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Updated: Jul 20, 2025
Murine Fetal Echocardiography
Published on: February 15, 2013
Combined prenatal US and post-mortem fetal MRI: can they replace conventional autopsy for fetal body abnormalities?
Marine Moeremans1, Fred E Avni2, Nicky d'Haene3
1Department of Radiology, Hôpital Delta (CHIREC), 1160, Brussels, Belgium. marine.moeremans@hotmail.com.
Objectives:
The acceptance of conventional autopsy (CA), the gold standard method for investigating fetal death, often remains problematic. Post-mortem magnetic resonance imaging (PMMRI) is increasingly advocated, particularly for neurologic malformations. However, PMMRI performances to diagnose non-neurologic malformations remain unclear. We aim to clarify whether a full body CA remains needed after prenatal ultrasound (US) and PMMRI in assessing non-neurologic fetal malformations.
Methods:
In this retrospective IRB-approved study, during a 6-year period, all fetuses who underwent PMMRI, prenatal US, and full body CA were included. Body abnormalities were identified in US, PMMRI, and CA reports. US and PMMRI images were all reviewed. All abnormalities were graded as major (2 points) or minor (1 point). Each technique (US, PMMRI, CA) was given a score by adding all grading points. In each fetus, results were compared for both separate and combined US and PMMRI to CA. Sensitivity and specificity were calculated for detecting major abnormalities.
Results:
Fifty fetuses were included. The score of CA, US, and PMMRI was respectively 53, 37, and 46. Compared with US-PMMRI, CA added information in 2 cases (4%) with major abnormalities and 7 cases (14%) with minor abnormalities. PMMRI and US were concordant in 36/50 (72%) fetuses. Separate US/PMMRI sensitivities and specificities for detecting major body malformations respectively were 80%/80% and 100%/94%. Combined US-PMMRI had a sensitivity of 90% and a specificity of 94%. Two cardiac malformations (2/6) were only described by CA.
Conclusions:
After prenatal US and PMMRI, few additional fetal body malformations are discovered with CA. Nevertheless, fetal heart autopsy remains mandatory.
Clinical Relevance Statement:
A cardiac conventional autopsy complemented by prenatal ultrasound and post-mortem MRI allows to detect all major fetal body abnormalities. With this efficient and much less invasive approach, a higher acceptance rate of fetal autopsy can be expected.
Key Points:
• Excepting cardiac malformations, most major fetal body malformations can reliably be identified by prenatal US combined with post-mortem MRI. • In the post-mortem diagnosis of fetal body malformations, a conventional autopsy limited to the fetal heart might replace a full body autopsy after a well-conducted prenatal US and post-mortem MRI.
Insights
Conventional autopsy (CA) for fetal death is often problematic. Post-mortem MRI (PMMRI) and ultrasound (US) can identify most fetal malformations, but cardiac autopsy remains essential for complete diagnosis.
Area of Science:
- Medical imaging
- Fetal pathology
- Diagnostic techniques
Background:
- Conventional autopsy (CA) is the standard for investigating fetal death but faces acceptance issues.
- Post-mortem magnetic resonance imaging (PMMRI) is increasingly used, especially for neurologic malformations.
- The diagnostic performance of PMMRI for non-neurologic malformations requires further clarification.
Purpose of the Study:
- To determine if a full body CA is necessary after prenatal ultrasound (US) and PMMRI for non-neurologic fetal malformations.
- To evaluate the combined diagnostic utility of US and PMMRI in detecting fetal malformations.
Main Methods:
- Retrospective study of 50 fetuses undergoing PMMRI, prenatal US, and full body CA over 6 years.
- Abnormalities were graded (major/minor), and scores assigned to US, PMMRI, and CA.
- Sensitivity and specificity were calculated for detecting major abnormalities, comparing combined US-PMMRI with CA.
Main Results:
- CA provided additional information in only 4% of major and 14% of minor abnormalities compared to combined US-PMMRI.
- Combined US-PMMRI sensitivity was 90% and specificity 94% for major malformations.
- Two cardiac malformations were identified solely by CA, highlighting its importance for specific conditions.
Conclusions:
- Prenatal US and PMMRI detect most fetal body malformations, reducing the need for full body CA.
- A conventional autopsy limited to the fetal heart, alongside US and PMMRI, is sufficient for comprehensive diagnosis.
- This less invasive approach may improve acceptance rates for fetal post-mortem examinations.
