Significance Of Ultrasonography And MRI In The Prenatal Diagnosis Of Cleft Lip And Palate

Objective To evaluate the accuracy of ultrasound(US)and magnetic resonance imaging(MRI)in the diagnosis of fetal cleft lip and palate.Methods Pregnant women suspected of fetal facial malformations or unable to clearly display normal maxillofacial anatomy were enrolled in the prospective blinded case-control study.All MRI examinations were performed with a 1.5 T MAGNETOM Amira(Siemens Shenzhen Magnetic Resonance Ltd.,Shenzhen,China)with body and spine array coils.All the patients were imaged in the supine position or left-lateral position with bladders moderately full.True fast imaging with steady-state precession(True FISP)and half-fourier acquired single-shot turbo spin-echo(HASTE)images were obtained without breath holding and maternal sedation in the axial,coronal,sagittal planes.All images were saved as DICOM format and send to picture archiving and communication systems(PACS).The US and MRI features were depicted according to the extent of the cleft abnormality as follows:isolated cleft lip(CL),cleft lip and combined with alveolus(CLA),cleft lip and cleft palate(CLP),isolated cleft palate(CP).And then further to classify into unilateral or bilateral defects.The US and MRI images were reviewed in a blinded fashion by experienced radiologists without knowledge of indications or prior imaging findings.The image quality of all the patients included was good(no motion artifacts,no warp around artifacts,high signal noise ratio).The US and MR-images were reviewed in a blinded fashion by two experienced radiologists respectively with more than 10 years'experience without knowledge of indications and prior imaging findings.If they could not reach an agreement,the discussion achieves a consensus.The prenatal US and MRI diagnosis were compared with the postnatal results.Receiver operating characteristic curve(ROC)analysis of data by SPSS20.0 software was conducted to compare the diagnostic efficiency of US and MRI.Diagnostic confidence was divided into four levels.Results A total of 47 individuals were included.The age of pregnant women was 25?35 years old;median age was 29 years old;mean age was 30 years,gestational age was 20?39 weeks;median gestational age was 28 weeks;mean gestational age 29 weeks.All of the 47 fetuses(25 cases of abortion,22 cases of birth)had craniofacial anomaly,including isolated cleft lip in 23 cases,unilateral cleft lip and alveolus in 1 case,cleft lip and cleft palate in 19 cases,and isolated cleft palate in 4 case.In the two cases of CP,one case was combined with bilateral external auditory atresia,while the other case was combined with holoprosencephaly.Furthermore,one fetus of the CLP was combined with heart defects.No other combination of malformation was found in the remaining the cases.US and MRI were consistent with the follow up in cleft lip detection.The accuracy,sensitivity and specificity of both US and MRI in the diagnosis of cleft lip were 100%.However,the diagnosis of cleft palate was different between them.7cases were missed by ultrasonography and 1 case by MRI.The accuracy of US and MRI in the detection of cleft palate was 93.6%vs.48.9%.The area under the curve(AUC)of US and MRI was 0.954 vs,0.704 for the detection of cleft lip and palate(P<0.05).The diagnostic confidence of MRI in the diagnosis or exclusion of cleft lip and palate was higher than that of US(91.5%vs.44.7%).Conclusion MRI is superior to US in the diagnosis of cleft lip and palate,which can serve as an auxiliary diagnostic method,especially when US is unable to confirm the presence of complicated cleft palate.