Diagnostic accuracy of fetal MRI to detect cleft palate: a meta-analysis

Abstract

This systematic review aims to determine the diagnostic accuracy of fetal MRI for detecting cleft palate in fetuses at risk for orofacial clefts. Pubmed, Embase, and CINAHL were searched systematically. A diagnostic study was included if it performed MRI (index test) and postnatal examination (reference test) in fetuses at risk for orofacial clefts. Methodological quality was assessed using the QUADAS-2. A meta-analysis was performed with a random-effects model, calculating the pooled sensitivity, specificity, and area under the curve. The search resulted in eight studies (334 fetuses) to be included: four prospective and four retrospective studies. The applicability concern was low. There was, however, a risk of selection and information bias. All studies showed that MRI well predicted the chance of cleft palate. The sensitivity results were homogeneous, but heterogeneity was assumed regarding the specificity estimate (Cochrane's Q test: p = 0.00). The pooled sensitivity was 0.97 (95% CI 0.93-0.99); the pooled specificity was 0.94 (0.89-0.97). The area under the curve was 0.98 (95% CI 0.98-0.99). Conclusion: This meta-analysis shows that MRI has an excellent sensitivity and good to excellent specificity for diagnosing cleft palate in fetuses at risk for orofacial clefts. Future research should assess applicability for clinical care. What is Known: • Using ultrasound for prenatal detection of cleft palate leads to misdiagnosis frequently. • MRI could potentially improve the prenatal detection rate of cleft palate. What is New: • Eight studies describe the diagnostic accuracy of MRI for detecting cleft palate. • Combined results show excellent sensitivity and good to excellent specificity.

Comparison of prenatal ultrasound with MRI in the evaluation and prediction of fetal orofacial clefts

“…OFCs may involve the lip, the primary palate and secondary palate, or the soft palate, and may also involve structures around the oral cavity, which can extend into the facial structures resulting in oral, facial, and craniofacial deformity [ 8 ]. However, the isolated cleft palate is difficult to detect on US images, and diagnosis of a cleft lip with or without cleft palate by US is not sufficiently accurate in primary care settings [ 7 , 9 , 10 ].…”

A new two‐dimensional sonographic approach to the assessment of the fetal hard and soft palates

“…6 However, long-term safety, the availability of materials (rapid sequence acquisition) along with fetal MRI expertise, increased burden of care, and cost-effectiveness warrant additional research to assess applicability for routine clinical care. 7 In this article, we present a novel 2D US approach using axial and sagittal planes to evaluate fetal palate and demonstrate the main differences between an intact palate, isolated CP, and CL/P.…”

Diagnostic Accuracy of Prenatal Fetal Ultrasound to Detect Cleft Palate in High‐Risk Fetuses

“…Fetal magnetic resonance imaging (MRI) may have utility for detecting cleft palate in high‐risk fetuses. A recent meta‐analysis of 8 studies (334 fetuses, mean gestational age 27.6 weeks) showed that MRI had a pooled sensitivity of 0.97 (95% CI 0.93–0.99), pooled specificity of 0.94 (0.89–0.97), and an area under the curve of 0.98 (95% CI 0.98–0.99) for diagnosing cleft palate in high‐risk fetuses 23 . Although MRI is currently the most reliable diagnostic method for cleft palate, it is expensive and wait times are long.…”

“…A recent meta-analysis of 8 studies (334 fetuses, mean gestational age 27.6 weeks) showed that MRI had a pooled sensitivity of 0.97 (95% CI 0.93-0.99), pooled specificity of 0.94 (0.89-0.97), and an area under the curve of 0.98 (95% CI 0.98-0.99) for diagnosing cleft palate in high-risk fetuses. 23 Although MRI is currently the most reliable diagnostic method for cleft palate, it is expensive and wait times are long. Furthermore, MRI is generally only available in tertiary care centers due to its high cost.…”