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Indications, advantages and limitations of perinatal postmortem imaging in clinical practice.

Arthurs OJ, Taylor AM, Sebire NJ - Pediatr Radiol (2014)

Bottom Line: Just as there is a range of paediatric imaging techniques available during life, a similar repertoire is available as part of the foetal and perinatal postmortem examination.In this article, we review the literature regarding the diagnostic utility of postmortem radiography, US, CT and MRI in this clinical setting.The main disadvantages of postmortem MRI include the longer duration of imaging, the need for appropriate training in the interpretation of normal postmortem changes, and possible non-diagnostic imaging examinations in early gestation foetuses.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH, UK, owen.arthurs@gosh.nhs.uk.

ABSTRACT
Just as there is a range of paediatric imaging techniques available during life, a similar repertoire is available as part of the foetal and perinatal postmortem examination. In this article, we review the literature regarding the diagnostic utility of postmortem radiography, US, CT and MRI in this clinical setting. There is limited direct evidence on the diagnostic utility of any of these techniques, apart from postmortem MRI, which when combined with other noninvasive investigations, has been shown to be highly sensitive and specific for many foetal postmortem diagnoses. The main disadvantages of postmortem MRI include the longer duration of imaging, the need for appropriate training in the interpretation of normal postmortem changes, and possible non-diagnostic imaging examinations in early gestation foetuses. As less-invasive autopsy becomes increasingly available, the true utility of these techniques will evolve, and clinical guidelines for maximal diagnostic yield can be developed.

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Postmortem imaging in a male fetus of 20 weeks gestation suspected of having skeletal dysplasia. Both postmortem radiograph (a) and postmortem CT image (b) of a foetus terminated for suspected skeletal dysplasia show crumpled long bones and ribs, representing multiple fractures of osteogenesis imperfecta type II. Image (a) reproduced with permission [16]
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Fig4: Postmortem imaging in a male fetus of 20 weeks gestation suspected of having skeletal dysplasia. Both postmortem radiograph (a) and postmortem CT image (b) of a foetus terminated for suspected skeletal dysplasia show crumpled long bones and ribs, representing multiple fractures of osteogenesis imperfecta type II. Image (a) reproduced with permission [16]

Mentions: In the context of foetal and childhood pathology, unenhanced postmortem CT gives excellent bony detail and provides good diagnostic-quality images in suspected skeletal dysplasias, with possible additional benefits from 3-D reconstructions (Fig. 4), and in fracture imaging in suspected neonatal non-accidental injury. However, it is difficult based on available data to quantify any diagnostic advantages of postmortem CT over plain radiography for dysplasia imaging [23], and no robust studies show a diagnostic advantage of postmortem CT over plain radiography for fracture imaging. It may be that bone length/biometry, ossification centres and the developmental stage of deciduous teeth are easier to determine on postmortem CT images than on postmortem radiographs, although only small studies have been carried out to date [24].Fig. 4


Indications, advantages and limitations of perinatal postmortem imaging in clinical practice.

Arthurs OJ, Taylor AM, Sebire NJ - Pediatr Radiol (2014)

Postmortem imaging in a male fetus of 20 weeks gestation suspected of having skeletal dysplasia. Both postmortem radiograph (a) and postmortem CT image (b) of a foetus terminated for suspected skeletal dysplasia show crumpled long bones and ribs, representing multiple fractures of osteogenesis imperfecta type II. Image (a) reproduced with permission [16]
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4381094&req=5

Fig4: Postmortem imaging in a male fetus of 20 weeks gestation suspected of having skeletal dysplasia. Both postmortem radiograph (a) and postmortem CT image (b) of a foetus terminated for suspected skeletal dysplasia show crumpled long bones and ribs, representing multiple fractures of osteogenesis imperfecta type II. Image (a) reproduced with permission [16]
Mentions: In the context of foetal and childhood pathology, unenhanced postmortem CT gives excellent bony detail and provides good diagnostic-quality images in suspected skeletal dysplasias, with possible additional benefits from 3-D reconstructions (Fig. 4), and in fracture imaging in suspected neonatal non-accidental injury. However, it is difficult based on available data to quantify any diagnostic advantages of postmortem CT over plain radiography for dysplasia imaging [23], and no robust studies show a diagnostic advantage of postmortem CT over plain radiography for fracture imaging. It may be that bone length/biometry, ossification centres and the developmental stage of deciduous teeth are easier to determine on postmortem CT images than on postmortem radiographs, although only small studies have been carried out to date [24].Fig. 4

Bottom Line: Just as there is a range of paediatric imaging techniques available during life, a similar repertoire is available as part of the foetal and perinatal postmortem examination.In this article, we review the literature regarding the diagnostic utility of postmortem radiography, US, CT and MRI in this clinical setting.The main disadvantages of postmortem MRI include the longer duration of imaging, the need for appropriate training in the interpretation of normal postmortem changes, and possible non-diagnostic imaging examinations in early gestation foetuses.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH, UK, owen.arthurs@gosh.nhs.uk.

ABSTRACT
Just as there is a range of paediatric imaging techniques available during life, a similar repertoire is available as part of the foetal and perinatal postmortem examination. In this article, we review the literature regarding the diagnostic utility of postmortem radiography, US, CT and MRI in this clinical setting. There is limited direct evidence on the diagnostic utility of any of these techniques, apart from postmortem MRI, which when combined with other noninvasive investigations, has been shown to be highly sensitive and specific for many foetal postmortem diagnoses. The main disadvantages of postmortem MRI include the longer duration of imaging, the need for appropriate training in the interpretation of normal postmortem changes, and possible non-diagnostic imaging examinations in early gestation foetuses. As less-invasive autopsy becomes increasingly available, the true utility of these techniques will evolve, and clinical guidelines for maximal diagnostic yield can be developed.

Show MeSH
Related in: MedlinePlus