Maria Azucena Calvo Garcia MD, Presenter: Nothing to Disclose

Beth M. Kline-Fath MD, Abstract Co-Author: Nothing to Disclose

Eva Ilse Rubio MD, Abstract Co-Author: Author, Amirsys, Inc

Arnold Carlson Merrow MD, Abstract Co-Author: Author for Amirsys, Inc

Carolina V. Guimaraes MD, Abstract Co-Author: Nothing to Disclose

To define the fetal MRI findings in cloacal exstrophy (CE), also known as the OEIS complex, in order to improve its detection so a confident prenatal diagnosis is provided.

We performed a retrospective review study of patients with CE who had pre- and postnatal assessment at our institution. Fetal MRI was obtained in 5 singleton pregnancies and in 1 dichorionic twin. Imaging was performed between 22 and 36 weeks of gestation. We recorded the presumptive US diagnosis at the time of the referral and after the fetal MRI. We analyzed the abdominal wall defect, the gastrointestinal-genitourinary system and the spine and limb defects. All this was compared with postnatal clinical, radiological and surgical diagnosis.

Prenatal diagnosis was CE at the time of the referral only in two and changed to all after the MRI. All fetuses had absent closure of the anterior pelvic ring with an anterior protuberant contour, a low omphalocele and absent meconium filled rectum and colon. There was a short prolapsing loop caudal to the omphalocele (4/6) and everted lateral bladder plates connecting the distal ureters (2/6). The exstrophy was covered in one fetus, represented by a thin-walled protruding cyst but exposed at birth. Absent bladder was noted in 5. The spinal defects included skin-covered dysraphism (5) and low conus/tethered cord (1). Renal findings included hydronephrosis (5), megaureter (2), renal ectopia (3) and duplication (2). Small hydrocolpos was noted in two and ambiguous genitalia in one.

Fetal MRI can provide a confident diagnosis of CE/OEIS complex helping with a more accurate prenatal counseling and a better planned neonatal care.

Fetal MRI allows excellent depiction of the fetal anatomy, including the GI tract and will provide key findings supporting a confident diagnosis of cloacal exstrophy.

Calvo Garcia, M, Kline-Fath, B, Rubio, E, Merrow, A, Guimaraes, C, Fetal MRI Findings in Cloacal Extrophy/OEIS Complex.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11002707.html