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Can we make an accurate diagnosis of pyriform sinus fistula by fetal MRI?
1Department of Radiology, Women & Children's Medical Center, Guangzhou Medical University, 9# Jin Sui Road, Guangzhou 510630, PR China.
Aim:
To review the fetal magnetic resonance imaging (MRI) features of pyriform sinus fistula (PSF) and to compare them with the postnatal clinical and surgical findings. The relevant medical literature is also discussed.
Materials And Methods:
The location, shape, signal, effects of adjacent structures and in utero changes detected on fetal MRI were reviewed in three cases of PSF. The patient's respiratory status at birth, the application of ex utero intrapartum therapy (EXIT), infectious complications in the neonatal period, and the surgical and pathological findings were also reviewed and discussed. The study consisted of three pregnant women between 18 and 38 years of age, each with a single fetus. Fetal MRI was performed at 26 and 38 weeks of gestation in case 1, at 34 weeks of gestation in case 2, and at 34 and 38 weeks of gestation in case 3. Postnatal clinical follow-up extended from 9 months to 3 years.
Results:
All lesions were well-circumscribed unilobular cysts with slightly thickened walls at the neck area. Case 1 was irregular in shape, and the other two cases were oval and extended longitudinally along the neck. The fluid contents showed signals consistent with amniotic fluid. Close contact with the thyroid gland was demonstrated to be a fairly characteristic feature that could be recognised on fetal MRI. The in utero follow-up detected slight changes in the signal, wall characteristics, contour, and airway deviation. Case 1 was bilaterally affected, causing it to be initially mistaken as macro-cystic lymphangioma. The diagnosis was corrected with the aid of postnatal imaging; however, a prenatal diagnosis was correctly made in cases 2 and 3. Airway obstruction was not observed in any of the three cases, and thus, EXIT was not applied. The fetal MRI findings were in good agreement with the postnatal clinical and surgical findings. In addition to the higher spatial delineation provided by fetal MRI, as described in the literature, the observation of close contact with the thyroid gland and a flattened deformity of the thyroid gland are other characteristic features.
Conclusion:
Fetal MRI is useful for displaying characteristics of PSF that can enable an accurate prenatal diagnosis.
Insights
Fetal magnetic resonance imaging (MRI) accurately identifies pyriform sinus fistula (PSF) features, aiding prenatal diagnosis. This imaging technique correlates well with postnatal findings, improving early detection of this condition.
Area of Science:
- Medical Imaging
- Fetal Medicine
- Pediatric Surgery
Background:
- Pyriform sinus fistula (PSF) is a congenital anomaly that can lead to significant neonatal complications.
- Accurate prenatal diagnosis of PSF is crucial for appropriate management and to prevent adverse outcomes.
Purpose of the Study:
- To review fetal magnetic resonance imaging (MRI) features of pyriform sinus fistula (PSF).
- To compare fetal MRI findings with postnatal clinical and surgical outcomes.
- To discuss the relevant medical literature on PSF diagnosis.
Main Methods:
- Retrospective review of three fetal MRI cases diagnosed with PSF.
- Analysis of lesion location, shape, signal characteristics, and effects on adjacent structures.
- Correlation of fetal MRI findings with postnatal clinical data, including respiratory status, surgical, and pathological results.
Main Results:
- Fetal MRI revealed well-circumscribed, unilobular cysts in the neck region.
- Characteristic findings included close contact with and potential flattening of the thyroid gland.
- Fetal MRI demonstrated in utero changes in lesion characteristics and minor airway deviation.
- Prenatal diagnosis was accurate in two out of three cases, with one case requiring postnatal imaging clarification.
- Fetal MRI findings correlated well with postnatal clinical and surgical outcomes.
Conclusions:
- Fetal MRI is a valuable tool for characterizing pyriform sinus fistula (PSF).
- The imaging features observed on fetal MRI can facilitate accurate prenatal diagnosis of PSF.
- Correlation with postnatal findings confirms the utility of fetal MRI in managing this condition.
