Post-mortem fetal MRI: what do we learn from it?

Postmortem Magnetic Resonance Imaging of In Utero Fetuses and Its Relationship With Postmortem Interval: A Multi-Organ Observational Study on Reduced Fetuses of Complicated Multiple Pregnancies

BACKGROUND

Despite technological advancements in perinatal imaging, autopsy examination is still regarded as the reference standard to determine the time and reason of the fetal death.

PURPOSE

This study was conducted to identify the intrauterine postmortem magnetic resonance imaging (PMMR) findings of fetuses, who underwent radiofrequency ablation (RFA).

STUDY TYPE

Prospective.

POPULATION

Fifty-three twin/triplet complicated pregnancies scheduled for selective reduction of one of the fetuses by RFA were included.

FIELD STRENGTH/SEQUENCE

The imaging methods used are T1-weighted gradient-echo imaging (T1 GRE), T2 half-Fourier acquisition single-shot turbo spin-echo (SSTSE), and diffusion-weighted imaging (DWI) sequences.

ASSESSMENT

The MRIs were interpreted by three radiologists.

STATISTICAL TESTS

Data were analyzed using the software package SPSS Statistics Version 22.0. The used tests included one-way analysis of variance (ANOVA) and Duncan tests (significance level: P value <0.05). This analysis was performed with scikit-learn library (version 1.1.1) in Python version 3.9.

RESULTS

Average PMMR scores of orbit, brain, and abdomen showed significant differences among different PM interval subgroups. The brain apparent diffusion coefficient (ADC) numbers of reduced and living fetuses were significantly different at any PM interval. To determine which findings are closely associated with the timing of fetal death, five different methods of feature selection were employed. The top eight selected features achieved the highest area under the curve (AUC) of 78.19%.

DATA CONCLUSION

In utero, PMMR findings may be associated with the time of fetal death. Among different fetal organs evaluated, particularly PMMR top eight features specifically scores of orbits were associated with PM intrauterine time after death.

LEVEL OF EVIDENCE

2 TECHNICAL EFFICACY: Stage 2.

3T MRI signal intensity profiles and thicknesses of transient zones in human fetal brain at mid-gestation

In this study we compare temporal lobe (TL) signal intensity (SI) profiles, along with the average thicknesses of the transient zones obtained from postmortem MRI (pMRI) scans and corresponding histological slices, to the frontal lobe (FL) SI and zone thicknesses, in normal fetal brains. The purpose was to assess the synchronization of the corticogenetic processes in different brain lobes. Nine postmortem human fetal brains without cerebral pathologies, from 19 to 24 weeks of gestation (GW) were analyzed on T2-weighted 3T pMRI, at the coronal level of the thalamus and basal ganglia. The SI profiles of the transient zones in the TL correlate well spatially and temporally to the signal intensity profile of the FL. During the examined period, in the TL, the intermediate and subventricular zone are about the size of the subplate zone (SP), while the superficial SP demonstrates the highest signal intensity. The correlation of the SI profiles and the distributions of the transient zones in the two brain lobes, indicates a time-aligned histogenesis during this narrow time window. The 3TpMRI enables an assessment of the regularity of lamination patterns in the fetal telencephalic wall, upon comparative evaluation of sizes of the transient developmental zones and the SI profiles of different cortical regions. A knowledge of normal vs. abnormal transient lamination patterns and the SI profiles is a prerequisite for further advancement of the MR diagnostic tools needed for early detection of developmental brain pathologies prenatally, especially mild white matter injuries such as lesions of TL due to prenatal cytomegalovirus infections, or cortical malformations.

Perinatal post-mortem magnetic resonance imaging (MRI) of the central nervous system (CNS): a pictorial review

Central nervous system (CNS) abnormalities cause approximately 32–37.7% of terminations of pregnancy (TOP). Autopsy is currently the gold standard for assessing dead foetuses and stillborn. However, it has limitations and is sometimes subject to parental rejection. Recent studies have described post-mortem foetal magnetic resonance imaging (MRI) as an alternative and even complementary to autopsy for CNS assessment. Radiologists now play a key role in the evaluation of perinatal deaths. Assessment of foetal CNS abnormalities is difficult, and interpretation of foetal studies requires familiarisation with normal and abnormal findings in post-mortem MRI studies as well as the strengths and limitations of the imaging studies. The purpose of this pictorial review is to report our experience in the post-mortem MRI evaluation of the CNS system, including a description of the protocol used, normal CNS findings related to post-mortem status, abnormal CNS findings in our sample, and the correlation of these findings with histopathological results.

