Prenatal diagnosis of esophageal atresia using sonography and magnetic resonance imaging

Background: The diagnosis of esophageal atresia may be suspected on prenata l ultrasound scan in fetuses with a small or absent stomach or unexplained polyhydramnios. However, these findings are thought to have a low positive predictive value and clinical decisions affecting timing or site of deliver y may be made erroneously. The authors evaluated the accuracy of fetal sono graphy followed by magnetic resonance imaging (MRI) for the diagnosis of th is lesion. Methods: Fetuses considered to be at risk for esophageal atresia based on d etailed obstetric sonography underwent fetal MRI using a single-shot rapid- acquisition technique, and the T-2-weighted images were evaluated prospecti vely. Scans were considered to be positive if the proximal esophagus was di lated, and the distal esophagus was not seen and negative if the esophagus was visualized throughout its length. Results: Ten fetuses underwent MRI scanning. All had a small or absent stom ach bubble with unexplained polyhydramnios. Four scans were considered to b e negative for esophageal atresia; all 4 were found to have a normal esopha gus after delivery. Six scans were considered to be positive; 5 had esophag eal atresia (2 with tracheoesophageal fistula and 3 without), and one had a neurologic syndrome with a normal esophagus. Conclusions: Magnetic resonance imaging appears to be accurate for establis hing or ruling out a prenatal diagnosis of esophageal atresia, and should b e considered in fetuses who are at high risk based on ultrasound findings. J Pediatr Surg 36:804-807. Copyright (C) 2001 by W.B. Saunders Company.