Application of MPVR and TL-VR with 64-row MDCT in neonates with congenital EA and distal TEF

Figure 1 The reconstruction techniques of multidetector-row computed tomography show a case of esophageal atresia and tracheoesophageal fistula with a long inter-pouch gap. A: Coronal view of multiple planar volume reconstruction showing a long gap between the proximal pouch (thin arrow) and distal pouch (thick arrow) as well as the tracheobronchial tree with an aspirating catheter in the proximal esophageal pouch; B: Oblique sagittal view of multiple planar volume reconstruction showing a long inter-pouch distance with a tenuous fistula; C: Posteroanterior projection of transparency lung volume rendering demonstrating the distance between esophageal segments and three-dimensional anatomy of esophageal pouches and tracheobronchial tree after removal of lungs in case 3 (a 3-d old male neonate).

Figure 2 The reconstruction techniques of multidetector-row computed tomography clearly demonstrate not only inter-pouch distance but also the distal fistula. A: Coronal view of multiple planar volume reconstruction showing esophageal pouches and tracheobronchial tree; B: Oblique sagittal view of multiple planar volume reconstruction demonstrating inter-pouch distance and tracheal connection with the distal esophageal pouch; C, D: Transparency lung volume rendering showing anteroposterior (C) and sagittal projection (D) in three-dimensional anatomy of esophageal pouches and fistula in case 8 (a 5-d old male infant).

Figure 3 The proximal esophageal pouch full of air was distended and pressed the trachea rightwards. A: Coronal view of multiple planar volume reconstruction showing a short inter-pouch gap, a distended proximal esophageal pouch, and rightward- shifted trachea; B: Oblique posteroanterior view of transparency lung volume rendering demonstrating the three-dimensional anatomy of esophageal pouches and shifted trachea case 6 (a 3-d-old female neonate).

Figure 4 Multiple planar volume reconstruction revealed the inter-pouch distance and the thin fistula which was not visualized by transparency lung volume rendering. A: Coronal view of multiple planar volume reconstruction showing esophageal segments and tracheobronchial tree; B: Oblique sagittal view of multiple planar volume reconstruction showing inter-pouch distance and tracheal connection with the distal esophageal pouch; C: Oblique sagittal view of transparency lung volume rendering demonstrating the three-dimensional anatomy of esophageal pouches but no fistula in case 20 (a 4-d old male infant).

Figure 5 Scattered plots about the findings of the reconstruction techniques of multidetector-row computed tomography and surgery. Scattered plot showing gaps determined by multiple planar volume reconstruction (MPVR) (y-axis) and observed at surgery (x-axis) (A), by transparency lung volume rendering (TL-VR) (y-axis) and observed at surgery (x-axis) (B) in 17 patients, and by MPVR and TL-VR (C) in 20 patients.