Laifer-Narin Sherelle, Schlechtweg Kathryn, Lee James, Booker Whitney, Miller Russell, Ayyala Rama S, Imahiyerobo Thomas
From the Department of Radiology.
College of Physicians and Surgeons.
Ann Plast Surg. 2019 Apr;82(4S Suppl 3):S242-S246. doi: 10.1097/SAP.0000000000001881.
Prenatal ultrasound is the standard modality to screen for fetal craniofacial malformations, but can be limited by sonographer experience, oligohydramnios, and maternal obesity. Fetal magnetic resonance imaging (MRI) can be used as an adjunct to ultrasound, but there is a paucity of literature on its performance. The objective of this study was to examine the accuracy of fetal MRI for prenatal diagnosis of craniofacial abnormalities in an at-risk patient population and to determine if accuracy is maintained before and after 24 weeks gestational age (GA).
This was a retrospective review of a single-center fetal MRI database including cases from March 2011 to November 2018. All cases were referred for MRI due to a suspected orofacial cleft or micrognathia upon screening ultrasound. Magnetic resonance imaging was performed and interpreted by dedicated fetal MRI radiologists. Prenatal findings were correlated with postnatal anatomy.
Sixty-one cases were identified. Ten were lost to follow-up and 9 underwent termination of pregnancy. Among the remaining 42 cases, MRI possessed a sensitivity of 91.7% and negative predictive value (NPV) of 90% for prenatal diagnosis of cleft palate. When performed at early GA, fetal MRI (n = 20) demonstrated sensitivity and NPV of 100% for cleft palate diagnosis. For cleft lip, MRI had 93.1% sensitivity and 86.7% NPV without significant decrease in accuracy at early GA. For micrognathia, MRI demonstrated 100% sensitivity and NPV overall, as well as at early and late gestational ages.
Fetal MRI is an accurate method for prenatal diagnosis of cleft palate, cleft lip, and micrognathia. Furthermore, it remains highly accurate even when performed before 24 weeks GA. We advocate the use of fetal MRI as an adjunct imaging modality to standard ultrasound for the evaluation of suspected fetal craniofacial anomalies to provide complete and accurate counseling to prospective parents and facilitate the planning of appropriate postnatal care.
产前超声是筛查胎儿颅面畸形的标准方法，但可能受到超声检查者经验、羊水过少和孕妇肥胖的限制。胎儿磁共振成像（MRI）可作为超声检查的辅助手段，但关于其性能的文献较少。本研究的目的是检验高危患者群体中胎儿MRI对产前诊断颅面异常的准确性，并确定在孕24周胎龄（GA）前后准确性是否保持一致。
这是一项对单中心胎儿MRI数据库的回顾性研究，包括2011年3月至2018年11月的病例。所有病例因超声筛查怀疑有口面部裂隙或小颌畸形而被转诊进行MRI检查。磁共振成像由专业的胎儿MRI放射科医生进行检查和解读。产前检查结果与产后解剖结构进行对比。
共识别出61例病例。10例失访，9例终止妊娠。在其余42例病例中，MRI对腭裂产前诊断的敏感性为91.7%，阴性预测值（NPV）为90%。在孕早期进行检查时，胎儿MRI（n = 20）对腭裂诊断的敏感性和NPV均为100%。对于唇裂，MRI的敏感性为93.1%，NPV为86.7%，在孕早期准确性无显著下降。对于小颌畸形，MRI总体以及在孕早期和晚期的敏感性和NPV均为100%。
胎儿MRI是产前诊断腭裂、唇裂和小颌畸形的准确方法。此外，即使在孕24周前进行检查，其准确性仍然很高。我们提倡将胎儿MRI作为标准超声的辅助成像手段，用于评估疑似胎儿颅面畸形，以便为准父母提供完整准确的咨询，并便于规划适当的产后护理。