Fetal postmortem imaging: an overview of current techniques and future perspectives

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.

The Subplate Layers: The Superficial and Deep Subplate Can be Discriminated on 3 Tesla Human Fetal Postmortem MRI

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.

Morphometric development of the human fetal cerebellum during the early second trimester

The protracted nature of development makes the cerebellum vulnerable to a broad spectrum of pathologic conditions, especially during the early fetal period. This study aims to characterize normal cerebellar growth in human fetuses during the early second trimester. We manually segmented the fetal cerebellum using 7.0-T high-resolution MR images obtained in 35 specimens with gestational ages ranging from 15 to 22 weeks. Volume measurements and shape analysis were performed to quantitatively evaluate global and regional cerebellar growth. The absolute volume of the fetal cerebellum showed a quadratic growth with increasing gestational age, while the pattern of relative volume changes revealed that the cerebellum grew at a greater pace than the cerebrum after 17 gestational weeks. Shape analysis was used to examine the distinctive development of subregions of the cerebellum. The extreme lateral portions of both cerebellar hemispheres showed the lowest rate of growth. The anterior lobe grew faster than most of the posterior lobe. These findings expand our understanding of the early growth pattern of the human cerebellum and could be further used to assess the developmental conditions of the fetal brain.

Intrauterine fetal MR versus postmortem MR imaging after therapeutic termination of pregnancy: evaluation of the concordance in the detection of brain abnormalities at early gestational stage

BACKGROUND AND PURPOSE

Fetal postmortem MR Imaging (pmMRI) has been recently used as an adjuvant tool to conventional brain autopsy after termination of pregnancy (TOP). Our purpose was to compare the diagnostic performance of intrauterine MRI (iuMRI) and pmMRI in the detection of brain anomalies in fetuses at early gestational age (GA).

MATERIAL AND METHODS

We retrospectively collected 53 fetuses who had undergone iuMRI and pmMRI for suspected brain anomalies. Two pediatric neuroradiologists reviewed iuMRI and pmMRI examinations separately and then together. We used Cohen's K to assess the agreement between pmMRI and iuMRI. Using the combined evaluation iuMRI+pMRI as the reference standard, we calculated the "correctness ratio." We used Somers' D to assess the cograduation between postmortem image quality and time elapsed after fetus expulsion.

RESULTS

Our data showed high agreement between iuMRI and pmMRI considering all the categories together, for both observers (K1 0.84; K2 0.86). The correctness ratio of iuMRI and pmMRI was 79% and 45% respectively. The major disagreements between iuMRI and pmMRI were related to postmortem changes as the collapse of liquoral structures and distorting phenomena. We also found a significant cograduation between the time elapsed from expulsion and pmMRI contrast resolution and distortive phenomena (both p < 0.001).

CONCLUSIONS

Our study demonstrates an overall high concordance between iuMRI and pmMRI in detecting fetal brain abnormalities at early GA. Nevertheless, for the correct interpretation of pmMRI, the revision of fetal examination seems to be crucial, in particular when time elapsed from expulsion is longer than 24 h.

KEY POINTS

• IuMRI and pmMRI showed overall high concordance in detecting fetal brain abnormalities at early GA. • PmMRI corroborated the antemortem diagnosis and it could be a valid alternative to conventional brain autopsy, only when the latter cannot be performed. • Some caution should be taken in interpreting pmMR images when performed after 24 h from fetal death.

The possibilities of studying human embryos and foetuses using micro-CT: a technical note

The purpose of the study was to discover a way to study the internal structure and evolution of human embryos noninvasively. The human embryo was stained with phosphotungstic acid solution (PTA) in ethanol (EPTA) and scanned using a micro computed tomography (micro-CT) scanner. Using appropriate software, a three-dimensional image of the embryo was created, which could be further exploited. The methodology described could be used for the non-destructive examination of the internal structure of the human embryo, and the resulting data can be used as a resource for medical students, gynaecologists, and paediatricians.

