The use of whole body diffusion-weighted post-mortem magnetic resonance imaging in timing of perinatal deaths

Shelmerdine, Susan C.; Main, Cheryl; Hutchinson, J. Ciaran; Langan, Dean; Sebire, Neil J.; Arthurs, Owen J.

doi:10.1007/s00414-018-1906-5

Cited by 12 publications

(10 citation statements)

References 16 publications

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“…The same study, however, found no similar relationship between perinatal deaths and stillbirths for unknown reasons [ 20 ]. Diffusion-weighted magnetic resonance imaging (DWI) with better models can also be useful in determining apparent brain diffusion coefficient (ADC) and degree of maceration during the gestation and post-mortem interval [ 21 , 22 ]. While PMMRI continues to be on the frontlines for increasing diagnostic capabilities, creating a cost-effective way to construct this apparatus so patients can have more accessible diagnostic tools in medical facilities throughout the nation could be pivotal.…”

Section: Reviewmentioning

confidence: 99%

The Practicality of Post-mortem Imaging in Prenatal, Perinatal, and Pediatric Cases

Ashby¹,

Razzak²,

Kogler³

et al. 2022

Cureus

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The essential role of the autopsy is seen in its contributions to medical care, scientific research, and family counseling. Major contributions are also noted in forensic pathology as a means to determine cause-ofdeath for legal and medical experts. However, autopsy acceptance rates are quite low due to an array of reasons including delayed burials, faith, and moral burdening. Thus, non-invasive post-mortem imaging strategies are becoming increasingly popular. The objective of this literature review is to evaluate the strengths and weaknesses of numerous post-mortem imaging modalities and consider their benefits over the traditional autopsy. The need for expertise in image interpretation for pediatric and perinatal cases is also discussed. A variety of publications, totaling 32 pieces, were selected from available literature on the basis of relevance. These articles studied various perinatal and pediatric post-mortem imaging strategies and their applications in clinical practice. Key strategies include post-mortem MRI, post-mortem CT, fetal postmortem sonography, post-mortem computed tomographic angiography, and three-dimensional surface scanning. There is a general consensus that no standard model for post-mortem imaging currently exists in the United States and European countries. Amongst the imaging modems studied, post-mortem MRI has been acknowledged to show the greatest promise in diagnostic accuracy for fetal age groups. Most studies demonstrated that post-mortem CT had limited use for autopsy. Post-mortem imaging strategies for autopsy have high potential given their minimal invasiveness and increasing popularity. Furthermore, it is vital to crafting a global standard procedure for post-mortem imaging for prenatal, perinatal, and pediatric cases to better understand the cause of death, decomposition factors, and effects in-utero, and to provide an alternative to traditional autopsy.

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Section: Reviewmentioning

confidence: 99%

The Practicality of Post-mortem Imaging in Prenatal, Perinatal, and Pediatric Cases

Ashby¹,

Razzak²,

Kogler³

et al. 2022

Cureus

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“…As part of the internal validity of this study, we obtained excellent concordance between the FLV/weight estimated by MRI and the liver weight at post-mortem assessment. Liver weight is directly affected by the maceration status of the fetus ( 32 , 33 ), being more affected in type-III maceration. However, 82% of the TOP-fetuses in our series had type-I maceration.…”

Section: Discussionmentioning

confidence: 99%

Fetal Liver Volume Assessment Using Magnetic Resonance Imaging in Fetuses With Cytomegalovirus Infection†

et al. 2022

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ObjectiveTo assess fetal liver volume (FLV) by magnetic resonance imaging (MRI) in cytomegalovirus (CMV)-infected fetuses compared to a group of healthy fetuses.MethodMost infected cases were diagnosed by the evidence of ultrasound abnormalities during routine scans and in some after maternal CMV screening. CMV-infected fetuses were considered severely or mildly affected according to prenatal brain lesions identified by ultrasound (US)/MRI. We assessed FLV, the FLV to abdominal circumference (AC) ratio (FLV/AC-ratio), and the FLV to fetal body volume (FBV) ratio (FLV/FBV-ratio). As controls, we included 33 healthy fetuses. Hepatomegaly was evaluated post-mortem in 11 cases of congenital CMV infection. Parametric trend and intraclass correlation analyses were performed.ResultsThere were no significant differences in FLV between infected (n = 32) and healthy fetuses. On correcting the FLV for AC and FBV, we observed a significantly higher FLV in CMV-infected fetuses. There were no significant differences in the FLV, or the FLV/AC or FLV/FBV-ratios according to the severity of brain abnormalities. There was excellent concordance between the fetal liver weight estimated by MRI and liver weight obtained post-mortem. Hepatomegaly was not detected in any CMV-infected fetus.ConclusionIn CMV-infected fetuses, FLV corrected for AC and FBV was higher compared to healthy controls, indicating relative hepatomegaly. These parameters could potentially be used as surrogate markers of liver enlargement.

