Minimally invasive, imaging guided virtual autopsy compared to conventional autopsy in foetal, newborn and infant cases: study protocol for the paediatric virtual autopsy trial.
BACKGROUND
In light of declining autopsy rates around the world, post-mortem MR imaging is a promising alternative to conventional autopsy in the investigation of infant death. A major drawback of this non-invasive autopsy approach is the fact that histopathological and microbiological examination of the tissue is not possible. The objective of this prospective study is to compare the performance of minimally invasive, virtual autopsy, including CT-guided biopsy, with conventional autopsy procedures in a paediatric population.


METHODS
Foetuses, newborns and infants that are referred for autopsy at three different institutions associated with the University of Zurich will be eligible for recruitment. All bodies will be examined with a commercial CT and a 3 Tesla MRI scanner, masked to the results of conventional autopsy. After cross-sectional imaging, CT-guided tissue sampling will be performed by a multifunctional robotic system (Virtobot) allowing for automated post-mortem biopsies. Virtual autopsy results will be classified with regards to the likely final diagnosis and major pathological findings and compared to the results of conventional autopsy, which remains the diagnostic gold standard.


CONCLUSIONS
There is an urgent need for the development of alternative post-mortem examination methods, not only as a counselling tool for families and as a quality control measure for clinical diagnosis and treatment but also as an instrument to advance medical knowledge and clinical practice. This interdisciplinary study will determine whether virtual autopsy will narrow the gap in information between non-invasive and traditional autopsy procedures.


BACKGROUND
ClinicalTrials.gov: NCT01888380.
Department of Neonatology, University Hospital Zurich, Zurich, Switzerland. christoph.rueegger@usz.ch.
Christoph M
CM
Rüegger
Christine
C
Bartsch
Rosa Maria
RM
Martinez
Steffen
S
Ross
Stephan A
SA
Bolliger
Brigitte
B
Koller
Leonhard
L
Held
Elisabeth
E
Bruder
Peter Karl
PK
Bode
Rosmarie
R
Caduff
Bernhard
B
Frey
Leonhard
L
Schäffer
Hans Ulrich
HU
Bucher
D001344:Autopsy / Q000379:methods*; D003430:Cross-Sectional Studies; D005333:Fetus / Q000473:pathology; D006801:Humans; D061705:Image-Guided Biopsy; D007223:Infant; D007231:Infant, Newborn; D011446:Prospective Studies; D016037:Single-Blind Method