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Lamouroux A, Cardoso M, Bottero C, Gallo M, Duraes M, Salerno J, Bertrand M, Rigau V, Fuchs F, Mousty E, Genevieve D, Subsol G, Goze-Bac C, Captier G. Micro-CT and high-field MRI for studying very early post-mortem human fetal anatomy at 8 weeks of gestation. Prenat Diagn 2024; 44:3-14. [PMID: 38161284 DOI: 10.1002/pd.6489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 10/19/2023] [Accepted: 12/02/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE This study involved very early post-mortem (PM) examination of human fetal anatomy at 8 weeks of gestation (WG) using whole-body multimodal micro-imaging: micro-CT and high-field MRI (HF-MRI). We discuss the potential place of this imaging in early first-trimester virtual autopsy. METHODS We performed micro-CT after different contrast-bath protocols including diffusible iodine-based contrast-enhanced (dice) and HF-MRI with a 9.4 T machine with qualitative and quantitative evaluation and obtained histological sections. RESULTS Nine fetuses were included: the crown-rump length was 10-24 mm and corresponded to 7 and 9 WG according to the Robinson formula. The Carnegie stages were 17-21. Dice micro-CT and HF-MRI presented high signal to noise ratio, >5, according to the Rose criterion, and for allowed anatomical phenotyping in these specimens. Imaging did not alter the histology, allowing immunostaining and pathological examination. CONCLUSION PM non-destructive whole-body multimodal micro-imaging: dice micro-CT and HF-MRI allows for PM human fetal anatomy study as early as 8 WG. It paves the way to virtual autopsy in the very early first trimester. Obtaining a precision phenotype, even regarding miscarriage products, allows a reverse phenotyping to select variants of interest in genome-wide analysis, offering potential genetic counseling for bereaved parents.
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Affiliation(s)
- Audrey Lamouroux
- Clinical Genetics Department, Montpellier University Hospital, University of Montpellier, Montpellier, France
- Obstetrical Gynaecology Department, Nîmes University Hospital, University of Montpellier, Nîmes, France
- Charles Coulomb Laboratory, UMR 5221 CNRS-UM, BNIF User Facility Imaging, University of Montpellier, CNRS, Montpellier, France
- ICAR Research Team, LIRMM, University of Montpellier, CNRS, Montpellier, France
- Univ. Montpellier, Montpellier, France
| | - Maïda Cardoso
- Charles Coulomb Laboratory, UMR 5221 CNRS-UM, BNIF User Facility Imaging, University of Montpellier, CNRS, Montpellier, France
- Univ. Montpellier, Montpellier, France
| | - Célia Bottero
- Obstetrical Gynaecology Department, Nîmes University Hospital, University of Montpellier, Nîmes, France
- Univ. Montpellier, Montpellier, France
| | - Mathieu Gallo
- Univ. Montpellier, Montpellier, France
- Pathology Department, Montpellier University Hospital, University of Montpellier, Montpellier, France
| | - Martha Duraes
- ICAR Research Team, LIRMM, University of Montpellier, CNRS, Montpellier, France
- Univ. Montpellier, Montpellier, France
- Anatomy Laboratory, Faculty of Medicine Montpellier-Nimes, University of Montpellier, Montpellier, France
- Obstetrical Gynaecology Department, Montpellier University Hospital, University of Montpellier, Montpellier, France
| | - Jennifer Salerno
- Obstetrical Gynaecology Department, Nîmes University Hospital, University of Montpellier, Nîmes, France
- Univ. Montpellier, Montpellier, France
- Gynaecology and Gynaecology Surgery Department, Clinique Beau Soleil, Montpellier, France
| | - Martin Bertrand
- Univ. Montpellier, Montpellier, France
- Experimental Anatomy Department, Faculty of Medicine Montpellier-Nimes, University Montpellier, Nîmes, France
- Digestive Surgery Department, Nimes University Hospital, Nîmes, France
| | - Valérie Rigau
- Univ. Montpellier, Montpellier, France
- Pathology Department, Montpellier University Hospital, University of Montpellier, Montpellier, France
| | - Florent Fuchs
- Univ. Montpellier, Montpellier, France
- Obstetrical Gynaecology Department, Montpellier University Hospital, University of Montpellier, Montpellier, France
- Inserm, CESP Center for Research in Epidemiology and Population Health, U1018, Reproduction and Child Development, Villejuif, France
- Desbrest Institute of Epidemiology and Public Health (IDESP), University of Montpellier, INSERM, Montpellier, France
| | - Eve Mousty
- Obstetrical Gynaecology Department, Nîmes University Hospital, University of Montpellier, Nîmes, France
- Univ. Montpellier, Montpellier, France
| | - David Genevieve
- Clinical Genetics Department, Montpellier University Hospital, University of Montpellier, Montpellier, France
- Univ. Montpellier, Montpellier, France
- Center for Rare Disease Development Anomaly and Malformative Syndromes, Montpellier University Hospital, Montpellier, France
| | - Gérard Subsol
- ICAR Research Team, LIRMM, University of Montpellier, CNRS, Montpellier, France
- Univ. Montpellier, Montpellier, France
| | - Christophe Goze-Bac
- Charles Coulomb Laboratory, UMR 5221 CNRS-UM, BNIF User Facility Imaging, University of Montpellier, CNRS, Montpellier, France
- Univ. Montpellier, Montpellier, France
| | - Guillaume Captier
- ICAR Research Team, LIRMM, University of Montpellier, CNRS, Montpellier, France
- Univ. Montpellier, Montpellier, France
- Anatomy Laboratory, Faculty of Medicine Montpellier-Nimes, University of Montpellier, Montpellier, France
- Paediatric Surgery Department, Montpellier University Hospital, University of Montpellier, Montpellier, France
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An P, Song L, Song P, Zhang J, Lin Y, Feng G, Liu J. Exploring the Role of Modified Vascular Anatomical Molding (MVAM) in Prenatal Diagnosis Teaching and Prognosis Prediction of Fetal Complex Congenital Heart Disease (CCHD): A Preliminary Study. Int J Gen Med 2023; 16:3229-3245. [PMID: 37546241 PMCID: PMC10403051 DOI: 10.2147/ijgm.s421751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 07/26/2023] [Indexed: 08/08/2023] Open
Abstract
Objective The present study aimed to explore the role of modified vascular anatomical molding (MVAM) in prenatal diagnosis teaching and prognosis prediction of fetal complex congenital heart disease (CCHD). Methods Step 1, MVAM method was used to cast the micro-blood vessels and trachea of 52 CCHD specimens. Subsequently, 52 MVAMs were analyzed and compared with the prenatal ultrasound to summarize their characteristics, misdiagnosis and MVAM's teaching role. Step 2, the surgical and follow-up data of 206 CCHD cases were retrospectively analyzed. Cases that evolved into critical illnesses or died within 1-3 years after surgery (poor prognosis) were classified into the study group (n = 77) and those with good prognosis into the control group (n = 129), which were split into the training set and the test set in the ratio 7:3 based on the time cut-off. In the training set, the prognosis of CCHD was predicted using the MVAM anatomical soft markers (distortion and narrowing of aorta/pulmonary artery, right ventricular infundibulum, etc.) and the decision curve analysis (DCA) performed. The model was validated using the test set, and a nomogram was finally established. Results It was observed that all 52 CCHD cases were confirmed using MVAM. A total of 91 cardiac malformations were recorded, among which 41 malformations were misdiagnosed, and 29 malformations were missed by the prenatal echocardiography. The MVAM method has a good teaching/feedback effect on prenatal diagnosis. The combined model exhibited a higher predictive performance in the training- and test-set. Its high clinical net benefit was proved by DCA. Additionally, the nomogram established using the combined model received a favorable response in clinical practice. Conclusion The research results indicated that MVAM improved the prenatal diagnosis teaching and training performance. The combined model established based on MVAM anatomical soft markers can offer a high clinical significance for prognosis prediction of CCHD.
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Affiliation(s)
- Peng An
- Department of Radiology, Xiangyang No.1 People’s Hospital, Hubei University of Medicine, Xiangyang, 441000, People’s Republic of China
- Hubei Provincial Clinical Research Center for Accurate Fetus Malformation Diagnosis, Hubei University of Medicine, Xiangyang, Hubei Province, 441000, People’s Republic of China
| | - Lina Song
- Department of Radiology, Xiangyang No.1 People’s Hospital, Hubei University of Medicine, Xiangyang, 441000, People’s Republic of China
| | - Ping Song
- Department of Obstetrics and Gynecology, Xiangyang No. 1 People’s Hospital, Hubei University of Medicine, Xiangyang, 441000, People’s Republic of China
| | - Junyan Zhang
- Department of Radiology, Xiangyang No.1 People’s Hospital, Hubei University of Medicine, Xiangyang, 441000, People’s Republic of China
- Department of Obstetrics and Gynecology, Xiangyang No. 1 People’s Hospital, Hubei University of Medicine, Xiangyang, 441000, People’s Republic of China
| | - Yong Lin
- Department of Radiology, Xiangyang No.1 People’s Hospital, Hubei University of Medicine, Xiangyang, 441000, People’s Republic of China
- Department of Obstetrics and Gynecology, Xiangyang No. 1 People’s Hospital, Hubei University of Medicine, Xiangyang, 441000, People’s Republic of China
| | - Guoyan Feng
- Department of Radiology, Xiangyang No.1 People’s Hospital, Hubei University of Medicine, Xiangyang, 441000, People’s Republic of China
| | - Junjie Liu
- Department of Obstetrics and Gynecology, Xiangyang No. 1 People’s Hospital, Hubei University of Medicine, Xiangyang, 441000, People’s Republic of China
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Simcock IC, Lamouroux A, Sebire NJ, Shelmerdine SC, Arthurs OJ. Less-invasive autopsy for early pregnancy loss. Prenat Diagn 2023; 43:937-949. [PMID: 37127547 DOI: 10.1002/pd.6361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 04/20/2023] [Accepted: 04/21/2023] [Indexed: 05/03/2023]
Abstract
Autopsy investigations provide valuable information regarding fetal death that can assist in the parental bereavement process, and influence future pregnancies, but conventional autopsy is often declined by parents because of its invasive approach. This has led to the development of less-invasive autopsy investigations based on imaging technology to provide a more accessible and acceptable choice for parents when investigating their loss. Whilst the development and use of more conventional clinical imaging techniques (radiographs, CT, MRI, US) are well described in the literature for fetuses over 20 weeks of gestational age, these investigations have limited diagnostic accuracy in imaging smaller fetuses. Techniques such as ultra-high-field MRI (>3T) and micro-focus computed tomography have been shown to have higher diagnostic accuracy whilst still being acceptable to parents. By further developing and increasing the availability of these more innovative imaging techniques, parents will be provided with a greater choice of acceptable options to investigate their loss, which may in turn increase their uptake. We provide a narrative review focussing on the development of high-resolution, non-invasive imaging techniques to evaluate early gestational pregnancy loss.
