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Post-mortem magnetic resonance imaging with computed tomography-guided biopsy for foetuses and infants: a
Christoph Martin Rüegger1, Dominic Gascho2, Peter Karl Bode3
1Newborn Research, Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland. christoph.rueegger@usz.ch.
Background:
Post-mortem imaging has been suggested as an alternative to conventional autopsy in the prenatal and postnatal periods. Noninvasive autopsies do not provide tissue for histological examination, which may limit their clinical value, especially when infection-related morbidity and mortality are suspected.
Methods:
We performed a prospective, multicentre, cross-sectional study to compare the diagnostic performance of post-mortem magnetic resonance imaging with computed tomography-guided biopsy (Virtopsy®) with that of conventional autopsy in foetuses and infants. Cases referred for conventional autopsy were eligible for enrolment. After post-mortem imaging using a computed tomography scanner and a magnetic resonance imaging unit, computed tomography-guided tissue sampling was performed. Virtopsy results were compared with conventional autopsy in determining the likely final cause of death and major pathologies. The primary outcome was the proportion of cases for which the same cause of death was determined by both methods. Secondary outcomes included the proportion of false positive and false negative major pathological lesions detected by virtopsy and the proportion of computed tomography-guided biopsies that were adequate for histological examination.
Results:
Overall, 101 cases (84 fetuses, 17 infants) were included. Virtopsy and autopsy identified the same cause of death in 91 cases (90.1%, 95% CI 82.7 to 94.5). The sensitivity and specificity of virtopsy for determining the cause of death were 96.6% (95% CI 90.6 to 98.8) and 41.7% (95% CI 19.3 to 68.0), respectively. In 32 cases (31.7%, 95% CI 23.4 to 41.3), major pathological findings remained undetected by virtopsy, and in 45 cases (44.6%, 95% CI 35.2 to 54.3), abnormalities were diagnosed by virtopsy but not confirmed by autopsy. Computed tomography-guided tissue sampling was adequate for pathological comments in 506 of 956 biopsies (52.7%) and added important diagnostic value in five of 30 cases (16.1%) with an unclear cause of death before autopsy compared with postmortem imaging alone. In 19 of 20 infective deaths (95%), biopsies revealed infection-related tissue changes. Infection was confirmed by placental examination in all fetal cases.
Conclusions:
Virtopsy demonstrated a high concordance with conventional autopsy for the detection of cause of death but was less accurate for the evaluation of major pathologies. Computed tomography-guided biopsy had limited additional diagnostic value.
Trial Registration:
ClinicalTrials.gov (NCT01888380).
Insights
Post-mortem imaging (Virtopsy®) accurately determined the cause of death in 90% of fetal and infant cases compared to conventional autopsy. However, it was less accurate for detecting major pathologies and offered limited diagnostic value from guided biopsies.
Area of Science:
- Forensic Pathology
- Medical Imaging
- Pediatric Pathology
Background:
- Post-mortem imaging offers a noninvasive alternative to conventional autopsy for prenatal and postnatal examinations.
- Limitations exist, particularly for infection-related deaths, as noninvasive methods lack tissue for histological analysis.
Purpose of the Study:
- To compare the diagnostic performance of post-mortem MRI and CT-guided biopsy (Virtopsy®) against conventional autopsy in fetuses and infants.
- To evaluate Virtopsy's accuracy in determining the cause of death and identifying major pathologies.
Main Methods:
- A prospective, multicenter, cross-sectional study enrolled 101 fetuses and infants undergoing conventional autopsy.
- Post-mortem MRI and CT imaging were performed, followed by CT-guided tissue sampling.
- Virtopsy results were compared with conventional autopsy findings.
Main Results:
- Virtopsy and autopsy identified the same cause of death in 90.1% of cases.
- Major pathological findings were missed by Virtopsy in 31.7% of cases and falsely diagnosed in 44.6%.
- CT-guided biopsies were adequate for examination in 52.7% of samples and provided additional diagnostic value in 16.1% of cases with initially unclear causes of death.
Conclusions:
- Virtopsy shows high concordance with conventional autopsy for cause of death determination but is less accurate for major pathologies.
- CT-guided biopsy provided limited additional diagnostic value in this study.
- Further research may be needed to enhance the diagnostic capabilities of noninvasive post-mortem imaging techniques.
