title: Acceptance, reliability and confidence of diagnosis of fetal and neonatal virtuopsy compared with conventional autopsy: a prospective study.
abstract: OBJECTIVE
  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 maternal-fetal 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Radiology, University Hospital Brugmann, Brussels, Belgium.
authors.forename: M
authors.initials: M
authors.lastname: Cannie
authors.forename: C
authors.initials: C
authors.lastname: Votino
authors.forename: Ph
authors.initials: P
authors.lastname: Moerman
authors.forename: R
authors.initials: R
authors.lastname: Vanheste
authors.forename: V
authors.initials: V
authors.lastname: Segers
authors.forename: K
authors.initials: K
authors.lastname: Van Berkel
authors.forename: M
authors.initials: M
authors.lastname: Hanssens
authors.forename: X
authors.initials: X
authors.lastname: Kang
authors.forename: T
authors.initials: T
authors.lastname: Cos
authors.forename: M
authors.initials: M
authors.lastname: Kir
authors.forename: L
authors.initials: L
authors.lastname: Balepa
authors.forename: L
authors.initials: L
authors.lastname: Divano
authors.forename: W
authors.initials: W
authors.lastname: Foulon
authors.forename: J
authors.initials: J
authors.lastname: De Mey
authors.forename: J
authors.initials: J
authors.lastname: Jani
mesh_terms: D000028:Abortion, Induced / Q000523:psychology; D000328:Adult; D001344:Autopsy / Q000295:instrumentation / Q000379:methods*; D002423:Cause of Death; D000013:Congenital Abnormalities / Q000175:diagnosis* / Q000401:mortality / Q000523:psychology; D005260:Female; D005315:Fetal Diseases / Q000175:diagnosis* / Q000401:mortality / Q000523:psychology; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D016015:Logistic Models; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008423:Maternal Age; D009035:Mothers / Q000523:psychology*; D015999:Multivariate Analysis; D010298:Parity; D010342:Patient Acceptance of Health Care; D011247:Pregnancy; D011446:Prospective Studies; D012067:Religion; D015203:Reproducibility of Results; D050497:Stillbirth / Q000523:psychology; D014057:Tomography, X-Ray Computed / Q000379:methods*