Fetal MRI of clubfoot associated with myelomeningocele.
BACKGROUND
The sensitivity and specificity of evaluating clubfoot deformity by MR in high-risk fetuses is currently unknown.


OBJECTIVE
To correlate fetal MRI with US in the assessment of clubfoot and to identify the MRI features most characteristic of clubfoot.


METHODS
With IRB approval and informed consent, the presence of fetal clubfoot was prospectively evaluated in mothers referred for MRI for a fetus with myelomeningocele. Two radiologists blind to the US results independently reviewed the MRI for the presence of clubfoot. MRI results were compared with US results obtained the same day and birth outcomes.


RESULTS
Of 20 patients enrolled, there were 13 clubfeet. Interobserver agreement for the presence of clubfoot was 100%. The sensitivity of the MRI exam was 100% and the specificity 85.2%. A dedicated sagittal imaging plane through the ankle region allowed the most confident diagnosis; medial deviation of the foot relative to the leg was seen in all 13 fetuses with clubfoot.


CONCLUSIONS
The correlation of fetal MRI with US in the evaluation of clubfoot yields a sensitivity of 100% and specificity of 85.2%. The sagittal plane provided the most useful information.
Servaes
Sabah
S
Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA. Servaes@email.chop.edu
Hernandez
Andrea
A
Gonzalez
Leonardo
L
Victoria
Teresa
T
Johnson
Mark
M
Jaramillo
Diego
D
Christopher Edgar
J
J
Johnson
Ann
A
D000015:Abnormalities, Multiple / Q000175:diagnosis*; D003025:Clubfoot / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008591:Meningomyelocele / Q000175:diagnosis*; D015588:Observer Variation; D011296:Prenatal Diagnosis / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016037:Single-Blind Method