title: Use of a confidence scale in reporting postmortem fetal magnetic resonance imaging.
abstract: OBJECTIVE
  Postmortem magnetic resonance imaging (MRI) may be an alternative to conventional autopsy. However, it is unclear how confident radiologists are in reporting such studies. We sought to determine the confidence with which radiologists report on various fetal organs by developing a scale to express their confidence of normality and abnormality, and to place this in the context of a pathological diagnosis of whether the organ was in fact normal or abnormal.
  
  
  METHODS
  Thirty fetuses, aged 16-39 gestational weeks and weighing 61-3270 g, underwent postmortem MRI prior to conventional autopsy. MRI studies were reported by two radiologists with access to the clinical and sonographic history: a neuroradiologist, reporting head and neck, and a pediatric radiologist, reporting thorax, abdomen and pelvis. Radiologists used a scale (0 = definitely abnormal, 100 = definitely normal, 50 = unable to comment) to indicate their confidence of anatomical structures being normal or abnormal, using a checklist. Conventional autopsies were performed by pediatric pathologists blinded to the MRI findings, and these were considered the reference standard.
  
  
  RESULTS
  Most normal fetal organs had high scores on postmortem MRI, with median confidence scores above 80. However, the atrioventricular valves, duodenum, bowel rotation and pancreas proved more difficult to assess, with median scores of 50, 60, 60 and 62.5, respectively. Abnormal cardiac atria and ventricles, kidneys, cerebral hemispheres and corpus callosum were always detected with high or moderate degrees of confidence (median scores of 2.5, 5, 0, 0 and 30 respectively). However, in two cases with abnormal cardiac outflow tracts, both cases scored 50. Kappa values, assessing agreement between MRI diagnoses of abnormality and autopsy, were high for the brain (0.83), moderate for the lungs (0.56) and fair for the heart (0.33).
  
  
  CONCLUSIONS
  This scoring system represents an attempt to define the confidence of radiologists to report varying degrees of normality and abnormality following z ex-utero fetal MRI. While most fetal anatomy is clearly visualized on postmortem MRI, radiologists may lack confidence reporting such studies and there are particular problems with assessment of some cardiac and gastrointestinal structures, both normal and abnormal.
authors.affiliation: Division of Maternal-Fetal Medicine, Addenbrooke's Hospital, Cambridge, UK.
authors.forename: A C G
authors.initials: AC
authors.lastname: Breeze
authors.forename: J J
authors.initials: JJ
authors.lastname: Cross
authors.forename: G A
authors.initials: GA
authors.lastname: Hackett
authors.forename: F A
authors.initials: FA
authors.lastname: Jessop
authors.forename: I
authors.initials: I
authors.lastname: Joubert
authors.forename: D J
authors.initials: DJ
authors.lastname: Lomas
authors.forename: P A K
authors.initials: PA
authors.lastname: Set
authors.forename: A L
authors.initials: AL
authors.lastname: Whitehead
authors.forename: C C
authors.initials: CC
authors.lastname: Lees
mesh_terms: D001344:Autopsy / Q000379:methods; D002983:Clinical Competence / Q000592:standards; D000013:Congenital Abnormalities / Q000000981:diagnostic imaging*; D005260:Female; D005313:Fetal Death / Q000209:etiology / Q000235:genetics*; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D011247:Pregnancy; D011296:Prenatal Diagnosis / Q000379:methods*; D011446:Prospective Studies; D011871:Radiology / Q000592:standards; D014463:Ultrasonography