Clinical utility of postmortem microcomputed tomography of the fetal heart: diagnostic imaging <i>vs</i> macroscopic dissection

Hutchinson, J. Ciaran; Arthurs, Owen J.; Ashworth, Michael; Ramsey, A. T.; Mifsud, William; Lombardi, Claudio; Sebire, Neil J.

doi:10.1002/uog.15764

Cited by 58 publications

(55 citation statements)

References 19 publications

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“…For example, the use of microcomputed tomography (micro-CT) is a technique for the high-resolution evaluation of anatomical features in organs and small fetuses. A study on ex-vivo isolated fetal heart and fetal heartelung blocks using micro-CT provided highly accurate three-dimensional rendering of complex congenital heart diseases [94]. For the evaluation of very small and early-age fetuses, high-frequency postmortem ultrasound, high-field PMMRI, and micro-CT are being evaluated [91].…”

Section: Other Techniquesmentioning

confidence: 99%

Perinatal death investigations: What is current practice?

Nijkamp

Sebire

Bouman

et al. 2017

Seminars in Fetal and Neonatal Medicine

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Perinatal death (PD) is a devastating obstetric complication. Determination of cause of death helps in understanding why and how it occurs, and it is an indispensable aid to parents wanting to understand why their baby died and to determine the recurrence risk and management in subsequent pregnancy. Consequently, a perinatal death requires adequate diagnostic investigation. An important first step in the analysis of PD is to identify the case circumstances, including relevant details regarding maternal history, obstetric history and current pregnancy (complications are evaluated and recorded). In the next step, placental examination is suggested in all cases, together with molecular cytogenetic evaluation and fetal autopsy. Investigation for fetal-maternal hemorrhage by Kleihauer is also recommended as standard. In cases where parents do not consent to autopsy, alternative approaches such as minimally invasive postmortem examination, postmortem magnetic resonance imaging, and fetal photographs are good alternatives. After all investigations have been performed it is important to combine findings from the clinical review and investigations together, to identify the most probable cause of death and counsel the parents regarding their loss.

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Section: Other Techniquesmentioning

confidence: 99%

Perinatal death investigations: What is current practice?

Nijkamp

Sebire

Bouman

et al. 2017

Seminars in Fetal and Neonatal Medicine

View full text Add to dashboard Cite

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“…The heads were then rinsed with distilled water to remove excess iodine, blotted dry and secured within a low density plastic container covered with polymer film to prevent specimen dehydration. Images were acquired using a Nikon XTH 225 ST micro-(m)-CT scanner, utilizing a molybdenum X-ray source with anode voltages ranging between 70 and 100 kV and detector exposure times of 500-708 ms over 3141 projections (2,14). Data were reconstructed using CTPro3D (Nikon Metrology, Tring) and post-processed with VG Studio MAX software (Volume Graphics GmbH, Heidelberg, Germany).…”

Section: Micro Computed Tomographymentioning

confidence: 99%

Preclinical transgenic and patient‐derived xenograft models recapitulate the radiological features of human adamantinomatous craniopharyngioma

et al. 2017

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To assess the clinical relevance of transgenic and patient‐derived xenograft models of adamantinomatous craniopharyngioma (ACP) using serial magnetic resonance imaging (MRI) and high resolution post‐mortem microcomputed tomography (μ‐CT), with correlation with histology and human ACP imaging. The growth patterns and radiological features of tumors arising in Hesx1Cre/+;Ctnnb1lox(ex3)/+ transgenic mice, and of patient‐derived ACP xenografts implanted in the cerebral cortex, were monitored longitudinally in vivo with anatomical and functional MRI, and by ex vivo μ‐CT at study end. Pathological correlates with hematoxylin and eosin stained sections were investigated. Early enlargement and heterogeneity of Hesx1Cre/+;Ctnnb1lox(ex3)/+ mouse pituitaries was evident at initial imaging at 8 weeks, which was followed by enlargement of a solid tumor, and development of cysts and hemorrhage. Tumors demonstrated MRI features that recapitulated those of human ACP, specifically, T1‐weighted signal enhancement in the solid tumor component following Gd‐DTPA administration, and in some animals, hyperintense cysts on FLAIR and T1‐weighted images. Ex vivo μ‐CT correlated with MRI findings and identified smaller cysts, which were confirmed by histology. Characteristic histological features, including wet keratin and calcification, were visible on μ‐CT and verified by histological sections of patient‐derived ACP xenografts. The Hesx1Cre/+;Ctnnb1lox(ex3)/+ transgenic mouse model and cerebral patient‐derived ACP xenografts recapitulate a number of the key radiological features of the human disease and provide promising foundations for in vivo trials of novel therapeutics for the treatment of these tumors.

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“…In addition, over half of our study sample was of smaller fetuses below 500‐g bodyweight in which there is a recognised reduced diagnostic accuracy rate of PMMR. This demographic skew could have affected the diagnostic accuracy of PMMR, particularly of cardiac anomalies . One way to combat this limitation in the future may be to image fetuses using 3T MRI or alternatively with microfocus computed tomography (micro‐CT); however, these facilities were not available to us at the time of the study.…”

Section: Discussionmentioning

confidence: 99%

“…This demographic skew could have affected the diagnostic accuracy of PMMR, particularly of cardiac anomalies. 23,24 One way to combat this limitation in the future may be to image fetuses using 3T MRI 25 or alternatively with microfocus computed tomography (micro-CT) 26 ; however, these facilities were not available to us at the time of the study.…”

Section: Discussionmentioning

confidence: 99%

Is traditional perinatal autopsy needed after detailed fetal ultrasound and post‐mortem MRI?

et al. 2019

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Objective To determine the additional yield from autopsy following prenatal ultrasound and post‐mortem magnetic resonance imaging (PMMR) for structural abnormalities. Method PMMR was performed on consecutive fetuses over a 6‐year period. Prenatal ultrasound and PMMR findings were categorised as concordant, partially concordant or discordant findings. The yield of new and clinically significant information from autopsy was assessed. Diagnostic accuracies for both modalities were calculated, using autopsy as reference standard. Results Our study consisted of 81 fetuses. PMMR and prenatal ultrasound findings were concordant in 44/81 (54.3%), partially concordant in 26/81 (32.1%) and discordant in 11/81 (13.6%) cases. In 19/81 cases (23%), autopsy provided additional information, which appeared clinically significant in 12 cases. In 10 of those 12 cases, there was discordance between PMMR and ultrasound. In only 2 of 44 cases where ultrasound and PMMR were concordant, did autopsy provide clinically significant information. Diagnostic accuracy rates for ultrasound were sensitivity of 76.8% (66.6%, 84.6%), specificity of 92.5% (88.9%, 95.0%). For PMMR the sensitivity was 79.0% (68.9%, 86.5%), specificity 97.9% (95.5%, 99.0%). PMMR had a significantly higher concordance rate with autopsy than ultrasound (89.0 vs 93.8%; P < .001). Conclusion Where PMMR and ultrasound are concordant, there is little additional yield from autopsy.

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Clinical utility of postmortem microcomputed tomography of the fetal heart: diagnostic imaging vs macroscopic dissection

Abstract: Objectives

Cited by 58 publications

References 19 publications

Perinatal death investigations: What is current practice?

Perinatal death investigations: What is current practice?

Preclinical transgenic and patient‐derived xenograft models recapitulate the radiological features of human adamantinomatous craniopharyngioma

Is traditional perinatal autopsy needed after detailed fetal ultrasound and post‐mortem MRI?

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