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Early Pathological and Magnetic Resonance Detection of Cerebral Injury Using a Rat Model of Neonatal Hypoxic Ischemic Encephalopathy
Published on: October 28, 2022
Diagnostic accuracy and limitations of post-mortem MRI for neurological abnormalities in fetuses and children
O J Arthurs1, S Thayyil2, S S Pauliah2
1Paediatric Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK; UCL Institute of Child Health, London, UK.
Aim:
To compare the diagnostic accuracy of non-invasive cerebral post-mortem magnetic resonance imaging (PMMRI) specifically for cerebral and neurological abnormalities in a series of fetuses and children, compared to conventional autopsy.
Materials And Methods:
Institutional ethics approval and parental consent was obtained. Pre-autopsy cerebral PMMRI was performed in a sequential prospective cohort (n = 400) of fetuses (n = 277; 185 ≤ 24 weeks and 92 > 24 weeks gestation) and children <16 years (n = 123) of age. PMMRI and conventional autopsy findings were reported blinded and independently of each other.
Results:
Cerebral PMMRI had sensitivities and specificities (95% confidence interval) of 88.4% (75.5 to 94.9), and 95.2% (92.1 to 97.1), respectively, for cerebral malformations; 100% (83.9 to 100), and 99.1% (97.2 to 99.7) for major intracranial bleeds; and 87.5% (80.1 to 92.4) and 74.1% (68 to 79.4) for overall brain pathology. Formal neuropathological examination was non-diagnostic due to maceration/autolysis in 43/277 (16%) fetuses; of these, cerebral PMMRI imaging provided clinically important information in 23 (53%). The sensitivity of PMMRI for detecting significant ante-mortem ischaemic injury was only 68% (48.4 to 82.8) overall.
Conclusions:
PMMRI is an accurate investigational technique for identifying significant neuropathology in fetuses and children, and may provide important information even in cases where autolysis prevents formal neuropathological examination; however, PMMRI is less sensitive at detecting hypoxic-ischaemic brain injury, and may not detect rarer disorders not encountered in this study.
Insights
Post-mortem MRI accurately detects fetal and childhood brain abnormalities, even when autolysis hinders traditional autopsy. However, it shows lower sensitivity for hypoxic-ischemic brain injury.
Area of Science:
- Neuropathology
- Medical Imaging
- Pediatric Pathology
Background:
- Conventional autopsy is the standard for diagnosing fetal and childhood neuropathology.
- Autolysis and maceration can compromise the diagnostic quality of post-mortem examinations.
- Non-invasive imaging techniques offer potential advantages in evaluating post-mortem neuropathology.
Purpose of the Study:
- To evaluate the diagnostic accuracy of non-invasive cerebral post-mortem magnetic resonance imaging (PMMRI).
- To compare PMMRI findings with conventional autopsy in fetuses and children.
- To assess PMMRI's utility in cases with autolytic changes.
Main Methods:
- A prospective cohort of 400 fetuses and children (<16 years) underwent pre-autopsy cerebral PMMRI.
- PMMRI and conventional autopsy findings were assessed independently and blinded.
- The study included fetuses at different gestational ages (≤24 weeks and >24 weeks).
Main Results:
- Cerebral PMMRI demonstrated high sensitivity and specificity for cerebral malformations and major intracranial bleeds.
- Overall brain pathology detection by PMMRI was 87.5% sensitive and 74.1% specific.
- In 16% of fetuses with non-diagnostic autolysis, PMMRI provided crucial information in 53% of cases.
Conclusions:
- Cerebral PMMRI is a valuable tool for diagnosing neuropathology in fetuses and children.
- PMMRI can yield important findings when conventional autopsy is compromised by autolysis.
- PMMRI's sensitivity is limited for detecting hypoxic-ischemic brain injury and rare disorders.
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