Minimally-invasive fetal autopsy using magnetic resonance imaging and percutaneous organ biopsies: clinical value and comparison to conventional autopsy
Minimally-invasive fetal autopsy using magnetic resonance imaging and percutaneous organ biopsies: clinical value and comparison to conventional autopsy
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DOI：
10.1002/uog.8844
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发表时间：
2011-03-01
影响因子：
7.1
通讯作者：
Lees, C. C.
中科院分区：
文献类型：
--
作者：
Breeze, A. C. G.;Jessop, F. A.;Lees, C. C.
目的尸检是胎儿死亡或终止胎儿畸形后的一项重要检查。在围产儿死亡的情况下，死后磁共振成像(MRI)可以提供与传统尸检质量相当的宏观信息。它不提供用于组织学检查的组织，这可能会限制复发风险咨询的质量和死亡原因的阐明。方法对44例死亡或异常终止的胎儿进行尸检，在常规尸检前行经皮胎儿主要器官(肝、肺、心、脾、肾、肾上腺和胸腺)的表面标志检查。我们比较了两种检查的重要发现，包括诊断信息和临床意义。辅助检查(如X线片和胎盘组织学)被认为是这两种尸检的共同特征。结果在21例尸检中，常规尸检提供了优于MIA的诊断信息。在两个案例中，MIA提供了比传统尸检更好的诊断信息，因为自溶阻止了对胎儿大脑的详细检查。在其余21例中，常规尸检和MIA提供了相同的诊断信息。然而，在临床意义方面，在32例(72.7%)病例中，MIA提供的信息至少与传统尸检的临床意义相同。结论虽然在某些情况下，MRI可以提供额外的信息，但常规的围产期尸检仍然是调查胎儿死亡的金标准。在基于MRI的胎儿尸检中，在没有影像指导的情况下增加经皮器官活检的效用仍未得到证实。在大多数病例中，死后MRI结合辅助检查，如胎盘组织学、病理学家的外部检查、细胞遗传学和X线平片，可提供同等临床意义的信息。版权所有(C)2011 ISUOG。作者：John Wiley&Sons，Ltd.
Objectives Autopsy is an important investigation following fetal death or termination for fetal abnormality. Postmortem magnetic resonance imaging (MRI) can provide macroscopic information of comparable quality to that of conventional autopsy in the event of perinatal death. It does not provide tissue for histological examination, which may limit the quality of counseling for recurrence risks and elucidation of the cause of death. We sought to examine the comparability and clinical value of a combination of postmortem MRI and percutaneous fetal organ biopsies (minimally invasive autopsy (MIA)) with conventional fetal autopsy.Methods Forty-four fetuses underwent postmortem MRI and attempted percutaneous biopsy (using surface landmarks) of major fetal organs (liver, lung, heart, spleen, kidney, adrenal and thymus) following fetal death or termination for abnormality, prior to conventional autopsy, which was considered the 'gold standard'. We compared significant findings of the two examinations for both diagnostic information and clinical significance. Ancillary investigations (such as radiographs and placental histology) were regarded as common to the two forms of autopsy.Results In 21 cases conventional autopsy provided superior diagnostic information to that of MIA. In two cases the MIA provided superior diagnostic information to that of conventional autopsy, when autolysis prevented detailed examination of the fetal brain. In the remaining 21 cases, conventional autopsy and MIA provided equivalent diagnostic information. With regard to clinical significance, however, in 32 (72.7%) cases, the MIA provided information of at least equivalent clinical significance to that of conventional autopsy. In no case did the addition of percutaneous biopsies reveal information of additional clinical significance.Conclusions Although in some cases MRI may provide additional information, conventional perinatal autopsy remains the gold standard for the investigation of fetal death. The utility of adding percutaneous organ biopsies, without imaging guidance, to an MRI-based fetal autopsy remains unproven. Postmortem MRI, combined with ancillary investigations such as placental histology, external examination by a pathologist, cytogenetics and plain radiography provided information of equivalent clinical significance in the majority of cases. Copyright (C) 2011 ISUOG. Published by John Wiley & Sons, Ltd.