Post-mortem MRI as an alternative to non-forensic autopsy in foetuses and children: from research into clinical practice

Abstract

Although post-mortem MRI (PMMR) was proposed as an alternative to conventional autopsy more than a decade ago, the lack of systematic validation has limited its clinical uptake. Minimally invasive autopsy (MIA) using PMMR together with ancillary investigations has now been shown to be as accurate as conventional autopsy in foetuses, newborns and infants and is particularly useful for cerebral, cardiac and genitourinary imaging. Unlike conventional autopsy, PMMR provides a permanent three-dimensional auditable record, with accurate estimation of internal organ volumes. MIA is becoming highly acceptable to parents and professionals, and there is widespread political support and public interest in its clinical implementation in the UK. In the short to medium term, it is desirable that a supraregional network of specialist centres should be established to provide this service within the current National Health Service framework.

Figures

Figure 1.

Changes in the neonatal autopsy rate (line with diamonds) and proportion of cases in which autopsy was offered to parents (line with squares) between 2000 and 2007 in the UK (adapted from the CEMACH data).

Figure 2.

Post-mortem MRI (axial T2 weighted sequence) of a four-year-old child with leukoencephalopathy, showing capillary haemangioma in the occipital region (arrow) with underlying white matter disease (a). Histology (haematoxylin and eosin stain) showing the capillary haemangioma (b).

Figure 3.

Rapid prototyping of foetal and neonatal organs from post-mortem MRI data. (a) Foetal brain inside the skull. Cerebrospinal fluid is shown in white with black arrow and intraventricular bleed in grey with black arrowhead. (b) Liver of a newborn. (c) Parietal skull fracture in an infant. (d) Foetal heart.

Figure 4.

Comparison of post-mortem MRI (a) and post-mortem CT (b) of a 27-week-old foetus with renal dysplasia (arrows). Visceral organs are not clearly seen on post-mortem CT, whilst the bony skeleton is clearly displayed on reconstruction of the CT image (c).