Ventilated postmortem computed tomography in children: feasibility and initial experience
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Ventilated postmortem computed tomography (vPMCT) is associated with improved pulmonary imaging compared to standard PMCT in adults. We aimed to evaluate the feasibility of performing ventilated PMCT in children.
Postmortem thoracic CT was performed before (PMCT) and after ventilation (vPMCT). We used a range of mouthpieces, including endotracheal tubes, bag and mask and laryngeal mask airway (LMA). Hounsfield units of the lungs at PMCT were measured for normal and abnormal lung areas, before and after ventilation. All patients underwent full conventional autopsy and histology.
Twelve patients underwent ventilated PMCT, median age 52 days (range 3–304 days). Ventilated PMCT provided diagnostic lung images in all 12 cases, compared to only three unventilated PMCT examinations (p < 0.005). In all cases, ventilated PMCT improved the image quality of aerated lungs irrespective of the method used. Average lung Hounsfield units decreased significantly with ventilation from pre-vPMCT values (−134.1 ± 215.1 vs post-vPMCT −531.8 ± 190.1; p < 0.001). LMA with continuous positive pressure ventilation subjectively provided the best results.
Ventilated PMCT significantly improves lung aeration in children and can aid recognition of areas of abnormality in paediatric lungs. Such advances will improve accuracy and uptake of imaging-assisted autopsies in children.
KeywordsPostmortem Computed tomography Children Lung Autopsy
Laryngeal mask airway
Positive end expiratory pressure
(Postmortem) magnetic resonance imaging
Ventilated postmortem computed tomography
OA is funded by an NIHR Clinician Scientist AWARD, and NJS is funded by an NIHR Senior Investigator award, Great Ormond Street Children’s Charity and the Great Ormond Street Hospital Biomedical Research Centre.
This article presents independent research funded by the National Institute for Health Research (NIHR) and supported by the Great Ormond Street Hospital Biomedical Research Centre. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.
This study complies with the current laws and ethical standards required in the UK.
Conflict of interest
The authors declare that they have no conflicts of interest.
- 8.Royal College of Pathologists Working Party on the Autopsy (2006) Guidelines on autopsy practice: scenario 9: stillborn infant (singleton). June 2006. http://www.rcpath.org/Resources/RCPath/ Migrated_Resources/Documents/G/G001Autopsy-Stillbirths-Jun06.pdf. Accessed Jan 2015
- 9.Sebire NJ, Weber MA, Thayyil S, Mushtaq I, Taylor A, Chitty LS (2012) Minimally invasive perinatal autopsies using magnetic resonance imaging and endoscopic postmortem examination (“keyhole autopsy”): feasibility and initial experience. J Matern Fetal Neonatal Med 25:513–518CrossRefPubMedGoogle Scholar