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“…В основе повышения значений коэффициента диффузии в легких лежат, по мнению авторов [38], посмертные изменения в виде экстравазации жидкой части крови в окружающие ткани. Следует также отметить, что в результате многофакторного регрессионного анализа значений измеряемого коэффициента диффузии в ткани миокарда, селезенки, коркового слоя почек, печени и поясничной мышцы при посмертной диффузионно-взвешенной МРТ установлено наличие значимых его взаимосвязей с выраженностью процессов мацерации [39]. Однако для оценки выраженности мацерации авторами использовалась оригинальная ее градация: отсутствие (0 баллов), умеренная (1) и выраженная (2), позволяющая судить только о степени ее выраженности, но не конкретном времени наступления гибели плода.…”

Section: посмертная мрт оценка давности внутриутробной гибели плодаunclassified

Postmortem Mri Evaluation of the Time of Intrauterine Fetal Death

Туманова¹,

Perinatology²,

Bychenko³

et al. 2020

Rejr

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stablishing the time of intrauterine fetal death is important for determining the cause of its death. At autopsy, the time of death is determined by evaluating the severity of maceration processes of the external integument, internal organs and placenta. This study involves dissection of the body and organs, as well as the time spent on preparation of micropreparations.Purpose. To study changes in organs and tissues of a deceased fetus depending on the time of its intrauterine death when using post-mortem MRI.Material and methods. The work had been base on a comprehensive post-mortem radiation and autopsy studies of the bodies of 38 stillborn babies who were born at gestational periods of 22-40 weeks. Depending on the time of fetal death, all observations were divided into 8 groups. Postmortem MRI study was performed in standard T1 and T2 modes on the 3T Siemens Magnetom Verio device (Germany) before autopsy. On T1-and T2weighted images (WI) in the sagittal projection, we determined the MR signal intensity of the liver, kidney, brain, femoral muscle, lung, skin in the hip area, anterior abdominal wall and fronto-parietal area of the head, as well as fluid in the pleural cavity and air near the anterior abdominal wall. Based on the obtained values, we calculated the MRI maceration index (MI) according to the formula: MI = (T2t / T1t) x (T1f / T2f) x (T1a / T2a), where T1t and T2t are the signal intensities of the studied tissue (t), T1f and T2f are the values of the signal intensity of the fluid (f) in the pleural cavity, T1a and T2a are the values of the intensity of the air signal (a) on T1-and T2-WI, respectively. The determination of the time of intrauterine death was carried out on the basis of the medical history of the pregnant woman, the history of childbirth, as well as the results of the pathological study.Results. In observations with antenatal fetal death, the calculated MRI of the maceration index depended on the studied region (organ, tissue) of the fetus and the length of time that passed from the moment of death to childbirth. All MI of the internal organs and skin of the fronto-parietal region of the head had significant direct relationships with the statute of limitations of fetal death. Based on mathematical analysis, we derived the formula for determining the time of intrauterine death of the fetus, which expresses the result as the hours the fetus was found in utero after death (time of intrauterine death): t = 16.87 + 95.38x MIk ² -75.32x MIk, where MIk -an indicator of maceration of kidney tissue.Conclusion. The use of postmortem MRI allows making an objective quantitative assessment of the time of intrauterine death of the fetus, which contributes to the effective establishment of the links of the stillbirth. The advantages of post-mortem MRI over autopsy include the non-invasive nature of the study, the possibility of archiving and subsequent multiple analysis of tomograms, as well as the speed of MRI analysis compared with the time necessary for an autopsy and preparation of histological ...

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The use of whole body diffusion-weighted post-mortem magnetic resonance imaging in timing of perinatal deaths

Cited by 12 publications

References 16 publications

The Practicality of Post-mortem Imaging in Prenatal, Perinatal, and Pediatric Cases

The Practicality of Post-mortem Imaging in Prenatal, Perinatal, and Pediatric Cases

Fetal Liver Volume Assessment Using Magnetic Resonance Imaging in Fetuses With Cytomegalovirus Infection†

Postmortem Mri Evaluation of the Time of Intrauterine Fetal Death

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