Corroboration of in utero MRI using post-mortem MRI and autopsy in foetuses with CNS abnormalities

Whitby, Elspeth; Variend, S.; Rutter, S.; Paley, Martyn; Wilkinson, Iain D.; Davies, Norman; Sparey, C; Griffiths, Paul D.

doi:10.1016/j.crad.2004.04.018

Cited by 31 publications

(25 citation statements)

References 8 publications

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“…USS was performed in a tertiary centre and/or conducted by foetal medicine experts in 21/34 studies [3, 18–21, 26–29, 31, 32, 35–38, 40–43, 47], in 12/34 it was either unclear or not specified [22–24, 30, 33, 34, 39, 45, 46, 48–50], and in one study [44] USS was performed in a routine clinical setting. Clear details regarding USS technique (transabdominal or transvaginal, views obtained) and equipment (manufacturer, transducer) were provided in 21 studies [18–20, 22, 24–26, 28, 32–37, 39, 40, 42, 43, 47, 48, 50].…”

Section: Resultsmentioning

confidence: 99%

“…The age range of foetuses reported across studies was 13–41 weeks gestation. Time delay between USS and iuMR was less than 2 weeks in 19/34 [3, 18–21, 23–25, 27, 30, 32, 33, 39, 41, 42, 44, 46, 47, 49] and not specified in 13/34 studies [22, 26, 28, 29, 31, 34, 36, 38, 40, 43, 45, 48, 50]. In two studies [35, 37] there were cases in which the time delay was greater than 2 weeks.…”

Section: Resultsmentioning

confidence: 99%

“…Experience of the clinician reporting the iuMR study was only available in 10/34 studies [20, 21, 25, 27, 28, 30, 32, 35, 37, 42], half of these quantified this in terms of years (between 1 and 15) the remaining gave a description of ‘experienced’. In two studies, the reporting radiologist was unaware of USS findings [21, 37].…”

Section: Resultsmentioning

confidence: 99%

“…Risk of bias for patient selection and applicability was low in 31/34 (91 %) studies [3, 18–45, 47, 50], high in one (6 %) [46] and unclear in two [48, 49] with high risk of bias due to patient selection criteria not being defined and retrospective study designs. The risk of bias due to conduct and interpretation of the index tests was low risk in 15/34 (44 %) [3, 18, 20, 21, 25, 28, 30, 32, 35–37, 40, 42, 43, 47], high risk in 4/34 (12 %) [38, 44–46] and unclear in 15/34 (44 %) [19, 22–24, 26, 27, 29, 31, 33, 34, 39, 41, 48–50]. Assessment of potential bias introduced by the reference standard was considered low risk in 19/34 (56 %) studies [3, 18, 19, 21, 22, 24, 28–31, 35, 36, 38, 40, 44, 47–50], high risk in nine (26 %) [20, 27, 32–34, 41, 43, 45, 46] and unclear in 6/34 (18 %) [23, 25, 26, 37, 39, 42], as there were a proportion of cases within the study that did not have a confirmed outcome or it was determined by clinical examination.…”

Section: Resultsmentioning

confidence: 99%

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A systematic review and meta-analysis to determine the contribution of mr imaging to the diagnosis of foetal brain abnormalities In Utero

et al. 2016

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ObjectivesThis systematic review was undertaken to define the diagnostic performance of in utero MR (iuMR) imaging when attempting to confirm, exclude or provide additional information compared with the information provided by prenatal ultrasound scans (USS) when there is a suspicion of foetal brain abnormality.MethodsElectronic databases were searched as well as relevant journals and conference proceedings. Reference lists of applicable studies were also explored. Data extraction was conducted by two reviewers independently to identify relevant studies for inclusion in the review. Inclusion criteria were original research that reported the findings of prenatal USS and iuMR imaging and findings in terms of accuracy as judged by an outcome reference diagnosis for foetal brain abnormalities.Results34 studies met the inclusion criteria which allowed diagnostic accuracy to be calculated in 959 cases, all of which had an outcome reference diagnosis determined by postnatal imaging, surgery or autopsy. iuMR imaging gave the correct diagnosis in 91 % which was an increase of 16 % above that achieved by USS alone.ConclusioniuMR imaging makes a significant contribution to the diagnosis of foetal brain abnormalities, increasing the diagnostic accuracy achievable by USS alone.Key points • Ultrasound is the primary modality for monitoring foetal brain development during pregnancy • iuMRI used together with ultrasound is more accurate for detecting foetal brain abnormalities • iuMR imaging is most helpful for detecting midline brain abnormalities • The moderate heterogeneity of reviewed studies may compromise findings

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

A systematic review and meta-analysis to determine the contribution of mr imaging to the diagnosis of foetal brain abnormalities In Utero

et al. 2016

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“…For example, discrepancy between antenatal ultrasound and autopsy findings, with regard to posterior fossa lesions and Dandy Walker malformations, have been reported in several studies 24 25. While, this might call for improved antenatal diagnostic methods, the correlation of antenatal imaging and autopsy findings appears to be higher, when postmortem MR is used for evaluation of the brain 26. This issue is highlighted in a recent case report, where the cerebellum was ‘missing’ at autopsy, even though it was clearly seen on antenatal ultrascan and postmortem MRI, albeit abnormal 24.…”

Section: Less Invasive Autopsy By Postmortem Mrimentioning

confidence: 99%

Less invasive autopsy: an evidenced based approach

Thayyil

2010

Archives of Disease in Childhood

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Despite the initial promises, less invasive autopsy by postmortem MRI has not gained widespread acceptance and is not yet used as a clinical tool. Current evidence on postmortem MRI is primarily limited to examination of fetal brain malformations. Large prospective studies funded by the UK Department of Health evaluating accuracy of postmortem MRI are now nearing completion. Less invasive autopsies may have a major effect in resurrecting autopsy rates; however, an evidence based and systematic approach towards less invasive autopsy process is mandatory to ensure postmortem data remains accurate and credible. This review summarises the current evidence, practical aspects and future directions for non-forensic less invasive autopsy in fetuses, newborns and children. A joint effort between clinicians, radiologists, pathologists, parent groups and funding bodies is essential for the successful implementation of less invasive autopsy in the UK.

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MRI in fetal necropsy

Brookes

Hagmann

2006

Magnetic Resonance Imaging

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The fetal autopsy involves a series of investigations of the corpse, most of which are noninvasive and acceptable to the majority of parents and their physicians. The value of the perinatal autopsy is manyfold and well established, and the results can provide a basis for parental and family counseling, inform future obstetric management, and provide audit for prenatal care. Many techniques originally developed for diagnosis, such as histology, biochemical tests, photography, x-rays, and cytogenetic karyotyping, have become standard tools in perinatal autopsies. However, there has been an inexorable decline in the autopsy consent rate over the last 30 years due to social and cultural factors, and perhaps ignorance of the benefits to be derived from the examination. Growing evidence suggests that postmortem fetal MRI can assist the pathologist at autopsy, and in many cases can obviate the need for dissection or at least minimize and focus it. For the majority of cases in which no consent for surgical autopsy is given, MRI together with other noninvasive postmortem tests can provide a great deal of the information that was previously available only from autopsy.

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Corroboration of in utero MRI using post-mortem MRI and autopsy in foetuses with CNS abnormalities

Cited by 31 publications

References 8 publications

A systematic review and meta-analysis to determine the contribution of mr imaging to the diagnosis of foetal brain abnormalities In Utero

A systematic review and meta-analysis to determine the contribution of mr imaging to the diagnosis of foetal brain abnormalities In Utero

Less invasive autopsy: an evidenced based approach

MRI in fetal necropsy

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