Novel Applications and Refinements of Current Imaging Techniques in Perinatal and Childhood Death Investigation

背景：据估计，在英国，每80个怀孕中就有一个会因为婴儿的异常而导致流产或死产。尸检可以提供死亡原因的信息，并有助于在未来怀孕时改变管理方式(1)，但许多父母拒绝接受这项检查，因为他们认为自己的孩子已经遭受了足够的痛苦。这意味着他们错过了关于孩子死亡原因以及未来孩子是否会遭遇类似命运的有价值的信息。我们机构率先采用了使用成像技术调查死因的较小侵入性方法，并表明，通过使用磁共振成像(MRI)和钥匙孔手术方法获取组织样本，我们在90%的病例中得到了与尸检相同的答案。然而，这种方法很昂贵，而且不幸的是，它并不广泛使用。我们相信，通过将超声成像与针刺活检结合使用，我们可以改进这项技术，它在皮肤上留下的记号更少、更小，如果它能达到与全面尸检相似的准确度，将更容易在全国推广。目的：这项研究将测试超声引导的针刺组织活检与尸检相比有多好。我们还将调查单独使用以及与组织采样结合使用时，不同的成像测试有多好。方法：同意进行儿童尸检的父母将接受一系列成像测试和侵入性较小的针吸活检。然后，我们将把这些结果与我们目前的尸检结果进行比较，并测试结果是否有任何差异。申请和好处：父母们告诉我们，在这个对他们来说非常困难和情绪化的时期，他们想要最低限度的尸检方法。通过展示一种侵入性较小的、以成像为导向的技术是可以实现的，并且可以给出准确的结果，我们打算为父母提供一种发现他们孩子死亡原因的替代方法。这不仅意味着提供针刺活组织检查，还意味着了解何时仅进行成像就足以做出诊断。通过使用另一种更可接受的调查方法收集的信息可能会帮助父母在悲痛过程中结束和理解孩子死亡的原因，并帮助了解未来孩子是否面临类似疾病的更高风险。提高这种调查的接受速度也可能意味着我们可以更好地理解和探索儿童死亡背后的原因。这有助于为改善孕产妇和儿童健康的公共卫生政策和倡议提供信息。目前，并不是英国所有的中心都能提供侵入性较小的调查方法。如果这项研究能够为更好的实践提供证据，我们希望这将为新的NHS尸检服务奠定基础。(1)Lawn Je，Cousens S，Zupan J.400万新生儿死亡：时间？哪里?为什么？《柳叶刀》2005；365：891-900(2)塔伊尔·S、Sebire NJ、Chitty LS等人对胎儿和儿童的尸检MRI与传统尸检的对比：一项前瞻性验证性研究。《柳叶刀》2013；382：223-233

Background:It is estimated that 1 in 80 pregnancies in the UK will result in a termination or stillbirth due to an abnormality of the baby. An autopsy can provide information on the cause of death and help change management in future pregnancies (1), however many parents refuse this examination as they feel their child has suffered through enough. This means they miss out on valuable information about why their child died and whether future children will suffer a similar fate.'Less invasive' ways for investigating the cause of death using imaging have been pioneered at our institution and shown that by using magnetic resonance imaging (MRI) together with 'key-hole' surgery methods to obtain tissue samples, we get the same answer as autopsy in >90% (2) cases. This method is however expensive and unfortunately not widely available. We believe we can improve on this technique by using ultrasound imaging with needle biopsies which makes fewer and smaller marks to the skin and would be easier to roll-out nationally if it can achieve a similar level of accuracy as a full autopsy.Aims:This study will test how good ultrasound guided needle tissue biopsies are compared to autopsy. We will also investigate how good different imaging tests are when used alone and in combination with tissue samplingMethods:Parents who consent for childhood autopsy will be offered a series of imaging tests and less invasive needle biopsies. We will then compare these results with our current autopsy results and test for any differences in findings. Applications and benefits:Parents tell us that they want the 'minimum necessary' approach to autopsy during this very difficult and emotional time for them. By showing that a less invasive, imaging-led technique is achievable and can give accurate results, we intend to offer parents an alternative method for discovering the cause for their child's death. This means not only offering needle biopsies, but also understanding when imaging alone would be sufficient in coming to a diagnosis.The information gathered by using an alternative, more acceptable method of investigation may help parents in their grieving process by providing closure and understanding for reasons behind their child's death, and help to understand whether future children are at increased risk of similar diseases.Increasing the rate of uptake of this investigation may also mean we can better understand and explore reasons behind why children die. This can help inform public health policies and initiatives in improving maternal and child health. At present not all centres in the UK can offer a less invasive method of investigation. If this research can provide evidence for better practice, we hope this will set the foundations of a new NHS autopsy service. (1) Lawn JE, Cousens S, Zupan J. 4 million neonatal deaths: When? Where? Why? Lancet 2005; 365:891-900(2) Thayyil S, Sebire NJ, Chitty LS et al Post-mortem MRI versus conventional autopsy in fetuses and children: a prospective validation study. Lancet 2013; 382: 223-233