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Affiliation(s)
- Ian C Simcock
- Department of Clinical Radiology, Great Ormond Street Hospital for Children, London, UK
- UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital for Children, London, UK
- NIHR Great Ormond Street Hospital Biomedical Research Centre, London, UK
| | - Audrey Lamouroux
- Department of Clinical Radiology, Great Ormond Street Hospital for Children, London, UK
- Obstetrical Gynaecology Department, Nîmes University Hospital, Nîmes, France
- Clinical Genetics Department, Montpellier University Hospital, Montpellier, France
- ICAR Research Team, LIRMM, CNRS and Charles Coulomb Laboratory, UMR 5221 CNRS-UM, BNIF User Facility Imaging, University of Montpellier, Nîmes and Montpellier, Montpellier, France
| | - Neil J Sebire
- UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital for Children, London, UK
- NIHR Great Ormond Street Hospital Biomedical Research Centre, London, UK
- Department of Histopathology, Great Ormond Street Hospital for Children, London, UK
| | - Susan C Shelmerdine
- Department of Clinical Radiology, Great Ormond Street Hospital for Children, London, UK
- UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital for Children, London, UK
- NIHR Great Ormond Street Hospital Biomedical Research Centre, London, UK
| | - Owen J Arthurs
- Department of Clinical Radiology, Great Ormond Street Hospital for Children, London, UK
- UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital for Children, London, UK
- NIHR Great Ormond Street Hospital Biomedical Research Centre, London, UK
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Ruican D, Petrescu AM, Istrate-Ofiţeru AM, Roșu GC, Zorilă GL, Dîră LM, Nagy RD, Mogoantă L, Pirici D, Iliescu DG. Confirmation of Heart Malformations in Fetuses in the First Trimester Using Three-Dimensional Histologic Autopsy. Obstet Gynecol 2023:00006250-990000000-00767. [PMID: 37141594 PMCID: PMC10184816 DOI: 10.1097/aog.0000000000005169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 02/09/2023] [Indexed: 05/06/2023]
Abstract
BACKGROUND We aimed to evaluate the usefulness of three-dimensional (3D) reconstruction of histology slides to confirm congenital heart disease (CHD) detected by first-trimester fetal cardiac ultrasonography. Conventional autopsy is hindered by the small size of the first-trimester fetal heart, and current CHD confirmation studies employ the use of highly specialized and expensive methods. TECHNIQUE An extended first-trimester ultrasound examination protocol was used to diagnose fetal heart anomalies. Medical termination of pregnancies was followed by fetal heart extraction. The specimens were sliced, and the histology slides were stained and scanned. The resulting images were processed, and volume rendering was performed using 3D reconstruction software. The volumes were analyzed by a multidisciplinary team of maternal-fetal medicine subspecialists and pathologists and compared with ultrasound examination findings. EXPERIENCE Six fetuses with heart malformations were evaluated using histologic 3D imaging: two with hypoplastic left heart syndrome, two with atrioventricular septal defects, one with an isolated ventricular septal defect, and one with transposition of the great arteries. The technique allowed us to confirm ultrasound-detected anomalies and also identified additional malformations. CONCLUSION After pregnancy termination or loss, histologic 3D imaging can be used to confirm the presence of fetal cardiac malformations detected during first-trimester ultrasound examination. Additionally, this technique has the potential to refine the diagnosis for counseling regarding recurrence risk and retains the advantages of standard histology.
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Affiliation(s)
- Dan Ruican
- Department of Obstetrics and Gynecology, University Emergency County Hospital, and the Doctoral School, the Department of Histology, the Research Centre for Microscopic Morphology and Immunology, and the Department of Obstetrics and Gynecology, University of Medicine and Pharmacy of Craiova, Craiova, Romania
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O'Keefe H, Shenfine R, Brown M, Beyer F, Rankin J. Are non-invasive or minimally invasive autopsy techniques for detecting cause of death in prenates, neonates and infants accurate? A systematic review of diagnostic test accuracy. BMJ Open 2023; 13:e064774. [PMID: 36609326 PMCID: PMC9827258 DOI: 10.1136/bmjopen-2022-064774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 12/04/2022] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES To assess the diagnostic accuracy of non-invasive or minimally invasive autopsy techniques in deaths under 1 year of age. DESIGN This is a systematic review of diagnostic test accuracy. The protocol is registered on PROSPERO. PARTICIPANTS Deaths from conception to one adjusted year of age. SEARCH METHODS MEDLINE (Ovid), EMBASE (Ovid), CINAHL (EBSCO), the Cochrane Library, Scopus and grey literature sources were searched from inception to November 2021. DIAGNOSTIC TESTS Non-invasive or minimally invasive diagnostic tests as an alternative to traditional autopsy. DATA COLLECTION AND ANALYSIS Studies were included if participants were under one adjusted year of age, with index tests conducted prior to the reference standard.Data were extracted from eligible studies using piloted forms. Risk of bias was assessed using Quality Assessment of Diagnostic Accuracy Studies-2. A narrative synthesis was conducted following the Synthesis without Meta-Analysis guidelines. Vote counting was used to assess the direction of effect. MAIN OUTCOME MEASURES Direction of effect was expressed as percentage of patients per study. FINDINGS We included 54 direct evidence studies (68 articles/trials), encompassing 3268 cases and eight index tests. The direction of effect was positive for postmortem ultrasound and antenatal echography, although with varying levels of success. Conversely, the direction of effect was against virtual autopsy. For the remaining tests, the direction of effect was inconclusive.A further 134 indirect evidence studies (135 articles/trials) were included, encompassing 6242 perinatal cases. The addition of these results had minimal impact on the direct findings yet did reveal other techniques, which may be favourable alternatives to autopsy.Seven trial registrations were included but yielded no results. CONCLUSIONS Current evidence is insufficient to make firm conclusions about the generalised use of non-invasive or minimally invasive autopsy techniques in relation to all perinatal population groups.PROSPERO registration numberCRD42021223254.
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Affiliation(s)
- Hannah O'Keefe
- NIHR Innovation Observatory, Newcastle University, Newcastle upon Tyne, UK
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Rebekka Shenfine
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Melissa Brown
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Fiona Beyer
- NIHR Innovation Observatory, Newcastle University, Newcastle upon Tyne, UK
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Judith Rankin
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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Accuracy and clinical utility of standard postmortem radiological imaging after early second trimester termination of pregnancy. Eur J Obstet Gynecol Reprod Biol 2022; 273:75-80. [PMID: 35504117 DOI: 10.1016/j.ejogrb.2022.04.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 04/09/2022] [Accepted: 04/24/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVE This study aims to assess accuracy and clinical utility of postmortem radiological exams [Magnetic Resonance Imaging (MRI), Computed Tomography (CT) and Radiography (XR)] after termination of pregnancy at <23 weeks' gestation for congenital fetal malformations in comparison to autopsy. STUDY DESIGN This a prospective single-center study on fetuses underwent termination of pregnancy for fetal defects. Overall concordance between any radiological exam and autopsy was evaluated. For postmortem MRI only, the following subgroups were analyzed: 1) total agreement; 2) agreement for main findings; 3) agreement for main findings but major relevant additional findings at autopsy; 4) total disagreement. RESULTS 174 cases were collected. The overall concordance with autopsy for main findings was 71% (115/163) for postmortem MRI and 99% (173/174) for prenatal ultrasound (US). Postmortem MRI detection rate was high for central nervous system (CNS) defects (98%), gastrointestinal, genitourinary and respiratory defects (100%), while it was poor for cardiovascular and musculoskeletal defects (25% and 42%, respectively). For musculoskeletal abnormalities, the performance of postmortem XR and postmortem CT exams improved the detection rate from 42% for postmortem MRI alone to 92%. CONCLUSIONS Postmortem MRI has a good overall concordance for fetal defects after termination of pregnancy performed at <23 weeks. Along with autopsy, postmortem MRI may be offered for all cases of CNS defects in order to prevent inconclusive exams due to autolysis of the brain tissue, while postmortem CT and postmortem XR are indicated for musculoskeletal defects. In the presence of multiple abnormalities or cardiac defects the couple should be counseled on the poor performance of radiological investigations.
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Tang H, Zhang Y, Dai C, Ru T, Li J, Chen J, Zhang B, Zhou K, Lv P, Liu R, Zhou Q, Zheng M. Postmortem 9.4-T MRI for Fetuses With Congenital Heart Defects Diagnosed in the First Trimester. Front Cardiovasc Med 2022; 8:764587. [PMID: 35155595 PMCID: PMC8830519 DOI: 10.3389/fcvm.2021.764587] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 12/24/2021] [Indexed: 11/13/2022] Open
Abstract
ObjectiveTo evaluate the feasibility of 9. 4-T postmortem MRI (pm-MRI) for assessment of major congenital heart defects (CHD) cases terminated in the early stage of gestation.MethodsFetuses with CHD detected by the detailed first-trimester ultrasound scan and terminated before 18 gestational weeks were recruited between January 2018 and June 2020. All fetuses were offered 9.4-T pm-MRI examinations and those terminated over 13+6 weeks were offered conventional autopsies simultaneously. Findings of pm-MRI were compared with those of conventional autopsy and prenatal ultrasound.ResultsA total of 19 fetuses with major CHD were analyzed, including 6 cases of the atrioventricular septal defect, 5 cases of Tetralogy of Fallot, 3 cases of hypoplastic left heart syndrome, 1 case of tricuspid atresia, 1 case of transposition of the great arteries, 1 case of severe tricuspid regurgitation, and 2 cases of complex CHD. Pm-MRI had concordant findings in 73.7% (14/19) cases, discordant findings in 15.8% (3/19) cases, and additional findings in 10.5% (2/19) cases when compared with prenatal ultrasound. Pm-MRI findings were concordant with autopsy in all 8 CHD cases terminated over 13+6 weeks.ConclusionIt is feasible to exhibit the structure of fetal heart terminated in the first trimester clearly on 9.4-T pm-MRI with an optimized scanning protocol. High-field pm-MRI could provide medical imaging information of CHD for those terminated in the early stage of gestation, especially for those limited by conventional autopsy.
