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Postmortem microfocus computed tomography for early gestation fetuses: a validation study against conventional

John C Hutchinson1, Xin Kang2, Susan Cheng Shelmerdine3

  • 1Department of Histopathology, Great Ormond Street Hospital for Children NHS Trust, London, UK; UCL Great Ormond Street Institute of Child Health.

American Journal of Obstetrics and Gynecology
|February 8, 2018
PubMed
Summary

Microfocus computed tomography (CT) offers a rapid, high-resolution, noninvasive method for fetal autopsy in early gestation. This advanced imaging technique shows high diagnostic accuracy, providing an acceptable alternative to conventional autopsy for parents.

Keywords:
autopsymicrofocus computed tomographypostmortemtermination of pregnancy

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Area of Science:

  • Medical Imaging
  • Radiology
  • Pathology

Background:

  • Conventional perinatal autopsy offers clinical insights but is invasive and not always accepted or available for early fetal loss.
  • Current imaging techniques lack sufficient resolution for small fetuses.
  • Microfocus computed tomography (CT) is a rapid, high-resolution imaging method with potential for noninvasive fetal examination.

Purpose of the Study:

  • To evaluate the diagnostic accuracy of microfocus CT for noninvasive postmortem examination of early gestation fetuses.
  • To compare microfocus CT findings with conventional autopsy results as the reference standard.

Main Methods:

  • A comparative study involving 20 fetuses (11-21 weeks gestation) using iodinated whole-body microfocus CT and conventional autopsy.
  • Double-blinded evaluation of imaging indices by pediatric radiologists, comparing diagnoses and organ-specific findings.
  • Fetuses were prepared with formalin and potassium tri-iodide for imaging.

Main Results:

  • Microfocus CT provided high-resolution (27 microm) noninvasive autopsy in minutes with high diagnostic accuracy for fetuses under 22 weeks gestation.
  • Agreement between microfocus CT and conventional autopsy was 93.8% for overall diagnoses and 97.5% for individual organ indices.
  • Microfocus CT identified 12 of 13 structural abnormalities (92.3%) and yielded fewer nondiagnostic indices in first-trimester losses.

Conclusions:

  • Postmortem whole-body fetal microfocus CT is a rapid, high-resolution, noninvasive technique for detailed fetal anatomic examination.
  • Microfocus CT may be a preferable alternative to MRI for early gestation fetuses and an acceptable option for parents declining invasive autopsy.
  • This method can facilitate postmortem examination and subsequent parental counseling.