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Fetal brain maceration score on postmortem magnetic resonance imaging vs. conventional autopsy

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Abstract

Background

Postmortem fetal magnetic resonance imaging (MRI) has been on the rise since it was proven to be a good alternative to conventional autopsy. Since the fetal brain is sensitive to postmortem changes, extensive tissue fixation is required for macroscopic and microscopic assessment. Estimation of brain maceration on MRI, before autopsy, may optimize histopathological resources.

Objective

The aim of the study is to develop an MRI-based postmortem fetal brain maceration score and to correlate it with brain maceration as assessed by autopsy.

Materials and methods

This retrospective single-center study includes 79 fetuses who had postmortem MRI followed by autopsy. Maceration was scored on MRI on a numerical severity scale, based on our brain-specific maceration score and the whole-body score of Montaldo. Additionally, maceration was scored on histopathology with a semiquantitative severity scale. Both the brain-specific and the whole-body maceration imaging scores were correlated with the histopathological maceration score. Intra- and interobserver agreements were tested for the brain-specific maceration score.

Results

The proposed brain-specific maceration score correlates well with fetal brain maceration assessed by autopsy (τ = 0.690), compared to a poorer correlation of the whole-body method (τ = 0.452). The intra- and interobserver agreement was excellent (correlation coefficients of 0.943 and 0.864, respectively).

Conclusion

We present a brain-specific postmortem MRI maceration score that correlates well with the degree of fetal brain maceration seen at histopathological exam. The score is reliably reproduced by different observers with different experience.

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Authors and Affiliations

  1. University Hospital of Leuven, Herestraat 49, 3000, Leuven, Belgium

    Nico Hustings

  2. Department of Radiology, Heilig-Hart Hospital of Mol, Leuven, Belgium

    Yannick Thonissen

  3. Department of Radiology, University Hospitals Leuven, Leuven, Belgium

    Lesley Cockmartin & Michael Aertsen

  4. Department of Biomedical Sciences, KU Leuven, Leuven, Belgium

    Koen Vanderseypen

  5. Department of Pathology, University Hospital of Leuven, Leuven, Belgium

    Marcella Baldewijns & Dietmar Rudolf Thal

  6. Department of Gynecology, University Hospital of Leuven, Leuven, Belgium

    Luc De Catte

  7. Leuven Brain Institute, KU-Leuven, Leuven, Belgium

    Dietmar Rudolf Thal

Authors
  1. Nico Hustings
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  2. Yannick Thonissen
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  3. Lesley Cockmartin
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  4. Koen Vanderseypen
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  5. Marcella Baldewijns
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  6. Luc De Catte
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  7. Dietmar Rudolf Thal
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  8. Michael Aertsen
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Corresponding author

Correspondence to Nico Hustings.

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Conflicts of interest

Author D.R.T. received speaker honorarium from Novartis Pharma Basel (Switzerland) and Biogen (USA), travel reimbursement from GE Healthcare (UK), and UCB (Belgium), and collaborated with GE Healthcare (UK), Novartis Pharma Basel (Switzerland), Probiodrug (Germany), and Janssen Pharmaceutical Companies (Belgium). Author D.R.T. also receives funding from FWO (G0F8516N, G065721N) and SAO/FRA (2020/017). The other authors declare no conflicts of interest.

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Hustings, N., Thonissen, Y., Cockmartin, L. et al. Fetal brain maceration score on postmortem magnetic resonance imaging vs. conventional autopsy. Pediatr Radiol 53, 929–941 (2023). https://doi.org/10.1007/s00247-022-05559-5

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  • DOI: https://doi.org/10.1007/s00247-022-05559-5

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