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Affiliation(s)
- Huirong Tang
- Department of Obstetrics and Gynecology, The Affiliated Drum and Tower Hospital of Medical School of Nanjing University, Nanjing, China
| | - Yan Zhang
- Department of Obstetrics and Gynecology, The Affiliated Drum and Tower Hospital of Medical School of Nanjing University, Nanjing, China
| | - Chenyan Dai
- Department of Obstetrics and Gynecology, The Affiliated Drum and Tower Hospital of Medical School of Nanjing University, Nanjing, China
| | - Tong Ru
- Department of Obstetrics and Gynecology, The Affiliated Drum and Tower Hospital of Medical School of Nanjing University, Nanjing, China
| | - Jie Li
- Department of Obstetrics and Gynecology, The Affiliated Drum and Tower Hospital of Medical School of Nanjing University, Nanjing, China
| | - Jieyu Chen
- Department of Pathology, The Affiliated Drum and Tower Hospital of Medical School of Nanjing University, Nanjing, China
| | - Bing Zhang
- Department of Radiology, The Affiliated Drum and Tower Hospital of Medical School of Nanjing University, Nanjing, China
| | - Kefeng Zhou
- Department of Radiology, The Affiliated Drum and Tower Hospital of Medical School of Nanjing University, Nanjing, China
| | - Pin Lv
- Department of Radiology, The Affiliated Drum and Tower Hospital of Medical School of Nanjing University, Nanjing, China
| | - Renyuan Liu
- Department of Radiology, The Affiliated Drum and Tower Hospital of Medical School of Nanjing University, Nanjing, China
| | - Qing Zhou
- Department of Cardiac Surgery, The Affiliated Drum and Tower Hospital of Medical School of Nanjing University, Nanjing, China
| | - Mingming Zheng
- Department of Obstetrics and Gynecology, The Affiliated Drum and Tower Hospital of Medical School of Nanjing University, Nanjing, China
- *Correspondence: Mingming Zheng
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Ulm B, Dovjak GO, Scharrer A, Muin DA, Zimpfer D, Prayer D, Weber M, Berger-Kulemann V. Diagnostic quality of 3Tesla postmortem magnetic resonance imaging in fetuses with and without congenital heart disease. Am J Obstet Gynecol 2021; 225:189.e1-189.e30. [PMID: 33662361 DOI: 10.1016/j.ajog.2021.02.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 02/16/2021] [Accepted: 02/18/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Postmortem confirmation of prenatally diagnosed congenital heart disease after termination of pregnancy and evaluation of potential cardiac defects after spontaneous fetal or neonatal death are essential. Conventional autopsy rates are decreasing, and 1.5Tesla magnetic resonance imaging has demonstrated limited diagnostic accuracy for postmortem cardiovascular assessment. OBJECTIVE This study aimed to evaluate the feasibility and image quality of cardiac 3Tesla postmortem magnetic resonance imaging and to assess its diagnostic accuracy in detecting fetal heart defects compared with conventional autopsy. Secondarily, the study aimed to explore whether clinical factors affect the quality of 3Tesla postmortem magnetic resonance imaging. STUDY DESIGN A total of 222 consecutive fetuses between 12 and 41 weeks' gestation, who underwent 3Tesla postmortem magnetic resonance imaging and conventional autopsy after spontaneous death or termination of pregnancy for fetal malformations, were included. First, 3Tesla postmortem magnetic resonance imaging of each fetus was rated as diagnostic or nondiagnostic for fetal cardiac assessment by 2 independent raters. The image quality of individual cardiac structures was then further evaluated by visual grading analysis. Finally, the presence or absence of a congenital heart defect was assessed by 2 radiologists and compared with autopsy results. RESULTS Overall, 87.8% of 3Tesla postmortem magnetic resonance imaging examinations were rated as diagnostic for the fetal heart. Diagnostic imaging rates of individual cardiac structures at 3Tesla postmortem magnetic resonance imaging ranged from 85.1% (atrioventricular valves) to 94.6% (pericardium), with an interrater agreement of 0.82 (0.78-0.86). Diagnostic imaging of the fetal aortic arch and the systemic veins at 3Tesla postmortem magnetic resonance imaging was possible from 12+5 weeks' gestation onward in 90.1% and 92.3% of cases, respectively. A total of 55 fetuses (24.8%) had at least 1 cardiac anomaly according to autopsy, 164 (73.9%) had a normal heart, and in 3 fetuses (1.4%), autopsy was nondiagnostic for the heart. Considering all examinations rated as diagnostic, 3Tesla postmortem magnetic resonance imaging provided high diagnostic accuracy for the detection of fetal congenital heart defects with a sensitivity of 87.8%, a specificity of 97.9%, and concordance with autopsy of 95.3%. 3Tesla postmortem magnetic resonance imaging was less accurate in young fetuses (<20 weeks compared with ≥20 weeks; P<.001), in fetuses with low birthweight (≤100 g compared with >100 g; P<.001), in cases after spontaneous fetal death (compared with other modes of death; P=.012), in cases with increasing latency between death and 3Tesla postmortem magnetic resonance imaging (P<.001), and in cases in which there was a high degree of maceration (maceration score of 3 compared with a score from 0 to 2; P=.004). CONCLUSION Diagnostic 3Tesla postmortem magnetic resonance imaging assessment of the fetal heart is feasible in most fetuses from 12 weeks' gestation onward. In diagnostic images, sensitivity and, particularly, specificity in the detection of congenital heart disease are high compared with conventional autopsy. Owing to its high diagnostic accuracy, we suggest that 3Tesla postmortem magnetic resonance imaging may serve as a suitable imaging modality with which to direct a targeted conventional autopsy when pathology resources are limited or to provide a virtual autopsy when full autopsy is declined by the parents.
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Affiliation(s)
- Barbara Ulm
- Division of Obstetrics and Fetomaternal Medicine, Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria.
| | - Gregor O Dovjak
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Anke Scharrer
- Department of Pathology, Medical University of Vienna, Vienna, Austria
| | - Dana A Muin
- Division of Obstetrics and Fetomaternal Medicine, Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - Daniel Zimpfer
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Daniela Prayer
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Michael Weber
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Vanessa Berger-Kulemann
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
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Utility of a modified vascular corrosion casting technique in the diagnosis of fetal total anomalous pulmonary venous connection. Sci Rep 2021; 11:11281. [PMID: 34050234 PMCID: PMC8163765 DOI: 10.1038/s41598-021-90681-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 05/04/2021] [Indexed: 12/30/2022] Open
Abstract
Total anomalous pulmonary venous connection (TAPVC) is a rare congenital cardiac malformation, and prenatal detection of TAPVC malformation remains a challenging. TAPVC can be easily missed or misdiagnosed in prenatal examinations. This study was aimed to use the modified vascular corrosion casting technique to prepare fetal cardiovascular casts with TAPVC and investigate the utility of cardiovascular casting for the demonstration of fetal TAPVC. The retrospective study enrolled twenty fetuses (22 to 29 + 4 gestational weeks) with TAPVC diagnosed by prenatal echocardiography and casting technique from May 2015 to May 2020. Pre- and postnatal medical records, including results obtained by prenatal ultrasound, postpartum computed tomography angiography, as well as anatomic and cardiovascular casting findings were carefully reviewed and analyzed. In twenty cases, 80% (16/20) had intra- or extracardiac malformations. The TAPVC types were supracardiac (n = 8), cardiac (n = 6), infracardiac (n = 4), and mixed (n = 2). The diagnosis of 1 case each of supracardiac and cardiac TAPVC was modified to partial anomalous pulmonary venous connection; additionally, 4 malformations were missed and 2 were misdiagnosed, including an anomalous left brachiocephalic vein in supracardiac TAPVC, abnormal inflow of the hepatic vein and a double inferior vena cava in infracardiac TAPVC; and bilateral ductus arteriosus in infracardiac TAPVC; a tetralogy of Fallot in cardiac TAPVC that was corrected to right ventricular double outlet; and an absence of ductus arteriosus that was misdiagnosed as slim ductus arteriosus. Comparing with ultrasound, casting technique has its own superiority in exhibiting TAPVC abnormalities, especially in certain types such as course, origin and absence abnormalities of ductus. Postpartum cardiovascular casts can accurately depict the branch structure of the heart's larger vessels, and may be used as a clinical assessment and teaching method in complex cardiac malformations.
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Whitby E, Offiah AC, Shelmerdine SC, van Rijn RR, Aertsen M, Klein WM, Perry D, Goergen SK, Abel C, Taranath A, Gascho D, Miller E, Arthurs OJ. Current state of perinatal postmortem magnetic resonance imaging: European Society of Paediatric Radiology questionnaire-based survey and recommendations. Pediatr Radiol 2021; 51:792-799. [PMID: 33367939 PMCID: PMC8055569 DOI: 10.1007/s00247-020-04905-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 09/02/2020] [Accepted: 11/09/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Postmortem magnetic resonance imaging (MRI) in perinatal and childhood deaths is increasingly used as a noninvasive adjunct or alternative to autopsy. Imaging protocols vary between centres and consensus guidelines do not exist. OBJECTIVE Our aim was to develop practical, standardised recommendations for perinatal postmortem MRI. MATERIALS AND METHODS Recommendations were based on the results of two surveys regarding local postmortem MRI practices sent electronically to all 14 members of the European Society of Paediatric Radiology (ESPR) Postmortem Imaging Task Force and 17 members of the International Society of Forensic Radiology and Imaging Task Force (25 different centres). RESULTS Overall, 11/14 (78.6%) respondents from different institutions perform postmortem MRI. All of these centres perform postmortem MRI for perinatal and neonatal deaths, but only 6/11 (54.5%) perform imaging in older children. CONCLUSION We propose a clinical standard for postmortem MRI sequences plus optional sequences for neuroimaging and cardiac anatomy depending on available scanning time and referral indications.
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Affiliation(s)
- Elspeth Whitby
- University of Sheffield and Sheffield Teaching Hospitals Foundation Trust, Jessop Wing, Tree Root Walk, Sheffield, S10 1SF, UK.
