Diagnostic accuracy of postmortem MRI for musculoskeletal abnormalities in fetuses and children

Area of Science:

• Forensic pathology
• Pediatric radiology
• Medical imaging

Background:

• Conventional autopsy is the standard for investigating fetal and pediatric deaths.
• Musculoskeletal (MSK) abnormalities can be challenging to detect and assess via traditional autopsy methods.
• Advanced imaging techniques like postmortem MRI (PMMR) offer potential for improved diagnostic accuracy.

Purpose of the Study:

• To compare the diagnostic accuracy of PMMR for musculoskeletal pathology in fetuses and children against conventional autopsy.
• To evaluate PMMR's effectiveness when combined with radiographic and histopathology assessments.
• To determine the sensitivity, specificity, and overall accuracy of PMMR in identifying MSK abnormalities.

Main Methods:

• A total of 400 cases (277 fetuses, 123 children) underwent PMMR using a 1.5T MRI scanner prior to conventional autopsy.
• PMMR images and autopsy findings were analyzed independently by blinded reviewers.
• Data included gestational age, age at death, and presence/absence of MSK abnormalities.

Main Results:

• Musculoskeletal abnormalities were identified in 11.7% of cases at autopsy.
• PMMR demonstrated high specificity (98.2%) but relatively low sensitivity (51.1%) for detecting MSK pathology.
• Overall diagnostic accuracy of PMMR for MSK abnormalities was 92.7%, with some abnormalities detected only by PMMR.

Conclusions:

• PMMR is valuable for excluding MSK abnormalities in minimally invasive autopsies.
• The sensitivity of PMMR alone for MSK pathology is limited.
• Integrating PMMR with clinical examination and skeletal radiography enhances the detection of clinically significant skeletal and soft tissue abnormalities.