Diagnostic quality of 3Tesla postmortem magnetic resonance imaging in fetuses with and without congenital heart disease

Ulm, Barbara; Dovjak, Gregor; Scharrer, Anke; Muin, D; Zimpfer, Daniel; Prayer, Daniela; Weber, Michael; Berger‐Kulemann, Vanessa

doi:10.1016/j.ajog.2021.02.030

Cited by 5 publications

(10 citation statements)

References 27 publications

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“…For the evaluation of the renal segment pm-MRI 3T obtained a sensitivity of 58.33% with a specificity of 98.81%, results consistent with other studies in the literature [ 23 , 24 ].…”

Section: Discussionsupporting

confidence: 89%

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Diagnostic value of virtual autopsy using pm-MRI at 3T on malformed second trimester fetuses vs classic autopsy

et al. 2021

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Objective To determine the diagnostic value of virtual autopsy using post mortem-MRI (pm-MRI) at 3Tesla (T) compared to classic autopsy for the confirmation of fetal structural anomalies and secondly to establish which cases of termination of pregnancy would benefit mostly from a virtual autopsy. Methods In each of 32 fetuses included in the study, 32 anatomical structures were assessed, after termination of pregnancy in the second trimester. All cases were evaluated by prenatal ultrasonography, virtual autopsy and classic autopsy, and then divided into four groups: Cerebral Group, Cardiac Group, Renal Group and Other Group (miscellaneous group). The concordance of virtual autopsy with classic autopsy was calculated overall and for each group and each structural item. Also, the concordance between the two methods was assessed using a diagnostic error score (DgE_score), calculated as the absolute value of the difference between the number of malformations detected by classic autopsy per case (CA score) and the number of malformations detected at virtual autopsy per case (VA score). Results Overall virtual autopsy demonstrated a diagnostic sensitivity (Se) compared to classic autopsy of 67.33% [95% CI 57.28–76.33], with a specificity (Sp) of 98.37% [95% CI 97.33–99.09], a positive predictive value (PPV) of 81.93% [95% CI 71.95–89.52], a negative predictive value (NPV) of 96.49% [95% CI 95.11–97.57] achieving a diagnostic accuracy of 95.31% [95% CI 93.83–96.52]. Overall, no statistic significant correlation was demonstrated between DgE_score and the gestational age of the fetuses or between DgE_score and the weight of the fetuses, but a significant correlation was revealed between the virtual autopsy and classic autopsy score. The diagnostic utility of virtual autopsy using pm-MRI at 3 T as compared to classic autopsy for each category of termination of pregnancy revealed in the Cerebral Group a Se of 80.00% [95% CI 28.36–99.49], with a 96.30% [95% CI 81.03–99.91], a PPV of 80.00% [95% CI 35.75–96.64] a NPV of 96.30% [95% CI 81.81–99.34], with a diagnostic accuracy of 93.75% [95% CI 79.19% to 99.23] and a Cohen’s Kappa coefficient of 0.76 [95% CI 0.4494–1.0765]; in the Renal Group a Se and Sp of 100%, but in the Cardiac Group the Se was only 60.00% [95% CI 26.24–87.84], Sp 75% [95% CI 34.91–96.81], the PPV 75.00% [95% CI 44.92–91.69], NPV 60% [95% CI 38.87–77.96], with a diagnostic accuracy of 66.67% [95% CI 40.99–86.66] and a Cohen’s Kappa coefficient of 0.32 [95% CI -0.07–0.76]. Conclusions The results support virtual autopsy using pm-MRI at 3T as a reliable alternative to classic autopsy for the non-forensic analysis of second trimester fetuses. Analyzing the diagnostic utility of virtual autopsy using pm-MRI at 3 T for the confirmation of prenatal ultrasound findings in second trimester fetuses as compared to classic autopsy, the best results were obtained in the Cerebral and Renal Group. Reserved results were found in the Cardiac Group. Therefore, for the pregnancies with termination of pregnancy for cerebral or renal abnormalities, virtual autopsy by pm-MRI at 3T can be taken into consideration as a first-line investigation to confirm the prenatal findings.

