Weijs T J, Goense L, van Rossum P S N, Meijer G J, van Lier A L H M W, Wessels F J, Braat M N G, Lips I M, Ruurda J P, Cuesta M A, van Hillegersberg R, Bleys R L A W
Department of Anatomy, University Medical Center Utrecht, Utrecht, The Netherlands.
Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
J Anat. 2017 Feb;230(2):262-271. doi: 10.1111/joa.12552. Epub 2016 Sep 23.
An organized layer of connective tissue coursing from aorta to esophagus was recently discovered in the mediastinum. The relations with other peri-esophageal fascias have not been described and it is unclear whether this layer can be visualized by non-invasive imaging. This study aimed to provide a comprehensive description of the peri-esophageal fascias and determine whether the connective tissue layer between aorta and esophagus can be visualized by magnetic resonance imaging (MRI). First, T2-weighted MRI scanning of the thoracic region of a human cadaver was performed, followed by histological examination of transverse sections of the peri-esophageal tissue between the thyroid gland and the diaphragm. Secondly, pretreatment motion-triggered MRI scans were prospectively obtained from 34 patients with esophageal cancer and independently assessed by two radiologists for the presence and location of the connective tissue layer coursing from aorta to esophagus. A layer of connective tissue coursing from the anterior aspect of the descending aorta to the left lateral aspect of the esophagus, with a thin extension coursing to the right pleural reflection, was visualized ex vivo in the cadaver on MR images, macroscopic tissue sections, and after histologic staining, as well as on in vivo MR images. The layer connecting esophagus and aorta was named 'aorto-esophageal ligament' and the layer connecting aorta to the right pleural reflection 'aorto-pleural ligament'. These connective tissue layers divides the posterior mediastinum in an anterior compartment containing the esophagus, (carinal) lymph nodes and vagus nerve, and a posterior compartment, containing the azygos vein, thoracic duct and occasionally lymph nodes. The anterior compartment was named 'peri-esophageal compartment' and the posterior compartment 'para-aortic compartment'. The connective tissue layers superior to the aortic arch and at the diaphragm corresponded with the currently available anatomic descriptions. This study confirms the existence of the previously described connective tissue layer coursing from aorta to esophagus, challenging the long-standing paradigm that no such structure exists. A comprehensive, detailed description of the peri-esophageal fascias is provided and, furthermore, it is shown that the connective tissue layer coursing from aorta to esophagus can be visualized in vivo by MRI.
最近在纵隔中发现了一层从主动脉延伸至食管的有组织的结缔组织。该层与其他食管周围筋膜的关系尚未见描述，并且尚不清楚这层组织能否通过无创成像显示。本研究旨在全面描述食管周围筋膜，并确定主动脉与食管之间的结缔组织层能否通过磁共振成像（MRI）显示。首先，对一具人类尸体的胸部区域进行T2加权MRI扫描，随后对甲状腺与膈肌之间的食管周围组织横切面进行组织学检查。其次，前瞻性地对34例食管癌患者进行预处理运动触发MRI扫描，并由两名放射科医生独立评估从主动脉至食管的结缔组织层的存在及位置。在尸体的离体MR图像、宏观组织切片、组织学染色后以及活体MR图像上，均可见到一层结缔组织从降主动脉前方向食管左侧延伸，并有一细支延伸至右胸膜返折处。连接食管与主动脉的这层组织被命名为“主动脉 - 食管韧带”，连接主动脉与右胸膜返折的层被命名为“主动脉 - 胸膜韧带”。这些结缔组织层将后纵隔分为一个前间隙，其中包含食管、（隆突下）淋巴结和迷走神经，以及一个后间隙，其中包含奇静脉、胸导管，偶尔还有淋巴结。前间隙被命名为“食管周围间隙”，后间隙为“主动脉旁间隙”。主动脉弓上方及膈肌处的结缔组织层与现有的解剖学描述相符。本研究证实了先前描述的从主动脉至食管的结缔组织层的存在，挑战了长期以来认为不存在此类结构的范式。本研究提供了食管周围筋膜的全面、详细描述，此外，还表明从主动脉至食管的结缔组织层可通过MRI在活体中显示。
