Abstract
Esophageal atresia (EA), with or without trachea-esophageal fistula (TEF), is one of the most challenging congenital anomalies in neonates, due to its high morbidity and mortality. The anatomy of the EA should be clearly known before surgery because the surgical approach of congenital EA with distal TEF depends on the correct evaluation of the trachea–bronchial tree and the distance between the proximal pouch and distal fistula.
To evaluate the application of multiple planar reformatting (MPR) and three-dimensional (3D) transparency lung volume rendering (TL-VR) with virtual tracheo-bronchoscopy by 64-row multidetector computed tomography (MDCT) in neonates with congenital EA and distal TEF.
Twenty-three neonates (10 boys and 13 girls) born with EA and distal TEF were enrolled in this study. All patients were preoperatively examined by 64 multidetector non-enhanced CT examinations with multiplanar reformatting, 3D volume rendering TLVR and virtual endoscopy. The MDCT findings were correlated with operative findings in 19 cases.
MDCT could detect the proximal esophageal pouches, gap distance in all patients. The gap distances ranged from 7mm to 38mm (mean 18mm). The gap distances by MDCT were the same of surgical findings in 14 cases and less than surgical findings by 1–2mm in 5 cases. No statistically significant difference was detected between the two measurements, P=0.908. The site of the fistula was seen by the axial images in 23 patients, followed by sagittal MPR and 3D TL-VR (20 patients), coronal MPR images in 18 patients while the virtual tracheo-bronchoscopy showed the site of the fistula in 16 patients. The most common site of distal fistula in this study was main trachea in 10 of 23 neonates (43.5%).
Preoperative MDCT scan with MPVR, 3D TL-VR of 64-row MDCT which is a noninvasive technique could provide more accurate information about the assessment of the origin of the fistula, the distal esophageal pouches and inter-pouch distance in neonates with EA and distal TEF.