Current state of perinatal postmortem magnetic resonance imaging: European Society of Paediatric Radiology questionnaire-based survey and recommendations

Whitby, Elspeth; Offiah, A.C.; Shelmerdine, Susan C.; Rijn, Rick R. van; Aertsen, Michaël; Klein, Willemijn M.; Perry, David; Goergen, Stacy; Abel, Christian; Taranath, Ajay; Gascho, Dominic; Miller, Elka; Arthurs, Owen J

doi:10.1007/s00247-020-04905-9

Cited by 8 publications

(5 citation statements)

References 18 publications

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“…In offering an OSB fetal surgery service it is important to promote MRI consistency and enhance fetal imaging expertise to benefit patient care. This is in line with work from other organizations such as the European Society of Pediatric Radiology which aim to improve perinatal MRI uniformity 23 . Our study objectives were to explore MRI capacity and acquisition for prenatal OSB assessment.…”

Section: Introductionsupporting

confidence: 65%

“…This is in line with work from other organizations such as the European Society of Pediatric Radiology which aim to improve perinatal MRI uniformity. 23 Our study objectives were to explore MRI capacity and acquisition for prenatal OSB assessment. We first undertook a survey assessing access, conduct and reporting of fetal MRI for OSB fetal surgery in the UK, Belgium and Ireland.…”

Section: Introductionmentioning

confidence: 99%

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Longitudinal MRI in the context of in utero surgery for open spina bifida: A descriptive study

Mufti,

Aertsen,

Thomson

et al. 2023

Acta Obstet Gynecol Scand

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IntroductionFetal surgery for open spina bifida (OSB) requires comprehensive preoperative assessment using imaging for appropriate patient selection and to evaluate postoperative efficacy and complications. We explored patient access and conduct of fetal magnetic resonance imaging (MRI) for prenatal assessment of OSB patients eligible for fetal surgery. We compared imaging acquisition and reporting to the International Society of Ultrasound in Obstetrics and Gynecology MRI performance guidelines.Material and methodsWe surveyed access to fetal MRI for OSB in referring fetal medicine units (FMUs) in the UK and Ireland, and two NHS England specialist commissioned fetal surgery centers (FSCs) at University College London Hospital, and University Hospitals KU Leuven Belgium. To study MRI acquisition protocols, we retrospectively analyzed fetal MRI images before and after fetal surgery for OSB.ResultsMRI for fetal OSB was accessible with appropriate specialists available to supervise, perform, and report scans. The average time to arrange a fetal MRI appointment from request was 4 ± 3 days (range, 0–10), the average scan time available was 37 ± 16 min (range, 20–80 min), with 15 ± 11 min (range, 0–30 min) extra time to repeat sequences as required. Specific MRI acquisition protocols, and MRI reporting templates were available in only 32% and 18% of units, respectively. Satisfactory T2‐weighted (T2W) brain imaging acquired in three orthogonal planes was achieved preoperatively in all centers, and 6 weeks postoperatively in 96% of FSCs and 78% of referring FMUs. However, for T2W spine image acquisition referring FMUs were less able to provide three orthogonal planes presurgery (98% FSC vs. 50% FMU, p < 0.001), and 6 weeks post‐surgery (100% FSC vs. 48% FMU, p < 0.001). Other standard imaging recommendations such as T1‐weighted (T1W), gradient echo (GE) or echoplanar fetal brain and spine imaging in one or two orthogonal planes were more likely available in FSCs compared to FMUs pre‐ and post‐surgery (p < 0.001).ConclusionsThere was timely access to supervised MRI for OSB fetal surgery assessment. However, the provision of images of the fetal brain and spine in sufficient orthogonal planes, which are required for determining eligibility and to determine the reversal of hindbrain herniation after fetal surgery, were less frequently acquired. Our evidence suggests the need for specific guidance in relation to fetal MRI for OSB. We propose an example guidance for MRI acquisition and reporting.

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Section: Introductionsupporting

confidence: 65%

Section: Introductionmentioning

confidence: 99%

Longitudinal MRI in the context of in utero surgery for open spina bifida: A descriptive study

Mufti,

Aertsen,

Thomson

et al. 2023

Acta Obstet Gynecol Scand

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“…Where cross-sectional postmortem imaging has shifted from research to accepted clinical practice, mainstream funding has not followed. This could be aided by the adoption of national/international guidelines for postmortem imaging, which the ESPR postmortem task force has advocated [ 2 , 11 , 12 ]. There is a growing acceptance of its utility, especially given the increasing evidence for its diagnostic accuracy, ability to demonstrate a variety of abnormal pathologies and increasing refusal by families for conventional autopsy.…”

Section: Discussionmentioning

confidence: 99%

Current and future funding streams for paediatric postmortem imaging: European Society of Paediatric Radiology survey results

et al. 2022

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Background Perinatal and childhood postmortem imaging has been accepted as a noninvasive alternative or adjunct to autopsy. However, the variation in funding models from institution to institution is a major factor prohibiting uniform provision of this service. Objective To describe current funding models employed in European and non-European institutions offering paediatric postmortem imaging services and to discuss the perceived barriers to future postmortem imaging service provision. Materials and methods A web-based 16-question survey was distributed to members of the European Society of Paediatric Radiology (ESPR) and ESPR postmortem imaging task force over a 6-month period (March-August 2021). Survey questions related to the radiologic and autopsy services being offered and how each was funded within the respondent’s institute. Results Eighteen individual responses were received (13/18, 72.2% from Europe). Only one-third of the institutions (6/18, 33.3%) have fully funded postmortem imaging services, with the remainder receiving partial (6/18, 33.3%) or no funding (5/18, 27.8%). Funding (full or partial) was more commonly available for forensic work (13/18, 72%), particularly where this was nationally provided. Where funding was not provided, the imaging and reporting costs were absorbed by the institute. Conclusion Increased access is required for the expansion of postmortem imaging into routine clinical use. This can only be achieved with formal funding on a national level, potentially through health care commissioning and acknowledgement by health care policy makers and pathology services of the value the service provides following the death of a fetus or child. Funding should include the costs involved in training, equipment, reporting and image acquisition. Supplementary Information The online version contains supplementary material available at 10.1007/s00247-022-05485-6.

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“…A recommended post-mortem MRI imaging protocol has been devised via an expert consensus survey conducted by the European Society of Paediatric Radiology (ESPR)[ 38 ]. An abbreviated protocol can also be followed if MRI scanner time is particularly limited [ 39 ].…”

Section: Published Protocols For Paediatric and Perinatal Post-mortem Imaging Techniquesmentioning

confidence: 99%

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

et al. 2021

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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.

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Current state of perinatal postmortem magnetic resonance imaging: European Society of Paediatric Radiology questionnaire-based survey and recommendations

Cited by 8 publications

References 18 publications

Longitudinal MRI in the context of in utero surgery for open spina bifida: A descriptive study

Longitudinal MRI in the context of in utero surgery for open spina bifida: A descriptive study

Current and future funding streams for paediatric postmortem imaging: European Society of Paediatric Radiology survey results

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

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