Evaluation of real-time single-shot fast spin-echo MRI for visualization of the fetal midline corpus callosum and secondary palate

OBJECTIVE. The objective of our study was to assess the visibility of the fetal corpus callosum and soft palate on standard single-shot fast spin-echo (SSFSE) imaging versus real-time (RT) SSFSE imaging. SUBJECTS AND METHODS. Part 1 of the study was a prospective analysis using a questionnaire rating the ease of use and utility of RT imaging. Part 2 of the study was a retrospective analysis of 69 fetal MRI studies with RT sagittal midline imaging of the head, face, or both. Standard and RT SSFSE image sets were de-identified, randomized, and shown to three pediatric neuroradiologists who rated on a 5-point scale whether the images were midline and how well they could see and characterize as normal the corpus callosum and secondary palate. The imaging results were correlated with postnatal diagnosis. Statistical methods included the Wilcoxon's signed rank test, McNemar chi-square test, and analysis of variance. RESULTS. Prospectively, the RT SSFSE technique was ranked as excellent in all the categories assessed. Retrospective analysis showed that the midline view obtained with RT SSFSE imaging was helpful in diagnosing the normal and abnormal secondary palate, allowing improved diagnosis of 19 (30.6%) of 62 cases of normal palate and four (57.1%) of seven cases of abnormal palate, when compared with the standard SSFSE technique. RT SSFSE imaging improved the ability to diagnose a normal corpus callosum on the midline view in 13 (27.6%) of 47 fetuses of 20 or more weeks gestational age. CONCLUSION. The RT SSFSE technique can aid in obtaining images in planes that are critical to the evaluation of a moving fetus, particularly when a midline sagittal view of the corpus callosum or palate is required. The use of this technique may lead to improved diagnosis of CNS or orofacial abnormalities in fetuses.