| | - Amaka C. Offiah
- Academic Unit of Child Health, University of Sheffield, Sheffield, UK ,Department of Radiology, Sheffield Children’s NHS Foundation Trust, University of Sheffield, Sheffield, UK
| | - Susan C. Shelmerdine
- Department of Clinical Radiology, Great Ormond Street Hospital for Children, London, UK ,UCL Great Ormond Street Institute of Child Health, London, UK
| | - Rick R. van Rijn
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Michael Aertsen
- Department of Radiology, University Hospitals KU Leuven, Leuven, Belgium
| | - Willemijn M. Klein
- Department of Radiology and Nuclear Medicine and Anatomy, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - David Perry
- Radiology Department, National Women’s Health and Starship Children’s Hospital, Auckland City Hospital, Auckland, New Zealand
| | - Stacy K. Goergen
- Monash Imaging, Clayton, Victoria Australia ,School of Clinical Sciences, Monash University, Clayton, Victoria Australia
| | - Christian Abel
- Department of Medical Imaging, John Hunter Hospital, Newcastle, New South Wales Australia
| | - Ajay Taranath
- Department of Medical Imaging, Women’s and Children’s Hospital, North Adelaide, South Australia Australia ,University of Adelaide, Adelaide, South Australia Australia
| | - Dominic Gascho
- Zurich Institute of Forensic Medicine, University of Zurich, Zurich, Switzerland
| | - Elka Miller
- Department of Medical Imaging, Children’s Hospital of Eastern Ontario, University of Ottawa, Ottawa, Canada
| | - Owen J. Arthurs
- Department of Clinical Radiology, Great Ormond Street Hospital for Children, London, UK ,UCL Great Ormond Street Institute of Child Health, London, UK
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11
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Shelmerdine SC, Simcock IC, Hutchinson JC, Guy A, Ashworth MT, Sebire NJ, Arthurs OJ. Postmortem microfocus computed tomography for noninvasive autopsies: experience in >250 human fetuses. Am J Obstet Gynecol 2021; 224:103.e1-103.e15. [PMID: 32682860 PMCID: PMC7805479 DOI: 10.1016/j.ajog.2020.07.019] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 07/02/2020] [Accepted: 07/14/2020] [Indexed: 12/16/2022]
Abstract
Background Noninvasive imaging autopsy alternatives for fetuses weighing <500 grams are limited. Microfocus computed tomography has been reported as a viable option in small case series with the potential to avoid an invasive autopsy. Implementation of postmortem microfocus computed tomography in a large cohort as part of routine clinical service has yet been unreported, and realistic “autopsy prevention rates” are unknown. Objective This study aimed to describe the range of abnormalities detectable on fetal microfocus computed tomography in a clinical setting and additional findings identified on the antenatal ultrasound and to estimate the invasive autopsy avoidance rate (ie, cases in which imaging was sufficient to deem autopsy unnecessary). Study Design A prospective observational case series of all fetuses referred for microfocus computed tomography imaging at a single institution was conducted for 3 years (2016–2019). Imaging was reported by 2 pediatric radiologists before autopsy, with “decision to proceed” based on the specialist perinatal pathologists’ judgment and parental consent. Agreement rates between microfocus computed tomography and antenatal ultrasound were evaluated, and where feasible, diagnostic accuracy for microfocus computed tomography was calculated using autopsy as a reference standard. Results A total of 268 fetuses were included (2–350 grams body weight; 11–24 weeks’ gestation), with cause for demise in 122 of 268 (45.5%). Of the 122 fetuses, 64 (52.5%) exhibited fetal anomalies. Although 221 of 268 (82.5%) fetuses had consent for invasive autopsy, only 29 of the 221 (13.1%) underwent this procedure, which implied an autopsy avoidance rate of 192 of 221 (86.9%). Complete agreement was present for all brain, thoracic, and abdominal pathologies, whereas sensitivity and specificity for cardiac anomalies were 66.7% and 91.7%, respectively. Microfocus computed tomography and antenatal ultrasound agreement was found in 219 of 266 cases (81.9%), with partial agreement in 21 of 266 (7.9%) and disagreement in 26 of 266 (10.5%), mostly because of additional cardiac, soft tissue, or genitourinary findings by microfocus computed tomography, which were not seen on the ultrasound. Conclusion Fetal microfocus computed tomography imaging is a viable and useful tool for imaging early gestational fetuses and can avoid the need for invasive autopsy. Confirmation of antenatal diagnoses is achieved in most cases, and additional anomalies may also be detected.
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Affiliation(s)
- Susan C Shelmerdine
- Department of Clinical Radiology, Great Ormond Street Hospital for Children, London, United Kingdom; UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital for Children, London, United Kingdom; National Institute for Health Research Biomedical Research Centre, Great Ormond Street Hospital, London, United Kingdom.
| | - Ian C Simcock
- Department of Clinical Radiology, Great Ormond Street Hospital for Children, London, United Kingdom; UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital for Children, London, United Kingdom; National Institute for Health Research Biomedical Research Centre, Great Ormond Street Hospital, London, United Kingdom
| | - John Ciaran Hutchinson
- Department of Paediatric Pathology, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Anna Guy
- Department of Clinical Radiology, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Michael T Ashworth
- Department of Paediatric Pathology, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Neil J Sebire
- UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital for Children, London, United Kingdom; Department of Paediatric Pathology, Great Ormond Street Hospital for Children, London, United Kingdom; National Institute for Health Research Biomedical Research Centre, Great Ormond Street Hospital, London, United Kingdom
| | - Owen J Arthurs
- Department of Clinical Radiology, Great Ormond Street Hospital for Children, London, United Kingdom; UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital for Children, London, United Kingdom; National Institute for Health Research Biomedical Research Centre, Great Ormond Street Hospital, London, United Kingdom
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Kang X, Carlin A, Cannie MM, Sanchez TC, Jani JC. Fetal postmortem imaging: an overview of current techniques and future perspectives. Am J Obstet Gynecol 2020; 223:493-515. [PMID: 32376319 DOI: 10.1016/j.ajog.2020.04.034] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 04/19/2020] [Accepted: 04/28/2020] [Indexed: 12/19/2022]
Abstract
Fetal death because of miscarriage, unexpected intrauterine fetal demise, or termination of pregnancy is a traumatic event for any family. Despite advances in prenatal imaging and genetic diagnosis, conventional autopsy remains the gold standard because it can provide additional information not available during fetal life in up to 40% of cases and this by itself may change the recurrence risk and hence future counseling for parents. However, conventional autopsy is negatively affected by procedures involving long reporting times because the fetal brain is prone to the effect of autolysis, which may result in suboptimal examinations, particularly of the central nervous system. More importantly, fewer than 50%-60% of parents consent to invasive autopsy, mainly owing to the concerns about body disfigurement. Consequently, this has led to the development of noninvasive perinatal virtual autopsy using imaging techniques. Because a significant component of conventional autopsy involves the anatomic examination of organs, imaging techniques such as magnetic resonance imaging, ultrasound, and computed tomography are possible alternatives. With a parental acceptance rate of nearly 100%, imaging techniques as part of postmortem examination have become widely used in recent years in some countries. Postmortem magnetic resonance imaging using 1.5-Tesla magnets is the most studied technique and offers an overall diagnostic accuracy of 77%-94%. It is probably the best choice as a virtual autopsy technique for fetuses >20 weeks' gestation. However, for fetuses <20 weeks' gestation, its performance is poor. The use of higher magnetic resonance imaging magnetic fields such as 3-Tesla may slightly improve performance. Of note, in cases of fetal maceration, magnetic resonance imaging may offer diagnoses in a proportion of brain lesions wherein conventional autopsy fails. Postmortem ultrasound examination using a high-frequency probe offers overall sensitivity and specificity of 67%-77% and 74%-90%, respectively, with the advantage of easy access and affordability. The main difference between postmortem ultrasound and magnetic resonance imaging relates to their respective abilities to obtain images of sufficient quality for a confident diagnosis. The nondiagnostic rate using postmortem ultrasound ranges from 17% to 30%, depending on the organ examined, whereas the nondiagnostic rate using postmortem magnetic resonance imaging in most situations is far less than 10%. For fetuses ≤20 weeks' gestation, microfocus computed tomography achieves close to 100% agreement with autopsy and is likely to be the technique of the future in this subgroup. The lack of histology has always been listed as 1 limitation of all postmortem imaging techniques. Image-guided needle tissue biopsy coupled with any postmortem imaging can overcome this limitation. In addition to describing the diagnostic accuracy and limitations of each imaging technology, we propose a novel, stepwise diagnostic approach and describe the possible application of these techniques in clinical practice as an alternative or an adjunct or for triage to select cases that would specifically benefit from invasive examination, with the aim of reducing parental distress and pathologist workload. The widespread use of postmortem fetal imaging is inevitable, meaning that hurdles such as specialized training and dedicated financing must be overcome to improve access to these newer, well-validated techniques.
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Affiliation(s)
- Xin Kang
- Departments of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Andrew Carlin
- Departments of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Mieke M Cannie
- Radiology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium; Department of Radiology, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Teresa Cos Sanchez
- Departments of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Jacques C Jani
- Departments of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium.
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Pogledic I, Schwartz E, Mitter C, Baltzer P, Milos RI, Gruber GM, Brugger PC, Hainfellner J, Bettelheim D, Langs G, Kasprian G, Prayer D. The Subplate Layers: The Superficial and Deep Subplate Can be Discriminated on 3 Tesla Human Fetal Postmortem MRI. Cereb Cortex 2020; 30:5038-5048. [PMID: 32377685 DOI: 10.1093/cercor/bhaa099] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 03/24/2020] [Accepted: 03/24/2020] [Indexed: 01/19/2023] Open
Abstract
The subplate (SP) is a transient structure of the human fetal brain that becomes the most prominent layer of the developing pallium during the late second trimester. It is important in the formation of thalamocortical and cortico-cortical connections. The SP is vulnerable in perinatal brain injury and may play a role in complex neurodevelopmental disorders, such as schizophrenia and autism. Nine postmortem fetal human brains (19-24 GW) were imaged on a 3 Tesla MR scanner and the T2-w images in the frontal and temporal lobes were compared, in each case, with the histological slices of the same brain. The brains were confirmed to be without any brain pathology. The purpose of this study was to demonstrate that the superficial SP (sSP) and deep SP (dSP) can be discriminated on postmortem MR images. More specifically, we aimed to clarify that the observable, thin, hyperintense layer below the cortical plate in the upper SP portion on T2-weighted MR images has an anatomical correspondence to the histologically established sSP. Therefore, the distinction between the sSP and dSP layers, using clinically available MR imaging methodology, is possible in postmortem MRI and can help in the imaging interpretation of the fetal cerebral layers.
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Affiliation(s)
- Ivana Pogledic
- Division of Neuroradiology and Musculoskeletal Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, 1090 Vienna, Austria
| | - Ernst Schwartz
- Computational Imaging Research Lab, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, 1090 Vienna, Austria
| | - Christian Mitter
- Division of Neuroradiology and Musculoskeletal Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, 1090 Vienna, Austria
| | - Pascal Baltzer
- Division of Molecular and Gender Imaging, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, 1090 Vienna, Austria
| | - Ruxandra-Iulia Milos
- Division of Molecular and Gender Imaging, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, 1090 Vienna, Austria
| | - Gerlinde Maria Gruber
- Department of Anatomy and Biomechanics, Karl Landsteiner University of Health Sciences, 3500 Krems, Austria
| | - Peter C Brugger
- Division of Anatomy, Center for Anatomy and Cell Biology, Medical University of Vienna, 1090 Vienna, Austria
| | | | - Dieter Bettelheim
- Division of Obstetrics and Feto-Maternal Medicine, Department of Obstetrics and Gynecology, Medical University of Vienna, 1090 Vienna, Austria
| | - Georg Langs
- Computational Imaging Research Lab, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, 1090 Vienna, Austria
| | - Gregor Kasprian
- Division of Neuroradiology and Musculoskeletal Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, 1090 Vienna, Austria
| | - Daniela Prayer
- Division of Neuroradiology and Musculoskeletal Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, 1090 Vienna, Austria
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Sandaite I, Lombardi C, Cook AC, Fabietti I, Deprest J, Boito S. Micro-computed tomography of isolated fetal hearts following termination of pregnancy: A feasibility study at 8 to 12 weeks' gestation. Prenat Diagn 2020; 40:984-990. [PMID: 32333804 DOI: 10.1002/pd.5719] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 04/18/2020] [Accepted: 04/21/2020] [Indexed: 01/04/2023]
Abstract
OBJECTIVES To assess the feasibility of retrieval of intact human fetal hearts after first trimester surgical termination of pregnancy (TOP) and subsequent anatomical assessment by postmortem micro-computed tomography (micro-CT). METHODS In a cohort of consenting women undergoing surgical TOP between 8 and 13 weeks' gestation, we attempted the retrieval of the fetal heart from the suction material. Specimens were immersion fixed in 10% formaldehyde, scanned by iodine-enhanced micro-CT and cardiac anatomy assessed by a multidisciplinary team using 3D-multiplanar analysis. RESULTS The median gestational age at TOP was 10.7 weeks (range 8.3-12.9). In 57 (95.0%) out of 60 suction specimens, the heart could be retrieved. The median cardiac length was 5 mm (range 2-8 mm), in three (5.3%), the heart was too damaged to assess cardiac anatomy and in five (8.7%) only the four chambers could be examined. In the remaining 49 (86.0%) cases, a detailed assessment of cardiac anatomy was possible, showing a major defect in two (4.1%) and a minor defect in four (8.2%). CONCLUSIONS Fetal hearts can be retrieved after first trimester TOP being intact in the vast majority of cases. Iodine-enhanced, postmortem micro-CT can be used to assess cardiac anatomy from as early as 8 weeks and to describe heart abnormalities.
