Less invasive autopsy: Benefits and limitations of the use of magnetic resonance imaging in the perinatal postmortem
Less invasive autopsy: Benefits and limitations of the use of magnetic resonance imaging in the perinatal postmortem
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DOI：
10.2350/07-01-0213.1
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发表时间：
2008-01-01
影响因子：
1.9
通讯作者：
Whitby, Elspeth H.
中科院分区：
文献类型：
--
作者：
Cohen, Marta C.;Paley, Martyn N.;Whitby, Elspeth H.
在英国，死后（PM）尸检率的下降反映了2000年器官保留危机后公众对这一程序看法的变化。磁共振成像（MRI）在胎儿，围产期和儿科尸检中的引入导致一些研究人员提出MRI可以取代传统的PM。我们评估了MRI在胎儿尸检中作为常规PM的补充或潜在替代方法的作用，并评估了每种技术的优点和局限性。我们回顾性分析了100例胎儿的PM和MRI检查。MRI仅限于大脑或大脑和脊髓。46例涉及终止妊娠; 30例为宫内胎儿死亡/死产; 16例为早产后新生儿死亡; 8例为流产。所有病例的平均孕龄为25.54周（范围：13-41周）。在90例完全PM中，有54例的MRI和尸检结果在大脑和脊柱的形态学上完全一致。尽管达成了这一一致，但在PM获得的信息与54例病例中的20例（37%）的死亡原因或机制相关。在24例尸检中，MRI为尸检提供了有价值的信息。然而，如果MRI是唯一的研究，24例病例中有17例（71%）丢失了重要信息。在12例病例中，PM明显优于MRI上级。从传统尸检中获得的综合结果在确定畸形或胎儿/围产期死亡的原因或机制方面仍然至关重要，因此对于向父母提供有关未来妊娠复发风险的咨询非常重要。
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.