Acceptance, reliability and confidence of diagnosis of fetal and neonatal virtuopsy compared with conventional autopsy: a prospective study
Acceptance, reliability and confidence of diagnosis of fetal and neonatal virtuopsy compared with conventional autopsy: a prospective study
复制标题
DOI：
10.1002/uog.10079
复制
发表时间：
2012-06-01
影响因子：
7.1
通讯作者：
Jani, J.
中科院分区：
文献类型：
--
作者：
Cannie, M.;Votino, C.;Jani, J.
目的 比较前瞻性母亲对胎儿和新生儿精细解剖与传统尸检的接受程度，并确定磁共振 (MR) 精细解剖可用于诊断各种胎儿解剖结构正常/异常的置信度。方法 对终止妊娠 (TOP)、宫内胎儿死亡 (IUFD) 或新生儿死亡的 96 名妇女（102 名胎儿/新生儿）进行 MR 和/或计算机断层扫描虚拟解剖和常规尸检。采用多变量逻辑回归分析来研究母亲年龄、TOP孕龄或IUFD后分娩、妊娠顺序、产次、宗教、获得同意的护理人员类型和死亡原因对母亲接受精密解剖和/或常规尸检的影响。当父母同意对妊娠 20 周的胎儿或新生儿进行 MR 详细解剖和常规尸检时，MR 详细解剖可用于诊断各种解剖结构正常/异常的置信度取决于常规尸检被认为是金标准的范围。在尸检中，我们将胎儿/新生儿分为具有正常或异常解剖结构的胎儿/新生儿；对这些组进行了单独分析。在虚拟解剖中，我们使用从 0（绝对异常）到 100（绝对正常）的评分标准，表明对尸检时定义的这两组中每个解剖结构的正常/异常诊断的置信度。结果 在 96 名女性中，99% (n = 95) 同意进行详细解剖，61.5% (n = 59) 同意常规尸检和详细解剖；即 36 人（37.5%）同意单独进行虚拟解剖。母亲对传统尸检的接受程度与单胎妊娠、非穆斯林母亲、TOP 妊娠早期或宫内节育器 (IUFD) 后分娩以及母亲胎儿医学专家获得同意独立呈正相关。对妊娠 20 周的 33 名胎儿进行了常规尸检和 MR 解剖，其中 19 名胎儿进行了包括大脑在内的完整尸检。在传统尸检中具有正常解剖结构的胎儿中，MR 精技检查与大脑、骨骼、除心脏外的胸部器官、除胰腺外的腹部器官、输尿管、膀胱和生殖器的高诊断置信度（分数> 80）相关。在尸检时解剖结构异常的胎儿中，MR 精技检查以高置信度（分数 < 20）检测到这些相同解剖结构的异常。然而，在三个案例中，除了传统尸检观察到的异常之外，精密解剖还诊断出大脑异常。结论 MR精密解剖几乎被所有母亲接受，而传统尸检则被大约三分之二的母亲接受，其中拒绝主要取决于我们无法控制的因素。尽管传统尸检仍然是黄金标准，但当前者被拒绝时，精湛解剖的高度接受度使其成为可接受的替代方案。版权所有 (C) 2012 ISUOG。由约翰·威利父子有限公司出版
Objectives To compare prospectively maternal acceptance of fetal and neonatal virtuopsy with that of conventional autopsy and to determine the confidence with which magnetic resonance (MR) virtuopsy can be used to diagnose normality/abnormality of various fetal anatomical structures. Methods MR and/or computed tomography virtuopsy and conventional autopsy were offered to 96 women (102 fetuses/neonates) following termination of pregnancy (TOP), intrauterine fetal death (IUFD) or neonatal death. Multivariable logistic regression analysis was used to investigate the effect on maternal acceptance of virtuopsy and/or conventional autopsy of the age of the mother, gestational age at TOP or delivery after IUFD, order of pregnancy, parity, religion, type of caregiver obtaining consent and reason for death. When parents consented to both MR virtuopsy and conventional autopsy of fetuses = 20 weeks of gestation or neonates, the confidence with which MR virtuopsy could be used to diagnose normality/abnormality of various anatomical structures was determined on a scale in which conventional autopsy was considered gold standard. On autopsy we classified fetuses/neonates as having either normal or abnormal anatomical structures; these groups were analyzed separately. At virtuopsy, we indicated confidence of diagnosis of normality/abnormality of every anatomical structure in each of these two groups defined at autopsy, using a scale from 0 (definitely abnormal) to 100 (definitely normal). Results Of the 96 women, 99% (n = 95) consented to virtuopsy and 61.5% (n = 59) to both conventional autopsy and virtuopsy; i.e. 36 (37.5%) consented to virtuopsy alone. Maternal acceptance of conventional autopsy was independently positively related to singleton pregnancy, non-Moslem mother, earlier gestation at TOP or delivery afer IUFD and a maternalfetal medicine specialist obtaining consent. Thirty-three fetuses = 20 weeks of gestation had both conventional autopsy and MR virtuopsy, of which 19 had a full autopsy including the brain. In fetuses with normal anatomical structures at conventional autopsy, MR virtuopsy was associated with high diagnostic confidence (scores > 80) for the brain, skeleton, thoracic organs except the heart, abdominal organs except the pancreas, ureters, bladder and genitals. In fetuses with abnormal anatomical structures at autopsy, MR virtuopsy detected the anomalies with high confidence (scores < 20) for these same anatomical structures. However, in three cases, virtuopsy diagnosed brain anomalies additional to those observed at conventional autopsy. Conclusion MR virtuopsy is accepted by nearly all mothers while conventional autopsy is accepted by about two-thirds of mothers, in whom refusal depends mainly on factors over which we have no control. Although conventional autopsy remains the gold standard, the high acceptance of virtuopsy makes it an acceptable alternative when the former is declined. Copyright (C) 2012 ISUOG. Published by John Wiley & Sons, Ltd.