Fetal MRI improves diagnostic accuracy in patients referred to a fetal center for suspected esophageal atresia.
OBJECTIVE
The purpose of this study was to describe prenatal imaging characteristics and outcomes of fetuses with suspected esophageal atresia (EA) in order to improve prenatal diagnosis, counseling, and management.


METHODS
The medical records of all patients referred to our multidisciplinary fetal center for suspected EA from January 2003 to April 2013 were reviewed retrospectively.


RESULTS
Thirty-three patients were referred with a prenatal diagnosis of possible EA. Following fetal center evaluation with MRI, EA was deemed unlikely in 6 (18%) fetuses. Of 27 fetuses in whom EA could not be excluded, EA was confirmed postnatally in 15 (56%), excluded in 7 (26%), and unconfirmed in 5 (3 fetal losses; 2 lost to follow-up). Imaging characteristics on fetal MRI associated with the highest positive predictive values (PPV) were an esophageal pouch (100%) and a small stomach (75%). The finding of polyhydramnios had high sensitivity (93%) but low specificity (31%) and PPV (61%) for a diagnosis of EA.


CONCLUSIONS
Prenatal imaging and fetal center evaluation correctly identify the presence or absence of esophageal atresia in 78% of patients referred on suspicion of this condition. The presence of an esophageal pouch on fetal MRI has significant predictive value for EA. These data may assist with evidence-based prenatal family counseling.
Texas Children's Fetal Center, Texas Children's Hospital, Houston, Texas; Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.
Cecilia G
CG
Ethun
Texas Children's Fetal Center, Texas Children's Hospital, Houston, Texas; Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.
Sara C
SC
Fallon
Texas Children's Fetal Center, Texas Children's Hospital, Houston, Texas; Department of Radiology, Baylor College of Medicine, Houston, Texas.
Christopher I
CI
Cassady
Texas Children's Fetal Center, Texas Children's Hospital, Houston, Texas; Department of Radiology, Baylor College of Medicine, Houston, Texas.
Amy R
AR
Mehollin-Ray
Texas Children's Fetal Center, Texas Children's Hospital, Houston, Texas; Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.
Oluyinka O
OO
Olutoye
Texas Children's Fetal Center, Texas Children's Hospital, Houston, Texas; Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.
Irving J
IJ
Zamora
Texas Children's Fetal Center, Texas Children's Hospital, Houston, Texas; Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.
Timothy C
TC
Lee
Texas Children's Fetal Center, Texas Children's Hospital, Houston, Texas; Department of Pediatrics, Division of Neonatology, Baylor College of Medicine, Houston, Texas.
Stephen E
SE
Welty
Texas Children's Fetal Center, Texas Children's Hospital, Houston, Texas; Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas. Electronic address: dcass@bcm.edu.
Darrell L
DL
Cass
D003376:Counseling; D004933:Esophageal Atresia / Q000175:diagnosis*; D004947:Esophagus / Q000000981:diagnostic imaging / Q000473:pathology; D005190:Family; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008279:Magnetic Resonance Imaging; D008297:Male; D006831:Polyhydramnios / Q000175:diagnosis; D011237:Predictive Value of Tests; D011247:Pregnancy; D011296:Prenatal Diagnosis; D012189:Retrospective Studies; D013270:Stomach / Q000000981:diagnostic imaging / Q000473:pathology; D016216:Ultrasonography, Prenatal
Esophageal atresia; Fetal MRI; Prenatal diagnosis; Tracheoesophageal fistula