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Affiliation(s)
- Inga Sandaite
- Fetal Medicine and Surgery Unit, Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy.,Division of Woman and Child, Department of Obstetrics & Gynaecology, University Hospitals Leuven, Leuven, Belgium
| | - Claudio Lombardi
- Department of Radiology, Studio Diagnostico Eco, Vimercate, Italy
| | - Andrew C Cook
- Research Department for Children's Cardiovascular Disease, UCL Institute of Cardiovascular Science, London, UK
| | - Isabella Fabietti
- Fetal Medicine and Surgery Unit, Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Jan Deprest
- Division of Woman and Child, Department of Obstetrics & Gynaecology, University Hospitals Leuven, Leuven, Belgium
| | - Simona Boito
- Fetal Medicine and Surgery Unit, Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
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15
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Wang Y, Zhang J, Feng W, Cao H, He Q, Xu J, Zeng H, Xie M. Description of misdiagnosis and missed diagnosis of fetal complex heart malformations by prenatal echocardiography combined with postnatal cardiovascular casting. Prenat Diagn 2020; 40:792-802. [PMID: 32239683 DOI: 10.1002/pd.5689] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 11/22/2019] [Accepted: 03/21/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To compare prenatal echocardiography with postnatal cardiovascular casting for detection of fetal cardiovascular malformations, and to discuss the causes of prenatal misdiagnosis and missed diagnosis. METHODS We retrospectively identified patients from 2013 to 2018 at our Maternal-Fetal Medicine Center who were reported to have a fetal diagnosis of severe congenital heart malformations (CHMs). Subjects had postnatal confirmation of CHMs. Prenatal and postnatal medical records, including ultrasound results and casting findings, were reviewed and analyzed. RESULTS Postnatal casting showed that all 35 fetuses had complex CHMs. In these 35 cases, 90 cardiovascular malformations were found by postnatal casting, and 69 were detected by prenatal echocardiography. Among the other 21 cardiovascular malformations, 7 were misdiagnosed and 14 diagnoses were missed by prenatal ultrasound. CONCLUSION Prenatal echocardiography may lead to misdiagnosis and missed diagnoses, especially in cases with great arterial branching anomalies. Postnatal casting can demonstrate the configuration of the great vessels and smaller branches directly. Thus, understanding of such malformations via postnatal casting may help to improve prenatal diagnostic accuracy.
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Affiliation(s)
- Yu Wang
- Department of Ultrasound, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang, China
| | - Jiaqi Zhang
- Department of Ultrasound, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang, China
| | - Wei Feng
- Department of Ultrasound, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang, China
| | - Haiyan Cao
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qiaoyue He
- Department of Ultrasound, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang, China
| | - Jinzhi Xu
- Department of Ultrasound, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang, China
| | - He Zeng
- Department of Ultrasound, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang, China
| | - Mingxing Xie
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Novel imaging techniques to study postmortem human fetal anatomy: a systematic review on microfocus-CT and ultra-high-field MRI. Eur Radiol 2019; 30:2280-2292. [PMID: 31834508 PMCID: PMC7062658 DOI: 10.1007/s00330-019-06543-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 10/10/2019] [Accepted: 10/23/2019] [Indexed: 01/07/2023]
Abstract
Background MRI and CT have been extensively used to study fetal anatomy for research and diagnostic purposes, enabling minimally invasive autopsy and giving insight in human fetal development. Novel (contrast-enhanced) microfocus CT (micro-CT) and ultra-high-field (≥ 7.0 T) MRI (UHF-MRI) techniques now enable micron-level resolution that combats the disadvantages of low-field MRI and conventional CT. Thereby, they might be suitable to study fetal anatomy in high detail and, in time, contribute to the postmortem diagnosis of fetal conditions. Objectives (1) To systematically examine the usability of micro-CT and UHF-MRI to study postmortem human fetal anatomy, and (2) to analyze factors that govern success at each step of the specimen preparation and imaging. Method MEDLINE and EMBASE were systematically searched to identify publications on fetal imaging by micro-CT or UHF-MRI. Scanning protocols were summarized and best practices concerning specimen preparation and imaging were enumerated. Results Thirty-two publications reporting on micro-CT and UHF-MRI were included. The majority of the publications focused on imaging organs separately and seven publications focused on whole body imaging, demonstrating the possibility of visualization of small anatomical structures with a resolution well below 100 μm. When imaging soft tissues by micro-CT, the fetus should be stained by immersion in Lugol’s staining solution. Conclusion Micro-CT and UHF-MRI are both excellent imaging techniques to provide detailed images of gross anatomy of human fetuses. The present study offers an overview of the current best practices when using micro-CT and/or UHF-MRI to study fetal anatomy for clinical and research purposes. Key Points • Micro-CT and UHF-MRI can both be used to study postmortem human fetal anatomy for clinical and research purposes. • Micro-CT enables high-resolution imaging of fetal specimens in relatively short scanning time. However, tissue staining using a contrast solution is necessary to enable soft-tissue visualization. • UHF-MRI enables high-resolution imaging of fetal specimens, without the necessity of prior staining, but with the drawback of long scanning time. Electronic supplementary material The online version of this article (10.1007/s00330-019-06543-8) contains supplementary material, which is available to authorized users.
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Kang X, Sanchez TC, Arthurs OJ, Bevilacqua E, Cannie MM, Segers V, Lecomte S, Sebire NJ, Jani JC. Postmortem fetal imaging: prospective blinded comparison of two-dimensional ultrasound with magnetic resonance imaging. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2019; 54:791-799. [PMID: 30644623 DOI: 10.1002/uog.20217] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Revised: 12/07/2018] [Accepted: 01/10/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To compare the diagnostic rate and accuracy of 3-Tesla (T) postmortem magnetic resonance imaging (PM-MRI) and postmortem ultrasound (PM-US) in an unselected fetal population. METHODS We performed prospectively, in a blinded manner, 3-T PM-MRI and PM-US on 160 unselected fetuses at 13-41 weeks of gestation. All imaging was reported according to a prespecified template, for five anatomical regions: brain, thorax, heart, abdomen and spine. The rates of non-diagnostic results for PM-US and PM-MRI were compared and, for results that were diagnostic, we calculated sensitivity, specificity and concordance rates for each anatomical region, using conventional autopsy as the reference standard. RESULTS 3-T PM-MRI performed significantly better than did PM-US overall and in particular for fetuses ≥ 20 weeks' gestation. Specifically, the non-diagnostic rates for PM-MRI vs PM-US were 4.4% vs 26.9% (7/160 vs 43/160; P < 0.001) for the brain, 5.2% vs 17.4% (8/155 vs 27/155; P < 0.001) for the thorax, 3.8% vs 30.6% (6/157 vs 48/157; P < 0.001) for the heart and 3.2% vs 23.6% (5/157 vs 37/157; P < 0.001) for the abdomen. For the spine, both techniques showed an equally low non-diagnostic rate. When both postmortem imaging techniques were diagnostic, they had similar accuracy, with no difference in sensitivity or specificity, and similar concordance with autopsy (PM-US, 79.5-96.5%; PM-MRI, 81.6-99.1%). CONCLUSIONS PM-MRI performed significantly better than PM-US in this unselected population, due mainly to a lower non-diagnostic rate. PM-MRI should remain the first-line imaging investigation for perinatal autopsy, but PM-US could be considered if MRI is not available, albeit with a higher non-diagnostic rate. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- X Kang
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - T Cos Sanchez
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - O J Arthurs
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - E Bevilacqua
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - M M Cannie
- Department of Radiology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
- Department of Radiology, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - V Segers
- Department of Feto-Pathology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - S Lecomte
- Department of Feto-Pathology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - N J Sebire
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - J C Jani
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
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Novel Application of the Pfirrmann Disc Degeneration Grading System to 9.4T MRI: Higher Reliability Compared to 3T MRI. Spine (Phila Pa 1976) 2019; 44:E766-E773. [PMID: 31205169 DOI: 10.1097/brs.0000000000002967] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Reliability study. OBJECTIVE To evaluate the applicability and reliability of 9.4T magnetic resonance imaging (MRI) in the assessment of degenerative disc disease compared with 3T MRI. SUMMARY OF BACKGROUND DATA MRI is a reliable indicator of biochemical changes in the intervertebral disc (IVD) including hydration status, proteoglycan content, and disc degeneration compared with anatomical and histological studies. High-field 9.4T MRI has been shown to provide superior resolution and anatomical detail. However, it has not been tested against current standard MRI techniques. METHODS Disc degeneration was initiated in 36 skeletally mature ewes 6 months prior to necropsy via validated surgical IVD injury models using either scalpel injury or drill-bit injury techniques at lumbar spine levels L2/3 and L3/4 with L1/2, L4/5, and L5/6 serving as control discs. All ex vivo IVDs were examined with 9.4T MRI and 3T MRI. All scans were analyzed using the Pfirrmann grading system by four independent observers. Intra- and interobserver reliability was assessed using kappa statistics and Spearman correlation. RESULTS Inter- and intraobserver agreement for 9.4T MRI was excellent, both at κ 0.91 (P < 0.001). Comparatively, 3T interobserver reliability demonstrated substantial agreement at κ 0.61 (P < 0.001). Complete agreement was obtained in 92.7% to 100% of discs at 9.4T compared with 69.7% to 83.1% at 3T. A difference of one grade or more occurred in 6.7% at 9.4T and 39.3% at 3T. 9.4T MRI scored 97.3% of discs as grade 1 to 2 compared with 71.3% at 3T. 3T MRI tended to over-score the extent of disc degeneration with 28.6% of discs scored as grade 3 or higher compared with 2.7% at 9.4T MRI. CONCLUSION 9.4T MRI study of IVD degeneration using the Pfirrmann grading system demonstrated excellent inter- and intraobserver reliability. Comparatively, 3T MRI demonstrated a tendency to over score the extent of disc degeneration. This improved reliability of 9.4T MRI holds great potential for its clinical applications. LEVEL OF EVIDENCE 3.
