Post mortem magnetic resonance imaging in the fetus, infant and child: A comparative study with conventional autopsy (MaRIAS Protocol)

Abstract

BackgroundMinimally invasive autopsy by post mortem magnetic resonance (MR) imaging has been suggested as an alternative for conventional autopsy in view of the declining consented autopsy rates. However, large prospective studies rigorously evaluating the accuracy of such an approach are lacking. We intend to compare the accuracy of a minimally invasive autopsy approach using post mortem MR imaging with that of conventional autopsy in fetuses, newborns and children for detection of the major pathological abnormalities and/or determination of the cause of death.Methods/DesignWe recruited 400 consecutive fetuses, newborns and children referred for conventional autopsy to one of the two participating hospitals over a three-year period. We acquired whole body post mortem MR imaging using a 1.5 T MR scanner (Avanto, Siemens Medical Solutions, Enlargen, Germany) prior to autopsy. The total scan time varied between 90 to 120 minutes. Each MR image was reported by a team of four specialist radiologists (paediatric neuroradiology, paediatric cardiology, paediatric chest & abdominal imaging and musculoskeletal imaging), blinded to the autopsy data. Conventional autopsy was performed according to the guidelines set down by the Royal College of Pathologists (UK) by experienced paediatric or perinatal pathologists, blinded to the MR data. The MR and autopsy data were recorded using predefined categorical variables by an independent person.DiscussionUsing conventional post mortem as the gold standard comparator, the MR images will be assessed for accuracy of the anatomical morphology, associated lesions, clinical usefulness of information and determination of the cause of death. The sensitivities, specificities and predictive values of post mortem MR alone and MR imaging along with other minimally invasive post mortem investigations will be presented for the final diagnosis, broad diagnostic categories and for specific diagnosis of each system.Clinical Trial RegistrationNCT01417962NIHR Portfolio Number: 6794

Essentials of forensic post-mortem MR imaging in adults

“…6,9,10,88,89 High soft-tissue contrast and the ability of MR to visualize soft-tissue pathology are also the principal reason why PMMR is the modality of choice in postmortem neonatal and paediatric imaging. [90][91][92][93] However, in post-mortem imaging of the adult, abdominal imaging plays a marginal role and according to Baglivo et al, 10 only 2% of all published articles on forensic post-mortem cross-sectional imaging are dedicated to abdominal imaging.…”

MRI of the Fetal Brain

“…d Coronal EPI sequence shows the bones as hypointense structures. The right humerus is bowed Postmortem MRI Perinatal autopsy is essential to determine the cause of death, and also to provide additional information about disease processes [43]. Autopsy may also be used to evaluate modern imaging methods.…”

Postmortem Cardiovascular Magnetic Resonance Imaging in Fetuses and Children

“…14 We obtained informed parental consent either as part of the autopsy consenting process or by separate telephone consenting, as described previously. [15][16][17] The study had institutional approval (04/Q0508/41). All of the fetuses and children (≤16 years of age) undergoing conventional autopsy were eligible for recruitment.…”