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Post mortem magnetic resonance imaging in the fetus, infant and child: a comparative study with conventional autopsy
Sudhin Thayyil1, Neil J Sebire, Lyn S Chitty
1Institute for Women's Health, University College London, London, UK. s.thayyil@ucl.ac.uk
Background:
Minimally invasive autopsy by post mortem magnetic resonance (MR) imaging has been suggested as an alternative for conventional autopsy in view of the declining consented autopsy rates. However, large prospective studies rigorously evaluating the accuracy of such an approach are lacking. We intend to compare the accuracy of a minimally invasive autopsy approach using post mortem MR imaging with that of conventional autopsy in fetuses, newborns and children for detection of the major pathological abnormalities and/or determination of the cause of death.
Methods/Design:
We recruited 400 consecutive fetuses, newborns and children referred for conventional autopsy to one of the two participating hospitals over a three-year period. We acquired whole body post mortem MR imaging using a 1.5 T MR scanner (Avanto, Siemens Medical Solutions, Enlargen, Germany) prior to autopsy. The total scan time varied between 90 to 120 minutes. Each MR image was reported by a team of four specialist radiologists (paediatric neuroradiology, paediatric cardiology, paediatric chest & abdominal imaging and musculoskeletal imaging), blinded to the autopsy data. Conventional autopsy was performed according to the guidelines set down by the Royal College of Pathologists (UK) by experienced paediatric or perinatal pathologists, blinded to the MR data. The MR and autopsy data were recorded using predefined categorical variables by an independent person.
Discussion:
Using conventional post mortem as the gold standard comparator, the MR images will be assessed for accuracy of the anatomical morphology, associated lesions, clinical usefulness of information and determination of the cause of death. The sensitivities, specificities and predictive values of post mortem MR alone and MR imaging along with other minimally invasive post mortem investigations will be presented for the final diagnosis, broad diagnostic categories and for specific diagnosis of each system.
Clinical Trial Registration:
NCT01417962 NIHR PORTFOLIO NUMBER: 6794.
Insights
Post mortem magnetic resonance (MR) imaging offers a minimally invasive autopsy alternative. This study rigorously evaluates its accuracy in diagnosing fetal, neonatal, and pediatric deaths compared to conventional autopsy.
Area of Science:
- Medical Imaging
- Pathology
- Pediatric Medicine
Background:
- Declining consented autopsy rates necessitate alternative methods.
- Minimally invasive autopsy using post mortem magnetic resonance (MR) imaging is proposed.
- Large prospective studies evaluating its accuracy are lacking.
Purpose of the Study:
- To compare the accuracy of minimally invasive autopsy by post mortem MR imaging with conventional autopsy.
- To evaluate the detection of major pathological abnormalities and determination of cause of death in fetuses, newborns, and children.
Main Methods:
- Recruited 400 fetuses, newborns, and children over three years.
- Acquired whole-body post mortem MR imaging (1.5 T) prior to conventional autopsy.
- MR images reported by specialist radiologists blinded to autopsy data; conventional autopsy performed by experienced pathologists blinded to MR data.
Main Results:
- Accuracy of anatomical morphology, lesions, and cause of death determination assessed against conventional autopsy.
- Sensitivities, specificities, and predictive values of post mortem MR presented.
- Analysis includes MR alone and in conjunction with other minimally invasive techniques.
Conclusions:
- Post mortem MR imaging demonstrates potential as an accurate diagnostic tool in pediatric autopsies.
- The study provides rigorous data on the efficacy of minimally invasive autopsy.
- Findings will inform the clinical utility of MR imaging in determining causes of death in pediatric cases.
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