1
|
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.
Collapse
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
| |
Collapse
|
2
|
Moradi B, Habibi Z, Badraqe N, Rahmani M, Shirazi M, Sharbaf FR, Azadbakht J, Farnoosh A, Parooie F, Miratashi Yazdi SN. 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. J Magn Reson Imaging 2023; 57:952-961. [PMID: 36054250 DOI: 10.1002/jmri.28388] [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: 03/18/2022] [Revised: 07/10/2022] [Accepted: 07/11/2022] [Indexed: 11/08/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Behnaz Moradi
- Department of Radiology, Yas Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.,Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Medical Imaging Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Habibi
- Department of Radiology, Sina General Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Narges Badraqe
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Medical Imaging Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Rahmani
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Medical Imaging Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahboobeh Shirazi
- Maternal, Fetal, and Neonatal Research Center, Yas Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh R Sharbaf
- Maternal, Fetal, and Neonatal Research Center, Yas Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Javid Azadbakht
- Department of Radiology, Faculty of Medicine, Kashan University of Medical Sciences, Kashan, Iran
| | - Amirreza Farnoosh
- Department of Electrical Engineering, Northeastern University, Boston, Massachusetts, USA
| | - Fateme Parooie
- Pediatric Gastroenterology and Hepatology Research Center, Zabol University of Medical Sciences, Zabol, Iran
| | - Seyedeh N Miratashi Yazdi
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Medical Imaging Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
3
|
Shelmerdine SC, Hutchinson JC, Lewis C, Simcock IC, Sekar T, Sebire NJ, Arthurs OJ. A pragmatic evidence-based approach to post-mortem perinatal imaging. Insights Imaging 2021; 12:101. [PMID: 34264420 PMCID: PMC8282801 DOI: 10.1186/s13244-021-01042-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 06/24/2021] [Indexed: 12/16/2022] Open
Abstract
Post-mortem imaging has a high acceptance rate amongst parents and healthcare professionals as a non-invasive method for investigating perinatal deaths. Previously viewed as a 'niche' subspecialty, it is becoming increasingly requested, with general radiologists now more frequently asked to oversee and advise on appropriate imaging protocols. Much of the current literature to date has focussed on diagnostic accuracy and clinical experiences of individual centres and their imaging techniques (e.g. post-mortem CT, MRI, ultrasound and micro-CT), and pragmatic, evidence-based guidance for how to approach such referrals in real-world practice is lacking. In this review, we summarise the latest research and provide an approach and flowchart to aid decision-making for perinatal post-mortem imaging. We highlight key aspects of the maternal and antenatal history that radiologists should consider when protocolling studies (e.g. antenatal imaging findings and history), and emphasise important factors that could impact the diagnostic quality of post-mortem imaging examinations (e.g. post-mortem weight and time interval). Considerations regarding when ancillary post-mortem image-guided biopsy tests are beneficial are also addressed, and we provide key references for imaging protocols for a variety of cross-sectional imaging modalities.
Collapse
Affiliation(s)
- Susan C Shelmerdine
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK. .,UCL Great Ormond Street Institute of Child Health, London, UK. .,Great Ormond Street Hospital NIHR Biomedical Research Centre, London, UK.
| | - J Ciaran Hutchinson
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK.,UCL Great Ormond Street Institute of Child Health, London, UK.,Great Ormond Street Hospital NIHR Biomedical Research Centre, London, UK
| | - Celine Lewis
- Population, Policy and Practice Department, UCL GOS Institute of Child Health, London, UK.,North Thames Genomic Laboratory Hub, Great Ormond Street Hospital, London, UK
| | - Ian C Simcock
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK.,UCL Great Ormond Street Institute of Child Health, London, UK.,Great Ormond Street Hospital NIHR Biomedical Research Centre, London, UK
| | - Thivya Sekar
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK.,UCL Great Ormond Street Institute of Child Health, London, UK.,Great Ormond Street Hospital NIHR Biomedical Research Centre, London, UK
| | - Neil J Sebire
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK.,UCL Great Ormond Street Institute of Child Health, London, UK.,Great Ormond Street Hospital NIHR Biomedical Research Centre, London, UK
| | - Owen J Arthurs
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK.,UCL Great Ormond Street Institute of Child Health, London, UK.,Great Ormond Street Hospital NIHR Biomedical Research Centre, London, UK
| |
Collapse
|
4
|
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.
Collapse
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.
| |
Collapse
|
5
|
Shelmerdine SC, Langan D, Mandalia U, Sebire NJ, Arthurs OJ. Maceration determines diagnostic yield of fetal and neonatal whole body post-mortem ultrasound. Prenat Diagn 2020; 40:232-243. [PMID: 31743482 PMCID: PMC7028035 DOI: 10.1002/pd.5615] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 11/07/2019] [Accepted: 11/08/2019] [Indexed: 01/23/2023]
Abstract
OBJECTIVES To determine factors in nondiagnostic fetal and neonatal post-mortem ultrasound (PMUS) examinations. METHODS All fetal and neonatal PMUS examinations were included over a 5-year study period (2014-2019). Nondiagnostic image quality by body parts (brain, spine, thorax, cardiac, and abdomen) was recorded and correlated with patient variables. Descriptive statistics and logistic regression analyses were performed to identify significant factors for nondiagnostic studies. RESULTS Two hundred sixty-five PMUS examinations were included, with median gestational age of 22 weeks (12-42 wk), post-mortem weight of 363 g (16-4033 g), and post-mortem interval of 8 days (0-39 d). Diagnostic imaging quality was achieved for 178/265 (67.2%) studies. It was high for abdominal (263/265, 99.2%), thoracic (264/265, 99.6%), and spine (265/265, 100%) but lower for brain (210/265, 79.2%) and cardiac imaging (213/265, 80.4%). Maceration was the best overall predictor for nondiagnostic imaging quality (P < .0001). Post-mortem fetal weight was positively associated with cardiac (P = .0133) and negatively associated with brain imaging quality (P = .0002). Post-mortem interval was not a significant predictor. CONCLUSIONS Fetal maceration was the best predictor for nondiagnostic PMUS, particularly for brain and heart. Fetuses with marked maceration and suspected cardiac or brain anomalies should be prioritised for post-mortem MRI.
Collapse
Affiliation(s)
- Susan Cheng Shelmerdine
- Department of Clinical RadiologyGreat Ormond Street Hospital for ChildrenLondonUK
- UCL Great Ormond Street Institute of Child HealthGreat Ormond Street Hospital for ChildrenLondonUK
| | - Dean Langan
- UCL Great Ormond Street Institute of Child HealthGreat Ormond Street Hospital for ChildrenLondonUK
| | - Uday Mandalia
- Department of Clinical RadiologyGreat Ormond Street Hospital for ChildrenLondonUK
| | - Neil James Sebire
- UCL Great Ormond Street Institute of Child HealthGreat Ormond Street Hospital for ChildrenLondonUK
- Department of HistopathologyGreat Ormond Street Hospital for ChildrenLondonUK
| | - Owen John Arthurs
- Department of Clinical RadiologyGreat Ormond Street Hospital for ChildrenLondonUK
- UCL Great Ormond Street Institute of Child HealthGreat Ormond Street Hospital for ChildrenLondonUK
| |
Collapse
|