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Post-mortem MRI versus conventional autopsy in fetuses and children: a prospective validation study
Sudhin Thayyil1, Neil J Sebire, Lyn S Chitty
1Centre for Cardiovascular Imaging, Institute of Cardiovascular Science, University College London (UCL), London, UK. s.thayyil@ucl.ac.uk
Lancet (London, England)
|May 21, 2013
Summary
Minimally invasive autopsy using MRI shows high accuracy for detecting causes of death in fetuses and infants, comparable to conventional autopsy. However, its accuracy decreases in older children, suggesting it
Area of Science:
- Forensic pathology
- Medical imaging
- Pediatric diagnostics
Background:
- Conventional autopsy is the gold standard for determining cause of death.
- Post-mortem MRI offers a potential non-invasive alternative.
- Large-scale prospective studies comparing post-mortem MRI accuracy to conventional autopsy are limited.
Purpose of the Study:
- To assess the accuracy of whole-body, post-mortem MRI in detecting major pathological lesions.
- To compare the diagnostic accuracy of minimally invasive autopsy (MIA) with conventional autopsy.
- To evaluate MIA's utility in fetuses and children.
Main Methods:
- A prospective validation study involving 400 fetuses and children (age <16 years).
- Whole-body MRI at 1.5 T was performed pre-autopsy.
- MRI findings, alone or with other minimally invasive techniques, were compared to conventional autopsy as the gold standard.
Main Results:
- Minimally invasive autopsy (MIA) showed concordance with conventional autopsy in 89.3% of cases.
- High concordance rates were observed in fetuses (94.6-95.7%) and infants (up to 1 year, 81.0-84.9%).
- Accuracy was lower in children aged over 1 year (53.6%). In 41% of cases, MIA was deemed sufficient, with 99.4% concordance.
Conclusions:
- MIA demonstrates accuracy comparable to conventional autopsy for fetuses, newborns, and infants.
- MIA is less accurate in older children (over 1 year).
- Jointly performed by pathologists and radiologists, MIA can be an acceptable alternative to conventional autopsy in selected pediatric cases.
