title: Fetal MRI of cloacal exstrophy.
abstract: BACKGROUND
  Prenatal ultrasonographic (US) diagnosis of cloacal exstrophy (CE) is challenging.
  
  
  OBJECTIVE
  To define the fetal MRI findings in CE.
  
  
  METHODS
  We performed a retrospective review of eight patients with CE. Imaging was performed between 22 weeks and 36 weeks of gestation with US in four and MRI in eight fetuses. Abdominal wall, gastrointestinal/genitourinary, and spine and limb abnormalities detected were compared with postnatal evaluation.
  
  
  RESULTS
  US failed to display CE in one of the four fetuses. Fetal MRI confirmed CE in all eight fetuses by demonstrating absence of a normal bladder and lack of meconium-filled rectum/colon, associated with protuberant pelvic contour and omphalocele. These findings correlated postnatally with CE, atretic hindgut and omphalocele. One fetus had imaging before rupture of the cloacal membrane, showing a protruding pelvic cyst. Absent bladder was noted in the remaining seven fetuses. Confirmed skin-covered spinal defects were noted in seven fetuses, low conus/tethered cord in one and clubfoot in three. Six fetuses had renal anomalies, two had hydrocolpos and one had ambiguous genitalia.
  
  
  CONCLUSIONS
  Fetal MRI provides a confident diagnosis of CE when a normal bladder is not identified, there is a protuberant abdominopelvic contour and there is absence of meconium-filled rectum and colon. Genitourinary and spinal malformations are common associations.
authors.affiliation: Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., MLC 5031, Cincinnati, OH 45229-3039, USA. maria.calvo@cchmc.org
authors.forename: Maria A
authors.initials: MA
authors.lastname: Calvo-Garcia
authors.forename: Beth M
authors.initials: BM
authors.lastname: Kline-Fath
authors.forename: Eva I
authors.initials: EI
authors.lastname: Rubio
authors.forename: Arnold C
authors.initials: AC
authors.lastname: Merrow
authors.forename: Carolina V
authors.initials: CV
authors.lastname: Guimaraes
authors.forename: Foong-Yen
authors.initials: FY
authors.lastname: Lim
mesh_terms: D001746:Bladder Exstrophy / Q000175:diagnosis* / Q000453:epidemiology*; D002988:Cloaca / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000473:pathology*; D003937:Diagnosis, Differential; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016216:Ultrasonography, Prenatal / Q000379:methods*