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Real-time Magnetic Resonance Imaging Aids Prenatal Diagnosis of Isolated Cleft Palate

Departments of Radiology (J.F.K.-T., D.L., C.M., N.F.) and Obstetrics and Gynecology (D.L., K.-H.L., B.C.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts USA; General Electric Applied Sciences Laboratory West, Menlo Park, California USA (R.F.B.); and Division of Plastic Surgery, Children’s Hospital, Boston, Massachusetts USA (J.B.M.).

Address correspondence to Deborah Levine, MD, Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 USA. E-mail: dlevine{at}bidmc.harvard.edu

Objective. Cleft of the secondary palate without cleft lip is difficult to visualize sonographically. This study was performed to assess the utility of sonography, standard magnetic resonance (MR) imaging, and real-time MR imaging in the diagnosis of isolated cleft palate. Methods. We prospectively assessed 5 fetuses at risk for isolated cleft palate on the basis of family history, micrognathia, or both, using sonography and standard and real-time single-shot fast spin echo MR sequences. Written informed consent was obtained under our Institutional Review Board–approved Health Insurance Portability and Accountability Act–compliant protocol. Images were assessed for confidence in a diagnosis of cleft or normal palate. Prenatal and postnatal diagnoses were compared. Results. In 3 fetuses, micrognathia was visualized by sonography and MR imaging with standard and real-time sequences. One fetus at 19 weeks had a wide cleft of the entire secondary palate, and another fetus at 33 weeks had a cleft of the soft palate; these defects were seen only with real-time MR imaging. One 35-week gestational age fetus had a cleft soft palate that was visualized on standard and real-time MR imaging. Two fetuses with no abnormalities had the normal midline secondary palate seen only on real-time MR imaging. In all fetuses, real-time images were helpful in assessing the secondary palate because the entire midline naso-oropharynx could be visualized. Conclusions. Real-time MR imaging allows for rapid assessment of the midline structures, providing accurate diagnosis of isolated cleft palate.

Key Words: cleft palate • cleft secondary palate • fetal magnetic resonance imaging • prenatal diagnosis

Abbreviations: MR, magnetic resonance • SSFSE, single-shot fast spin echo • TE, echo time • TR, repetition time

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