Post-mortem magnetic resonance foetal imaging: a study of morphological correlation with conventional autopsy and histopathological findings

The aim of the present study is to offer our experience concerning post-mortem magnetic resonance (PMMR) in foetal death cases and an evaluation of the differences between the findings acquired by PMMR and by forensic autopsy. Fifteen foetuses were recruited from July 2014 to December 2015. These had suffered intrauterine death in women in the 21st to 38th week of gestation who were treated in the emergency department for non-perception of foetal movements. We performed a PMMR on foetuses, 3 ± 1 days on average from the time of death, and then a complete forensic autopsy was performed. All 15 foetuses were examined with a whole-body study protocol, starting from the skull, down to and including the lower limbs. The total time of examination ranged from 20 to 30 min in each case. The external evaluation and description of post-mortem phenomena (maceration), record of the weight and detection and the various measurements of foetal diameters were evaluated before performing autopsy. A complete histopathological study was performed in each case. Out of 15 cases examined, eight were negative for structural anatomical abnormalities and/or diseases, both in the preliminary radiological examination and the traditional autopsy. In the remaining seven cases, pathological findings were detected by PMMR with corresponding results at autopsy. PMMR can provide useful information on foetal medical conditions and result in improved diagnostic classification. It may enable the planning of a more suitable technique before proceeding to autopsy, including focusing on certain aspects of organ pathology otherwise not detectable. The association between PMMR, post-mortem examination and related histological study of the foetus-placenta unit could help reduce the percentage of cases in which the cause of foetal death remains unexplained. Lastly, it may allow a selective sampling of the organ in order to target histological investigations.

The use of magnetic resonance in the hospital and coronial pediatric postmortem examination

The role of magnetic resonance imaging (MRI) has rapidly progressed from being a research tool to an ancillary pre-autopsy imaging technique and now an adjunct of the postmortem (PM) examination. In this review, we describe our experience with the use of PM MRI over the last 6 years in more than 300 fetal PM examinations, initially as research and finally the most recent use in 30 pediatric coronial autopsies. The pediatric pathologist and the neonatal and fetal radiologist retrospectively measured the impact on diagnosis at each stage of the development of the technique together. All imaging techniques have the advantage of being non-invasive, more acceptable to the public, especially certain religious groups and provide a permanent record of the features observed.

Diffusion-weighted perinatal postmortem magnetic resonance imaging as a marker of postmortem interval

Objective

To evaluate perinatal body organ apparent diffusion coefficient (ADC) values at postmortem magnetic resonance imaging (PMMR) in order to evaluate postmortem changes.

Methods

Postmortem diffusion-weighted imaging (DWI) of the thorax and abdomen were performed with diffusion gradient values b = 0, 500, and 1000 s/mm² on 15 foetal and childhood cases (mean 33.3 ± 7.8 weeks gestation) compared to 44 live infants (mean age 75.5 ± 53.4 days). Mean ADC values were calculated from regions of interest (ROIs) for the lungs, liver, spleen and renal cortex, compared to normative live infantile body ADC values of similar gestational age.

Results

Mean ADC values were significantly lower in postmortem cases than in normal controls for liver (0.88 10^-3 mm²/s ± SD 0.39 vs. 1.13 ± 0.13; p < 0.05) and renal cortex (0.85 ± 0.26 vs. 1.19 ± 0.13; p < 0.05) but not spleen or muscle. Mean lung ADC values were significantly higher than normal controls (1.06 ± 0.18 vs. 0 ± 0; p < 0.001), and there was a significant correlation between postmortem interval and lung ADC (R² = 0.55).

Conclusion

Lung PMMR ADC values are related to postmortem interval, making them a potential marker of time since death. Further research is needed to understand the organ-specific changes which occur in the postmortem period.

Key Points

• Liver and spleen PM ADC values were lower than controls.

• Lung ADC changes correlate with PM interval.

• These findings may be useful in medicolegal cases.

Foetal "black bone" MRI: utility in assessment of the foetal spine

OBJECTIVE

Foetal CT has recently been added to the foetal imaging armamentarium, but this carries with it the risks of ionizing radiation, both to the mother and the foetus. Foetal "black bone" MRI is a new technique that allows assessment of the foetal skeleton without the risk of exposure to ionizing radiation and is a potential new sequence in foetal MRI examination.

METHODS

Retrospective review of all foetal MRI studies over the past 4- to 5-year period identified 36 cases where susceptibility weighted imaging was used. Cases were selected from this group to demonstrate the potential utility of this sequence.

RESULTS

This sequence is most frequently useful not only in the assessment of spinal abnormalities, most commonly the bony abnormalities in myelomeningocele, but also in cases of scoliosis, segmentation anomalies and sacrococcygeal teratoma.

CONCLUSION

Although the utility of this sequence is still being evaluated, it provides excellent contrast between the mineralized skeleton and surrounding soft tissues compared with standard half Fourier acquisition single-shot turbo-spin echo sequences. Further assessment is required to determine whether black bone MRI can more accurately evaluate the level of bony defect in spina bifida aperta, an important prognostic factor. Potential further uses include the assessment of skeletal dysplasias, evaluation of the skull base and craniofacial skeleton in certain congenital anomalies and the post-mortem evaluation of the foetal skeleton potentially obviating the need for necropsy.

