Purpose or Case Report: Prenatal diagnosis of esophageal atresia (EA) remains challenging, with indirect signs such as polyhydramnios, a small or absent stomach bubble, and a dilated upper esophageal pouch often being nonspecific. Only 10-40% of EA cases are diagnosed prenatally. Fetal MRI can overcome ultrasound limitations; however, constraints like motion can hinder evaluation of the esophagus. One approach to improve image quality is super-resolution imaging with slice-to-volume reconstruction (SVR). This technique enhances diagnostic accuracy by generating high-resolution 3D images from standard fetal MRI slices. We present two instances where super-resolution imaging with SVR was employed to accurately diagnose EA and assess the presence or absence tracheoesophageal fistulas (TEF).

Case 1: A 30 3/7-week gestation male fetus was referred for fetal MRI following ultrasonographic findings of a dilated right atrium, a single umbilical artery, a small fetal stomach, and a urinary tract dilation observed at 27 2/7 weeks. Fetal MRI revealed a dilated upper esophageal pouch with a small amount of fluid in the distal esophagus, and a diminutive stomach. 3D-rendered super-resolution images demonstrated a dilated atretic upper esophageal pouch and a TEF originating from the left mainstem bronchus. The application of super-resolution imaging with SVR was crucial to determine the precise origin of the TEF from the left mainstem bronchus, findings that were later confirmed by bronchoscopy and surgery.

Case 2: A 33 2/7-week gestation male fetus was referred for fetal MRI due to polyhydramnios and inability to visualize the stomach on an ultrasound performed at 31 weeks. Fetal MRI confirmed polyhydramnios with a distended, fluid-filled proximal esophagus, consistent with EA. The stomach was decompressed, and the distal esophagus was not visualized. 3D-rendered super-resolution imaging with SVR confirmed the dilated upper esophagus and revealed that it ended 0.5 cm below the level of the carina. The imaging also demonstrated a gap between the distal end of the esophageal pouch and the gastroesophageal junction at the level of the diaphragm, supporting the absence of the distal esophagus.

The use of super-resolution imaging with SVR provided detailed, pre-surgical 3D anatomical depictions in both cases of EA, with and without TEF. This technique demonstrates significant potential for accurately delineating the relevant surgical anatomy, which can improve surgical planning and outcomes.
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