The future of pediatric and perinatal postmortem imaging

Abstract

The field and applications of post-mortem imaging are exponentially growing. Its potential to identify the cause of death in trauma and ballistic cases is now properly documented, as well as its use in drug mules identification. In pediatric and perinatal practice, large significant series are less available, except for MRI and central nervous system analysis where scientific evidence is now robust. In this review, after a short historical review and analysis of current problems and challenges, we will try to depict the way we see the future of this sub-specialty of post-mortem cross sectional, including in the scope all specific situations : terminations of pregnancy, intrauterine death, sudden unexpected infant death, and identification issues.

Post-mortem magnetic resonance foetal imaging: a study of morphological correlation with conventional autopsy and histopathological findings

“…In conclusion, in the immediate future the association between PMMR, post-mortem examination and related histological study of the foetus-placenta unit could help reduce the percentage of cases in which the cause of foetal death remains unexplained [54][55][56]. The technique may play a role in developing less invasive autopsy methods, particularly when parents do not consent to a full autopsy being performed, to give as much information as possible to prevent intrauterine foetal death and to help parents to be fully informed with regard to this dramatic event [12].…”

Lung density measurement in postmortem computed tomography: a new tool to assess immediate neonatal breath in suspected neonaticides

“…The development of postmortem imaging has brought many perspectives for post-mortem explorations [9], especially in perinatology [10]. It has become a reliable, non-invasive and available tool in addition to conventional autopsy techniques.…”

Pediatric postmortem computed tomography: initial experience at a children’s hospital in the United States

“…While radiographs have been used for more than a century to augment autopsy findings, ultrasound (US), CT and MRI have been introduced more recently for postmortem imaging [1][2][3]. Pediatric postmortem imaging is a nascent field with much to be learned regarding best practices, imaging protocols and differentiation of antemortem pathology from expected postmortem changes [1,[3][4][5][6][7][8][9][10][11][12][13], although interest has grown [4] with the journal Pediatric Radiology publishing a minisymposium on pediatric postmortem imaging in April 2014 based on an initiative led by the European Society of Paediatric Radiology (ESPR) [3,[7][8][9][14][15][16][17][18][19][20][21][22][23][24]. In the USA forensic and hospital practice varies compared to other countries' legal and health systems and must be tailored to conform to local requirements.…”

“…Since 1895, radiographs have been used for autopsy and forensic investigation [19]. In children, they provide an adjunct to pediatric autopsies for suspected fracture, skeletal malformation or dysplasia [2,8,12,19,27,28].…”

“…Since 1895, radiographs have been used for autopsy and forensic investigation [19]. In children, they provide an adjunct to pediatric autopsies for suspected fracture, skeletal malformation or dysplasia [2,8,12,19,27,28]. The overall diagnostic yield of postmortem radiographs in fetuses with no suspected skeletal abnormality is low [2,8,12,27] and therefore might best be reserved for use in high-risk cases.…”