Advertisement

European Radiology

, Volume 25, Issue 2, pp 306–314 | Cite as

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

  • V. HochartEmail author
  • P. Verpillat
  • C. Langlois
  • C. Garabedian
  • J. Bigot
  • V. Houfflin Debarge
  • R. Sfeir
  • F. E. Avni
Pediatric

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.

Keywords

Oesophageal atresia Fetus Fetal magnetic resonance imaging Pouch sign Prenatal diagnosis 

Abbreviations and acronyms

CCAM

Congenital cystic adenomatoid malformation

EA

Oesophageal atresia

fMRI

Fetal MR imaging

fCT

Fetal CT

GW

Gestation week

IAC

Interatrial communication

IVC

Interventricular communication

NPV

Negative predictive value

PPV

Positive predictive value

TEF

Tracheoesophageal fistula

TGV

Transposition of great vessels

Notes

Acknowledgments

The scientific guarantor of this publication is Dr Avni Freddy. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. One of the authors has significant statistical expertise. Institutional review board approval was not required because of the methodology. Written informed consent was not required for this study because of the methodology. Some study subjects or cohorts have been previously reported by Garabedian et al. (Prenat. Diagnosis 34(9):839–842, 2014). The purpose of that study was completely different from our aims: in their article, they based their evaluation on the final primary diagnosis of each examination (presence or absence of oesophageal atresia) of the few common patients that were involved; they did not focus their study on a sytematic review of the fetal MRI findings as we did.

Methodology: retrospective, diagnostic study, performed at one institution.

