Assessing the use of magnetic resonance imaging virtopsy as an alternative to autopsy: a systematic review and meta-analysis

Ahmad, Maqbool; Sharif, Kamal; Qayyum, Haisum; Ehsanullah, Bushra; Balyasnikova, Svetlana; Wale, Anita; Shanmuganandan, Arun; Siddiqui, Muhammed R; Athanasiou, Thanos; Kemp, Graham J.

doi:10.1136/postgradmedj-2017-134945

Cited by 20 publications

(16 citation statements)

References 30 publications

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“…In terms of finances, a previous systematic review by Ahmad et al 4 described a potential cost saving with MRI virtopsy compared with invasive autopsy of approximately 33% (based on a full body MRI costing £226.34 and an autopsy costing £471.80, with a paediatric MRI virtopsy sensitivity rate of 73%). Using their same reference for costing,29 an ultrasound study taking approximately 20 min (costing £56 per case, with similar whole-body ultrasound pooled sensitivity rate of 74%) could offer even further benefits.…”

Section: Discussionmentioning

confidence: 99%

“…The majority of studies relating to post-mortem imaging in children have related to post-mortem MRI (PMMR), with a recently published systematic review4 reporting sensitivity rates of 0.73 (95% CI: 0.56 to 0.84) in a pooled sample of 953 children across eight studies. For post-mortem CT imaging, there have been fewer studies in children compared with adults, with the majority reporting CT to be of lower yield in identification for the cause of death in non-suspicious (ie, ‘natural’ deaths) and perinatal losses,5–7 with a slight increase in benefit within a forensic setting 8 9…”

Section: Introductionmentioning

confidence: 99%

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Diagnostic accuracy of perinatal post-mortem ultrasound (PMUS): a systematic review

Shelmerdine

Langan²,

Sebire

et al. 2019

bmjpo

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ObjectiveUltrasound is ubiquitous in live paediatric imaging; however, its usage in post-mortem setting is less established. This systematic review aims to evaluate the diagnostic accuracy of paediatric post-mortem ultrasound (PMUS).DesignMEDLINE, Embase and Cochrane Library databases were queried for studies published between 1998 and 2018 assessing PMUS diagnostic accuracy rates in children<18 years old, using autopsy as reference standard. Risk of bias was assessed using Quality Assessment of Diagnostic Accuracy Studies 2. A bivariate random-effects model was used to obtain combined mean estimates of sensitivity and specificity for different body systems.ResultsFour studies were included, all relating to ultrasound for perinatal deaths. The mean diagnostic sensitivity and specificity for neurological abnormalities were 84.3% (95% CI: 70.8% to 92.2%) and 96.7% (95% CI: 86.5% to 99.3%); for cardiothoracic abnormalities 52.1% (95% CI: 27.6% to 75.5%,) and 96.6% (95% CI: 86.8% to 99.2%); and for abdominal abnormalities 78.4% (95% CI: 61.0% to 89.4%) and 97.3% (95% CI: 88.9% to 99.4%). Combining all body systems, the mean sensitivity and specificity were 73.3% (95% CI: 59.9% to 83.5%) and 96.6% (95% CI: 92.6% to 98.4%).ConclusionsPMUS demonstrates a reasonable diagnostic accuracy, particularly for abdominal and neurological abnormalities, although cardiac anomalies were less readily identified.Trial registration numberCRD42018106968.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Diagnostic accuracy of perinatal post-mortem ultrasound (PMUS): a systematic review

Shelmerdine

Langan²,

Sebire

et al. 2019

bmjpo

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“…Die zunehmende technische Weiterentwicklung der MRT prädestiniert daher die Ganzkörper-MRT für die PMMR als Screeninguntersuchung [9,10]. Trotz des vereinfachten Untersuchungsprotokolls liegt dabei die Sensitivität mit 83 % im guten Durchschnitt der publizier-ten PMMR-Studien bei Erwachsenen [14]. Die Studie bestätigt die Wertigkeit der PMMR auch mit einer verblindeten radiologischen Diagnostik ohne das Bias der Befundung durch Kenntnis der Anamnese, wie von Eriksson kritisiert [4].…”

Section: Diskussionunclassified

“…Auch der Befund einer ausgeprägten Mediastinitis als Todesursache wurde mit der PMMR trotz fehlender Anamnese korrekt gestellt. Hier kommt die gute Differenzierung von pathologischen postmortalen Weichteilveränderungen in der MRT zum Tragen [5,9,14,15]. In einer Studie mit alleinigen traumatischen Todesursachen konnte entsprechend in 39 von 40 Fällen mit der PMMR die Todesursache diagnostiziert werden.…”

Section: Diskussionunclassified

Todesursachenbestimmung mit verblindeter koronaler Ganzkörper-MRT im Vergleich zur rechtsmedizinischen Untersuchung

et al. 2019

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“…Reasonable levels of diagnostic accuracy from smaller cohorts performed in other European and Indian centres are also being published. While sensitivity rates for whole body diagnoses have been reported as high as 89%, a recently published systematic review incorporating several international studies has estimated the pooled sensitivity for paediatric PMMR at 0.73 (95% confidence interval [CI] 0.56‐0.84) …”

Section: Introductionmentioning

confidence: 99%

Latest developments in post‐mortem foetal imaging

et al. 2019

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A sustained decline in parental consent rates for perinatal autopsies has driven the development of less‐invasive methods for death investigation. A wide variety of imaging modalities have been developed for this purpose and include post‐mortem whole body magnetic resonance imaging (MRI), ultrasound, computed tomography (CT) and micro‐focus CT techniques. These are also vital for “minimally invasive” methods, which include potential for tissue sampling, such as image guidance for targeted biopsies and laparoscopic‐assisted techniques. In this article, we address the range of imaging techniques currently in clinical practice and those under development. Significant advances in high‐field MRI and micro‐focus CT imaging show particular promise for smaller and earlier gestation foetuses. We also review how MRI biomarkers such as diffusion‐weighted imaging and organ volumetric analysis may aid diagnosis and image interpretation in the absence of autopsy data. Three‐dimensional printing and augmented reality may help make imaging findings more accessible to parents, colleagues and trainees.

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Assessing the use of magnetic resonance imaging virtopsy as an alternative to autopsy: a systematic review and meta-analysis

Abstract: MRI virtopsy may offer a viable alternative to traditional autopsy. By using MRI virtopsy, a potential cost reduction of at least 33% is feasible, and therefore ought to be considered in eligible patients.

Cited by 20 publications

References 30 publications

Diagnostic accuracy of perinatal post-mortem ultrasound (PMUS): a systematic review

Diagnostic accuracy of perinatal post-mortem ultrasound (PMUS): a systematic review

Todesursachenbestimmung mit verblindeter koronaler Ganzkörper-MRT im Vergleich zur rechtsmedizinischen Untersuchung

Latest developments in post‐mortem foetal imaging

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