M, Prayer D (2011) Magnetic resonance imaging of the normal fetal esophagus. Ultrasound Obstet Gynecol 38:568–574PubMedCrossRef

24.

Sodhi KS, Saxena AK, Ahuja CK, Rao K, Menon P, Kandelwal N (2013) Postoperative appearances of esophageal atresia repair: retrospective study of 210 patients with review of literature - what the radiologist should know. Acta Radiol 54:221–225PubMedCrossRef

25.

Goyal A, Jones MO, Couriel JM, Losty PD (2006) Oesophageal atresia and tracheo-oesophageal fistula. Arch Dis Child Fetal Neonatal Ed 91:381–384CrossRef

26.

Holland AJA, Fitzgerald DA (2010) Oesophageal atresia and tracheo-oesophageal fistula: current management strategies and complications. Paediatr Respir Rev 11:100–106, quiz 106–107PubMedCrossRef

27.

Gottrand F (2012) Devenir à moyen et long terme des enfants atteints d’atrésie de l’œsophage. Arch Pédiatr 19:932–938 (in French)PubMedCrossRef

28.

Avni EF, Rypens F, Milaire J (1994) Fetal esophagus: normal sonographic appearance. J Ultrasound Med 13:175–180PubMed

29.

Develay-Morice J-E, Rathat G, Duyme M et al (2007) Ultrasonography of fetal esophagus: healthy appearance and prenatal diagnosis of a case of esophagus atresia with esotracheal fistula. Gynecol Obstet Fertil 35:249–257PubMedCrossRef

30.

Patenaude Y, Pugash D, Lim K, Morin L, Committee DI, Lim K (2014) The use of magnetic resonance imaging in the obstetric patient. J Obstet Gynaecol Can 36:349–363PubMed

31.

Victoria T, Jaramillo D, Roberts TPL, Zarnow D, Johnson AM, Delgado J (2014) Fetal magnetic resonance imaging: jumping from 1.5 to 3 tesla (preliminary experience). Pediatr Radiol 44:376–386, quiz 373–375PubMedCrossRef

32.

Garabedian C, Verpillat P, Czerkiewicz I et al (2014) Does a combination of ultrasound, MRI and biochemical amniotic fluid analysis improves prenatal diagnosis of esophageal atresia? Prenat Diagn 34(9):839–842PubMedCrossRef

33.

Barth RA (2012) Imaging of fetal chest masses. Pediatr Radiol 42(Suppl 1):S62–S73PubMedCrossRef

34.

Recio Rodríguez M, Martínez de Vega V, Cano Alonso R, Carrascoso Arranz J, Ten Martínez P, Pérez Pedregosa J (2012) MR imaging of thoracic abnormalities in the fetus. Radiographics 32:E305–E321PubMedCrossRef

35.

Daltro P, Werner H, Gasparetto TD et al (2010) Congenital chest malformations: a multimodality approach with emphasis on fetal MR imaging. Radiographics 30:385–395PubMedCrossRef

36.

Briganti V, Oriolo L, Buffa V, Garofalo S, Cavallaro S, Calisti A (2005) Tracheomalacia in oesophageal atresia: morphological considerations by endoscopic and CT study. Eur J Cardio Thorac Surg 28:11–15CrossRef

37.

Briganti V, Oriolo L, Mangia G, Buffa V, Calisti A (2006) Tracheomalacia in esophageal atresia. Usefulness of preoperative imaging evaluation for tailored surgical correction. J Pediatr Surg 41:1624–1628PubMedCrossRef

38.

Cassart M, Massez A, Cos T et al (2007) Contribution of three-dimensional computed tomography in the assessment of fetal skeletal dysplasia. Ultrasound Obstet Gynecol 29:537–543PubMedCrossRef

Titel: The contribution of fetal MR imaging to the assessment of oesophageal atresia
verfasst von: V. Hochart
P. Verpillat
C. Langlois
C. Garabedian
J. Bigot
V. Houfflin Debarge
R. Sfeir
F. E. Avni
Publikationsdatum: 01.02.2015
Verlag: Springer Berlin Heidelberg
Erschienen in: European Radiology / Ausgabe 2/2015
Print ISSN: 0938-7994
Elektronische ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-014-3444-y

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The contribution of fetal MR imaging to the assessment of oesophageal atresia