Comparison of diagnostic performance for perinatal and paediatric post-mortem imaging: CT versus MRI
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To compare the diagnostic yield of whole-body post-mortem computed tomography (PMCT) imaging to post-mortem magnetic resonance (PMMR) imaging in a prospective study of fetuses and children.
We compared PMCT and PMMR to conventional autopsy as the gold standard for the detection of (a) major pathological abnormalities related to the cause of death and (b) all diagnostic findings in five different body organ systems.
Eighty two cases (53 fetuses and 29 children) underwent PMCT and PMMR prior to autopsy, at which 55 major abnormalities were identified. Significantly more PMCT than PMMR examinations were non-diagnostic (18/82 vs. 4/82; 21.9 % vs. 4.9 %, diff 17.1 % (95 % CI 6.7, 27.6; p < 0.05)). PMMR gave an accurate diagnosis in 24/55 (43.64 %; 95 % CI 31.37, 56.73 %) compared to 18/55 PMCT (32.73 %; 95 % CI 21.81, 45.90). PMCT was particularly poor in fetuses <24 weeks, with 28.6 % (8.1, 46.4 %) more non-diagnostic scans. Where both PMCT and PMMR were diagnostic, PMMR gave slightly higher diagnostic accuracy than PMCT (62.8 % vs. 59.4 %).
Unenhanced PMCT has limited value in detection of major pathology primarily because of poor-quality, non-diagnostic fetal images. On this basis, PMMR should be the modality of choice for non-invasive PM imaging in fetuses and children.
• Overall 17.1 % more PMCT examinations than PMMR were non-diagnostic
• 28.6 % more PMCT were non-diagnostic than PMMR in fetuses <24 weeks
• PMMR detected almost a third more pathological abnormalities than PMCT
• PMMR gave slightly higher diagnostic accuracy when both were diagnostic
KeywordsPost-mortem Fetus CT MRI Perinatal
less invasive autopsy (no incision is made)
minimally invasive autopsy (incision or biopsy is made, but no full autopsy)
post-mortem computed tomography
post-mortem magnetic resonance
sudden unexpected death in infancy
The scientific guarantor of this publication is Andrew M. Taylor. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. This is an independent report commissioned and funded by the Policy Research Programme in the Department of Health (0550004). This work was undertaken at GOSH/ICH, UCLH/ UCL who received a proportion of funding from the UK Department of Health’s NIHR Biomedical Research Centre funding scheme. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health. NJS and LC are supported by NIHR Senior Investigator awards. AMT is supported by an NIHR Senior Research fellow award, NJS is supported by a NIHR Senior Investigator award, and OA and ST are supported by an NIHR Clinician Scientist fellowship awards. LSC, NJS and AMT receive funding from the Great Ormond Street Hospital Children’s Charity and ACO from The Sheffield Children’s Hospital Charity. One of the authors has significant statistical expertise (AW). Institutional review board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study. Some study subjects or cohorts have been previously reported in Thayyil et al., Lancet 2013 , and Arthurs OJ et al., European Radiology 2014. Methodology: prospective, diagnostic study, multicenter study. ClinicalTrials.gov Identifier: NCT01417962
MaRIAS (Magnetic Resonance Imaging Autopsy Study) Collaborative Group
Ms Shea Addison (Research Assistant, UCL), Dr Michael Ashworth (Consultant in Paediatric Pathology, GOSH) Dr Alan Bainbridge (MR Physicist, UCL), Dr Jocelyn Brookes (Consultant in Interventional Radiology, UCH), Prof Lyn Chitty (Professor of Genetics and Fetal Medicine, UCLH and GOSH), Dr WK ‘Kling’ Chong (Consultant in Paediatric Neuroradiology, GOSH), Dr Roxana Gunny (Consultant in Paediatric Neuroradiology, GOSH), Dr Tom Jacques (Consultant in Paediatric Neuropathology, GOSH), Mr Rod Jones (Research MR radiographer, UCL), Dr Mark Lythgoe (Director, Centre for Advanced Biomedical Imaging, UCL), Dr Marion Malone (Consultant in Paediatric pathology, GOSH), Wendy Norman (Research MR radiographer, UCL), Dr Oystein Olsen (Consultant in Paediatric Chest and Abdomen Imaging, GOSH), Dr Catherine M Owens (Consultant in Paediatric Chest and Abdomen Imaging, GOSH), Dr Amaka C Offiah (Reader in Paediatric Musculoskeletal Imaging, University of Sheffield), Dr Nicola Robertson (Professor of Perinatal Neuroscience, UCH), Dr Tony Risdon (Consultant in Paediatric Forensic Pathology, GOSH), Prof Neil Sebire (Professor of Perinatal and Paediatric Developmental Pathology, GOSH), Dr Rosemary Scott (Consultant in Perinatal pathology, UCH), Dr Dawn Saunders (Consultant in Paediatric Neuroradiology, GOSH), Dr Silvia Schievano (Senior Research Fellow in Medical Engineering, UCL), Ms Angie Scales (Family liaison sister, GOSH), Prof Andrew Taylor (Chief Investigator; Professor of Cardiovascular Imaging, UCL), Sudhin Thayyil (Clinical Reader in Neonatology, Imperial), Angie Wade (Professor of Medical Statistics, UCL).
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