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

Abstract

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.

Comparison of postmortem whole‐body contrast‐enhanced microfocus computed tomography and high‐field magnetic resonance imaging of human fetuses

“…However, in this preclinical experimental setting, the actual sample size was considerably higher, since we compared 112 images and assessed 21 anatomical structures. Also, given the clear significant differences in image quality between the two modalities studied and the fact that HF‐MRI 41 and micro‐CT 42 have the same factors affecting their image quality (i.e. body weight and maceration), scanning more individual fetuses in the same age category would not have a significant impact on the results.…”

Neuropathologic findings in a young woman 4 years following declaration of brain death: case analysis and literature review

“…Consequently, in stillbirth the term “necrotic” is not used for this appearance, acknowledging that the fetus was “viable” before the intrauterine demise (whatever its underlying reason). In this setting, the term “mummification” may be applied, particularly referring to a prolonged period of retention in utero; here, anatomic relationships may be relatively well preserved and even amenable to radiographic delineation of cortical ribbon from deeper tissues ( 34 ). “Mummification” is also used in the forensic setting to describe preservation by desiccation, in bodies in dry environments ( Table 4 ; Fig.…”

Microfocus computed tomography for fetal postmortem imaging: an overview

“…Micro-CT imaging, however, can even be used in embryos (Fig. 1) before 8 weeks of gestation [16] and in macerated fetuses [17]. Although at this early stage of gestation, not much is known about pathophysiology because there is a lack of data on these early stages, micro-CT has been found to be a good, if not better, alternative to autopsy for postmortem imaging of fetuses at early gestation [11][12][13]16].…”