Table 1.
Studies on post-mortem MRI (PMMR) in foetuses and infants
| Study | Design | MR sequence | N | Organs examined | Results |
|---|---|---|---|---|---|
| Brookes et al16 | Prospective | 1.5-T, 2D T2W, saline bags and small coils used to improve signal | 20 | Whole body | Comparable accuracy only in 12 cases, although good correlation for brain lesions. MRI missed bladder abnormality, periaqueductal bleed, pulmonary hyperplasia. Poor accuracy for cardiac lesions |
| Alderliesten et al22 | Prospective | 2D T1W in 16, 2D T2W in 10 | 26 | Whole body | 8 of 18 major malformations were missed by PMMR. Poor accuracy for cardiac lesions |
| Woodward et al21 | Prospective | 3D T2W with 3-mm slice thickness | 26 | Whole body | 37 of 47 major malformations detected by MRI. Accuracy better for CNS abnormalities and poor for cardiac lesions |
| Breeze et al23 | Prospective | 2D T2W | 30 | Whole body | High sensitivity (87%) for detection of brain lesions, but poor for heart (25%) and lungs (62%) |
| Griffiths et al19 | Prospective | 1.5-T, 2D T2W | 32 | Brain and spine | MR 100% sensitivity for detection of CNS lesions. How the gold standard was PMMR, rather than autopsy, in some of these foetuses |
| Hagmann et al24 | Unclear | 1.5-T, 2D T2W | 37 | Kidneys | PMMR detected all five cases that had a structural renal abnormality. Blinding of radiologists and pathologist unclear |
| Widjaja et al25 | Unclear | 1.5-T, 2D T2W | 41 | Spine | 10 cases with a spinal abnormality noted on prenatal USS and 31 foetuses without abnormality included. Post-mortem MR detected abnormality in all cases. Selected cases and blinding of radiologists and pathologist unclear |
| Huisman et al26 | Prospective | 1.5-T, 2D T1/T2W | 10 | Whole body | PMMR detected all abnormalities noted at autopsy. Blinding of radiologists and pathologist unclear. Small number of likely preselected cases |
| Cohen et al27 | Retrospective | 1.5-T, 2D T2W | 100 | Brain | Retrospective review with inclusion of previous cases. 60% agreement between MR and autopsy findings |
| Thayyil et al28 | Prospective | 9.4-T, 1.5-T, 3D T2W | 18 | Whole body | High-field MRI gives good tissue characterization in small foetuses less than 22 weeks old |
| Breeze et al17 | Prospective | 2D T2W | 44 | Whole body | MIA done, including MRI and percutaneous organ biopsies. MIA provided information of at least equivalent clinical significance for 72.7% of cases |
| Sebire et al20 | Prospective | 1.5-T, T1/T2W | 10 | Whole body | MIA done, including MRI and percutaneous organ biopsies. Good concordance with autopsy results |
| Cannie et al18 | Prospective | 1.5-T, 2D T1/T2W | 96 | Whole body | Virtopsy is reliable for most structures except heart and urogenitals, can be confidently used in the second half of pregnancy to determine normality or abnormality |
| Votino et al29 | Prospective | 9.4-T, 3.0-T, 1.5-T 2D and 3D T2W | 24 | Heart | High-field MRI gave good visualization of the heart irrespective of gestational age (4-T MRI could identify 7 of 8 cases of major congenital heart disease) |
| Sandaite et al30 | Retrospective | 3-T, 3D T2W | 39 | Heart | Normal cardiac structures visualized for foetuses beyond 14 weeks of gestation |
| Thayyil et al31 | Prospective | 1.5-T, T1/T2W | 400 | Whole body | 89.3% concordant with conventional autopsy. Better in foetuses and newborns and infants. Less accurate in children |
2D, two-dimensional; 3D, three-dimensional; CNS, central nervous system; MIA, minimally invasive autopsy; T1W, T1 weighted; T2W, T2 weighted; USS, ultrasounds scan.
Table adapted with permission from Elsevier.3