Maceration determines diagnostic yield of fetal and neonatal whole body post‐mortem ultrasound

Shelmerdine, Susan C.; Langan, Dean; Mandalia, Uday; Sebire, Neil J.; Arthurs, Owen J.

doi:10.1002/pd.5615

Cited by 10 publications

(16 citation statements)

References 29 publications

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“…Whilst we focussed on image quality in this study, a recent diagnostic accuracy study showed that maceration rendered up to 50% of imaging non-diagnostic, in particular for the brain [ 20 ] and heart [ 9 , 30 ], although analysis at autopsy is equally extremely challenging. Further optimisation of micro-CT may help provide greater diagnostic yield in future.…”

Section: Discussionmentioning

confidence: 99%

“…Minimally-invasive imaging techniques which are more acceptable to parents [ 3 – 5 ] have been developed to determine the causes of miscarriage and stillbirth, and to assist in the planning of future pregnancies [ 6 – 10 ]. Most current clinically available scanning methods do not provide sufficient image resolution of smaller fetuses [ 9 , 11 ], necessitating trialling higher resolution techniques [ 10 , 12 – 14 ].…”

Section: Introductionmentioning

confidence: 99%

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Micro-CT yields high image quality in human fetal post-mortem imaging despite maceration

et al. 2021

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Background Current clinical post-mortem imaging techniques do not provide sufficiently high-resolution imaging for smaller fetuses after pregnancy loss. Post-mortem micro-CT is a non-invasive technique that can deliver high diagnostic accuracy for these smaller fetuses. The purpose of the study is to identify the main predictors of image quality for human fetal post-mortem micro-CT imaging. Methods Human fetuses were imaged using micro-CT following potassium tri-iodide tissue preparation, and axial head and chest views were assessed for image quality on a Likert scale by two blinded radiologists. Simple and multivariable linear regression models were performed with demographic details, iodination, tissue maceration score and imaging parameters as predictor variables. Results 258 fetuses were assessed, with median weight 41.7 g (2.6–350 g) and mean gestational age 16 weeks (11–24 weeks). A high image quality score (> 6.5) was achieved in 95% of micro-CT studies, higher for the head (median = 9) than chest (median = 8.5) imaging. The strongest negative predictors of image quality were increasing maceration and body weight (p < 0.001), with number of projections being the best positive imaging predictor. Conclusions High micro-CT image quality score is achievable following early pregnancy loss despite fetal maceration, particularly in smaller fetuses where conventional autopsy may be particularly challenging. These findings will help establish clinical micro-CT imaging services, addressing the need for less invasive fetal autopsy methods.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Micro-CT yields high image quality in human fetal post-mortem imaging despite maceration

et al. 2021

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“…the 'post-mortem interval') has not been reported as a major factor in diagnostic postmortem imaging quality, the degree of maceration does (relating to time between intra-uterine foetal demise and delivery, so-called intra-uterine retention time). This has been reported to be the most significant factor in acquiring a diagnostic quality post-mortem ultrasound study [16,17] due to the degree of tissue breakdown and laxity of skull sutures. It would therefore be helpful to preferentially acquire an MRI where maceration is known to be extensive (usually when the intra-uterine retention time is estimated > 24 h).…”

Section: What Imaging Modalities Are Best Suited For Perinatal Post-mortem Imaging?mentioning

confidence: 99%

“…The highest sensitivity rates were found for brain imaging (84%) and lowest for cardiothoracic abnormalities (51%). It is important to note that extensive maceration reduces the diagnostic quality of the imaging, particularly for brain imaging [16,17]. Where there is maceration or a need to confirm and characterise an underlying cardiac anomaly, post-mortem MRI may be the more appropriate imaging modality.…”

Section: Ultrasoundmentioning

confidence: 99%

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

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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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“…По данным S. Shelmerdine с соавт. [33] именно мацерация является основным фактором, снижающим эффективность УЗИ погибших плодов и новорожденных, особенно для выявления патологии головного мозга и сердца.…”

Section: посмертная мрт оценка давности внутриутробной гибели плодаunclassified

Postmortem Mri Evaluation of the Time of Intrauterine Fetal Death

Туманова¹,

Perinatology²,

Bychenko³

et al. 2020

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stablishing the time of intrauterine fetal death is important for determining the cause of its death. At autopsy, the time of death is determined by evaluating the severity of maceration processes of the external integument, internal organs and placenta. This study involves dissection of the body and organs, as well as the time spent on preparation of micropreparations.Purpose. To study changes in organs and tissues of a deceased fetus depending on the time of its intrauterine death when using post-mortem MRI.Material and methods. The work had been base on a comprehensive post-mortem radiation and autopsy studies of the bodies of 38 stillborn babies who were born at gestational periods of 22-40 weeks. Depending on the time of fetal death, all observations were divided into 8 groups. Postmortem MRI study was performed in standard T1 and T2 modes on the 3T Siemens Magnetom Verio device (Germany) before autopsy. On T1-and T2weighted images (WI) in the sagittal projection, we determined the MR signal intensity of the liver, kidney, brain, femoral muscle, lung, skin in the hip area, anterior abdominal wall and fronto-parietal area of the head, as well as fluid in the pleural cavity and air near the anterior abdominal wall. Based on the obtained values, we calculated the MRI maceration index (MI) according to the formula: MI = (T2t / T1t) x (T1f / T2f) x (T1a / T2a), where T1t and T2t are the signal intensities of the studied tissue (t), T1f and T2f are the values of the signal intensity of the fluid (f) in the pleural cavity, T1a and T2a are the values of the intensity of the air signal (a) on T1-and T2-WI, respectively. The determination of the time of intrauterine death was carried out on the basis of the medical history of the pregnant woman, the history of childbirth, as well as the results of the pathological study.Results. In observations with antenatal fetal death, the calculated MRI of the maceration index depended on the studied region (organ, tissue) of the fetus and the length of time that passed from the moment of death to childbirth. All MI of the internal organs and skin of the fronto-parietal region of the head had significant direct relationships with the statute of limitations of fetal death. Based on mathematical analysis, we derived the formula for determining the time of intrauterine death of the fetus, which expresses the result as the hours the fetus was found in utero after death (time of intrauterine death): t = 16.87 + 95.38x MIk ² -75.32x MIk, where MIk -an indicator of maceration of kidney tissue.Conclusion. The use of postmortem MRI allows making an objective quantitative assessment of the time of intrauterine death of the fetus, which contributes to the effective establishment of the links of the stillbirth. The advantages of post-mortem MRI over autopsy include the non-invasive nature of the study, the possibility of archiving and subsequent multiple analysis of tomograms, as well as the speed of MRI analysis compared with the time necessary for an autopsy and preparation of histological ...

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Maceration determines diagnostic yield of fetal and neonatal whole body post‐mortem ultrasound

Cited by 10 publications

References 29 publications

Micro-CT yields high image quality in human fetal post-mortem imaging despite maceration

Micro-CT yields high image quality in human fetal post-mortem imaging despite maceration

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

Postmortem Mri Evaluation of the Time of Intrauterine Fetal Death

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