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Diagnostic accuracy of post-mortem MRI for thoracic abnormalities in fetuses and children
Owen J Arthurs1, Sudhin Thayyil, Oystein E Olsen
1Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK, owen.arthurs@gosh.nhs.uk.
Objectives:
To compare the diagnostic accuracy of post-mortem magnetic resonance imaging (PMMR) specifically for non-cardiac thoracic pathology in fetuses and children, compared with conventional autopsy.
Methods:
Institutional ethics approval and parental consent was obtained. A total of 400 unselected fetuses and children underwent PMMR before conventional autopsy, reported blinded to the other dataset.
Results:
Of 400 non-cardiac thoracic abnormalities, 113 (28 %) were found at autopsy. Overall sensitivity and specificity (95 % confidence interval) of PMMR for any thoracic pathology was poor at 39.6 % (31.0, 48.9) and 85.5 % (80.7, 89.2) respectively, with positive predictive value (PPV) 53.7 % (42.9, 64.0) and negative predictive value (NPV) 77.0 % (71.8, 81.4). Overall agreement was 71.8 % (67.1, 76.2). PMMR was most sensitive at detecting anatomical abnormalities, including pleural effusions and lung or thoracic hypoplasia, but particularly poor at detecting infection.
Conclusions:
PMMR currently has relatively poor diagnostic detection rates for the commonest intra-thoracic pathologies identified at autopsy in fetuses and children, including respiratory tract infection and diffuse alveolar haemorrhage. The reasonable NPV suggests that normal thoracic appearances at PMMR exclude the majority of important thoracic lesions at autopsy, and so could be useful in the context of minimally invasive autopsy for detecting non-cardiac thoracic abnormalities.
Key Points:
• PMMR has relatively poor diagnostic detection rates for common intrathoracic pathology • The moderate NPV suggests that normal PMMR appearances exclude most important abnormalities • Lung sampling at autopsy remains the "gold standard" for pulmonary pathology.
Insights
Post-mortem MRI (PMMR) shows poor accuracy for detecting non-cardiac thoracic pathology in children, missing common infections. However, a normal PMMR can help exclude significant thoracic abnormalities, aiding minimally invasive autopsy.
Area of Science:
- Pediatric pathology
- Medical imaging
- Forensic medicine
Background:
- Conventional autopsy is the standard for diagnosing pediatric thoracic pathology.
- Post-mortem magnetic resonance imaging (PMMR) is an emerging non-invasive technique.
- Evaluating PMMR's accuracy for non-cardiac thoracic conditions in fetuses and children is crucial.
Purpose of the Study:
- To assess the diagnostic accuracy of PMMR for non-cardiac thoracic pathology in fetuses and children.
- To compare PMMR findings with conventional autopsy results.
- To determine PMMR's utility in minimally invasive autopsy protocols.
Main Methods:
- A prospective study involving 400 fetuses and children.
- PMMR was performed prior to conventional autopsy.
- Autopsy and PMMR reports were generated blinded to each other.
Main Results:
- PMMR demonstrated poor overall sensitivity (39.6%) and specificity (85.5%) for thoracic pathology.
- Detection rates were low for infections like respiratory tract infection.
- PMMR showed higher sensitivity for anatomical abnormalities such as pleural effusions and lung hypoplasia.
Conclusions:
- PMMR has limited diagnostic accuracy for common pediatric intrathoracic pathologies.
- A normal PMMR finding has a reasonable negative predictive value, suggesting the absence of significant lesions.
- PMMR may complement minimally invasive autopsy for non-cardiac thoracic abnormalities, but autopsy remains definitive for pulmonary pathology.
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