Diagnostic accuracy and limitations of post-mortem MRI for neurological abnormalities in fetuses and children. Issue 8 (August 2015)

• Record Type: Journal Article
• Authors: Arthurs, O.J.; Thayyil, S.; Pauliah, S.S.; Jacques, T.S.; Chong, W.K.; Gunny, R.; Saunders, D.; Addison, S.; Lally, P.; Cady, E.; Jones, R.; Norman, W.; Scott, R.; Robertson, N.J.; Wade, A.; Chitty, L.; Taylor, A.M.; Sebire, N.J.; Magnetic Resonance Imaging Autopsy Study (MaRIAS) Collaborative Group, †
• Is Part Of: Clinical radiology. Volume 70:Issue 8(2015)
• Page Start: 872
• Page End: 880
• Publication Date: 2015-08
• Subjects: Medical radiology -- Periodicals; Radiotherapy -- Periodicals; Radiotherapy -- Periodicals; Radiology -- Periodicals; Societies, Medical -- Periodicals; Medical radiology; Radiotherapy; Electronic journals; Periodicals; 616.0757
• DOI: 10.1016/j.crad.2015.04.008
• Languages: English
• ISSNs: 0009-9260

Abstract

<abstract xml:lang="en" abstract-type="author" id="abs0010"> <title> <x xml:space="preserve">Abstract</x> </title> <sec> <title id="sectitle0010">Aim</title> <p id="abspara0010">To compare the diagnostic accuracy of non-invasive cerebral post-mortem magnetic resonance imaging (PMMRI) specifically for cerebral and neurological abnormalities in a series of fetuses and children, compared to conventional autopsy.</p> </sec> <sec> <title id="sectitle0015">Materials and methods</title> <p id="abspara0015">Institutional ethics approval and parental consent was obtained. Pre-autopsy cerebral PMMRI was performed in a sequential prospective cohort (<italic>n</italic> = 400) of fetuses (<italic>n</italic> = 277; 185 ≤ 24 weeks and 92 > 24 weeks gestation) and children <16 years (<italic>n</italic> = 123) of age. PMMRI and conventional autopsy findings were reported blinded and independently of each other.</p> </sec> <sec> <title id="sectitle0020">Results</title> <p id="abspara0020">Cerebral PMMRI had sensitivities and specificities (95% confidence interval) of 88.4% (75.5 to 94.9), and 95.2% (92.1 to 97.1), respectively, for cerebral malformations; 100% (83.9 to 100), and 99.1% (97.2 to 99.7) for major intracranial bleeds; and 87.5% (80.1 to 92.4) and 74.1% (68 to 79.4) for overall brain pathology. Formal neuropathological examination was non-diagnostic due to maceration/autolysis in 43/277 (16%) fetuses; of these, cerebral PMMRI imaging provided clinically important information in 23 (53%). The sensitivity of PMMRI for detecting significant ante-mortem ischaemic injury was only 68% (48.4 to 82.8) overall.</p> </sec> <sec> <title id="sectitle0025">Conclusions</title> <p id="abspara0025">PMMRI is an accurate investigational technique for identifying significant neuropathology in fetuses and children, and may provide important information even in cases where autolysis prevents formal neuropathological examination; however, PMMRI is less sensitive at detecting hypoxic–ischaemic brain injury, and may not detect rarer disorders not encountered in this study.</p> </sec> </abstract>