Diagnostic Yield of Post-Mortem Fetal Micro-CT for Central Nervous System Abnormalities

This study demonstrates the central nervous system (CNS) abnormalities detected using fetal post-mortem micro-focus computed tomography (Micro-CT), independent of whether the abnormality contributed to the main diagnosis or cause of death.

We retrospectively analyzed 1200 whole body post-mortem fetal Micro-CT scans in an unselected consecutive cohort between 2017 and 2024. The following categories for CNS abnormalities were used: enlarged cerebral spinal fluid (CSF) spaces, midline abnormalities, neural tube defects, disorders of neuronal proliferation, neuronal migration, and hindbrain development, and other cranial and facial abnormalities.

Overall, 78 individual CNS abnormalities were identified in 62/1200 (5.2%) fetuses. The most common CNS abnormalities were neural tube defects (18/78; 23.1%), ventriculomegaly (16/78; 20.5%), and intracranial hemorrhage (12/78; 15.4%). CNS abnormalities were isolated findings in 27/62 (44%) abnormal cases, and part of a wider spectrum of extra-CNS abnormalities in 35/62 (56%) of cases. The commonest extra-CNS association was musculoskeletal (25/59; 42%). Despite significant maceration causing reduced image quality in 408/1200 (34%) cases, Micro-CT gave diagnostic CNS imaging in all 792/1200 (66%) fetuses with low, mild, or moderate maceration (score below 4).

Post-mortem Micro-CT imaging can identify a wide range of CNS abnormalities following pregnancy loss in early gestation fetuses, even in the presence of maceration.