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Fetal brain maceration score on postmortem magnetic resonance imaging vs. conventional autopsy
Nico Hustings1, Yannick Thonissen2, Lesley Cockmartin3
1University Hospital of Leuven, Herestraat 49, 3000, Leuven, Belgium. nico.hustings@uzleuven.be.
Background:
Postmortem fetal magnetic resonance imaging (MRI) has been on the rise since it was proven to be a good alternative to conventional autopsy. Since the fetal brain is sensitive to postmortem changes, extensive tissue fixation is required for macroscopic and microscopic assessment. Estimation of brain maceration on MRI, before autopsy, may optimize histopathological resources.
Objective:
The aim of the study is to develop an MRI-based postmortem fetal brain maceration score and to correlate it with brain maceration as assessed by autopsy.
Materials And Methods:
This retrospective single-center study includes 79 fetuses who had postmortem MRI followed by autopsy. Maceration was scored on MRI on a numerical severity scale, based on our brain-specific maceration score and the whole-body score of Montaldo. Additionally, maceration was scored on histopathology with a semiquantitative severity scale. Both the brain-specific and the whole-body maceration imaging scores were correlated with the histopathological maceration score. Intra- and interobserver agreements were tested for the brain-specific maceration score.
Results:
The proposed brain-specific maceration score correlates well with fetal brain maceration assessed by autopsy (τ = 0.690), compared to a poorer correlation of the whole-body method (τ = 0.452). The intra- and interobserver agreement was excellent (correlation coefficients of 0.943 and 0.864, respectively).
Conclusion:
We present a brain-specific postmortem MRI maceration score that correlates well with the degree of fetal brain maceration seen at histopathological exam. The score is reliably reproduced by different observers with different experience.
Insights
A new brain-specific score using postmortem MRI accurately assesses fetal brain maceration compared to autopsy. This method improves reliability and optimizes histopathological resource allocation.
Area of Science:
- Medical Imaging
- Pathology
- Forensic Science
Background:
- Postmortem fetal magnetic resonance imaging (MRI) is an emerging alternative to conventional autopsy.
- Fetal brains require fixation for assessment due to postmortem sensitivity.
- Assessing brain maceration via MRI before autopsy can optimize histopathology resources.
Purpose of the Study:
- Develop an MRI-based scoring system for postmortem fetal brain maceration.
- Correlate the developed MRI score with autopsy-based maceration assessment.
Main Methods:
- Retrospective analysis of 79 fetuses undergoing postmortem MRI and autopsy.
- Scoring maceration using a novel brain-specific MRI scale and a whole-body scale.
- Histopathological assessment of maceration using a semiquantitative scale.
- Correlation analysis between imaging scores and histopathology, including intra- and interobserver reliability testing.
Main Results:
- The brain-specific MRI maceration score showed good correlation with autopsy findings (τ = 0.690).
- The whole-body MRI score had a poorer correlation (τ = 0.452).
- Excellent intra- and interobserver agreement was achieved for the brain-specific score (correlation coefficients 0.943 and 0.864).
Conclusions:
- A brain-specific postmortem MRI maceration score effectively correlates with histopathological findings.
- The developed score is reproducible and reliable across different observers.
