The Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
Center for Pulmonary Imaging Research, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
Neonatology. 2023;120(2):185-195. doi: 10.1159/000526794. Epub 2023 Feb 22.
There is currently no validated diagnostic modality to characterize the anatomy and predict outcomes of tracheal esophageal defects, such as esophageal atresia (EA) and tracheal esophageal fistulas (TEFs). We hypothesized that ultra-short echo-time MRI would provide enhanced anatomic information allowing for evaluation of specific EA/TEF anatomy and identification of risk factors that predict outcome in infants with EA/TEF.
In this observational study, 11 infants had pre-repair ultra-short echo-time MRI of the chest completed. Esophageal size was measured at the widest point distal to the epiglottis and proximal to the carina. Angle of tracheal deviation was measured by identifying the initial point of deviation and the farthest lateral point proximal to the carina.
Infants without a proximal TEF had a larger proximal esophageal diameter (13.5 ± 5.1 mm vs. 6.8 ± 2.1 mm, p = 0.07) when compared to infants with a proximal TEF. The angle of tracheal deviation in infants without a proximal TEF was larger than infants with a proximal TEF (16.1 ± 6.1° vs. 8.2 ± 5.4°, p = 0.09) and controls (16.1 ± 6.1° vs. 8.0 ± 3.1°, p = 0.005). An increase in the angle of tracheal deviation was positively correlated with duration of post-operative mechanical ventilation (Pearson r = 0.83, p < 0.002) and total duration of post-operative respiratory support (Pearson r = 0.80, p = 0.004).
These results demonstrate that infants without a proximal TEF have a larger proximal esophagus and a greater angle of tracheal deviation which is directly correlated with the need for longer post-operative respiratory support. Additionally, these results demonstrate that MRI is a useful tool to assess the anatomy of EA/TEF.
目前尚无经过验证的诊断方式可用于描述气管食管瘘（如食管闭锁（EA）和气管食管瘘（TEF））的解剖结构并预测其结果。我们假设超短回波时间 MRI 可提供增强的解剖学信息，从而评估特定的 EA/TEF 解剖结构，并确定可预测 EA/TEF 婴儿预后的危险因素。
在这项观察性研究中，11 名婴儿在修复前完成了胸部超短回波时间 MRI。在会厌软骨远端和隆突近端测量食管最宽处的直径。通过确定初始偏离点和隆突近端最外侧的最远点来测量气管偏离的角度。
与近端 TEF 婴儿相比，无近端 TEF 的婴儿近端食管直径更大（13.5 ± 5.1mm 比 6.8 ± 2.1mm，p = 0.07）。无近端 TEF 的婴儿气管偏离角度大于近端 TEF 婴儿（16.1 ± 6.1°比 8.2 ± 5.4°，p = 0.09）和对照组（16.1 ± 6.1°比 8.0 ± 3.1°，p = 0.005）。气管偏离角度的增加与术后机械通气时间（Pearson r = 0.83，p < 0.002）和术后呼吸支持总时间（Pearson r = 0.80，p = 0.004）呈正相关。
这些结果表明，无近端 TEF 的婴儿近端食管较大，气管偏离角度较大，与术后呼吸支持时间延长直接相关。此外，这些结果表明 MRI 是评估 EA/TEF 解剖结构的有用工具。
