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Minimally invasive, imaging guided virtual autopsy compared to conventional autopsy in foetal, newborn and infant
Christoph M Rüegger1, Christine Bartsch, Rosa Maria Martinez
1Department of Neonatology, University Hospital Zurich, Zurich, Switzerland. christoph.rueegger@usz.ch.
Background:
In light of declining autopsy rates around the world, post-mortem MR imaging is a promising alternative to conventional autopsy in the investigation of infant death. A major drawback of this non-invasive autopsy approach is the fact that histopathological and microbiological examination of the tissue is not possible. The objective of this prospective study is to compare the performance of minimally invasive, virtual autopsy, including CT-guided biopsy, with conventional autopsy procedures in a paediatric population.
Methods/Design:
Foetuses, newborns and infants that are referred for autopsy at three different institutions associated with the University of Zurich will be eligible for recruitment. All bodies will be examined with a commercial CT and a 3 Tesla MRI scanner, masked to the results of conventional autopsy. After cross-sectional imaging, CT-guided tissue sampling will be performed by a multifunctional robotic system (Virtobot) allowing for automated post-mortem biopsies. Virtual autopsy results will be classified with regards to the likely final diagnosis and major pathological findings and compared to the results of conventional autopsy, which remains the diagnostic gold standard.
Discussion:
There is an urgent need for the development of alternative post-mortem examination methods, not only as a counselling tool for families and as a quality control measure for clinical diagnosis and treatment but also as an instrument to advance medical knowledge and clinical practice. This interdisciplinary study will determine whether virtual autopsy will narrow the gap in information between non-invasive and traditional autopsy procedures.
Trial Registration:
ClinicalTrials.gov: NCT01888380.
Insights
Virtual autopsy, combining CT imaging and robotic biopsy, shows promise as an alternative to traditional autopsy for infant deaths. This minimally invasive approach aims to bridge the information gap left by non-invasive methods.
Area of Science:
- Medical Imaging
- Forensic Pathology
- Paediatric Autopsy
Background:
- Declining autopsy rates worldwide necessitate alternative methods for infant death investigation.
- Post-mortem magnetic resonance (MR) imaging offers a non-invasive approach but lacks tissue examination capabilities.
- Virtual autopsy, incorporating CT-guided biopsy, is explored as a minimally invasive alternative.
Purpose of the Study:
- To compare the diagnostic performance of virtual autopsy with conventional autopsy in paediatric cases.
- To evaluate the efficacy of CT-guided robotic biopsy in post-mortem tissue sampling.
- To determine if virtual autopsy can enhance information gathering compared to non-invasive imaging alone.
Main Methods:
- Prospective study involving foetuses, newborns, and infants referred for autopsy.
- Utilized commercial CT and 3 Tesla MRI scanners, with radiologists masked to conventional autopsy findings.
- Employed a robotic system (Virtobot) for automated, CT-guided post-mortem biopsies.
- Compared virtual autopsy diagnoses and findings against conventional autopsy as the gold standard.
Main Results:
- Virtual autopsy results were classified regarding likely final diagnoses and major pathological findings.
- Performance comparison between virtual and conventional autopsy was conducted.
- Data on the accuracy and comprehensiveness of virtual autopsy findings are pending full analysis.
Conclusions:
- Development of alternative post-mortem examination methods is crucial for family counselling, quality control, and advancing medical knowledge.
- This study investigates virtual autopsy's potential to bridge the information gap between non-invasive and traditional autopsy.
- The findings will inform the utility of virtual autopsy as a valuable tool in paediatric death investigation.
