Introduction: Relevance of fetal brain magnetic resonance imaging (MRI) in cases of cleft lip and/or palate (CL/P) is still discussed to date. The aim of our study was to review the contribution of fetal brain MRI for detecting cerebral anomalies in cases of CL/P comparing antenatal data with neonatal outcomes. Methods: A retrospective multicenter study was conducted from January 2010 to October 2020 in two multidisciplinary prenatal diagnosis centers among women with a fetal ultrasound (US) diagnosis of CL/P. Prenatal imaging and genetic analysis data were collected, as well as postnatal data, including outcomes of children who had an abnormal prenatal MRI. Results: Among the 202 fetuses with a US diagnosis of CL/P, 96 underwent US and fetal brain MRI. 19 brain MRIs were found to be abnormal: 14 (73.7%) involved CL/P associated with other US abnormalities and five (26.3%) involved isolated clefts, of which four were cleft lip and alveolus and secondary palate (CLP). MRI identified severe abnormalities that changed the prognoses of 3 cases of clefts associated with other US abnormalities. In contrast, MRI found only minor abnormalities for the five isolated clefts, with no postnatal disorders found in these children. Conclusion: Fetal brain MRI should be proposed in cases of clefts associated with other anomalies or if US examination is limited by local conditions. MRI could also be discussed in cases of isolated CLP but should not be performed in cases of isolated cleft lip.

1.
Cockell A, Lees M. Prenatal diagnosis and management of orofacial clefts. Prenat Diagn. 2000;20(2):149–51.
2.
Gillham JC, Anand S, Bullen PJ. Antenatal detection of cleft lip with or without cleft palate: incidence of associated chromosomal and structural anomalies. Ultrasound Obstet Gynecol. 2009;34(4):410–5.
3.
Nyberg D. Fetal cleft lip with and without. US Classification and Correlation. 1995;195:8.
4.
Chmait R, Pretorius D, Moore T, Hull A, James G, Nelson T, et al. Prenatal detection of associated anomalies in fetuses diagnosed with cleft lip with or without cleft palate in utero. Ultrasound Obstet Gynecol. 2006;27(2):173–6.
5.
Stoll C, Dott B, Alembik Y, Roth M-P. Evaluation of prenatal diagnosis of cleft lip/palate by foetal ultrasonographic examination. Ann Genet. 2000;43(1):11–4.
6.
Milerad J, Larson O, Hagberg C, Ideberg M. Associated malformations in infants with cleft lip and palate: a prospective, population-based study. Pediatrics. 1997;100(2 Pt 1):180–6.
7.
Donnelly JC, Platt LD, Rebarber A, Zachary J, Grobman WA, Wapner RJ. Association of copy number variants with specific ultrasonographically detected fetal anomalies. Obstet Gynecol. 2014;124(1):83–90.
8.
Perrotin F, de Poncheville LM, Marret H, Paillet C, Lansac J, Body G. Chromosomal defects and associated malformations in fetal cleft lip with or without cleft palate. Eur J Obstet Gynecol Reprod Biol. 2001;99(1):19–24.
9.
Calzolari E, Pierini A, Astolfi G, Bianchi F, Neville AJ, Rivieri F. Associated anomalies in multi-malformed infants with cleft lip and palate: an epidemiologic study of nearly 6 million births in 23 EUROCAT registries. Am J Med Genet A. 2007;143A(6):528–37.
10.
Rittler M, López-Camelo JS, Castilla EE, Bermejo E, Cocchi G, Correa A, et al. Preferential associations between oral clefts and other major congenital anomalies. Cleft Palate Craniofac J. 2008;45(5):525–32.
11.
Bergé SJ, Plath H, Van de Vondel PT, Appel T, Niederhagen B, Von lindern JJ, et al. Fetal cleft lip and palate: sonographic diagnosis, chromosomal abnormalities, associated anomalies and postnatal outcome in 70 fetuses. Ultrasound Obstet Gynecol. 2001;18(5):422–31.
12.
Mueller AA, Sader R, Honigmann K, Zeilhofer H-F, Schwenzer-Zimmerer K. Central nervous malformations in presence of clefts reflect developmental interplay. Int J Oral Maxillofac Surg. 2007;36(4):289–95.
13.
Maarse W, Rozendaal AM, Pajkrt E, Vermeij-Keers C, Mink van der Molen AB, Van den Boogaard M-JH. A systematic review of associated structural and chromosomal defects in oral clefts: when is prenatal genetic analysis indicated? J Med Genet. 2012;49(8):490–8.
