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Fetal MRI of clubfoot associated with myelomeningocele

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Abstract

Background

The sensitivity and specificity of evaluating clubfoot deformity by MR in high-risk fetuses is currently unknown.

Objective

To correlate fetal MRI with US in the assessment of clubfoot and to identify the MRI features most characteristic of clubfoot.

Materials and methods

With IRB approval and informed consent, the presence of fetal clubfoot was prospectively evaluated in mothers referred for MRI for a fetus with myelomeningocele. Two radiologists blind to the US results independently reviewed the MRI for the presence of clubfoot. MRI results were compared with US results obtained the same day and birth outcomes.

Results

Of 20 patients enrolled, there were 13 clubfeet. Interobserver agreement for the presence of clubfoot was 100%. The sensitivity of the MRI exam was 100% and the specificity 85.2%. A dedicated sagittal imaging plane through the ankle region allowed the most confident diagnosis; medial deviation of the foot relative to the leg was seen in all 13 fetuses with clubfoot.

Conclusion

The correlation of fetal MRI with US in the evaluation of clubfoot yields a sensitivity of 100% and specificity of 85.2%. The sagittal plane provided the most useful information.

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References

  1. Quinn TM, Hubbard AM, Adzick NS (1998) Prenatal magnetic resonance imaging enhances fetal diagnosis. J Pediatr Surg 33:553–558

    Article  CAS  PubMed  Google Scholar 

  2. Breysem L, Bosmans H, Dymarkowski S et al (2003) The value of fast MR imaging as an adjunct to ultrasound in prenatal diagnosis. Eur Radiol 13:1538–1548

    Article  CAS  PubMed  Google Scholar 

  3. Tamsel S, Ozbek SS, Sener RN et al (2004) MR imaging of fetal abnormalities. Comput Med Imaging Graph 28:141–149

    Article  CAS  PubMed  Google Scholar 

  4. Levine D, Barnes PD, Sher S et al (1998) Fetal fast MR imaging: reproducibility, technical quality, and conspicuity of anatomy. Radiology 206:549–554

    CAS  PubMed  Google Scholar 

  5. Kubik-Huch RA, Huisman TA, Wisser J et al (2000) Ultrafast MR imaging of the fetus. AJR 174:1599–1606

    CAS  PubMed  Google Scholar 

  6. Huppert BJ, Brandt KR, Ramin KD et al (1999) Single-shot fast spin-echo MR imaging of the fetus: a pictorial essay. Radiographics 19 Spec No:S215–S227

    CAS  PubMed  Google Scholar 

  7. Applegate KE (2004) Can MR imaging be used to characterize fetal musculoskeletal development? Radiology 233:305–306

    Article  PubMed  Google Scholar 

  8. Connolly SA, Jaramillo D, Hong JK et al (2004) Skeletal development in fetal pig specimens: MR imaging of femur with histologic comparison. Radiology 233:505–514

    Article  PubMed  Google Scholar 

  9. Benacerraf BR, Frigoletto FD (1985) Prenatal ultrasound diagnosis of clubfoot. Radiology 155:211–213

    CAS  PubMed  Google Scholar 

  10. Garjian KV, Pretorius DH, Budorick NE et al (2000) Fetal skeletal dysplasia: three-dimensional US—initial experience. Radiology 214:717–723

    CAS  PubMed  Google Scholar 

  11. Dighe M, Fligner C, Cheng E et al (2008) Fetal skeletal dysplasia: an approach to diagnosis with illustrative cases. Radiographics 28:1061–1077

    Article  PubMed  Google Scholar 

  12. Cassart M, Massez A, Cos T et al (2007) Contribution of three-dimensional computed tomography in the assessment of fetal skeletal dysplasia. Ultrasound Obstet Gynecol 29:537–543

    Article  CAS  PubMed  Google Scholar 

  13. Westcott MA, Dynes MC, Remer EM et al (1992) Congenital and acquired orthopedic abnormalities in patients with myelomeningocele. Radiographics 12:1155–1173

    CAS  PubMed  Google Scholar 

  14. Keret D, Ezra E, Lokiec F et al (2002) Efficacy of prenatal ultrasonography in confirmed club foot. J Bone Joint Surg Br 84:1015–1019

    Article  CAS  PubMed  Google Scholar 

  15. Offerdal K, Jebens N, Blaas HG et al (2007) Prenatal ultrasound detection of talipes equinovarus in a non-selected population of 49, 314 deliveries in Norway. Ultrasound Obstet Gynecol 30:838–844

    Article  CAS  PubMed  Google Scholar 

  16. Canto MJ, Cano S, Palau J et al (2008) Prenatal diagnosis of clubfoot in low-risk population: associated anomalies and long-term outcome. Prenat Diagn 28:343–346

    Article  CAS  PubMed  Google Scholar 

  17. Cohen-Overbeek TE, Grijseels EW, Lammerink EA et al (2006) Congenital talipes equinovarus: comparison of outcome between a prenatal diagnosis and a diagnosis after delivery. Prenat Diagn 26:1248–1253

    Article  CAS  PubMed  Google Scholar 

  18. Treadwell MC, Stanitski CL, King M (1999) Prenatal sonographic diagnosis of clubfoot: implications for patient counseling. J Pediatr Orthop 19:8–10

    Article  CAS  PubMed  Google Scholar 

  19. Mammen L, Benson CB (2004) Outcomes of fetuses with clubfeet diagnosed by prenatal sonography. J Ultrasound Med 23:497–500

    PubMed  Google Scholar 

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Acknowledgement

This work was supported by an SPR seed grant.

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Authors and Affiliations

  1. Department of Radiology, The Children’s Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA, 19104, USA

    Sabah Servaes, Andrea Hernandez, Leonardo Gonzalez, Teresa Victoria, Diego Jaramillo, J. Christopher Edgar & Ann Johnson

  2. Department of Fetal Surgery, The Children’s Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA, 19104, USA

    Mark Johnson

Authors
  1. Sabah Servaes
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  2. Andrea Hernandez
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  3. Leonardo Gonzalez
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  4. Teresa Victoria
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  5. Mark Johnson
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  6. Diego Jaramillo
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  7. J. Christopher Edgar
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  8. Ann Johnson
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Corresponding author

Correspondence to Sabah Servaes.

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Servaes, S., Hernandez, A., Gonzalez, L. et al. Fetal MRI of clubfoot associated with myelomeningocele. Pediatr Radiol 40, 1874–1879 (2010). https://doi.org/10.1007/s00247-010-1708-5

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  • DOI: https://doi.org/10.1007/s00247-010-1708-5

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