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The role of post-mortem MRI in the neonatal intensive care unit
K Z Leadbetter1, Z A Vesoulis2, F V White3
1Department of Pediatrics, Southern Illinois University School of Medicine, Springfield, IL, USAs.
Objective:
Post-mortem examination can provide important information about the cause of death and play a significant role in the bereavement process. Autopsies reveal previous unknown medical problems approximately 20 to 30% of the time. A non-invasive magnetic resonance imaging-based post-mortem examination (PM-MRI) may provide an alternative for families who do not consent to an autopsy.
Study Design:
This study was a prospective observational study of recently expired neonates and infants. Subjects underwent a full body MRI scan (brain, chest, abdomen and pelvis) followed by conventional autopsy if the family desired to have one. MRI results were compared with autopsy findings and the ante-mortem clinical diagnosis. A follow-up survey was conducted to investigate family perceptions of the PM-MRI process.
Results:
Thirty-one infants underwent full PM-MRI. Of 31 infants, 19 (61%) had complete agreement between the clinician's impression and PM-MRI. Twenty-four infants also had conventional autopsy, with 14/24 (58%) infants having PM-MRI results consistent with autopsy findings. PM-MRI was superior at detection of free intraperitoneal/intrathoracic air and hepatic iron overload. Whole-body PM-MRI did not have the resolution to detect focal/microscopic injury, vascular remodeling and some forms of brain injury. Of those families who remembered the PM-MRI findings, the majority felt that the information was useful.
Conclusions:
PM-MRI studies may provide an important adjunct to conventional autopsy and a substitute when the latter is not possible for personal or religious reasons. Clinicians should be aware of, and communicate with the family, the resolution limits of the whole-body PM-MRI to detect certain types of injury.
Insights
Post-mortem magnetic resonance imaging (PM-MRI) offers a non-invasive alternative to conventional autopsy for infants, providing valuable information for families. While PM-MRI shows promise, clinicians must communicate its resolution limitations for detecting certain injuries.
Area of Science:
- Medical Imaging
- Pathology
- Pediatric Medicine
Background:
- Post-mortem examinations are crucial for determining cause of death and aiding the bereavement process.
- Conventional autopsies reveal previously unknown medical conditions in 20-30% of cases.
- Non-invasive post-mortem magnetic resonance imaging (PM-MRI) presents an alternative for families declining traditional autopsy.
Purpose of the Study:
- To evaluate the efficacy of whole-body PM-MRI in neonates and infants.
- To compare PM-MRI findings with conventional autopsy results and ante-mortem diagnoses.
- To assess family perceptions of the PM-MRI process.
Main Methods:
- Prospective observational study involving neonates and infants.
- Full-body PM-MRI scans (brain, chest, abdomen, pelvis) were performed.
- Comparison of MRI findings with conventional autopsy and clinical data; family surveys were conducted.
Main Results:
- 31 infants underwent PM-MRI; 61% showed agreement with clinical impressions.
- 14 out of 24 infants (58%) had PM-MRI findings consistent with autopsy results.
- PM-MRI excelled in detecting free air and hepatic iron overload but had limitations in identifying microscopic injuries and certain brain injuries.
Conclusions:
- PM-MRI can serve as a valuable adjunct or substitute for conventional autopsy, especially for religious or personal objections.
- Clinicians must inform families about the resolution limits of PM-MRI regarding specific injury detection.
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