Micro-computed tomography: a new diagnostic tool in postmortem assessment of brain anatomy in small fetuses

Lombardi, Sophie; Scola, Elisa; Ippolito, Davide; Zambelli, Vanessa; Botta, Giovanni; Cuttin, Serena; Triulzi, Fabio; Lombardi, Claudio

doi:10.1007/s00234-019-02168-2

Cited by 16 publications

(18 citation statements)

References 24 publications

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“…Micro-CT is a technique that can achieve high resolution of anatomical structures [ 15 – 19 ] and with the addition of a potassium tri-iodide (I 2 KI) contrast agent can provide detailed soft tissue imaging which can identify developmental abnormalities in early pregnancy where conventional autopsy is challenging [ 15 , 16 , 20 – 24 ]. Micro CT has been used to image human fetuses with high diagnostic accuracy [ 20 , 25 ], but the optimal imaging parameters across a range of fetal size, gestation, and maceration and how these relate to image quality have yet to be determined.…”

Section: Introductionmentioning

confidence: 99%

Micro-CT yields high image quality in human fetal post-mortem imaging despite maceration

et al. 2021

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Background Current clinical post-mortem imaging techniques do not provide sufficiently high-resolution imaging for smaller fetuses after pregnancy loss. Post-mortem micro-CT is a non-invasive technique that can deliver high diagnostic accuracy for these smaller fetuses. The purpose of the study is to identify the main predictors of image quality for human fetal post-mortem micro-CT imaging. Methods Human fetuses were imaged using micro-CT following potassium tri-iodide tissue preparation, and axial head and chest views were assessed for image quality on a Likert scale by two blinded radiologists. Simple and multivariable linear regression models were performed with demographic details, iodination, tissue maceration score and imaging parameters as predictor variables. Results 258 fetuses were assessed, with median weight 41.7 g (2.6–350 g) and mean gestational age 16 weeks (11–24 weeks). A high image quality score (> 6.5) was achieved in 95% of micro-CT studies, higher for the head (median = 9) than chest (median = 8.5) imaging. The strongest negative predictors of image quality were increasing maceration and body weight (p < 0.001), with number of projections being the best positive imaging predictor. Conclusions High micro-CT image quality score is achievable following early pregnancy loss despite fetal maceration, particularly in smaller fetuses where conventional autopsy may be particularly challenging. These findings will help establish clinical micro-CT imaging services, addressing the need for less invasive fetal autopsy methods.

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Section: Introductionmentioning

confidence: 99%

Micro-CT yields high image quality in human fetal post-mortem imaging despite maceration

et al. 2021

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“…Currently, there are different non-invasive alternatives to an autopsy that allow the study of the human fetal heart. Contrast-enhanced micro-computed tomography (micro-CT) is one of the alternative methods that has proven to be feasible in the postmortem evaluation of the human fetal heart since the 8° WG, reaching adequate detection rate compared to the gold standard technique [ 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 ]. Besides the clinical domain, it can be used for educational and teaching purposes, having the potential to generate overriding medical and non-medical areas for future scientific and engineering advancements in the field of pediatric cardiology [ 35 , 36 , 37 , 38 , 39 , 40 ].…”

Section: Introductionmentioning

confidence: 99%

“…When compared to other non-invasive postmortem techniques, micro-CT seems to have a better balance between advantages and limitations for studying isolated fetal hearts [ 41 , 42 , 43 , 44 ]. Previously published studies on this technique are heterogeneous in their objectives, studied population, methods and imaging analysis [ 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 ].…”

Section: Introductionmentioning

confidence: 99%

Postmortem Micro-CT of Human Fetal Heart—A Systematic Literature Review

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Lombardi

et al. 2021

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Micro-computed tomography (CT) is a non-invasive alternative to conventional macroscopic dissection for the evaluation of human fetal cardiac anatomy. This paper aims to systematically review the literature regarding the use of micro-CT to examine human fetal hearts, to illustrate its educational and research implications and to explain its possible directions for the future. A systematic literature review was conducted following the PRISMA statement to identify publications concerning micro-CT applications for the isolated human fetal heart. The search strategy identified nine eligible studies. Micro-CT is technically feasible for postmortem examination of the human fetal heart coming from early and late termination of pregnancy. It reaches high diagnostic accuracy, and it seems to perform better than autopsy in small samples or in the case of early termination of pregnancy. Applications derived from micro-CT allow multiple off-time evaluations and interdisciplinary comparisons for educational purposes and research perspectives in biological and bioengineering domains.

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“…While not necessarily preventing an invasive autopsy per se, the analysis of foetal pathological specimens can also be performed using micro‐CT, enabling pathologists to understand the organ they intend to dissect before causing any destruction to the tissue. This has been demonstrated for ex vivo organ in foetuses including the brain, heart and kidneys . This can be useful for identification of lesions not readily seen at microscopy or potentially destroyed during dissection, such as rhabdomyomas in a case of tuberous sclerosis …”

Section: Introductionmentioning

confidence: 99%

Latest developments in post‐mortem foetal imaging

et al. 2019

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A sustained decline in parental consent rates for perinatal autopsies has driven the development of less‐invasive methods for death investigation. A wide variety of imaging modalities have been developed for this purpose and include post‐mortem whole body magnetic resonance imaging (MRI), ultrasound, computed tomography (CT) and micro‐focus CT techniques. These are also vital for “minimally invasive” methods, which include potential for tissue sampling, such as image guidance for targeted biopsies and laparoscopic‐assisted techniques. In this article, we address the range of imaging techniques currently in clinical practice and those under development. Significant advances in high‐field MRI and micro‐focus CT imaging show particular promise for smaller and earlier gestation foetuses. We also review how MRI biomarkers such as diffusion‐weighted imaging and organ volumetric analysis may aid diagnosis and image interpretation in the absence of autopsy data. Three‐dimensional printing and augmented reality may help make imaging findings more accessible to parents, colleagues and trainees.

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Micro-computed tomography: a new diagnostic tool in postmortem assessment of brain anatomy in small fetuses

Cited by 16 publications

References 24 publications

Micro-CT yields high image quality in human fetal post-mortem imaging despite maceration

Micro-CT yields high image quality in human fetal post-mortem imaging despite maceration

Postmortem Micro-CT of Human Fetal Heart—A Systematic Literature Review

Latest developments in post‐mortem foetal imaging

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