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CME Credit Offered
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Poster Session 4

(1194) MRI-Based Prediction of the Need for Surgical Intervention in Fetuses with Micrognathia

Friday, January 31, 2025
4:00 PM – 6:00 PM  
Objective:

Diagnosis of fetal micrognathia, characterized by a small fetal mandible causing upper airway obstruction and immediate postnatal respiratory distress, has historically relied on subjective ultrasound assessments. More recent objective measurements including the inferior facial angle (IFA), jaw index (JI), mandibular width/maxillary ratio (MD/MX ratio), and oropharyngeal area (OP) aim to enhance diagnostic accuracy. This study aimed to evaluate the ability of fetal MRI measurements to predict the need for immediate postnatal surgical intervention.

Study Design:

We conducted a retrospective query of our Radiology database for ‘micrognathia’ cases from 2007 to 2022. Radiologists, blinded to clinical details, independently assessed JI, IFA, MD/MX ratio, and OP area. Baseline demographics, comorbidities and clinical outcome metrics including the need for any Otolaryngologic surgical intervention were collected. Logistic regression models were fitted to examine the association between each parameter and the need for surgery, using median radiologist-assessed values.

Results:

Forty fetal MRI scans of 37 patients were analyzed at a median gestational age of 27 weeks. Median values of JI, IFA, MD/MX ratio, and OP area were lower in cases requiring surgical intervention compared to those not needing surgery, but these differences were not statistically significant (p > 0.05). Receiver operating characteristic (ROC) analysis revealed optimal cutoffs for predicting surgery. The more reliable predictors demonstrated modest performance: JI (sensitivity 65.4%, specificity 63%) and IFA (sensitivity 52.5%, specificity 52.8).

Conclusion:

While not statistically significant, both JI and IFA showed modest performance as predictors of the need for the need for surgical intervention compared to MD/MX ratios and OP area when assessed via ROC curves. This suggests their potential utility in delivery planning and selection of surgical management strategies.