References

  1. 1.
    Spitz L (2006) Esophageal atresia. Lessons I have learned in a 40-year experience. J Pediatr Surg 41:1635–1640PubMedCrossRefGoogle Scholar
  2. 2.
    Vogt E (1929) Congenital esophageal atresia. AJR 22:463–465Google Scholar
  3. 3.
    Ladd WE (1944) The surgical treatment of esophageal atresia and tracheoesophageal fistulas. NEJM 230:625–637CrossRefGoogle Scholar
  4. 4.
    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 85:747–754CrossRefGoogle Scholar
  5. 5.
    Oddsberg J, Lu Y, Lagergren J (2010) Maternal diabetes and risk of esophageal atresia. J Pediatr Surg 45:2004–2008PubMedCrossRefGoogle Scholar
  6. 6.
    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 88:137–143PubMedGoogle Scholar
  7. 7.
    Sfeir R, Bonnard A, Khen-Dunlop N et al (2013) Esophageal atresia: data from a national cohort. J Pediatr Surg 48:1664–1669PubMedCrossRefGoogle Scholar
  8. 8.
    Sfeir R, Michaud L, Salleron J, Gottrand F (2013) Epidemiology of esophageal atresia. Dis Esophagus 26:354–355PubMedCrossRefGoogle Scholar
  9. 9.
    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 97:227–232PubMedCrossRefGoogle Scholar
  10. 10.
    Stringer MD, McKenna KM, Goldstein RB, Filly RA, Adzick NS, Harrison MR (1995) Prenatal diagnosis of esophageal atresia. J Pediatr Surg 30:1258–1263PubMedCrossRefGoogle Scholar
  11. 11.
    Houben CH, Curry JI (2008) Current status of prenatal diagnosis, operative management and outcome of esophageal atresia/tracheo-esophageal fistula. Prenat Diagn 28:667–675PubMedCrossRefGoogle Scholar
  12. 12.
    Brantberg A, Blaas H-GK, Haugen SE, Eik-Nes SH (2007) Esophageal obstruction-prenatal detection rate and outcome. Ultrasound Obstet Gynecol 30:180–187PubMedCrossRefGoogle Scholar
  13. 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 22:669–674PubMedCrossRefGoogle Scholar
  14. 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 11:138–140PubMedCrossRefGoogle Scholar
  15. 15.
    Has R, Günay S, Topuz S (2004) Pouch sign in prenatal diagnosis of esophageal atresia. Ultrasound Obstet Gynecol 23:523–524PubMedCrossRefGoogle Scholar
  16. 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 38:225–228PubMedCrossRefGoogle Scholar
  17. 17.
    Langer JC, Hussain H, Khan A et al (2001) Prenatal diagnosis of esophageal atresia using sonography and magnetic resonance imaging. J Pediatr Surg 36:804–807PubMedCrossRefGoogle Scholar
  18. 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–S11PubMedCrossRefGoogle Scholar
  19. 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 34:471–474PubMedCrossRefGoogle Scholar
  20. 20.
    Chittmittrapap S, Spitz L, Kiely EM, Brereton RJ (1989) Oesophageal atresia and associated anomalies. Arch Dis Child 64:364–368PubMedCentralPubMedCrossRefGoogle Scholar
  21. 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 74PubMedCrossRefGoogle Scholar
  22. 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 13:775–799PubMedCrossRefGoogle Scholar
  23. 23.
    Brugger PC, Weber M, Prayer D (2011) Magnetic resonance imaging of the normal fetal esophagus. Ultrasound Obstet Gynecol 38:568–574PubMedCrossRefGoogle Scholar
  24. 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 54:221–225PubMedCrossRefGoogle Scholar
  25. 25.
    Goyal A, Jones MO, Couriel JM, Losty PD (2006) Oesophageal atresia and tracheo-oesophageal fistula. Arch Dis Child Fetal Neonatal Ed 91:381–384CrossRefGoogle Scholar
  26. 26.
    Holland AJA, Fitzgerald DA (2010) Oesophageal atresia and tracheo-oesophageal fistula: current management strategies and complications. Paediatr Respir Rev 11:100–106, quiz 106–107PubMedCrossRefGoogle Scholar
  27. 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)PubMedCrossRefGoogle Scholar
  28. 28.
    Avni EF, Rypens F, Milaire J (1994) Fetal esophagus: normal sonographic appearance. J Ultrasound Med 13:175–180PubMedGoogle Scholar
  29. 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 35:249–257PubMedCrossRefGoogle Scholar
  30. 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 36:349–363PubMedGoogle Scholar
  31. 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 373–375PubMedCrossRefGoogle Scholar
  32. 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):839–842PubMedCrossRefGoogle Scholar
  33. 33.
    Barth RA (2012) Imaging of fetal chest masses. Pediatr Radiol 42(Suppl 1):S62–S73PubMedCrossRefGoogle Scholar
  34. 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–E321PubMedCrossRefGoogle Scholar
  35. 35.
    Daltro P, Werner H, Gasparetto TD et al (2010) Congenital chest malformations: a multimodality approach with emphasis on fetal MR imaging. Radiographics 30:385–395PubMedCrossRefGoogle Scholar
  36. 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 28:11–15CrossRefGoogle Scholar
  37. 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 41:1624–1628PubMedCrossRefGoogle Scholar
  38. 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 29:537–543PubMedCrossRefGoogle Scholar

Copyright information

© European Society of Radiology 2014

Authors and Affiliations

  • V. Hochart
    • 1
    Email author
  • P. Verpillat
    • 1
  • C. Langlois
    • 2
  • C. Garabedian
    • 3
  • J. Bigot
    • 1
  • V. Houfflin Debarge
    • 3
  • R. Sfeir
    • 4
  • F. E. Avni
    • 1
  1. 1.Department of Pediatric RadiologyCHRU Lille, Jeanne de Flandre HospitalLilleFrance
  2. 2.Department of BiostatisticsEA2694 USDL CHRU LilleLilleFrance
  3. 3.Department of Obstetrics and GynecologyCHRU Lille, Jeanne de Flandre HospitalLilleFrance
  4. 4.Department of Pediatric Surgery, Reference Center for Congenital Anomalies of the EsophagusCHRU Lille, Jeanne de Flandre HospitalLilleFrance

Personalised recommendations