Postmortem magnetic resonance imaging vs autopsy of second trimester fetuses terminated due to anomalies

Abstract

Introduction Our aim was to investigate the accuracy of postmortem fetal magnetic resonance imaging (MRI) compared with fetal autopsy in second trimester pregnancies terminated due to fetal anomalies. A secondary aim was to compare the MRI evaluations of two senior radiologists. Material and methods This was a prospective study including 34 fetuses from pregnancies terminated in the second trimester due to fetal anomalies. All women accepted a postmortem MRI and an autopsy of the fetus. Two senior radiologists performed independent evaluations of the MRI images. A senior pathologist performed the fetal autopsies. The degree of concordance between the MRI evaluations and the autopsy reports was estimated as well as the consensus between the radiologists. Results Thirty‐four fetuses were evaluated. Sixteen cases were associated with the central nervous system (CNS), five were musculoskeletal, one cardiovascular, one was associated with the urinary tract, and 11 cases had miscellaneous anomalies such as chromosomal aberrations, infections and syndromes. In the 16 cases related to the CNS, both radiologists reported all or some, including the most clinically significant anomalies in 15 (94%; CI 70%‐100%) cases. In the 18 non‐CNS cases, both radiologists reported all or some, including the most clinically significant anomalies in six (33%; CI 5%‐85%) cases. In 21 cases (62%; CI 44%‐78%), both radiologists held opinions that were consistent with the autopsy reports. The degree of agreement between the radiologists was high, with a Cohen's Kappa of 0.87. Conclusions Postmortem fetal MRI can replace autopsy for second trimester fetuses with CNS anomalies. For non‐CNS anomalies, the concordance is lower but postmortem MRI can still be of value when autopsy is not an option.

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

“…9,15e19 The diagnostic accuracy of 1.5 Tesla (T) pmMRI in small fetuses at less than 20 to 24 weeks' gestation is lower than 50% with regard to the fetal heart. 9,17,20 The better imaging quality of 3T cardiac pmMRI has been reported, 14e17 with fewer nondiagnostic examinations (11.6% in 3T vs 32.7% in 1.5T), higher sensitivity (48% vs 36%), specificity (95.1% vs 70.5%), and concordance rates (81.4% vs 60.5%) in the detection of abnormalities for 3T pmMRI than 1.5T pmMRI, particularly in fetuses younger than 20 weeks' gestation. 17 This study comprehensively examines cardiac 3T pmMRI.…”

Perinatal post-mortem magnetic resonance imaging (MRI) of the central nervous system (CNS): a pictorial review

“…Post-mortem perinatal imaging has many opportunities for further research. Indeed, post-mortem MRI and autopsy have a high macroscopic correlation and may be complementary techniques for the evaluation of the CNS [ 8 , 9 , 31 , 45 , 55 ]. Therefore, as suggested by other authors, the combination of these techniques could change the approach to the autopsy process itself [ 8 ].…”

Visualisation of fetal meconium on post-mortem magnetic resonance imaging scans: a retrospective observational study

“…5,6 The use of fetal MRI at post-mortem is also increasing, as a more acceptable alternative to traditional invasive autopsy to correlate with parental wishes. [7][8][9] Rates of concordance between detection of fetal pathology in traditional autopsy and post-mortem MRI are high, [10][11][12][13] and together with the increased acceptability of PM MRI to parents this shows it is a satisfactory alternative when traditional autopsy is declined. 14 It shows more detailed anatomy than magnetic resonance (MR) scans in utero due to higher resolution images taken over a longer time and no movement artefact, for more reliable diagnosis of antenatally detected pathology.…”