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© 2008 by the American Institute of Ultrasound in Medicine
J Ultrasound Med 27:1573-1581 • 0278-4297

Multislice Display of the Fetal Face Using 3-Dimensional Ultrasonography

Michele C. McGahan, MD, Gladys A. Ramos, MD, Chenita Landry, MD, Tanya Wolfson, MA, B. Brooke Sowell, MS, Deborah D’Agostini, RDMS, Cesar Patino, MD, RDMS, Thomas R. Nelson, PhD and Dolores H. Pretorius, MD

Departments of Radiology (M.C.M., D.D., C.P., T.R.N., D.H.P.), Reproductive Medicine (G.A.R.), and Preventive Medicine (T.W., B.B.S.), University of California, San Diego, La Jolla, California USA; and University of Louisville, Louisville, Kentucky USA (C.L.).

Address correspondence to Dolores H. Pretorius, MD, Department of Radiology, University of California, 9300 Campus Point Dr, 7756, La Jolla, CA 92037 USA. E-mail: dpretorius{at}ucsd.edu

Objective. Multislice 3-dimensional ultrasonography (3DUS) allows ultrasonographic volume data to be presented in parallel slices. Our aim was to develop a technique using a multislice display to specifically differentiate the maxilla (primary palate) from the mandible and to display the orbits in a single image in fetuses with normal anatomy and cleft lip/palate. Methods. Three-dimensional ultrasonographic volumes of the fetal face were acquired in 142 patients (49 prospective and 93 retrospective). Fifteen patients had a confirmed diagnosis of cleft lip with or without cleft palate. Three readers manipulated volumes in a standardized fashion to show the orbits, maxilla, and mandible. The best interslice distance was determined. Image quality was assessed. Results. The mean gestational age of the fetuses was 23 weeks (range, 11–38 weeks). The mean interval distance used varied from 3 to 3.7 mm (range, 1–5.8 mm). The interval distance correlated with gestational age (Spearman {rho} = 0.66; P < .0001). Image quality obtained through multislice evaluation of the orbits, maxilla, and mandible was high and did not vary with gestational age, interval distance, retrospective versus prospective acquisition, or 3DUS versus 4-dimensional volumes. A higher image quality rating was associated with axial and sagittal planes of acquisition as opposed to coronal and oblique planes (Wilcoxon P < .002). All cases of cleft lip with or without cleft palate were correctly identified retrospectively. Conclusions. Multislice 3DUS evaluation of the fetal face can be performed successfully with high image quality. This technique can be used to consistently and accurately differentiate the fetal primary palate and mandible. Fetuses with cleft lip with or without cleft palate can be identified with confidence.

Key Words: cleft palate • fetal cleft lip • fetal face • fetal palate • 3-dimensional ultrasonography • tomographic imaging

Abbreviations: 4DUS, 4-dimensional ultrasonography • ICC, intraclass correlation coefficient • 3DUS, 3-dimensional ultrasonography • TUI, tomographic ultrasound imaging • 2DUS, 2-dimensional ultrasonography

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Copyright © 2008 by the American Institute of Ultrasound in Medicine.