Image analysis of neurofacial effects of prenatal alcohol exposure

Fetal alcohol syndrome was first described in the literature over 50 years ago and is widely recognized as a devastating public health problem. Prevalence in the U.S. is estimated to be as high as 2.0-7.0 per 1000 individuals in school-age populations. However, prevalence dramatically increases when we consider the full spectrum of prenatal alcohol-associated effects, with estimates of fetal alcohol spectrum disorders (FASD) ranging as high as 2-5% in the U.S. and Western Europe. The diagnosis of FASDs relies upon identifying a range of physical defects and specific neurocognitive and behavioral profiles. FAS is at the most severe end of the spectrum with multiple diagnostic criteria stating reliance on the recognition of at least two of the three cardinal facial features; a smooth philtrum, a thin upper lip vermillion and reduced palpebral fissure length. Alcohol exposed individuals who lack the required criteria for a FAS diagnosis are inherently challenging to identify and subsequently suffer high rates of missed diagnoses and misdiagnosis. In this chapter, we review the 2D and 3D imaging based methods for identifying the range of FASD associated facial dysmorphism across the FASD spectrum, and discuss the identification of and relationships between the face, brain and neurocognitive performance.