The contribution of fetal MR imaging to the assessment of oesophageal atresia
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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.
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.
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.
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.
• 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.
KeywordsOesophageal atresia Fetus Fetal magnetic resonance imaging Pouch sign Prenatal diagnosis
Abbreviations and acronyms
Congenital cystic adenomatoid malformation
Fetal MR imaging
Negative predictive value
Positive predictive value
Transposition of great vessels
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.
- 2.Vogt E (1929) Congenital esophageal atresia. AJR 22:463–465Google Scholar