A pragmatic evidence-based approach to post-mortem perinatal imaging

Abstract

Post-mortem imaging has a high acceptance rate amongst parents and healthcare professionals as a non-invasive method for investigating perinatal deaths. Previously viewed as a ‘niche’ subspecialty, it is becoming increasingly requested, with general radiologists now more frequently asked to oversee and advise on appropriate imaging protocols. Much of the current literature to date has focussed on diagnostic accuracy and clinical experiences of individual centres and their imaging techniques (e.g. post-mortem CT, MRI, ultrasound and micro-CT), and pragmatic, evidence-based guidance for how to approach such referrals in real-world practice is lacking. In this review, we summarise the latest research and provide an approach and flowchart to aid decision-making for perinatal post-mortem imaging. We highlight key aspects of the maternal and antenatal history that radiologists should consider when protocolling studies (e.g. antenatal imaging findings and history), and emphasise important factors that could impact the diagnostic quality of post-mortem imaging examinations (e.g. post-mortem weight and time interval). Considerations regarding when ancillary post-mortem image-guided biopsy tests are beneficial are also addressed, and we provide key references for imaging protocols for a variety of cross-sectional imaging modalities.

Comparison of postmortem whole‐body contrast‐enhanced microfocus computed tomography and high‐field magnetic resonance imaging of human fetuses

“…Methods In this study, the imaging process and quality of micro-CT and HF-MRI were compared using both qualitative and quantitative assessments. For the qualitative evaluation, fetal anatomy experts scored 56 HF-MRI and 56 micro-CT images of four human fetuses aged [13][14][15][16][17][18] gestational weeks on two components: overall image quality and the ability to recognize and assess 21 anatomical structures. For the quantitative evaluation, participants segmented manually three organs with increasing complexity to assess interobserver variability.…”

“…In addition, early gestational loss (< 20 weeks) requires specialist high-resolution imaging due to small fetal size. Imaging modalities such as high-field MRI (HF-MRI, ≥ 3 Tesla (T)) and microfocus CT (micro-CT) are potential options for the latter group 15 . Due to increased magnetic field strength, HF-MRI allows submillimeter spatial resolutions, enabling detailed examination of fetal anatomy, including the brain [16][17][18] , inner ear 19 and extremities 20 .…”

“…Although both micro‐CT and HF‐MRI appear feasible for postmortem fetal imaging, the choice of imaging technique is currently based mainly on the availability of imaging equipment rather than their specific advantages and disadvantages. It has been hypothesized that the two imaging techniques lead to similar results 15 , but they have not been compared directly.…”

Editorial for “Post‐Mortem MR Relaxometry of In Utero Fetuses and Its Relationship With Post‐Mortem Interval; a Multi‐Organ Observational Study on Reduced Fetuses of Complicated Multiple Pregnancies”

“…B eing the most useful investigation for stillbirths, perinatal autopsy discovers additional diagnoses beyond clinical suspicions in almost half of cases and contributes to the family by investigating the cause of death, determining the severity of malformation, reducing risk for existing children, and planning future pregnancies. 1 However, most parents refuse autopsy due to the grief for the dissection processing and religion issue, leading to low autopsy uptake rates. 2 Providing noninvasive screen and less invasive sampling, imaging or endoscopic examination combined with minimally invasive autopsy is more acceptable than traditional autopsy although the accuracy remains to be improved due to potential sampling errors 2 and image misinterpretation.…”

“…Being the most useful investigation for stillbirths, perinatal autopsy discovers additional diagnoses beyond clinical suspicions in almost half of cases and contributes to the family by investigating the cause of death, determining the severity of malformation, reducing risk for existing children, and planning future pregnancies 1 . However, most parents refuse autopsy due to the grief for the dissection processing and religion issue, leading to low autopsy uptake rates 2 .…”