Relevance of fetal brain MRI compared to ultrasound for detecting cerebral anomalies in fetuses with cleft lip and/or palate: a cohort study

Introduction: Relevance of fetal brain 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 (MDPDCs) among women with a fetal 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 an 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 thatchanged the prognoses of three 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 (CL).