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Postmortem fetal MR imaging: comparison with findings at autopsy
P J Woodward1, R Sohaey, D P Harris
1Department of Radiology, University of Utah, Salt Lake City 84132, USA.
Objective:
The purpose of this study was to prospectively compare findings from postmortem fetal MR imaging with findings at autopsy.
Subjects And Methods:
Twenty-six fetuses were imaged on a 1.5-T MR scanner using two-dimensional and high-resolution three-dimensional fast spin-echo techniques immediately before autopsy. The MR images were reviewed independently by three radiologists who evaluated then for major and minor malformations. These findings were then compared with those at autopsy.
Results:
The 26 subjects had 47 major and 11 minor malformations. All three radiologists correctly identified 37 of the major malformations on the MR images (detection rate, 79%), and at least one of the three reviewers correctly identified 43 of the abnormalities (detection rate, 91%). Only one of the 11 minor anomalies was identified by any reviewer. Reviewers made six false-positive diagnoses. In two cases, both with major CNS malformations, MR imaging was superior to autopsy in defining in situ relationships.
Conclusion:
Although autopsy remains the study of choice for evaluating causes of fetal death, MR imaging is an excellent alternative when autopsy is refused. Additionally, MR imaging may be a valuable adjunct to autopsy for fetuses with CNS anomalies.
Insights
Postmortem fetal MR imaging accurately detects major fetal malformations, offering a valuable alternative to autopsy when it is refused. This imaging technique can also complement autopsy for central nervous system anomalies.
Area of Science:
- Medical Imaging
- Radiology
- Fetal Medicine
Background:
- Autopsy is the traditional method for evaluating fetal deaths.
- Limitations exist in autopsy, particularly for subtle anomalies or when consent is withheld.
Purpose of the Study:
- To prospectively compare postmortem fetal magnetic resonance (MR) imaging findings with autopsy results.
- To assess the diagnostic accuracy of fetal MR imaging for detecting malformations.
Main Methods:
- Twenty-six fetuses underwent 1.5-T MR imaging using 2D and 3D fast spin-echo techniques before autopsy.
- Three radiologists independently reviewed MR images for major and minor malformations.
- MR findings were compared with subsequent autopsy diagnoses.
Main Results:
- A total of 47 major and 11 minor malformations were identified.
- Radiologists detected 79% of major malformations on MR images (37/47) and 91% (43/47) with at least one reviewer.
- Minor anomalies had low detection rates; six false-positive diagnoses were made.
- MR imaging demonstrated superiority over autopsy in defining in situ relationships for two central nervous system (CNS) malformations.
Conclusions:
- Postmortem fetal MR imaging is an excellent alternative when autopsy is refused.
- MR imaging can be a valuable adjunct to autopsy, especially for evaluating CNS anomalies.
- Autopsy remains the gold standard for determining the cause of fetal death.