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Staicu A, Albu C, Popa-Stanila R, Chiriac L, Boitor-Borza D, Bondor C, Kovacs T, Caracostea G, Rotar IC, Turcu RVF, Simon S, Muresan D, Stamatian F. Potential clinical benefits and limitations of fetal virtopsy using high-field MRI at 7 Tesla versus stereomicroscopic autopsy to assess first trimester fetuses. Prenat Diagn 2019; 39:505-518. [PMID: 30980413 DOI: 10.1002/pd.5457] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 03/21/2019] [Accepted: 03/23/2019] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The aim of this study was to establish the diagnostic accuracy of high-field magnetic resonance imaging (MRI) at 7 Tesla (T) compared with that of stereomicroscopic autopsy for assessing first trimester fetuses. METHODS Nine consecutive cases of first trimester fetuses resulting from spontaneous and therapeutic pregnancy termination were considered. The cases were divided into two groups according to gestational age: the Embryo Group with cases of nine to 10 gestational weeks (GWs) and the Fetus Group with cases of 13 GWs. The first group was scanned using three-dimensional fast imaging with steady state precession (3D FISP), and the second group was scanned using a two-dimensional (2D) turbo spin-echo high-resolution T2-weighted imaging (T2 WI) protocol. A radiologist and two embryologists interpreted the images. All cases were evaluated by invasive autopsy, with pathologist blinded to the imaging results. In total, the database included 270 items for evaluation (9 cases × 30 structures/case). RESULTS The global agreement between fetal high-field virtopsy and microscopic or stereomicroscopic autopsy was evaluated using 225 evaluation items visible by both methods. Overall, using microscopic examination and stereomicroscopic autopsy as the gold standard, fetal high-field virtopsy had a sensitivity of 94.6% [95% CI, 87.2-98.3] and a specificity of 97.6% [95% CI, 95-98.8]. The positive predictive value (PPV) was 93% [95% CI, 85.7-96.6], and the negative predictive value (NPV) was 98.2% [95% CI, 95.7-99.4]. Cohen kappa coefficient of agreement was k = 0.92 [95% CI, 0.82-0.97], and the McNemar test showed p = 1.00. CONCLUSIONS Virtual autopsy using high-field MRI at 7 T can be considered a safe alternative approach to stereomicroscopic autopsy for the assessment of fetal structural anomalies at the end of the first trimester of pregnancy.
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Affiliation(s)
- Adelina Staicu
- 1st Department of Obstetrics and Gynaecology, "Iuliu Haţieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Camelia Albu
- Department of Pathology, "Iuliu Haţieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Centre of Advanced Research Studies, Emergency County Hospital, IMOGEN, Cluj-Napoca, Romania
| | - Roxana Popa-Stanila
- Centre of Advanced Research Studies, Emergency County Hospital, IMOGEN, Cluj-Napoca, Romania.,Department of Radiology, "Iuliu Haţieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Liviu Chiriac
- Department of Medical Biophysics, "Iuliu Haţieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania.,National Magnetic Resonance Centre, Babeș Bolyai University, Cluj-Napoca, Romania
| | - Dan Boitor-Borza
- Department of Human Anatomy and Embryology, "Iuliu Haţieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Cosmina Bondor
- Department of Medical Informatics and Biostatistics, "Iuliu Haţieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Tunde Kovacs
- 1st Department of Obstetrics and Gynaecology, "Iuliu Haţieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Centre of Advanced Research Studies, Emergency County Hospital, IMOGEN, Cluj-Napoca, Romania
| | - Gabriela Caracostea
- 1st Department of Obstetrics and Gynaecology, "Iuliu Haţieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Ioana Cristina Rotar
- 1st Department of Obstetrics and Gynaecology, "Iuliu Haţieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - R V Flaviu Turcu
- National Magnetic Resonance Centre, Babeș Bolyai University, Cluj-Napoca, Romania.,Faculty of Physic, Babeș Bolyai University, Cluj-Napoca, Romania
| | - Simion Simon
- National Magnetic Resonance Centre, Babeș Bolyai University, Cluj-Napoca, Romania.,Faculty of Physic, Babeș Bolyai University, Cluj-Napoca, Romania
| | - Daniel Muresan
- 1st Department of Obstetrics and Gynaecology, "Iuliu Haţieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Florin Stamatian
- Centre of Advanced Research Studies, Emergency County Hospital, IMOGEN, Cluj-Napoca, Romania
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TO THE EDITOR. Spine (Phila Pa 1976) 2019; 44:E630-E631. [PMID: 31046002 DOI: 10.1097/brs.0000000000003026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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21
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Sandrini C, Lombardi C, Shearn AIU, Ordonez MV, Caputo M, Presti F, Luciani GB, Rossetti L, Biglino G. Three-Dimensional Printing of Fetal Models of Congenital Heart Disease Derived From Microfocus Computed Tomography: A Case Series. Front Pediatr 2019; 7:567. [PMID: 32039123 PMCID: PMC6985276 DOI: 10.3389/fped.2019.00567] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 12/27/2019] [Indexed: 12/14/2022] Open
Abstract
This article presents a case series of n = 21 models of fetal cardiovascular anatomies obtained from post mortem microfocus computed tomography (micro-CT) data. The case series includes a broad range of diagnoses (e.g., tetralogy of Fallot, hypoplastic left heart syndrome, dextrocardia, double outlet right ventricle, atrio-ventricular septal defect) and cases also had a range of associated extra-cardiac malformations (e.g., VACTERL syndrome, central nervous system anomalies, renal anomalies). All cases were successfully reconstructed from the microfocus computed tomography data, demonstrating the feasibility of the technique and of the protocols, including in-house printing with a desktop 3D printer (Form2, Formlabs). All models were printed in 1:1 scale as well as with the 5-fold magnification, to provide insight into the intra-cardiac structures. Possible uses of the models include education and training.
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Affiliation(s)
- Camilla Sandrini
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | | | - Andrew I U Shearn
- Bristol Medical School, Bristol Heart Institute, University of Bristol, Bristol, United Kingdom
| | - Maria Victoria Ordonez
- Bristol Medical School, Bristol Heart Institute, University of Bristol, Bristol, United Kingdom
| | - Massimo Caputo
- Bristol Medical School, Bristol Heart Institute, University of Bristol, Bristol, United Kingdom
| | - Francesca Presti
- Division of Obstetrics and Gynecology B, Department of Surgery, Dentistry, Pediatrics and Gynecology, University of Verona, Verona, Italy
| | - Giovanni Battista Luciani
- Division of Cardiac Surgery, Department of Surgery, Dentistry, Pediatrics and Gynecology, University of Verona, Verona, Italy
| | - Lucia Rossetti
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Giovanni Biglino
- Bristol Medical School, Bristol Heart Institute, University of Bristol, Bristol, United Kingdom.,National Heart and Lung Institute, Imperial College London, London, United Kingdom
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Sandrini C, Rossetti L, Zambelli V, Zanarotti R, Bettinazzi F, Soldá R, Di Pace C, Hoxha S, Ribichini FL, Faggian G, Lombardi C, Luciani GB. Accuracy of Micro-Computed Tomography in Post-mortem Evaluation of Fetal Congenital Heart Disease. Comparison Between Post-mortem Micro-CT and Conventional Autopsy. Front Pediatr 2019; 7:92. [PMID: 30968009 PMCID: PMC6440368 DOI: 10.3389/fped.2019.00092] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Accepted: 03/01/2019] [Indexed: 11/13/2022] Open
Abstract
Aims: Early prenatal diagnosis of congenital heart disease is feasible. Conventional autopsy is the current gold standard method for post-mortem confirmation. Radiologic techniques alternative to conventional autopsy, such as post-mortem micro-computed tomography, have been proposed in case of limited diagnostic accuracy (i.e., early termination of pregnancy, samples of small dimension or of low weight). The aim of the present study was to define accuracy of micro-computed tomography for post-mortem diagnosis of congenital heart disease in gross anatomy samples. Methods and Results: Fetal heart underwent in-utero prenatal echocardiography and ex-vivo post-mortem evaluation by 9 μm resolution micro-computed tomography and conventional autopsy. For each case, 25 indices of cardiac anatomy were studied by post-mortem micro-computed tomography and conventional autopsy; these were used to compare the two post mortem techniques. Ten samples were examined (gestational age between 12 + 4 and 21 + 6 weeks of gestation). Considering comparable indices, agreement between post-mortem micro-computed tomography and conventional autopsy was of 100% and sensitivity and specificity were of 100%. In "challenging specimens," post-mortem micro-computed tomography diagnoses more indices as compared to conventional autopsy and 84% of "not-diagnostic" indices at conventional autopsy would be diagnostic at post-mortem micro-computed tomography. Conclusion: Micro-computed tomography can be a valid diagnostic alternative to conventional autopsy for post-mortem evaluation of human fetal heart. In addition, it may prove superior to conventional autopsy particularly in cases coming from early termination of pregnancy or in samples of small dimension or of low weight.
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Affiliation(s)
- Camilla Sandrini
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Lucia Rossetti
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Vanessa Zambelli
- School of Medicine and Surgery, University of Milano Bicocca, Monza, Italy
| | | | - Franca Bettinazzi
- Division of Obstetrics and Gynecology, Department of Surgery, Dentistry, Pediatrics and Gynecology, University of Verona, Verona, Italy
| | - Roberta Soldá
- Division of Obstetrics and Gynecology, Department of Surgery, Dentistry, Pediatrics and Gynecology, University of Verona, Verona, Italy
| | - Concetta Di Pace
- Department of Pathology, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Stiljan Hoxha
- Division of Cardiac Surgery, Department of Surgery, Dentistry, Pediatrics and Gynecology, University of Verona, Verona, Italy
| | | | - Giuseppe Faggian
- Division of Cardiac Surgery, Department of Surgery, Dentistry, Pediatrics and Gynecology, University of Verona, Verona, Italy
| | | | - Giovanni Battista Luciani
- Division of Cardiac Surgery, Department of Surgery, Dentistry, Pediatrics and Gynecology, University of Verona, Verona, Italy
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Blondiaux E, Autret G, Dhombres F, Gonzales M, Audureau E, Clément O, Jouannic JM, Houyel L. Evaluation of septal insertion of atrioventricular valves in fetuses by postmortem 4.7 Tesla cardiac MRI: A feasibility study. Diagn Interv Imaging 2018; 100:109-116. [PMID: 30527913 DOI: 10.1016/j.diii.2018.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 10/18/2018] [Accepted: 11/12/2018] [Indexed: 12/01/2022]
Abstract
PURPOSE The purpose of this study was to compare non-invasive high-spatial-resolution postmortem cardiac magnetic resonance imaging (MRI) and autopsy findings for evaluating the septal insertion of atrioventricular valves in fetuses. MATERIALS AND METHODS Five fetal heart specimens including two normal hearts, one heart with complete atrioventricular septal defect (AVSD) and two hearts with linear insertion of atrioventricular valves (LIAVV; gestational age 17 to 34 weeks) were studied with cardiac MRI using a 4.7 T MRI scanner without sample preparation. Three (3D) and two-dimensional (2D) turbo-RARE (rapid imaging with refocused echoes) sequences in four-chamber and left-ventricular long-axis planes were obtained with a minimal isotropic/in-plane resolution of 156μm. Nonparametric tests were performed to compare the distance between insertions of medial leaflets of the atrioventricular valves and the inlet/outlet distance ratio between MRI and autopsy findings in normal, complete AVSD and with linear insertion of atrioventricular valves (LIAVV) fetal hearts. RESULTS Despite apparent differences between LIAVV/normal hearts, no significant differences were found between differential insertion of medial leaflets and inlet/outlet distance ratios with both techniques. Very good to excellent reliability between both techniques was found for differential insertion (ICC: 87.2%; 95% CI: -21.7%, 99.1%) (P=0.963) and inlet/outlet distance ratio (ICC 98.3%; 95%CI: 85.2%, 99.8%) (P=0.537) measurements. CONCLUSION Postmortem cardiac MRI could replace autopsy for assessing normal or abnormal septal insertion of atrioventricular valves in fetuses without requiring specific preparation of the heart.
