Boundary Formation of the Human Caudal Foregut During the Early Fetal Period: Three-Dimensional Analysis Using T1-Weighted and Diffusion Tensor Images.

Introduction: While caudal foregut development in human fetuses has been outlined in previous research, the formation of its border region remains unclear. This study aimed to visualize the precise timeline of caudal foregut boundary formation. Methods: Three-dimensional images of the foregut from T1-weighted scans of 24 fetuses (crown–rump length [CRL]: 34–103 mm) were analyzed to measure the wall thickness and lumen diameter at nine specific sites. The internal structure in the border region was verified using histological sections and diffusion tensor imaging (DTI) tractography. Results: The lower esophageal and pyloric canal walls were thicker in samples with a CRL ≥50 mm. The esophageal wall at the esophageal hiatus, where the lower esophageal sphincter is located, was particularly thick in samples with a CRL ≥88 mm. Increased wall thickness at the esophageal hiatus and pyloric canal resulted in a narrower lumen. The pyloric canal lumen narrowed from its distal to proximal sections. The lumen diameter-to-wall thickness ratio at the esophageal hiatus and proximal pyloric was negatively correlated with CRL. The thickened esophageal wall at the esophageal hiatus had a thick submucosa, and all layers in the pyloric canal thickened with growth. DTI tractography revealed that the lower esophageal wall mainly comprised longitudinal fibers, whereas the pyloric canal wall consisted solely of circular fibers, with fractional anisotropy increasing with growth. Conclusion: This study provides a comprehensive timeline of normal caudal foregut boundary formation during the early human fetal period, thereby improving the understanding of congenital foregut obstruction pathogenesis.