MRI for definitive in utero diagnosis of cleft palate: a useful adjunct to antenatal care?
OBJECTIVE
To assess the use of fetal magnetic resonance imaging (MRI) in obtaining a definitive prenatal diagnosis of cleft palate.


METHODS
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.


METHODS
Tertiary referral center for facial clefts--the Spires Cleft Centre, Oxford Children's Hospital, Oxford, United Kingdom.


METHODS
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.
Nuffield Department of Surgery, John Radcliffe Hospital and Spires Cleft Centre, Oxford Children’s Hospital, Oxford, UK. mdescamps@doctors.org.uk
Marjanne J L
MJ
Descamps
Stephen J
SJ
Golding
Jane
J
Sibley
Anthony
A
McIntyre
Christopher
C
Alvey
Timothy
T
Goodacre
D002971:Cleft Lip / Q000175:diagnosis*; D002972:Cleft Palate / Q000175:diagnosis*; D003376:Counseling; D017352:Echo-Planar Imaging; D005260:Female; D006801:Humans; D011247:Pregnancy; D011263:Pregnancy Trimester, Third; D011295:Prenatal Care; D011296:Prenatal Diagnosis / Q000379:methods*; D011871:Radiology / Q000193:education; D012680:Sensitivity and Specificity; D016037:Single-Blind Method; D062606:Tertiary Care Centers; D016216:Ultrasonography, Prenatal; D006113:United Kingdom