Less invasive autopsy: an evidenced based approach

Thayyil, Sudhin

doi:10.1136/adc.2009.165704

Cited by 22 publications

(13 citation statements)

References 35 publications

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“…The Chief Medical Officer (UK) recommended rigorous evaluation of post mortem MR imaging as an alternative for autopsy, before it is widely introduced into the UK clinical practice. Following this, the UK Department of Health funded the present study (MaRIAS-Magnetic Resonance Imaging Autopsy Study) for systematic and rigorous evaluation of post mortem MR imaging as an alternative for conventional autopsy with a view to making recommendations to the Department of Health with regard to the advisability of introduction into routine clinical practice, either on its own or along with other minimally invasive post mortem investigations [37]. …”

Section: Discussionmentioning

confidence: 99%

Post mortem magnetic resonance imaging in the fetus, infant and child: A comparative study with conventional autopsy (MaRIAS Protocol)

et al. 2011

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BackgroundMinimally invasive autopsy by post mortem magnetic resonance (MR) imaging has been suggested as an alternative for conventional autopsy in view of the declining consented autopsy rates. However, large prospective studies rigorously evaluating the accuracy of such an approach are lacking. We intend to compare the accuracy of a minimally invasive autopsy approach using post mortem MR imaging with that of conventional autopsy in fetuses, newborns and children for detection of the major pathological abnormalities and/or determination of the cause of death.Methods/DesignWe recruited 400 consecutive fetuses, newborns and children referred for conventional autopsy to one of the two participating hospitals over a three-year period. We acquired whole body post mortem MR imaging using a 1.5 T MR scanner (Avanto, Siemens Medical Solutions, Enlargen, Germany) prior to autopsy. The total scan time varied between 90 to 120 minutes. Each MR image was reported by a team of four specialist radiologists (paediatric neuroradiology, paediatric cardiology, paediatric chest & abdominal imaging and musculoskeletal imaging), blinded to the autopsy data. Conventional autopsy was performed according to the guidelines set down by the Royal College of Pathologists (UK) by experienced paediatric or perinatal pathologists, blinded to the MR data. The MR and autopsy data were recorded using predefined categorical variables by an independent person.DiscussionUsing conventional post mortem as the gold standard comparator, the MR images will be assessed for accuracy of the anatomical morphology, associated lesions, clinical usefulness of information and determination of the cause of death. The sensitivities, specificities and predictive values of post mortem MR alone and MR imaging along with other minimally invasive post mortem investigations will be presented for the final diagnosis, broad diagnostic categories and for specific diagnosis of each system.Clinical Trial RegistrationNCT01417962NIHR Portfolio Number: 6794

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Section: Discussionmentioning

confidence: 99%

Post mortem magnetic resonance imaging in the fetus, infant and child: A comparative study with conventional autopsy (MaRIAS Protocol)

et al. 2011

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“…23,24 In summary, we have demonstrated both significant differences and similarities in autopsy cases of infants examined at one centre over the past 100 years, where the postmortem examination itself, which besides the use of ancillary investigations, remains essentially the same. 25 Recent advances however, include development of the less-invasive autopsy, using MRI, 26,27 the minimally invasive autopsy, using laparoscopy and the molecular autopsy. 28 In another 100 years, we hope that there will not only be changes in mortality patterns but also improvements in the identification of currently 'unknown' causes of death.…”

Section: Discussionmentioning

confidence: 99%

Changing patterns of infant death over the last 100 years: autopsy experience from a specialist children's hospital

Pryce¹,

Weber

Ashworth

et al. 2012

J R Soc Med

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Objectives Infant mortality has undergone a dramatic reduction in the UK over the past century because of improvements in public health policy and medical advances. Postmortem examinations have been performed at Great Ormond Street Hospital for over 100 years, and analysis of cases across this period has been performed to assess changing patterns of infant deaths undergoing autopsy. Design Autopsy reports from 1909 and 2009 were examined. Age, major pathology and cause of death was reviewed from these cases and entered into an anonymized database. A subsequent comparative analysis was performed. Setting All postmortems performed and reported at Great Ormond Street Hospital in 1909 and 2009. Participants Infant deaths, aged 0–365 days, were identified and subsequently analysed for the two years. Main outcome measures Comparative proportional analysis of postmortem findings from the two time periods. Results Three-hundred and fifty-seven and 347 autopsy reports were identified from 1909 and 2009 including 178 and 128 infant deaths, respectively. The commonest cause of death in 1909 was infection (74%) compared to 20% of deaths in 2009. The most frequent final ‘diagnosis’ in 2009 was ‘unexplained sudden unexpected infant death (SUDI)’, despite a full postmortem including ancillary investigations. In contrast, there were no such cases recorded in 1909, but there were frequent deaths due to gastroenteritis and malnutrition together accounting for 16% of cases, compared to one case of gastroenteritis in 2009. Fifteen percent of 1909 cases had infections which are almost never fatal with appropriate treatment in 2009, including tuberculosis, diphtheria and syphilis. Congenital anomalies were detected with similar frequencies at both time points, (21% and 19% in 1909 and 2009, respectively). Conclusion In the UK, significant changes in patterns of pathology have occurred in paediatric autopsy cases performed at a single specialist centre. Fatal infections and malnutrition (both poverty-related) have reduced yet the incidence of congenital anomalies has remained similar.

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“…Ex vivo technologies have the potential to not only support autopsies that otherwise would be performed manually (Thayyil et al , 2013), but investigations that make use of such technologies have the potential to identify abnormal trajectories of brain growth that may be associated with extremely early stage development of neurological disorders, such as autism. However, there are many challenges to overcome when making such pattern recognition technologies widely available and useful, including the need for reliable data analysis techniques that can handle the large-scale deformation differences observed in ex vivo specimens relative to that observed in vivo , contrast differences (Augustinack et al , 2014), challenges associated with ex vivo ventricular bleeds without dilation (Thayyil 2011; Thayyil et al 2013) and more.…”

Section: Future Directionsmentioning

confidence: 99%

Ex vivo fetal brain MRI: Recent advances, challenges, and future directions

et al. 2019

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During early development, the fetal brain undergoes dynamic morphological changes. These changes result from neurogenic events, such as neuronal proliferation, migration, axonal elongation, retraction, and myelination. The duration and intensity of these events vary across species. Comparative assessments of these neurogenic events give us insight into evolutionary changes and the complexity of human brain development. Recent advances in magnetic resonance imaging (MRI), especially ex vivo MRI, permit characterizing and comparing fetal brain development across species. Comparative ex vivo MRI studies support the detection of speciesspecific differences that occur during early brain development. In this review, we provide a comprehensive overview of ex vivo MRI studies that characterize early brain development in humans, monkeys, cats, as well as rats/mice. Finally, we discuss the current advantages and limitations of ex vivo fetal brain MRI.

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Less invasive autopsy: an evidenced based approach

Cited by 22 publications

References 35 publications

Post mortem magnetic resonance imaging in the fetus, infant and child: A comparative study with conventional autopsy (MaRIAS Protocol)

Post mortem magnetic resonance imaging in the fetus, infant and child: A comparative study with conventional autopsy (MaRIAS Protocol)

Changing patterns of infant death over the last 100 years: autopsy experience from a specialist children's hospital

Ex vivo fetal brain MRI: Recent advances, challenges, and future directions

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