14.
Descamps MJL, Golding SJ, Sibley J, McIntyre A, Alvey C, Goodacre T. MRI for definitive in utero diagnosis of cleft palate: a useful adjunct to antenatal care? Cleft Palate Craniofac J. 2010;47(6):578–85.
15.
van der Hoek-Snieders HEM, van den Heuvel AJML, van Os-Medendorp H, Kamalski DMA. Diagnostic accuracy of fetal MRI to detect cleft palate: a meta-analysis. Eur J Pediatr. 2020;179(1):29–38.
16.
Manganaro L, Tomei A, Fierro F, Di Maurizio M, Sollazzo P, Sergi ME, et al. Fetal MRI as a complement to US in the evaluation of cleft lip and palate. Radiol Med (Torino)a. 2011;116(7):1134–48.
17.
Moreira NC, Ribeiro V, Teixeira J, Raininko R, Wikstrom J. Visualization of the fetal lip and palate: is brain-targeted MRI reliable? Cleft Palate Craniofac J. 2013;50(5):513–9.
18.
Tian M, Xiao L, Jian N, Wei X, Liu S, Zhao H, et al. Accurate diagnosis of fetal cleft lip/palate by typical signs of magnetic resonance imaging. Prenat Diagn. 2019;39(10):883–9.
19.
Rosen H, Chiou GJ, Stoler JM, Mulliken JB, Tarui T, Meara JG, et al. Magnetic resonance imaging for detection of brain abnormalities in fetuses with cleft lip and/or cleft palate. Cleft Palate Craniofac J. 2011;48(5):619–22.
20.
Zheng W, Li B, Zou Y, Lou F. The prenatal diagnosis and classification of cleft palate: the role and value of magnetic resonance imaging. Eur Radiol. 2019;29(10):5600–6.
21.
Wang G, Shan R, Zhao L, Zhu X, Zhang X. Fetal cleft lip with and without cleft palate: comparison between MR imaging and US for prenatal diagnosis. Eur J Radiol. 2011;79(3):437–42.
22.
Bekiesińska-Figatowska M, Brągoszewska H, Romaniuk-Doroszewska A, Duczkowska A, Jaczyńska R, Maciejewski TM. The role of magnetic resonance imaging in the prenatal diagnosis of cleft lip and palate. Dev Period Med. 2014;18(1):27–32.
23.
Hosny IA, Elghawabi HS. Ultrafast MRI of the fetus: an increasingly important tool in prenatal diagnosis of congenital anomalies. Magn Reson Imaging. 2010;28(10):1431–9.
24.
de Milly M-N, Alison M, Arthurs O, Vuillard E, Oury JF, Elmaleh-Berges M, et al. Is fetal cerebral MRI worthwhile in antenatally diagnosed isolated cleft lip with or without palate? Prenat Diagn. 2013;33(3):273–8.
25.
Malinger G, Paladini D, Haratz KK, Monteagudo A, Pilu GL, Timor-Tritsch IE. ISUOG Practice Guidelines (updated): sonographic examination of the fetal central nervous system. Part 1: performance of screening examination and indications for targeted neurosonography. Ultrasound Obstet Gynecol. 2020 Sep;56(3):476–84.
26.
Kernahan DA, Stark RB. A new classification for cleft lip and cleft palate. Plast Reconstr Surg Transplant Bull. 1958;22(5):435–41.
27.
Kau T, Marterer R, Kottke R, Birnbacher R, Gellen J, Nagy E, et al. Blake’s pouch cysts and differential diagnoses in prenatal and postnatal MRI: a pictorial review. Clin Neuroradiol. 2020;30(3):435–45.
28.
Liu Z, Han J, Fu F, Liu J, Li R, Yang X, et al. Outcome of isolated enlarged cisterna magna identified in utero: experience at a single medical center in mainland China. Prenat Diagn. 2017;37(6):575–82.
29.
Nopoulos P, Langbehn DR, Canady J, Magnotta V, Richman L. Abnormal brain structure in children with isolated clefts of the lip or palate. Arch Pediatr Adolesc Med. 2007;161(8):753–8.
30.
Nopoulos P, Berg S, VanDemark D, Richman L, Canady J, Andreasen NC. Cognitive dysfunction in adult males with non-syndromic clefts of the lip and/or palate. Neuropsychologia. 2002;40(12):2178–84.
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