Accurate diagnosis of fetal cleft lip/palate by typical signs of magnetic resonance imaging

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ObjectiveThis study aims to evaluate the accuracy of magnetic resonance imaging (MRI) in diagnosing orofacial clefts and proposes specific signs for determining the type of cleft.MethodsPregnant women in whom fetal facial malformations are suspected by ultrasonography (US) underwent 1.5 T MRI. The accuracy of the prenatal US and MRI diagnosis was compared with the postnatal findings.ResultsA total of 71 fetuses were included in the final analysis, which comprised of 35 cases of isolated cleft lip, six cases of cleft lip and alveolus, 21 cases of cleft lip and palate, four cases of isolated cleft palate, and five normal fetuses. MRI was more sensitive than US (MRI 100%, US 77.5%; Fisher’s exact test: MRI vs US P=0.000). The accuracy of MRI for all types was 100%. Specific signs (Inverted T, L/anti-L, U, and “Notch” signs) were proposed, indicating the normal hard, unilateral cleft, bilateral cleft, and cleft soft palates, respectively, which can facilitate the identification of different types of cleft palates.ConclusionMRI can accurately diagnose the type of cleft based on typical signs, which can serve as a definite diagnostic modality and an effective supplement of US.What’s already known about this topic?Ultrasonography is the first line imaging modality for the antenatal diagnosis of facial malformations. However, the diagnosis of fetal isolated palates cleft palate can easily be missed.What does this study add?In this study on fetuses with a suspicion of cleft, the accuracy of MRI is 100%. Specific signs (Inverted T, L/anti-L, U, and “Notch”) may indicate the normal hard, unilateral cleft, bilateral cleft, and cleft soft palates, respectively. This can facilitate further characterization of the cleft subtypes.

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