The Evaluation of the Four-Chamber Cardiac Dissection Method of the Fetal Heart as an Alternative to Conventional Inflow–Outflow Dissection in Small Gestational-Age Fetuses

Abstract

The examination of very small fetal hearts requires special equipment and a specialist that are not available in many general pathology laboratories. Compared to conventional examination, the four-chamber cardiac dissection (4CCD) method can be performed by any pathologist using instruments generally available in pathology services. The aim of this study is to evaluate the efficiency of the 4CCD method in the examination of small fetal hearts using post-mortem magnetic resonance imaging (pm-MRI) at 7T as the standard. Twelve fetuses with gestational ages between 13 and 19 weeks have been included in this study. All fetuses underwent pm-MRI examination prior to pathologic examination. The 4CCD method was used for the cardiac examination in all cases following the same guidelines for cardiac sectioning. The 4CCD was able to identify all cardiac anatomic structures as compared to pm-MRI at 7T, demonstrating a sensibility of 95.8% (95% CI, 94.5–95.8) and specificity of 100% (95% CI, 32.3–100). The overall accuracy in identifying cardiac anatomic structures was 95.8% (95% CI, 93.4–95.8). Additionally, the 4CCD method was able to detect cardiac anomalies with an overall diagnostic accuracy of 91% (95% CI, 85.8–94.2), sensibility of 67.6% (95% CI, 54.5–75.3), and specificity of 97% (95% CI, 93.7–99) as compared to pm-MRI at 7T. The four-chamber view dissection method can be considered as an alternative to the conventional inflow–outflow dissection method in selected cases.

Postmortem imaging of fetuses at early gestations: A comparison of microfocus computed tomography with postmortem magnetic resonance at 9.4 T and postmortem ultrasound

“…Furthermore, the cost of MRI is higher than PMUS and probably micro‐CT 14 . Finally, the reported scanning duration for high‐field MRI is between 2 and 18 h, and in our study between 1.5 and 2 h (due to repositioning), whereas a full body micro‐CT can be achieved within 60 min 12,15,16 Therefore, high‐field MRI is likely not the best choice in comparison with micro‐CT.…”

“…requirements for its installation reduce the current and foreseen clinical availability of these machines. The clinically available 7 T magnets offer only a resolution of 0.5 mm voxel size that is obviously inferior to the micron-level resolution offered by micro-CT. 14 Furthermore, the cost of MRI is higher than PMUS and probably micro-CT. 14 Finally, the reported scanning duration for high-field MRI is between 2 and 18 h, and in our study between 1.5 and 2 h (due to repositioning), whereas a full body micro-CT can be achieved within 60 min 12,15,16 Therefore, high-field MRI is likely not the best choice in comparison with micro-CT.…”

Confirmation of Heart Malformations in Fetuses in the First Trimester Using Three-Dimensional Histologic Autopsy

“…[8][9][10] In contrast with the second trimester, when conventional autopsy can be performed to evaluate fetal heart structures, [11][12][13] first-trimester conventional autopsy is less accurate. 14 Fetal autopsies after firsttrimester loss or termination are hindered by the small cardiac size as well as the cardiac anatomy's intricacy and great diversity of cardiac malformations. In addition, accuracy can be heavily influenced by the experience of the pathologist.…”