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Postmortem microfocus computed tomography for noninvasive autopsies: experience in >250 human fetuses
Susan C Shelmerdine1, Ian C Simcock1, John Ciaran Hutchinson2
1Department of Clinical Radiology, Great Ormond Street Hospital for Children, London, United Kingdom; UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital for Children, London, United Kingdom; National Institute for Health Research Biomedical Research Centre, Great Ormond Street Hospital, London, United Kingdom.
Microfocus computed tomography (CT) offers a noninvasive alternative for fetal imaging, successfully avoiding invasive autopsies in 86.9% of cases. This advanced imaging technique detects a wide range of fetal abnormalities, aiding in diagnosis and reducing the need for traditional autopsy procedures.
Area of Science:
- Medical Imaging
- Radiology
- Fetal Medicine
Background:
- Limited noninvasive imaging alternatives exist for fetuses under 500 grams.
- Microfocus computed tomography (CT) shows promise in small studies for avoiding invasive fetal autopsies.
- Implementation in large clinical cohorts and actual autopsy prevention rates remain largely unreported.
Purpose of the Study:
- To detail abnormalities detectable by fetal microfocus CT in a clinical setting.
- To identify additional findings via microfocus CT not seen on antenatal ultrasound.
- To estimate the invasive autopsy avoidance rate when microfocus CT imaging is sufficient.
Main Methods:
- Prospective observational case series over 3 years (2016-2019).
- Inclusion of all fetuses referred for microfocus CT imaging.
- Radiologist interpretation, pathologist judgment, and parental consent guided autopsy decisions.
- Evaluation of agreement between microfocus CT and antenatal ultrasound, and diagnostic accuracy against autopsy where feasible.
Main Results:
- 268 fetuses included (2-350g, 11-24 weeks gestation); 45.5% had a cause of demise.
- Microfocus CT imaging led to an 86.9% autopsy avoidance rate (192/221 cases).
- High agreement for brain, thoracic, and abdominal pathologies; good sensitivity (66.7%) and specificity (91.7%) for cardiac anomalies.
- Microfocus CT identified additional findings in 10.5% of cases compared to antenatal ultrasound.
Conclusions:
- Fetal microfocus CT is a valuable tool for imaging early-gestation fetuses.
- It effectively confirms antenatal diagnoses and can avoid invasive autopsies.
- The technique is capable of detecting additional anomalies not visible on ultrasound.
