Postmortem Cardiovascular Magnetic Resonance Imaging in Fetuses and Children

Abstract

Despite this, there has been a global reduction in fetal and pediatric autopsies in the last decade. Current fetal autopsy rates are <50%, and neonatal autopsy rates are <20% in the Background-Perinatal and pediatric autopsies have declined worldwide in the past decade. We compared the diagnostic accuracy of postmortem, cardiovascular magnetic resonance (CMR) imaging with conventional autopsy and histopathology assessment in fetuses and children. Methods and Results-We performed postmortem magnetic resonance imaging in 400 fetuses and children, using a 1.5-T Siemens Avanto magnetic resonance scanner before conventional autopsy. A pediatric CMR imager reported the CMR images, masked to autopsy information. The pathologists were masked to the information from CMR images. The institutional research ethics committee approved the study, and parental consent was obtained. Assuming a diagnostic accuracy of 50%, 400 cases were required for a 5% precision of estimate. Three cases were excluded from analysis, 2 with no conventional autopsy performed and 1 with insufficient CMR sequences performed. Thirty-eight CMR data sets were nondiagnostic (37 in fetuses ≤24 weeks; 1 in a fetus >24 weeks

Comparison of conventional autopsy and magnetic resonance imaging in determining the cause of sudden death in the young

“…There are relatively few published studies examining the role of post-mortem imaging in children and adults compared with conventional autopsy [13,15,17-22]. In a systematic review performed by Thayyil et al , 35 children and adults had been studied in this way between 1990 and 2009, where the sensitivity was 28% and the specificity was 64% for these studies [22].…”

“…Interestingly, common causes of sudden death cases specifically were frequently missed on CT and MR imaging in the study, however the overall impression was that CT and MR imaging may be useful in some circumstances compared with the traditional autopsy [18]. Most recently, a series of 400 post-mortem cases in fetuses and children was reported, which showed high sensitivity, specificity, positive and negative predictive values in identifying structural cardiac pathology post-mortem with cardiac MR imaging [17]. While the cohort differs from our study as they only included fetuses and children ≤16 years, with nearly three quarters of their cohort being stillborn fetuses, the study supports the utility of post-mortem MR imaging as an alternative to conventional autopsy.…”

“…Using post-mortem imaging as an alternative “minimally invasive” autopsy has been proposed [12]. The majority of studies to date examining the accuracy of post-mortem magnetic resonance (MR) imaging examination have focused on fetal and neonatal deaths [13-17]. A single study comparing post-mortem CT and MR imaging in assessing cause of death in adults suggested CT may be more accurate in this setting [18].…”

Update: Causes and symptoms of sudden cardiac death in young athletes

“…A recent study using magnetic resonance imaging (MRI) supports a way to get more information in a more humanistic way. Taylor at al compared the diagnostic accuracy of postmortem MRI to conventional autopsy and histopathology assessment in 400 fetuses and children [29]. Three cases were excluded from analysis, 2 with no conventional autopsy performed and 1 with inadequate MRI images.…”

Neonatal Autopsy: A 21st Century Approach?

“…Some of their examples listed as “unlikely detectable” were atrial septal defect (ASD), pneumonia, and hypoplasia of the ductus venosus. Data published in 2015 demonstrate that ASDs are commonly diagnosed [9, 10], but we agree that sepsis is challenging [11], although certain infections (e.g., CMV) may have maternal or placental sequelae that do not require invasive autopsy.…”