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Fetal MRI clues to diagnose cloacal malformations

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Abstract

Background

Prenatal US detection of cloacal malformations is challenging and rarely confirms this diagnosis.

Objective

To define the prenatal MRI findings in cloacal malformations.

Materials and methods

We performed a retrospective study of patients with cloacal malformations who had pre- and post-natal assessment at our institution. Fetal MRI was obtained in six singleton pregnancies between 26 and 32 weeks of gestation. Imaging analysis was focused on the distal bowel, the urinary system and the genital tract and compared with postnatal clinical, radiological and surgical diagnoses.

Results

The distal bowel was dilated and did not extend below the bladder in five fetuses. They had a long common cloacal channel (3.5–6 cm) and a rectum located over the bladder base. Only one fetus with a posterior cloacal variant had a normal rectum. Three fetuses had increased T2 signal in the bowel and two increased T1/decreased T2 signal bladder content. All had renal anomalies, four had abnormal bladders and two had hydrocolpos.

Conclusion

Assessment of the anorectal signal and pelvic anatomy during the third trimester helps to detect cloacal malformations in the fetus. The specificity for this diagnosis was highly increased when bowel fluid or bladder meconium content was identified.

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Authors and Affiliations

  1. Department of Radiology, MLC 5031, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH, 45229, USA

    Maria A. Calvo-Garcia, Beth M. Kline-Fath, Manish N. Patel & Steven Kraus

  2. Colorectal Center for Children, Pediatric Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

    Marc A. Levitt & Alberto Peña

  3. Fetal Care Center of Cincinnati, Pediatric Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

    Foong-Yen Lim & Timothy M. Crombleholme

  4. Department of Radiology, Arkansas Children’s Hospital, Little Rock, AR, USA

    Leann E. Linam

Authors
  1. Maria A. Calvo-Garcia
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  2. Beth M. Kline-Fath
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  3. Marc A. Levitt
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  4. Foong-Yen Lim
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  5. Leann E. Linam
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  6. Manish N. Patel
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  7. Steven Kraus
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  8. Timothy M. Crombleholme
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  9. Alberto Peña
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Corresponding author

Correspondence to Maria A. Calvo-Garcia.

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Calvo-Garcia, M.A., Kline-Fath, B.M., Levitt, M.A. et al. Fetal MRI clues to diagnose cloacal malformations. Pediatr Radiol 41, 1117–1128 (2011). https://doi.org/10.1007/s00247-011-2020-8

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  • DOI: https://doi.org/10.1007/s00247-011-2020-8

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