Combination of two-dimensional ultrasonography with multiple three-dimensional ultrasonographic technologies in prenatal diagnosis of fetal cleft lip/palate

Abstract

Objective To evaluate the value of the combination of two-dimensional ultrasonogrphy (2D) with multiple three-dimensional (3D) ultrasonographic technologies in prenatal diagnosis of fetal cleft lip/palate. Methods Two-dimensional ultrasonography and 3D ultrasonography were utilized to evaluate 19168 fetal faces when anomaly scans were performed during the second trimester. Multiple 3D ultrasonographic technologies, including surface imaging, tomography ultrasound imaging (TUI), and OmniView mode, were used. All fetuses were followed to live birth or induced abortion. Results Thirty-six fetuses were detected with cleft lip/palate by prenatal ultrasonography screening among the 19168 cases, with a detection rate of 0.19%. Of 36 fetuses with cleft lip and palate, eight with cleft lip (CL) were detected by 2D ultrasonography, TUI, and OmniView mode; however, 1 was missed by 3D surface imaging. Both 2D and 3D imaging techniques showed the continuity interruption of the upper lip, but 3D imaging was more intuitive. Among 11 cases with cleft lip and alveolus (CLA), 8 were detected by 2D ultrasonography, 9 each were detected by 3D surface imaging and TUI, and 2 had missed diagnosis; 10 were detected by OmniView technology and 1 was missed; 10 were detected by combined 2D with 3D ultrasonography , and 1 was missed. The main ultrasonographic features of CLA were: continuity of upper lip and alveolar process was interrupted, 2D ultrasound was difficult to display alveolar process cleft, and TUI and OmniView can display alveolar process cleft from multiple angles. Among 17 fetuses with cleft lip and palate (CLP), 10 were detected by 2D ultrasonography, 13 by surface imaging, 15 by TUI, and 16 by OmniView mode. All of the 17 fetuses were detected by combined 2D with 3D ultrasonography. The ultrasonographic signs of CLP were the continuous interruption of the upper lip, primary palate, and secondary palate. TUI and OmniView can display the primary palate and secondary palate from multiple angles, which is better than 2D ultrasound with regard to displaying the primary palate and secondary palate. Conclusions Both 2D and 3D ultrasonography have a high detection accuracy for fetal CL. However, 3D ultrasonography is better than 2D ultrasonography for diagnosis of fetal cleft palate. Combination of 2D ultrasonography with 3D can significantly improve the detection rate of cleft lip/palate and avoid missed diagnosis and misdiagnosis. Key words: Ultrasonography, prenatal; Three dimensional ultrasonography; Fetus; Cleft lip; Cleft palate