MRI more accurate for prenatal cleft lip and palate than sonography

Fetal MRI allows more detailed and conclusive prenatal evaluation of the upper lip than sonography alone, allowing for better diagnosis of cleft lip and palate in fetuses, according to researchers from Harvard Medical School and Beth Israel Deaconess Medical Center and Children’s Hospital in Boston, MA.

According to the article, cleft lip and palate is the most common facial malformation in newborns, affecting about 1 in 700 births worldwide, and there are a number of benefits to the patient and the patient’s family in diagnosing the condition before the birth of the child, say the researchers. “It is important to detect cleft lip and palate prenatally in order to screen for associated syndromes and chromosome abnormalities. If cleft lip and palate is detected, families can be prepared for the appearance of the baby at the time of birth. The parents can also be appropriately counseled regarding the expected appearance after surgery is performed,” said Deborah Levine, MD, one of the authors of the article.

The researchers state that the reported detection rates of sonography for cleft lip and palate range too broadly to be trustworthy, between 16–93%, and are dependent on many variables, whereas fetal MRI is less dependent than sonography on such factors as amniotic fluid volume, fetus position, the mother’s physical characteristics and shadows from bones. Fetal MRI also allows for detection of soft palate defects, which can be difficult to visualize on sonography. Knowledge of soft palate defects is important due to the potential complications after birth.

“Cleft lip and palate may also be difficult to visualize in the early second trimester when many studies are being performed, and views of the face are not required by the American Institute of Ultrasound Medicine/American College of Radiology guidelines for obstetric ultrasound,” said Dr. Levine.

The article appears in the July 2004 issue of the American Journal of Roentgenology.