ADVANCES IN KNOWLEDGE

Foetal black bone MRI can be performed using susceptibility weighted imaging and allows better demonstration of the mineralized skeleton compared with standard sequences.

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

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

Development of the subcortical brain structures in the second trimester: assessment with 7.0-T MRI

INTRODUCTION

This study aims to obtain the signal intensity changes and quantitative measurements of the subcortical brain structures of 12-22 weeks gestational age (GA).

METHODS

Sixty-nine fetal specimens were selected and scanned by 7.0-T MR. The signal intensity changes of the subcortical brain structures were analyzed. The three-dimensional visualization models of the germinal matrix, caudate nucleus, lentiform nucleus, and dorsal thalamus were rebuilt with Amira 4.1, and the developmental trends between the measurements and GA were analyzed.

RESULTS

The germinal matrix was delineated on 7.0-T MR images at 12 weeks GA, with high signals on T1-weighted images (WI). While at 16 weeks GA, the caudate nucleus, lentiform nucleus, and internal and external capsules could be distinguished. The caudate nucleus was high signal intensity on T1WI. The signal intensity of the putamen was high on T1WI during 15-17 weeks GA and was delineated as an area with uneven signal intensities. The signal intensity of the peripheral area of the putamen became higher after 18 weeks GA. The signal intensity of the globus pallidus was high on T1WI and low on T2WI after 20 weeks GA. At 18 weeks GA, the claustrum was delineated with low signals on T2WI. Measurements of the germinal matrix, caudate nucleus, lentiform nucleus, and dorsal thalamus linearly increased with the GA.

CONCLUSION

Development of the subcortical brain structures during 12-22 weeks GA could be displayed with 7.0-T MRI. The measurement provides significant reference beneficial to the clinical evaluation of fetal brain development.

Post-mortem magnetic resonance imaging and its irreplaceable role in determining CNS malformation (hydranencephaly)--case report

Post-mortem magnetic resonance appears to be a method supplementary to classic pathological-anatomical autopsy in determining foetal abnormalities. Frequently, it plays a key role, primarily where autopsy options are in some way limited (developed autolysis, dilatation of the ventricular system). This case report demonstrates that post-mortem magnetic resonance imaging can precisely determine the type of congenital malformation (hydranencephaly), by contrast to ultrasound, with which alobar holoprosencephaly has been described, often presenting a differential diagnosis problem. Pathological-anatomical autopsy was significantly limited due to this diagnosis and this methodology was incapable of unequivocally determining the type of malformation. We would like to demonstrate by this case report the necessity of performing post-mortem magnetic resonance imaging so that we may precisely determine the diagnosis as requested by the parents and also be able to answer the question posed by risks for future pregnancies.

Meningocerebral Angiodysplasia: Post-Mortem Magnetic Resonance Imaging and Autopsy

This case report describes a finding of vascular malformation of an aborted foetus of gestational age of the 22nd week. This concerns meningocerebral angiodysplasia, located in the posterior fossa and around the thalami. This disease is rare and is often accompanied by renal agenesis. The finding was complicated by hydrocephalus. Our report compares all three diagnostic methods (prenatal ultrasonography, post-mortem MR and autopsy). Prenatal ultrasonography described only hydrocephalus and reduction of cerebral parenchyma. MR displayed the extent of the malformation, the exact diagnosis was however determined by histological examination. MR described agenesis of structures of midbrain, which was confirmed by autopsy.

Variations in cortical folding patterns are related to individual differences in temperament

There is evidence that anterior cingulate cortex (ACC) function is related to individual differences in temperament. An important question regards how early such brain-behavior associations emerge. We examined the relationship between cortical folding patterns of the ACC, which are functionally relevant and primarily determined by birth, and individual differences in four core temperament dimensions (Effortful Control, Negative Affectivity, Surgency, and Affiliation). Magnetic resonance imaging was used to classify 153 (81 male) early adolescents as displaying a leftward asymmetric, rightward asymmetric, or symmetric pattern of ACC folding, as indexed by the incidence and extent of the paracingulate sulcus (PCS). A leftward asymmetric pattern of ACC folding was associated with significantly higher temperamental Effortful Control and lower Negative Affectivity than a rightward asymmetric pattern. Further, this difference was significant only for males. Across males and females, a symmetric pattern was associated with higher temperamental Affiliation than was a rightward asymmetric pattern of ACC folding. These findings suggest that early neurodevelopmental processes contribute to individual differences in temperament. They also illustrate sexual dimorphisms in the neural underpinnings of temperament.