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Affiliation(s)
- E Blondiaux
- Laboratoire d'imagerie biomédicale, CNRS 7371, Inserm 1146, department of radiology, Sorbonne université, hôpital Trousseau, hôpitaux universitaires de l'Est parisien, AP-HP, 75012 Paris, France.
| | - G Autret
- Inserm U970, plateforme imageries du vivant, Paris cardiovascular research center, université Paris Descartes, Sorbonne Paris cité, 75015 Paris, France
| | - F Dhombres
- Faculté de médecine, department of fetal medicine, Sorbonne université, hôpital Trousseau, hôpitaux universitaires de l'Est parisien, AP-HP, 75012 Paris, France
| | - M Gonzales
- Faculté de médecine, department of fetal medicine, Sorbonne université, hôpital Trousseau, hôpitaux universitaires de l'Est parisien, AP-HP, 75012 Paris, France
| | - E Audureau
- LIC EA 4393, department of public health, université Paris Est Créteil, hôpital Henri-Mondor, AP-HP, 94000 Créteil, France
| | - O Clément
- Inserm U970, plateforme imageries du vivant, Paris cardiovascular research center, université Paris Descartes, Sorbonne Paris cité, 75015 Paris, France
| | - J-M Jouannic
- Faculté de médecine, department of fetal medicine, Sorbonne université, hôpital Trousseau, hôpitaux universitaires de l'Est parisien, AP-HP, 75012 Paris, France
| | - L Houyel
- Congenital and Pediatric Cardiology Unit, Centre de Référence Maladies Cardiaques Congénitales Complexes-M3C, hôpital Necker-Enfants Malades, AP-HP, 75006 Paris, France; Université Paris-Descartes, Sorbonne Paris Cité, 75005 Paris, France
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Votino C, Cos Sanchez T, Bessieres B, Segers V, Kadhim H, Razavi F, Condorelli M, Votino R, D'Ambrosio V, Jani J. Minimally invasive fetal autopsy using ultrasound: a feasibility study. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2018; 52:776-783. [PMID: 25130705 DOI: 10.1002/uog.14642] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2014] [Revised: 06/18/2014] [Accepted: 07/22/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVES To evaluate postmortem ultrasound (PM-US) for minimally invasive autopsy, and to demonstrate its feasibility, sensitivity and specificity, as compared with conventional autopsy, in detecting major congenital abnormalities. METHODS Over a 19-month study period from 1 March 2012 to 30 September 2013, we recruited from a referral hospital 88 consecutive fetuses, at 11-40 weeks' gestation, which had undergone termination, miscarriage or intrauterine fetal death. We performed PM-US using different transducers and compared the data with those from conventional autopsy. The latter was performed, according to the Societé Francaise de Foetopathologie (France) guidelines, by experienced perinatal pathologists who were blinded to the ultrasound data. RESULTS Complete virtual autopsy by ultrasound was possible in 95.5% of the cases. The sensitivity of PM-US for detecting brain abnormalities was 90.9% (95% CI, 58.7-99.8%) and the specificity was 87.3% (95% CI, 75.5-94.7%). In 20% of cases, a neuropathological examination was not possible due to severe maceration. The sensitivity for detection of thoracic abnormalities was 88.9% (95% CI, 65.3-98.6%) and the specificity was 92.8% (95% CI, 84.1-97.6%), and the sensitivity for detection of abdominal anomalies was 85.7% (95% CI, 57.2-98.2%) and the specificity was 94.6% (95% CI, 86.7-98.5%). CONCLUSION This pilot study confirms the feasibility of PM-US for virtual autopsy as early as 11 weeks' gestation. This new technique shows high sensitivity and specificity in detecting congenital structural abnormalities as compared with conventional autopsy. Copyright © 2014 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- C Votino
- Departments of Obstetrics and Gynaecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - T Cos Sanchez
- Departments of Obstetrics and Gynaecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - B Bessieres
- Department of Feto-Pathology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
- Départment de Génétique Histologie-Embryologie-Cytogénétique, Hopital Necker-Enfant Malade, AP-HP, Paris, France
| | - V Segers
- Department of Feto-Pathology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - H Kadhim
- Department of Neuropathology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - F Razavi
- Départment de Génétique Histologie-Embryologie-Cytogénétique, Hopital Necker-Enfant Malade, AP-HP, Paris, France
| | - M Condorelli
- Departments of Obstetrics and Gynaecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - R Votino
- Departments of Obstetrics and Gynaecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - V D'Ambrosio
- Departments of Obstetrics and Gynaecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - J Jani
- Departments of Obstetrics and Gynaecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
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Dutch guideline for clinical foetal-neonatal and paediatric post-mortem radiology, including a review of literature. Eur J Pediatr 2018; 177:791-803. [PMID: 29675642 PMCID: PMC5958158 DOI: 10.1007/s00431-018-3135-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 02/05/2018] [Accepted: 03/26/2018] [Indexed: 01/08/2023]
Abstract
UNLABELLED Clinical post-mortem radiology is a relatively new field of expertise and not common practice in most hospitals yet. With the declining numbers of autopsies and increasing demand for quality control of clinical care, post-mortem radiology can offer a solution, or at least be complementary. A working group consisting of radiologists, pathologists and other clinical medical specialists reviewed and evaluated the literature on the diagnostic value of post-mortem conventional radiography (CR), ultrasonography, computed tomography (PMCT), magnetic resonance imaging (PMMRI), and minimally invasive autopsy (MIA). Evidence tables were built and subsequently a Dutch national evidence-based guideline for post-mortem radiology was developed. We present this evaluation of the radiological modalities in a clinical post-mortem setting, including MIA, as well as the recently published Dutch guidelines for post-mortem radiology in foetuses, neonates, and children. In general, for post-mortem radiology modalities, PMMRI is the modality of choice in foetuses, neonates, and infants, whereas PMCT is advised in older children. There is a limited role for post-mortem CR and ultrasonography. In most cases, conventional autopsy will remain the diagnostic method of choice. CONCLUSION Based on a literature review and clinical expertise, an evidence-based guideline was developed for post-mortem radiology of foetal, neonatal, and paediatric patients. What is Known: • Post-mortem investigations serve as a quality check for the provided health care and are important for reliable epidemiological registration. • Post-mortem radiology, sometimes combined with minimally invasive techniques, is considered as an adjunct or alternative to autopsy. What is New: • We present the Dutch guidelines for post-mortem radiology in foetuses, neonates and children. • Autopsy remains the reference standard, however minimal invasive autopsy with a skeletal survey, post-mortem computed tomography, or post-mortem magnetic resonance imaging can be complementary thereof.
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Post-mortem whole-body magnetic resonance imaging of human fetuses: a comparison of 3-T vs. 1.5-T MR imaging with classical autopsy. Eur Radiol 2017; 27:3542-3553. [PMID: 28116518 DOI: 10.1007/s00330-016-4725-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 10/24/2016] [Accepted: 12/20/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To prospectively compare diagnostic accuracy of fetal post-mortem whole-body MRI at 3-T vs. 1.5-T. METHODS Between 2012 and 2015, post-mortem MRI at 1.5-T and 3-T was performed in fetuses after miscarriage/stillbirth or termination. Clinical MRI diagnoses were assessed using a confidence diagnostic score and compared with classical autopsy to derive a diagnostic error score. The relation of diagnostic error for each organ group with gestational age was calculated and 1.5-T with 3-T was compared with accuracy analysis. RESULTS 135 fetuses at 12-41 weeks underwent post-mortem MRI (followed by conventional autopsy in 92 fetuses). For all organ groups except the brain, and for both modalities, the diagnostic error decreased with gestation (P < 0.0001). 3-T MRI diagnostic error was significantly lower than that of 1.5-T for all anatomic structures and organ groups, except the orbits and brain. This difference was maintained for fetuses <20 weeks gestation. Moreover, 3-T was associated with fewer non-diagnostic scans and greater concordance with classical autopsy than 1.5-T MRI, especially for the thorax, heart and abdomen in fetuses <20 weeks. CONCLUSION Post-mortem fetal 3-T MRI improves confidence scores and overall accuracy compared with 1.5-T, mainly for the thorax, heart and abdomen of fetuses <20 weeks of gestation. KEY POINTS • In PM-MRI, diagnostic error using 3-T is lower than that with 1.5-T. • In PM-MRI, diagnostic scan rate is higher using 3-T than 1.5-T. • In PM-MRI, concordance with classical autopsy increases with 3-T. • PM-MRI using 3-T is particularly interesting for thoracic and abdominal organs. • PM-MRI using 3-T is particularly interesting for fetuses < 20 weeks' gestation.
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Abu-Rustum RS, Ziade MF, Abu-Rustum SE, Daou LS. Are There Head Volume Alterations at 11 to 14 Weeks in Fetuses with Congenital Heart Defects? A First Trimester Case Series. AJP Rep 2016; 6:e232-8. [PMID: 27308099 PMCID: PMC4907783 DOI: 10.1055/s-0036-1584241] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Accepted: 04/11/2016] [Indexed: 02/07/2023] Open
Abstract
Objective This study aims to assess head volume (HV) alterations at 11 to 14 weeks in fetuses with congenital heart defects (CHD). Methods A retrospective case-control study on 100 normal and 26 CHD fetuses was conducted. The fetuses had a first trimester scan with volume data sets stored from which HV was calculated. The mean HV and HV as a function of crown-rump length (CRL) in normal fetuses were compared with established normograms. Mean HV, HV as a function of CRL, and HV/CRL were compared between normal and CHD fetuses. Nonparametric Kruskal-Wallis H test was used with p < 0.05 considered significant. Results Overall, 83 normal and 19 CHD fetuses were included. The mean HV and HV as a function of CRL in the normal fetuses were comparable to what has been established (p = 0.451 and 0.801, respectively). The mean HV was statistically smaller in fetuses with CHD, particularly those with hypoplastic left heart (HLH): 10.7 mL in HLH versus 13.0 mL in normal fetuses (p = 0.043). The HV/CRL was statistically smaller in fetuses with CHD (p = 0.01). Conclusion Despite the small sample size, our case series suggests that alterations in HV may potentially be apparent as early as 11 to 14 weeks in CHD fetuses, particularly those with HLH. Larger prospective studies are needed to validate our findings.
