Annemarie Stroustrup Smith MS, PRESENTER: Nothing to Disclose

Abstract: HTML Purpose: Magnetic resonance imaging (MRI) is used increasingly for evaluation of fetal abnormalities that are difficult to identify by ultrasonography (US) alone. The use of US in identifying cleft lip with or without cleft palate in the fetus has been well described in the sonographic literature, however to our knowledge, there are no analyses of cleft lip or cleft palate as visualized antenatally by MRI. The determination of cleft soft palate is of particular importance since hearing loss and difficulty with speech are associated with cleft soft palate. Methods and Materials: A search was made of our databases of over 500 fetal MRIs for cases with pre- or postnatal diagnosis of facial clefting. Twenty-two fetal MRI studies corresponded to fetuses that match these criteria. Three reviewers retrospectively evaluated each MRI and corresponding US study to assess the ability of MRI to visualize the structural elements of facial clefting. During review of images, the reviewers remained blinded to final diagnosis of type of cleft. We evaluated visualization of the lips (complete or incomplete cleft), alveolus (cleft or not cleft), nose, and soft palate (cleft or not cleft) by US and MRI. Outcome was by autopsy, surgery, and postnatal imaging. Results: Of the twenty-two cases reviewed, 9 demonstrated unilateral cleft lip (2 isolated incomplete cleft lip, 1 incomplete cleft lip with cleft palate, and 6 complete cleft lip and palate), 7 had bilateral cleft lip and palate (2 with incomplete cleft lip), 3 had a medial facial cleft associated with holoprosencephaly, and 3 had isolated cleft soft palate. Cleft lip was more easily detected on ultrasound, although it was difficult to distinguish between incomplete and complete cleft lip when a cleft palate was present. Cleft alveolus was equally well visualized on US and MRI, except when face position limited assessment on ultrasound late in gestation. Cleft soft palate was better visualized on MR than on US, however, it could be inferred on ultrasound where a high position of the tongue was visualized. Cleft soft palate could be visualized directly on MR as absence of the midline low signal intensity soft palate, although this evaluation was at times difficult due to the presence of para-midline palate. Conclusion: Knowledge of the appearance of cleft lip, cleft alveolus, and cleft soft palate on US and MRI will aid in prenatal diagnosis and appropriate counseling of patients. The sensitivity and specificity of MR in the prospective determination of cleft soft palate has yet to be established.      

Stroustrup Smith MS, A, Evaluation of Fetal Facial Clefting by Ultrasound and Magnetic Resonance Imaging.  Radiological Society of North America 2003 Scientific Assembly and Annual Meeting, November 30 - December 5, 2003 ,Chicago IL. http://archive.rsna.org/2003/3106448.html