Less invasive autopsy: benefits and limitations of the use of magnetic resonance imaging in the perinatal postmortem

The decline in the postmortem (PM) autopsy rate in the United Kingdom paralleled the change in public perception of this procedure after the organ retention crisis in 2000. The introduction of magnetic resonance imaging (MRI) in the fetal, perinatal, and pediatric autopsy led some investigators to propose that MRI could replace the conventional PM. We assessed the role of MRI in fetal autopsy as an addition or a potential replacement method to the conventional PM and to evaluate the benefits and limitations of each technique. We retrospectively reviewed the PM and MRI examination of 100 fetuses. The MRI was limited to the brain or brain and spinal cord. Forty-six cases involved termination of pregnancy; 30 were intrauterine fetal deaths/stillbirths; 16 were premature deliveries followed by neonatal death; and 8 were miscarriages. The mean gestational age of all cases was 25.54 weeks (range: 13-41 weeks). In 54 of the 90 full PMs, there was a complete agreement between the MRI and autopsy findings on the morphology of the brain and spine. Despite this agreement, the information gained at the PM was relevant to find the cause or mechanism of death in 20 of 54 cases (37%). In 24 autopsies the MRI added valuable information to the autopsy. However, if MRI had been the only investigation, essential information would have been lost in 17 of 24 cases (71%). In 12 cases the PM was clearly superior to the MRI. The integrated result obtained from the traditional autopsy remains crucial in determining the cause or mechanism of the malformation or of the fetal/perinatal death and accordingly is important for the counseling offered to parents regarding the recurrence risk for future pregnancies.

Guidelines for Investigating Stillbirths: An Update of a Systematic Review

OBJECTIVE

To identify formal, publicly available guidelines for stillbirth investigation and to identify the most appropriate clinical practice guideline (or component of a guideline) for use in Alberta.

METHODS

A systematic literature search was conducted to identify primary and secondary research studies published between January 1985 and August 2006 and formal, publicly available guidelines on the subject of stillbirth investigation. The Cochrane Library, PubMed, EMBASE, CINAHL, HealthSTAR, Science Citation Index, BIOSIS, and the NHS and CRD databases were searched. The methodological quality of the selected primary research studies was assessed according to specific criteria.

RESULTS

All six of the publicly available clinical practice guidelines selected for this review outlined similar steps in the stillbirth investigation but differed about which tests to include and which components should be core or additional investigations. They agreed on including several elements for routine investigation, such as complete autopsy and detailed examination of the cord and placenta. Of 61 retrieved primary research studies, only seven met the inclusion criteria. No studies compared the value of specific guidelines. Although reviewed evidence highlights the value of fetal autopsy and placental examinations as integral components of stillbirth investigation, the value of other components is still not clear.

CONCLUSIONS

No firm scientific judgement could be made about which clinical practice guideline for stillbirth investigation is the most appropriate or which components are essential. Currently here is no generally accepted reference guideline for stillbirth investigation. Fetal autopsy and placental examination remain important components, assuming the postmortem examination is of high quality. These data may be helpful in counselling parents who are considering whether or not to consent to a postmortem examination.

Postmortem magnetic resonance imaging as an adjunct to perinatal autopsy for renal-tract abnormalities

The aim of this study was to compare postmortem magnetic resonance imaging (MRI) of the renal system with autopsy in perinatal and fetal deaths. 37 deaths were studied and renal abnormalities were found in five of these cases. Postmortem MRI provided information of diagnostic utility comparable to that obtained by autopsy.

Postmortem computed tomography and magnetic resonance imaging in a case of terminal-stage small cell lung cancer: an experience of autopsy imaging in tumor-related death

We report a case of terminal-stage small-cell lung cancer with multiple metastases in which postmortem computed tomography and magnetic resonance imaging (collectively called "autopsy imaging") were performed and correlated with conventional autopsy findings. In this case, autopsy imaging provided contemporaneous data that supported conventional autopsy findings. Autopsy imaging revealed the process of primary tumor growth, changes in metastatic lesions, and occurrences of new metastases in the terminal stage and made it easier to understand the clinical course of the patient. The usefulness of autopsy imaging after traumatic death, sudden death from natural causes, or congenital anomaly has been reported. Here, we attempted a preliminary study of its use in the detection of death due to tumor. Our results indicated that autopsy imaging provides useful information in cancer-related death and may be an alternative when conventional autopsy cannot be performed.