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Affiliation(s)
| | - M. Fouad Ziade
- Faculty of Public Health, Lebanese University, Tripoli, Lebanon
| | | | - Linda S. Daou
- Department of Pediatric Cardiology, St. Joseph University, Beirut, Lebanon
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Comparison of diagnostic performance for perinatal and paediatric post-mortem imaging: CT versus MRI. Eur Radiol 2015; 26:2327-36. [PMID: 26489748 DOI: 10.1007/s00330-015-4057-9] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 09/10/2015] [Accepted: 10/06/2015] [Indexed: 01/10/2023]
Abstract
OBJECTIVES To compare the diagnostic yield of whole-body post-mortem computed tomography (PMCT) imaging to post-mortem magnetic resonance (PMMR) imaging in a prospective study of fetuses and children. METHODS We compared PMCT and PMMR to conventional autopsy as the gold standard for the detection of (a) major pathological abnormalities related to the cause of death and (b) all diagnostic findings in five different body organ systems. RESULTS Eighty two cases (53 fetuses and 29 children) underwent PMCT and PMMR prior to autopsy, at which 55 major abnormalities were identified. Significantly more PMCT than PMMR examinations were non-diagnostic (18/82 vs. 4/82; 21.9 % vs. 4.9 %, diff 17.1 % (95 % CI 6.7, 27.6; p < 0.05)). PMMR gave an accurate diagnosis in 24/55 (43.64 %; 95 % CI 31.37, 56.73 %) compared to 18/55 PMCT (32.73 %; 95 % CI 21.81, 45.90). PMCT was particularly poor in fetuses <24 weeks, with 28.6 % (8.1, 46.4 %) more non-diagnostic scans. Where both PMCT and PMMR were diagnostic, PMMR gave slightly higher diagnostic accuracy than PMCT (62.8 % vs. 59.4 %). CONCLUSION Unenhanced PMCT has limited value in detection of major pathology primarily because of poor-quality, non-diagnostic fetal images. On this basis, PMMR should be the modality of choice for non-invasive PM imaging in fetuses and children. KEY POINTS • Overall 17.1 % more PMCT examinations than PMMR were non-diagnostic • 28.6 % more PMCT were non-diagnostic than PMMR in fetuses <24 weeks • PMMR detected almost a third more pathological abnormalities than PMCT • PMMR gave slightly higher diagnostic accuracy when both were diagnostic.
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Taylor AM, Arthurs OJ, Sebire NJ. Postmortem cardiac imaging in fetuses and children. Pediatr Radiol 2015; 45:549-55. [PMID: 25828357 PMCID: PMC4381101 DOI: 10.1007/s00247-014-3164-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Revised: 07/11/2014] [Accepted: 08/20/2014] [Indexed: 11/26/2022]
Abstract
Fetal and pediatric cardiac autopsies have a crucial role in the counseling of parents with regard to both the cause of death of their child and the implications of such findings for future pregnancies, as well as for quality assurance of antenatal screening programs and antemortem diagnostic procedures. Postmortem imaging allows an opportunity to investigate the heart in situ prior to dissection, and both postmortem CT and postmortem MRI have shown excellent accuracy in detecting the majority of clinically significant cardiac lesions in the perinatal and pediatric population. As less-invasive autopsy becomes increasingly popular, clinical guidelines for maximal diagnostic yield in specific circumstances can be developed.
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Affiliation(s)
- Andrew M. Taylor
- Cardiorespiratory Division, Level 7, Old Nurses Home, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- UCL Institute of Cardiovascular Science, London, UK
| | - Owen J. Arthurs
- UCL Institute of Cardiovascular Science, London, UK
- Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH UK
| | - Neil J. Sebire
- UCL Institute of Cardiovascular Science, London, UK
- Department of Histopathology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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Lombardi CM, Zambelli V, Botta G, Moltrasio F, Cattoretti G, Lucchini V, Fesslova V, Cuttin MS. Postmortem microcomputed tomography (micro-CT) of small fetuses and hearts. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2014; 44:600-609. [PMID: 24585450 DOI: 10.1002/uog.13330] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Revised: 01/29/2014] [Accepted: 01/31/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To assess the feasibility and utility of contrast-enhanced microcomputed tomography (micro-CT) for identifying structural anomalies in ex-vivo first- and second-trimester human fetuses and isolated fetal hearts. METHODS Radiopaque iodine staining and micro-CT scanning protocols were first developed in rodent studies and then used to examine routinely fixed whole human fetuses (n = 7, weight 0.1-90 g, gestational age, 7-17 weeks) and isolated fetal hearts (n = 14, weight 0.1-5.2 g, gestational age, 11-22 weeks). Samples were scanned using an isotropic resolution of 18 (and, if necessary, 9 or 35) µm and findings were interpreted jointly by four fetal pathologists, a fetal cardiologist and a radiologist. Samples with gestational ages ≥ 13 weeks also underwent conventional autopsy or dissection. RESULTS Micro-CT identified all anatomical structures and abnormalities documented by the macroscopic examination. In all seven cases involving fetuses ≤ 13 weeks (four fetuses, three isolated hearts), micro-CT excluded the presence of structural anomalies. In the remaining 14 cases, it provided all the information obtained with invasive autopsy or dissection and in seven of the 14 (two fetuses, five isolated hearts) it furnished additional diagnostic details. CONCLUSIONS This pilot study confirms the feasibility of postmortem contrast-enhanced micro-CT assessment of structural anomalies in whole small fetuses and fetal hearts. Further study is needed to confirm our findings, particularly in whole fetuses, and to define the extent to which this virtual examination might be used instead of conventional invasive autopsy.
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Affiliation(s)
- C M Lombardi
- Department of Radiology-Studio Diagnostico Eco, Vimercate, Milan, Italy
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Abstract
First trimester sonography is a widely used technique to examine the foetus early in pregnancy. The desire to recognise complex anatomy already in early developmental stages stresses the need for a thorough knowledge of basic developmental processes as well as recognition of cardiac compartments based on their morphology. In this paper, we describe the possibilities and limitations of sonographic assessment of the foetal heart between 10 and 14 weeks of gestation and correlate this to morphology. Examples of the most commonly detected congenital anomalies are atrioventricular septal defects, transposition of the great arteries, and hypoplastic left heart, which are shown in this paper.
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Sandaite I, Dymarkowski S, De Catte L, Moerman P, Gewillig M, Fedele L, Deprest J, Claus F. Fetal heart pathology on postmortem 3-T magnetic resonance imaging. Prenat Diagn 2013; 34:223-9. [DOI: 10.1002/pd.4283] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2013] [Revised: 11/06/2013] [Accepted: 11/08/2013] [Indexed: 11/11/2022]
Affiliation(s)
- Inga Sandaite
- Department of Radiology; University Hospitals Leuven; Leuven Belgium
- Department of Obstetrics and Gynaecology; Fondazione Csa' Granda, Ospedale Maggiore Policlinico; Milan Italy
| | | | - Luc De Catte
- Department of Obstetrics and Gynaecology; University Hospitals Leuven; Leuven Belgium
| | - Philippe Moerman
- Department of Pathology; University Hospitals Leuven; Leuven Belgium
| | - Marc Gewillig
- Department of Pediatric and Congenital Cardiology; University Hospitals Leuven; Leuven Belgium
| | - Luigi Fedele
- Department of Obstetrics and Gynaecology; Fondazione Csa' Granda, Ospedale Maggiore Policlinico; Milan Italy
| | - Jan Deprest
- Department of Obstetrics and Gynaecology; University Hospitals Leuven; Leuven Belgium
| | - Filip Claus
- Department of Radiology; University Hospitals Leuven; Leuven Belgium
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Wielandner A, Mlczoch E, Prayer D, Berger-Kulemann V. Potential of magnetic resonance for imaging the fetal heart. Semin Fetal Neonatal Med 2013; 18:286-97. [PMID: 23742821 DOI: 10.1016/j.siny.2013.05.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Significant congenital heart disease (sCHD) affects 3.6 per 1000 births, and is often associated with extracardiac and chromosomal anomalies. Although early mortality has been substantially reduced and the rate of long-term survival has improved, sCHD is, after preterm birth, the second most frequent cause of neonatal infant death. The prenatal detection of cardiac and vascular abnormalities enables optimal parental counselling and perinatal management. Echocardiography (ECG) is the first-line examination and gold standard by which cardiac malformations are defined. However, adequate examination by an experienced healthcare provider with modern technical imaging equipment is required. In addition, maternal factors and the gestational age may lower the image quality. Fetal magnetic resonance imaging (MRI) has been implemented over the last several years and is already used in the clinical routine as a second-line approach to assess fetal abnormalities. MRI of the fetal heart is still not routinely performed. Nevertheless, fetal cardiac MRI has the potential to complement ultrasound in detecting cardiovascular malformations and extracardiac lesions. The present work reviews the potential of MRI to delineate the anatomy and pathologies of the fetal heart. This work also deals with the limitations and continuing developments designed to overcome the current problems in cardiac imaging, including fast fetal heart rates, the lack of ECG-gating, and the presence of fetal movements.
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Affiliation(s)
- Alice Wielandner
- Department of Radiology, Medical University of Vienna, AKH, Vienna, Austria
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Sandaite I, De Catte L, Moerman P, Gewillig M, Fedele L, Deprest J, Claus F. A morphometric study of the human fetal heart on post-mortem 3-tesla magnetic resonance imaging. Prenat Diagn 2013; 33:318-27. [DOI: 10.1002/pd.4070] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Inga Sandaite
- Department of Radiology; University Hospitals Leuven; Leuven Belgium
- Department of Obstetrics and Gynaecology, Fondazione Ca' Granda; Ospedale Maggiore Policlinico; Milan Italy
| | - Luc De Catte
- Department of Obstetrics and Gynaecology; University Hospitals Leuven; Leuven Belgium
| | - Philippe Moerman
- Department of Pathology; University Hospitals Leuven; Leuven Belgium
| | - Marc Gewillig
- Department of Pediatric and Congenital Cardiology; University Hospitals Leuven; Leuven Belgium
| | - Luigi Fedele
- Department of Obstetrics and Gynaecology, Fondazione Ca' Granda; Ospedale Maggiore Policlinico; Milan Italy
| | - Jan Deprest
- Department of Obstetrics and Gynaecology; University Hospitals Leuven; Leuven Belgium
| | - Filip Claus
- Department of Radiology; University Hospitals Leuven; Leuven Belgium
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Verhoye M, Votino C, Cannie MM, Segers V, Mabiglia C, Cos T, Lipombi D, Jani JC. Post-mortem high-field magnetic resonance imaging: effect or various factors. J Matern Fetal Neonatal Med 2013; 26:1060-5. [DOI: 10.3109/14767058.2013.767891] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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