Minimally invasive, imaging guided virtual autopsy compared to conventional autopsy in foetal, newborn and infant cases: study protocol for the paediatric virtual autopsy trial

Abstract

BackgroundIn light of declining autopsy rates around the world, post-mortem MR imaging is a promising alternative to conventional autopsy in the investigation of infant death. A major drawback of this non-invasive autopsy approach is the fact that histopathological and microbiological examination of the tissue is not possible. The objective of this prospective study is to compare the performance of minimally invasive, virtual autopsy, including CT-guided biopsy, with conventional autopsy procedures in a paediatric population.Methods/DesignFoetuses, newborns and infants that are referred for autopsy at three different institutions associated with the University of Zurich will be eligible for recruitment. All bodies will be examined with a commercial CT and a 3 Tesla MRI scanner, masked to the results of conventional autopsy. After cross-sectional imaging, CT-guided tissue sampling will be performed by a multifunctional robotic system (Virtobot) allowing for automated post-mortem biopsies. Virtual autopsy results will be classified with regards to the likely final diagnosis and major pathological findings and compared to the results of conventional autopsy, which remains the diagnostic gold standard.DiscussionThere is an urgent need for the development of alternative post-mortem examination methods, not only as a counselling tool for families and as a quality control measure for clinical diagnosis and treatment but also as an instrument to advance medical knowledge and clinical practice. This interdisciplinary study will determine whether virtual autopsy will narrow the gap in information between non-invasive and traditional autopsy procedures.Trial RegistrationClinicalTrials.gov: NCT01888380

Parental acceptance of minimally invasive fetal and neonatal autopsy compared with conventional autopsy

“…Several teams have tried to overcome this shortcoming by adding systematic organ biopsies, with postmortem laparoscopy or percutaneous needle biopsies . A multicenter prospective study comparing PM‐MRI in association with computed tomography (CT)‐guided organ biopsies is ongoing . Lately, perinatal healthcare professionals were questioned about their acceptance of conventional autopsy and minimally invasive autopsy (MIA) including PM‐MRI combined with laparoscopic‐guided tissue sampling.…”

“Donating our bodies to science”: A discussion about autopsy and organ donation in Turner syndrome

“…Tissues that are obtained from autopsy are routinely examined for histology, using unique stains for each cell type and organ, for microbiology, if an infectious cause of death is suspected, or for tumor markers, if there is evidence of cancer (Rüegger et al, 2014). For individuals with TS, genetic analysis of the chromosomal complement is a critical component of autopsy.…”

Less invasive investigation of perinatal death

“…11 A Swiss study is underway to investigate the accuracy of automated paediatric and perinatal postmortem biopsies using a robotic system. 12 Parental views on the trade-off between the acceptability of any investigation and diagnostic certainty now need to be examined …”