MRI for definitive in utero diagnosis of cleft palate: a useful adjunct to antenatal care?

Journal article

OBJECTIVE: To assess the use of fetal magnetic resonance imaging (MRI) in obtaining a definitive prenatal diagnosis of cleft palate. DESIGN: All expectant mothers with a sonographically diagnosed fetal cleft lip or a previously affected child with cleft palate were offered antenatal MRI at around 34 weeks' gestation. Images were interpreted by a consultant radiologist who was blinded to the ultrasound diagnosis. Two MRI readings were performed: one at the time of examination and one at the end of the study to elicit the radiologist's learning curve. MRI findings were correlated with the birth diagnosis. SETTING: Tertiary referral center for facial clefts--the Spires Cleft Centre, Oxford Children's Hospital, Oxford, United Kingdom. PARTICIPANTS: Study participants included 49 pregnant women between 24 and 37 weeks' gestation, four with a family history of cleft posterior palate and 45 with a facial cleft on a 20-week ultrasound. RESULTS: The positive predictive value of fetal MRI for involvement of the palate was 96%, and the negative predictive value was 80%. The accuracy in predicting palatal clefting of four different MRI signs is discussed. The radiologist's interpretation skills significantly improved between the two MRI readings. CONCLUSIONS: Fetal MRI enables us to predict accurately the extent of a cleft palate after an ultrasound diagnosis of cleft lip. With more accurate diagnosis of the severity of the cleft, we can counsel patients more precisely and plan postnatal management correctly.

Authors: Descamps, M; Golding, S; Sibley, J; McIntyre, A; Alvey, C

• Publication status: Published
• Journal: Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association
• Volume: 47
• Issue: 6
• Pages: 578-585
• Publication date: 2010-11-01
• DOI: 10.1597/09-070
• EISSN: 1545-1569
• ISSN: 1055-6656
• Language: English
• Keywords: Pregnancy Trimester, Third; Counseling; Prenatal Diagnosis; Cleft Lip; Radiology; Cleft Palate; Humans; Single-Blind Method; Sensitivity and Specificity; Female; Echo-Planar Imaging; Tertiary Care Centers; Prenatal Care; Ultrasonography, Prenatal; Pregnancy; Great Britain