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Evaluation of Real-Time Single-Shot Fast Spin-Echo MRI for Visualization of the Fetal Midline Corpus Callosum and Secondary Palate

Deborah Levine1,2, Cristina Cavazos1, Joao Fernando Kazan-Tannus1, Charles A. McKenzie1, Vandana Dialani1, Caroline D. Robson3, Richard L. Robertson3, Tina Young Poussaint3, Reed F. Busse4 and Neil M. Rofsky1

1 Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave., Boston, MA 02215.
2 Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA.
3 Department of Radiology, Children's Hospital, Boston, MA.
4 GE Healthcare, Menlo Park, CA.


Figure 1
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  		Fig. 1A —Fetus with cleft palate and normal corpus callosum. Standard (A) and real-time (RT) (B) single-shot fast spin-echo images obtained at 26 weeks gestation show corpus callosum, which was scored indeterminate by all reviewers on standard imaging and as probably normal on RT imaging. Palate was scored indeterminate by all reviewers on standard imaging and as definitely abnormal on RT images. Note tongue (T) is more clearly defined on RT image because it is outlined by fluid. In region where secondary palate should be located (arrow, B) only fluid is seen. This communication between oro- and nasopharynx on RT image—with no intervening midline palate tissue—allows diagnosis of cleft secondary palate.

 

Figure 2
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  		Fig. 1B —Fetus with cleft palate and normal corpus callosum. Standard (A) and real-time (RT) (B) single-shot fast spin-echo images obtained at 26 weeks gestation show corpus callosum, which was scored indeterminate by all reviewers on standard imaging and as probably normal on RT imaging. Palate was scored indeterminate by all reviewers on standard imaging and as definitely abnormal on RT images. Note tongue (T) is more clearly defined on RT image because it is outlined by fluid. In region where secondary palate should be located (arrow, B) only fluid is seen. This communication between oro- and nasopharynx on RT image—with no intervening midline palate tissue—allows diagnosis of cleft secondary palate.

 

Figure 3
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  		Fig. 2A —Fetus with complete agenesis of corpus callosum and normal palate. Standard (A) and real-time (RT) (B) single-shot fast spin-echo images obtained at 30 weeks gestation show agenesis of corpus callosum and normal palate. Corpus callosum was scored definitely abnormal by all reviewers on standard imaging and on RT imaging. Palate was scored definitely normal by all reviewers on standard imaging and as probably normal on RT imaging. In A, T indicates tongue; arrowhead, hard palate; and arrow, soft palate.

 

Figure 4
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  		Fig. 2B —Fetus with complete agenesis of corpus callosum and normal palate. Standard (A) and real-time (RT) (B) single-shot fast spin-echo images obtained at 30 weeks gestation show agenesis of corpus callosum and normal palate. Corpus callosum was scored definitely abnormal by all reviewers on standard imaging and on RT imaging. Palate was scored definitely normal by all reviewers on standard imaging and as probably normal on RT imaging. In A, T indicates tongue; arrowhead, hard palate; and arrow, soft palate.

 

Figure 5
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  		Fig. 3A —Fetus with cleft soft palate. Standard (A) and real-time (RT) (B) single-shot fast spin-echo images obtained at 34 weeks gestation show cleft soft palate. Corpus callosum was scored indeterminate by all reviewers on standard imaging and as definitely normal on RT imaging. Palate was scored indeterminate on standard imaging and as definitely abnormal on RT imaging by two reviewers, with a third reviewer scoring it as indeterminate. This image shows hard palate (arrow) with tongue (arrowheads) extending into nasopharynx, above palatal shelf.

 

Figure 6
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  		Fig. 3B —Fetus with cleft soft palate. Standard (A) and real-time (RT) (B) single-shot fast spin-echo images obtained at 34 weeks gestation show cleft soft palate. Corpus callosum was scored indeterminate by all reviewers on standard imaging and as definitely normal on RT imaging. Palate was scored indeterminate on standard imaging and as definitely abnormal on RT imaging by two reviewers, with a third reviewer scoring it as indeterminate. This image shows hard palate (arrow) with tongue (arrowheads) extending into nasopharynx, above palatal shelf.

 

Figure 7
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  		Fig. 4 —Graph shows percentage of cases (y-axis) in which scores on real-time (RT) single-shot fast spin-echo (SSFSE) imaging were 4 or 5, compared with scores of 1, 2, or 3 on SSFSE with respect to gestational age: 17-19 weeks, black bars; 20-26 weeks, gray bars; 27-32 weeks, white bars; and 33-37 weeks, striped bars. CC = corpus callosum.

 

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