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Diagnostic accuracy of post mortem MRI for abdominal abnormalities in foetuses and children
Owen J Arthurs1, Sudhin Thayyil2, Catherine M Owens3
1Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK; Institute of Child Health, UCL, London, UK.
Background:
To compare the diagnostic accuracy of post-mortem magnetic resonance imaging (PMMR) specifically for abdominal pathology in foetuses and children, compared to conventional autopsy.
Methods:
Institutional ethics approval and parental consent was obtained. 400 unselected foetuses and children underwent PMMR using a 1.5T Siemens Avanto MR scanner before conventional autopsy. PMMR images and autopsy findings were reported blinded to the other data respectively.
Results:
Abdominal abnormalities were found in 70/400 (12%) autopsies. Overall sensitivity and specificity (95% confidence interval) of PMMR for abdominal pathology was 72.5% (61.0, 81.6) and 90.8% (87.0, 93.6), with positive (PPV) and negative predictive values (NPV) of 64.1% (53.0, 73.9) and 93.6% (90.2, 95.8) respectively. PMMR was good at detecting renal abnormalities (sensitivity 80%), particularly in foetuses, and relatively poor at detecting intestinal abnormalities (sensitivity 50%). Overall accuracy was 87.4% (83.6, 90.4).
Conclusions:
PMMR has high overall accuracy for abdominal pathology in foetuses, newborns and children. PMMR is particularly good at detecting renal abnormalities, and relatively poor at detecting intestinal abnormalities. In clinical practice, PMMR may be a useful alternative or adjunct to conventional autopsy in foetuses and children for detecting abdominal abnormalities.
Insights
Post-mortem MRI (PMMR) shows high accuracy for diagnosing fetal and pediatric abdominal pathology. This imaging technique is effective for detecting renal abnormalities but less so for intestinal issues, offering a potential alternative to conventional autopsy.
Area of Science:
- Medical Imaging
- Pediatric Pathology
- Forensic Medicine
Background:
- Conventional autopsy is the standard for diagnosing abdominal pathology in fetuses and children.
- Diagnostic accuracy of post-mortem magnetic resonance imaging (PMMR) for abdominal conditions in this population is not fully established.
Purpose of the Study:
- To compare the diagnostic accuracy of PMMR against conventional autopsy for abdominal pathology in fetuses and children.
- To evaluate PMMR's effectiveness in detecting specific abdominal abnormalities.
Main Methods:
- 400 fetuses and children underwent PMMR prior to conventional autopsy.
- PMMR images and autopsy findings were analyzed separately by blinded reviewers.
- A 1.5T Siemens Avanto MR scanner was utilized.
Main Results:
- PMMR demonstrated an overall accuracy of 87.4% for abdominal pathology.
- Sensitivity and specificity for PMMR were 72.5% and 90.8%, respectively.
- PMMR excelled in detecting renal abnormalities (80% sensitivity) but was less effective for intestinal issues (50% sensitivity).
Conclusions:
- PMMR offers high diagnostic accuracy for abdominal pathology in pediatric cases.
- PMMR is a valuable tool for identifying renal abnormalities and may serve as an alternative or adjunct to conventional autopsy.
- Further evaluation is needed for PMMR's utility in diagnosing intestinal pathologies.
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