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Learning effect on perinatal post-mortem magnetic resonance imaging reporting: single reporter diagnostic accuracy of
Clare Ashwin1, J Ciaran Hutchinson1,2, Xin Kang3
1Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.
Objective:
The objective of the study is to compare diagnostic accuracy of perinatal post-mortem magnetic resonance (PMMR) imaging against conventional autopsy, when reported by a single-blinded observer for all organ systems following a period of initial experience.
Methods:
We compared pre-autopsy PMMR with conventional autopsy for the detection of (1) major pathological abnormalities related to the cause of death and (2) all diagnostic findings in five different body organ systems. PMMR was reported blinded to autopsy findings.
Results:
In 201 cases, 123/146 (84.2%) of major abnormalities were identified by PMMR. Overall diagnostic accuracy of PMMR was 89.6% [95% confidence interval (CI): 84.3, 93.2%] across all cases, with high concordance 91.8% (95% CI: 89.9, 93.4%) across most organ systems. Our study showed higher concordance than single reporter statistics previously reported in neurological [92.2% vs 73.8%; diff 18.4% (95% CI: 11.0, 25.4%) p < 0.01] and thoracic systems [93.7% vs 81.2%; diff 12.5% (95% CI: 6.3, 18.4%) p < 0.01] and slightly better overall [91.8% vs 87.1%; diff 4.7% (95% CI: 2.1, 7.3%) p < 0.01].
Conclusion:
The PMMR examinations can be reliably reported by a single radiologist, following a period of experience and training with this specific modality, with high-diagnostic accuracy for all organ systems. © 2017 John Wiley & Sons, Ltd.
Insights
Perinatal post-mortem MRI (PMMR) demonstrates high diagnostic accuracy for detecting abnormalities across all organ systems, comparable to conventional autopsy. This imaging technique is reliable for single-expert reporting after initial training.
Area of Science:
- Medical Imaging
- Pathology
- Radiology
Background:
- Conventional autopsy is the standard for perinatal death investigation.
- Post-mortem magnetic resonance (PMMR) imaging offers a non-invasive alternative.
- Evaluating PMMR's diagnostic accuracy against autopsy is crucial for its clinical integration.
Purpose of the Study:
- To compare the diagnostic accuracy of perinatal post-mortem magnetic resonance (PMMR) imaging with conventional autopsy.
- To assess PMMR's reliability when interpreted by a single, blinded observer after initial experience.
- To evaluate PMMR's performance across all major organ systems.
Main Methods:
- A comparative study involving 201 cases of perinatal death.
- Pre-autopsy PMMR imaging was performed and interpreted blinded to autopsy findings.
- Conventional autopsy was conducted, and findings were compared for major abnormalities and all diagnostic findings in five organ systems.
Main Results:
- PMMR identified 84.2% of major abnormalities related to the cause of death.
- Overall diagnostic accuracy of PMMR was 89.6%, with high concordance (91.8%) across organ systems.
- PMMR showed significantly higher concordance than previously reported single-reporter statistics in neurological and thoracic systems.
Conclusions:
- Perinatal post-mortem MRI can be reliably reported by a single radiologist with high diagnostic accuracy.
- PMMR demonstrates excellent performance across all organ systems, supporting its role in perinatal death investigation.
- The findings suggest PMMR is a valuable, accurate tool following adequate training and experience.
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