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“…For the evaluation of the renal segment pm-MRI 3T obtained a sensitivity of 58.33% with a specificity of 98.81%, results consistent with other studies in the literature [ 23 , 24 ].…”

Section: Discussionsupporting

confidence: 89%

“…Pm-MRI at 3 T should nevertheless be regarded as a potential tool to assess cardiac segment, as new studies arise with promising good results in identifying with high specificity the nonseptal cardiac in fetuses weighing more than 100 g, with low degree maceration [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

Diagnostic value of virtual autopsy using pm-MRI at 3T on malformed second trimester fetuses vs classic autopsy

et al. 2021

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“…Out of 62 articles, eight (13%) articles had a low risk of bias,182–189 45 (72%) articles had some concerns,185 190–234 and nine (15%) articles had a high risk of bias235–243 (figure 2).…”

Section: Resultsmentioning

confidence: 99%

Are non-invasive or minimally invasive autopsy techniques for detecting cause of death in prenates, neonates and infants accurate? A systematic review of diagnostic test accuracy

et al. 2023

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ObjectivesTo assess the diagnostic accuracy of non-invasive or minimally invasive autopsy techniques in deaths under 1 year of age.DesignThis is a systematic review of diagnostic test accuracy. The protocol is registered on PROSPERO.ParticipantsDeaths from conception to one adjusted year of age.Search methodsMEDLINE (Ovid), EMBASE (Ovid), CINAHL (EBSCO), the Cochrane Library, Scopus and grey literature sources were searched from inception to November 2021.Diagnostic testsNon-invasive or minimally invasive diagnostic tests as an alternative to traditional autopsy.Data collection and analysisStudies were included if participants were under one adjusted year of age, with index tests conducted prior to the reference standard.Data were extracted from eligible studies using piloted forms. Risk of bias was assessed using Quality Assessment of Diagnostic Accuracy Studies-2. A narrative synthesis was conducted following the Synthesis without Meta-Analysis guidelines. Vote counting was used to assess the direction of effect.Main outcome measuresDirection of effect was expressed as percentage of patients per study.FindingsWe included 54 direct evidence studies (68 articles/trials), encompassing 3268 cases and eight index tests. The direction of effect was positive for postmortem ultrasound and antenatal echography, although with varying levels of success. Conversely, the direction of effect was against virtual autopsy. For the remaining tests, the direction of effect was inconclusive.A further 134 indirect evidence studies (135 articles/trials) were included, encompassing 6242 perinatal cases. The addition of these results had minimal impact on the direct findings yet did reveal other techniques, which may be favourable alternatives to autopsy.Seven trial registrations were included but yielded no results.ConclusionsCurrent evidence is insufficient to make firm conclusions about the generalised use of non-invasive or minimally invasive autopsy techniques in relation to all perinatal population groups.PROSPERO registration numberCRD42021223254.

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“…However, in this preclinical experimental setting, the actual sample size was considerably higher, since we compared 112 images and assessed 21 anatomical structures. Also, given the clear significant differences in image quality between the two modalities studied and the fact that HF‐MRI 41 and micro‐CT 42 have the same factors affecting their image quality (i.e. body weight and maceration), scanning more individual fetuses in the same age category would not have a significant impact on the results.…”

Section: Discussionmentioning

confidence: 99%

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

Dawood

Honhoff

Post

et al. 2022

Ultrasound in Obstet & Gyne

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What are the novel findings of this work?This is the first study to compare microfocus computed tomography (micro-CT) and high-field magnetic resonance imaging (HF-MRI) in postmortem whole-body fetal imaging. We have shown that micro-CT enables higher quality imaging, with higher resolution, image contrast and signal-to-noise ratio, compared with HF-MRI. Furthermore, the ability to recognize and assess anatomical structures is greater when using micro-CT images. What are the clinical implications of this work?This work represents advancement in postmortem fetal imaging as a service for parents who have experienced early pregnancy loss. Previously, it was assumed that the performance of HF-MRI and micro-CT was similar and that the choice of the imaging modality should depend on availability. Here, we provide substantial evidence that micro-CT is superior to HF-MRI and, therefore, should be the preferred imaging modality.

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Diagnostic quality of 3Tesla postmortem magnetic resonance imaging in fetuses with and without congenital heart disease

Cited by 5 publications

References 27 publications

Diagnostic value of virtual autopsy using pm-MRI at 3T on malformed second trimester fetuses vs classic autopsy

Diagnostic value of virtual autopsy using pm-MRI at 3T on malformed second trimester fetuses vs classic autopsy

Are non-invasive or minimally invasive autopsy techniques for detecting cause of death in prenates, neonates and infants accurate? A systematic review of diagnostic test accuracy

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

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