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Normal perinatal and paediatric postmortem magnetic resonance imaging appearances.

Arthurs OJ, Barber JL, Taylor AM, Sebire NJ - Pediatr Radiol (2015)

Bottom Line: A thorough knowledge of normal postmortem changes is therefore required within postmortem magnetic resonance imaging to ensure that these are not mistakenly interpreted as significant pathology.Similarly, some changes that are interpreted as pathological if they occur during life may be artefacts on postmortem magnetic resonance imaging that are of limited significance.This review serves to illustrate briefly those postmortem magnetic resonance imaging changes as part of the normal changes after death in fetuses and children, and highlight imaging findings that may confuse or mislead an observer to identifying pathology where none is present.

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
As postmortem imaging becomes more widely used following perinatal and paediatric deaths, the correct interpretation of images becomes imperative, particularly given the increased use of postmortem magnetic resonance imaging. Many pathological processes may have similar appearances in life and following death. A thorough knowledge of normal postmortem changes is therefore required within postmortem magnetic resonance imaging to ensure that these are not mistakenly interpreted as significant pathology. Similarly, some changes that are interpreted as pathological if they occur during life may be artefacts on postmortem magnetic resonance imaging that are of limited significance. This review serves to illustrate briefly those postmortem magnetic resonance imaging changes as part of the normal changes after death in fetuses and children, and highlight imaging findings that may confuse or mislead an observer to identifying pathology where none is present.

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Dependent lung changes. Axial high-resolution T2-weighted postmortem magnetic resonance imaging in a term stillbirth. There are dependent changes in both lungs, which are a normal finding. There is also normal postmortem sedimentation or layering of blood in the heart, shown as a fluid-fluid level (white arrow). Note that by imaging earlier in the postmortem interval in this case, fluid redistribution and gas in the heart may not yet have accumulated (compared to Figs. 4 and 5)
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Fig6: Dependent lung changes. Axial high-resolution T2-weighted postmortem magnetic resonance imaging in a term stillbirth. There are dependent changes in both lungs, which are a normal finding. There is also normal postmortem sedimentation or layering of blood in the heart, shown as a fluid-fluid level (white arrow). Note that by imaging earlier in the postmortem interval in this case, fluid redistribution and gas in the heart may not yet have accumulated (compared to Figs. 4 and 5)

Mentions: Autolysis, and maceration where appropriate, is likely to account for several of the changes of fluid accumulation that are observed with cellular breakdown. In the postmortem fetus and child, fluid normally accumulates in the subcutaneous tissues, pleural space, pericardial sac and peritoneal cavity (Figs. 4 and 5), none of which represents a pathological process in most cases. The relative distribution of fluid between body compartments is usually evenly distributed and typically gravity dependent; fluid accumulation in one compartment out of proportion to the others may be considered pathological. For example, together with difficulties in interpreting postmortem changes in the lungs (Fig. 6), pleural effusions could be interpreted as parapneumonic effusions (and may therefore suggest a cause of death), whereas effusions in keeping with the degree of fluid redistribution elsewhere in the subcutaneous tissues and ascites is likely to be non-pathological. Foetal hydrops can therefore sometimes be difficult to discriminate from normal postmortem changes, and it may be only the antemortem history or antenatal US examinations that may suggest the difference.Fig. 4


Normal perinatal and paediatric postmortem magnetic resonance imaging appearances.

Arthurs OJ, Barber JL, Taylor AM, Sebire NJ - Pediatr Radiol (2015)

Dependent lung changes. Axial high-resolution T2-weighted postmortem magnetic resonance imaging in a term stillbirth. There are dependent changes in both lungs, which are a normal finding. There is also normal postmortem sedimentation or layering of blood in the heart, shown as a fluid-fluid level (white arrow). Note that by imaging earlier in the postmortem interval in this case, fluid redistribution and gas in the heart may not yet have accumulated (compared to Figs. 4 and 5)
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4381098&req=5

Fig6: Dependent lung changes. Axial high-resolution T2-weighted postmortem magnetic resonance imaging in a term stillbirth. There are dependent changes in both lungs, which are a normal finding. There is also normal postmortem sedimentation or layering of blood in the heart, shown as a fluid-fluid level (white arrow). Note that by imaging earlier in the postmortem interval in this case, fluid redistribution and gas in the heart may not yet have accumulated (compared to Figs. 4 and 5)
Mentions: Autolysis, and maceration where appropriate, is likely to account for several of the changes of fluid accumulation that are observed with cellular breakdown. In the postmortem fetus and child, fluid normally accumulates in the subcutaneous tissues, pleural space, pericardial sac and peritoneal cavity (Figs. 4 and 5), none of which represents a pathological process in most cases. The relative distribution of fluid between body compartments is usually evenly distributed and typically gravity dependent; fluid accumulation in one compartment out of proportion to the others may be considered pathological. For example, together with difficulties in interpreting postmortem changes in the lungs (Fig. 6), pleural effusions could be interpreted as parapneumonic effusions (and may therefore suggest a cause of death), whereas effusions in keeping with the degree of fluid redistribution elsewhere in the subcutaneous tissues and ascites is likely to be non-pathological. Foetal hydrops can therefore sometimes be difficult to discriminate from normal postmortem changes, and it may be only the antemortem history or antenatal US examinations that may suggest the difference.Fig. 4

Bottom Line: A thorough knowledge of normal postmortem changes is therefore required within postmortem magnetic resonance imaging to ensure that these are not mistakenly interpreted as significant pathology.Similarly, some changes that are interpreted as pathological if they occur during life may be artefacts on postmortem magnetic resonance imaging that are of limited significance.This review serves to illustrate briefly those postmortem magnetic resonance imaging changes as part of the normal changes after death in fetuses and children, and highlight imaging findings that may confuse or mislead an observer to identifying pathology where none is present.

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
As postmortem imaging becomes more widely used following perinatal and paediatric deaths, the correct interpretation of images becomes imperative, particularly given the increased use of postmortem magnetic resonance imaging. Many pathological processes may have similar appearances in life and following death. A thorough knowledge of normal postmortem changes is therefore required within postmortem magnetic resonance imaging to ensure that these are not mistakenly interpreted as significant pathology. Similarly, some changes that are interpreted as pathological if they occur during life may be artefacts on postmortem magnetic resonance imaging that are of limited significance. This review serves to illustrate briefly those postmortem magnetic resonance imaging changes as part of the normal changes after death in fetuses and children, and highlight imaging findings that may confuse or mislead an observer to identifying pathology where none is present.

Show MeSH
Related in: MedlinePlus