Sonographic demonstration of fetal esophagus using three‐dimensional ultrasound imaging

Abstract

Objective To evaluate the feasibility of antenatal direct visualization of normal and abnormal fetal esophagus using three‐dimensional ultrasound (3D‐US) with Crystal Vue rendering technology. Methods Between February and April 2018, 3D‐US volumes were collected from a non‐consecutive series of singleton pregnancies, referred for clinically indicated detailed prenatal ultrasound at 19–28 weeks' gestation to one of two fetal medicine units in Italy. 3D volumes were acquired from a midsagittal section of the fetal thorax and upper abdomen with the fetus lying in supine position. Postprocessing with multiplanar mode was applied to orientate the volume and identify the esophagus. The region of interest was angled by approximately 30° to the spine and its thickness was adjusted in order to optimize visualization of the intrathoracic and intra‐abdominal course of the esophagus. Crystal Vue software was used for image rendering of the fetal trunk in the coronal plane. Postnatal follow‐up was available in all cases. Results During the study period, 91 pregnancies met the inclusion criteria and were recruited. The study cohort included two pregnancies with suspicion of esophageal atresia due to suboptimal visualization of the stomach. Of the 89 cases with normal stomach on two‐dimensional (2D) imaging, 3D‐US with Crystal Vue rendering technology allowed direct evaluation of the whole course of the esophagus in 74 (83.1%). In the two cases with small or absent stomach bubble on 2D imaging, esophageal atresia was demonstrated antenatally on 3D Crystal Vue imaging and was confirmed postnatally. The mean time required for offline postprocessing and visualization of the esophageal anatomy was 4 min. Conclusions Using 3D‐US with Crystal Vue rendering, it is possible to visualize antenatally the normal fetal esophagus and demonstrate presence of esophageal atresia. This should facilitate prenatal counseling and management of cases with suspected esophageal atresia. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.

Chromosome Analysis and Postnatal Follow-Up of Fetuses With Abnormal Ultrasound Findings

“…Remarkably, in our study, 2 cases in which esophageal atresia was missed in prenatal ultrasound had co-existent esophagotracheal stula, making a correct prenatal diagnosis more challenging. More recently, Dall'Asta et al 25 demonstrated that the detection of esophageal atresia is possible when three-dimensional ultrasound and Crystal Vue rendering techniques are used. Thus, employing the most current ultrasound methods may increase the accuracy of prenatal detection of esophageal atresia.…”

Applications of Advanced Ultrasound Technology in Obstetrics

“…While 2D ultrasound examination with gray scale and color flow is the stand the antenatal diagnosis of placenta accreta spectrum disorders [22], 3D ultrasoun It is difficult to visualize esophagus on 2D ultrasound examination. The use of 3D ultrasound with multiplanar analysis and Crystal Vue rendering may make the visualization possible [55]. Three-dimensional (3D) volumes are acquired from a midsagittal section of the thorax and upper abdomen with the fetus lying in supine position.…”

Fetal esophageal imaging: Early pregnancy as a window of opportunity

“…Previous studies that evaluated the feasibility of esophageal visualization during the midtrimester anomaly scan [16][17][18][19] have demonstrated the cervical esophagus in 16%-93% of the cases and the thoracic esophagus in 91.7%-99.5% of the cases. At this stage in pregnancy, due to its length and angled course, the esophagus is demonstrated in segments 17 consequently, a small disruption of the esophagus may be missed.…”

“…It has been previously shown that the normal appearance of the intact esophagus is an uninterrupted echogenic bundle of fibers, visualized as echogenic lines, which is the sonographic signal projected by the collapsed esophageal muscular walls. 17 In order to improve the detection rate of EA several studies have evaluated the feasibility of demonstrating the fetal esophagus throughout pregnancy including during the midtrimester anomaly scan [16][17][18][19] and during the first trimester anomaly scan. 18 The aim of this study was to describe a "one shot" esophageal imaging technique, visualizing the entire esophagus along its longitudinal axis in a single view, and evaluate the feasibility of its use at first and early second trimester.…”

“…Yet, there are some major limitations that prevent its ubiquitous application. The prenatal detection of an esophageal pouch requires significant expertise, it is time consuming and the region of interest may be obscured at advanced gestational age 12,16,17 . Therefore, a targeted pouch scan is usually reserved for highly suspicious cases and there is a need for an additional screening tool that would improve the rate as well as the timing of antenatal suspicion of EA.…”