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Quantification of maceration changes using post mortem MRI in fetuses
P Montaldo1, S Addison2, V Oliveira2
1Centre for Perinatal Neuroscience, Imperial College London, Du Cane Road, London, W12 0HS, UK. p.montaldo@imperial.ac.uk.
Background:
Post mortem imaging is playing an increasingly important role in perinatal autopsy, and correct interpretation of imaging changes is paramount. This is particularly important following intra-uterine fetal death, where there may be fetal maceration. The aim of this study was to investigate whether any changes seen on a whole body fetal post mortem magnetic resonance imaging (PMMR) correspond to maceration at conventional autopsy.
Methods:
We performed pre-autopsy PMMR in 75 fetuses using a 1.5 Tesla Siemens Avanto MR scanner (Erlangen, Germany). PMMR images were reported blinded to the clinical history and autopsy data using a numerical severity scale (0 = no maceration changes to 2 = severe maceration changes) for 6 different visceral organs (total 12). The degree of maceration at autopsy was categorized according to severity on a numerical scale (1 = no maceration to 4 = severe maceration). We also generated quantitative maps to measure the liver and lung T2.
Results:
The mean PMMR maceration score correlated well with the autopsy maceration score (R(2) = 0.93). A PMMR score of ≥4.5 had a sensitivity of 91%, specificity of 64%, for detecting moderate or severe maceration at autopsy. Liver and lung T2 were increased in fetuses with maceration scores of 3-4 in comparison to those with 1-2 (liver p = 0.03, lung p = 0.02).
Conclusions:
There was a good correlation between PMMR maceration score and the extent of maceration seen at conventional autopsy. This score may be useful in interpretation of fetal PMMR.
Insights
Post mortem magnetic resonance imaging (PMMR) effectively identifies fetal maceration, correlating well with autopsy findings. This imaging technique aids in interpreting post-mortem changes in fetuses.
Area of Science:
- Medical Imaging
- Pathology
- Forensic Medicine
Background:
- Post mortem imaging is crucial for perinatal autopsy interpretation.
- Fetal maceration following intra-uterine fetal death requires accurate assessment.
- This study evaluates post mortem magnetic resonance imaging (PMMR) for detecting maceration.
Purpose of the Study:
- To determine if PMMR findings correlate with fetal maceration observed during conventional autopsy.
- To assess the utility of PMMR in evaluating post-mortem changes in fetuses.
Main Methods:
- Seventy-five fetuses underwent pre-autopsy PMMR using a 1.5 Tesla scanner.
- PMMR images were scored for maceration severity in 6 visceral organs, blinded to autopsy data.
- Quantitative T2 maps of the liver and lungs were generated.
Main Results:
- A strong correlation (R²=0.93) was found between PMMR maceration scores and autopsy scores.
- PMMR demonstrated 91% sensitivity and 64% specificity for moderate/severe maceration.
- Increased liver and lung T2 values were associated with higher maceration scores.
Conclusions:
- PMMR provides a reliable assessment of fetal maceration, correlating well with conventional autopsy findings.
- The PMMR maceration score is a valuable tool for interpreting post-mortem changes in fetuses.
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