Minimally invasive fetal postmortem examination using magnetic resonance imaging and computerised tomography: current evidence and practical issues

Abstract

For a variety of reasons, acceptance of traditional postmortem examination following foetal or neonatal death has declined significantly in recent years in the UK. Here, we review the case for the development of less invasive autopsy using combined investigations including imaging techniques, in particular, magnetic resonance imaging and computerised tomography. Copyright © 2010 John Wiley & Sons, Ltd.

Performance of post-mortem CT compared to autopsy in children

“…Gold standard for defining sensitivity was the combination of autopsy and PMCT. Linear regression analysis and Pearson's correlation coefficients indicate that no linear correlation is present performance of native (unenhanced) CT alone, which is not well suited to detecting parenchymal and soft tissue findings, as described by Thayyil et al [1]. Indeed, confident diagnoses of parenchymal or soft tissue pathologies usually require the injection of contrast agent in routine clinical CT.…”

“…Unsuspected malformations or anatomical anomalies that are not externally evident are still challenges for postmortem imaging. For cardiac malformations or coronary diseases, some elements of diagnoses will surely be available if MRI and PMCT angiography are used [1,2,25].…”

“…In the nonmedicolegal cases, consent for autopsy is frequently not provided by the family. Indeed, a reduction in the proportion of parents who consent to a conventional autopsy in a non-forensic context has been observed in recent years [1]. Such consent is not absolutely necessary from a legal point of view in forensic cases in most countries.…”

Fetal Dysmorphology

“…Fetal autopsy is still regarded as the gold standard procedure for identification of fetal abnormalities 2,3 but assessment of the fetus by a clinical geneticist or other specialist with expertise in dysmorphology may also be informative. When coupled with other investigations which are non-invasive or involve only sampling of blood or other body fluids, examination for external malformations and dysmorphic features may complement autopsy findings or provide important information as to the causation of fetal abnormalities when autopsy is not possible 4,5 .This situation is now becoming more common as rates of fetal autopsy have dropped significantly in the UK in recent years 6 .…”

Fetal organ weight estimation by postmortem high‐field magnetic resonance imaging before 20 weeks' gestation

“…This low rate reflects the difficulties that fetal medicine specialists face in obtaining parental consent for a conventional autopsy 2 . In circumstances where consent is declined for conventional autopsy, postmortem magnetic resonance imaging (MRI) allows minimally invasive autopsy, with much higher acceptance rates 3,4 .…”