Diagnostic accuracy of postmortem MRI for musculoskeletal abnormalities in fetuses and children
Owen J Arthurs, Sudhin Thayyil, Shea Addison, Angie Wade, Rod Jones, Wendy Norman, Rosemary Scott, Nicola J Robertson, Lyn S Chitty, Andrew M Taylor, Neil J Sebire, Amaka C Offiah, Magnetic Resonance Imaging Autopsy Study (MaRIAS) Collaborative Group, Shea Addison, Michael Ashworth, Alan Bainbridge, M R Physicist, Jocelyn Brookes, Lyn Chitty, W K Kling Chong, Andrew Cook, Enrico de Vita, M R Physicist, Roxana Gunny, Brian Harding, Tom Jacques, Rod Jones, Mark Lythgoe, Marion Malone, Wendy Norman, Oystein Olsen, Catherine M Owens, Amaka C Offiah, Nicola Robertson, Tony Risdon, Neil Sebire, Rosemary Scott, Dawn Saunders, Silvia Schievano, Angie Scales, Andrew Taylor, Sudhin Thayyil, Angie Wade, Owen J Arthurs, Sudhin Thayyil, Shea Addison, Angie Wade, Rod Jones, Wendy Norman, Rosemary Scott, Nicola J Robertson, Lyn S Chitty, Andrew M Taylor, Neil J Sebire, Amaka C Offiah, Magnetic Resonance Imaging Autopsy Study (MaRIAS) Collaborative Group, Shea Addison, Michael Ashworth, Alan Bainbridge, M R Physicist, Jocelyn Brookes, Lyn Chitty, W K Kling Chong, Andrew Cook, Enrico de Vita, M R Physicist, Roxana Gunny, Brian Harding, Tom Jacques, Rod Jones, Mark Lythgoe, Marion Malone, Wendy Norman, Oystein Olsen, Catherine M Owens, Amaka C Offiah, Nicola Robertson, Tony Risdon, Neil Sebire, Rosemary Scott, Dawn Saunders, Silvia Schievano, Angie Scales, Andrew Taylor, Sudhin Thayyil, Angie Wade
Abstract
Objectives: The aim of this study was to compare the diagnostic accuracy of postmortem magnetic resonance (PMMR) imaging specifically for musculoskeletal pathology in fetuses and children, compared with conventional autopsy, with radiographic and histopathology assessment.
Methods: Institutional ethics approval and parental consent was obtained. A total of 400 cases underwent PMMR using a 1.5 T Siemens Avanto MR scanner before conventional autopsy. PMMR images and autopsy findings were reported blinded to the other data, respectively.
Results: A total of 400 cases were reported, with 277 (69%) fetuses (185 ≤24 weeks' gestation and 92 >24 weeks' gestation) and 123 children (42 newborns aged <1 month, 53 infants ≤12 months and 28 children ≤16 years). Musculoskeletal (MSK) abnormalities were found at autopsy in 47/400 (11.7%). Overall sensitivity and specificity (with 95% confidence interval) of PMMR for MSK pathology were 51.1% (37.0, 65.0) and 98.2% (96.2, 99.2), with positive and negative predictive values of 79.3% (61.6, 90.2) and 93.8% (90.8, 95.9), respectively. Overall accuracy between PMMR and autopsy for MSK abnormalities was 92.7% (89.7, 94.9). In some cases, PMMR detected MSK abnormalities not routinely examined for or detected at traditional autopsy.
Conclusion: Minimally invasive autopsy has good diagnostic accuracy for the exclusion of MSK abnormalities, but sensitivity is relatively poor. When PMMR is used with clinical examination and skeletal radiographs, all skeletal and soft tissue abnormalities of clinical significance are likely to be detected, even if not directly relevant to the cause of death.
Trial registration: ClinicalTrials.gov NCT01417962.
© 2014 John Wiley & Sons, Ltd.
Source: PubMed