title: Diagnostic accuracy of postmortem MRI for musculoskeletal abnormalities in fetuses and children.
abstract: OBJECTIVE
  The aim of this study was to compare the diagnostic accuracy of postmortem magnetic resonance (PMMR) imaging specifically for musculoskeletal pathology in fetuses and children, compared with conventional autopsy, with radiographic and histopathology assessment.
  
  
  METHODS
  Institutional ethics approval and parental consent was obtained. A total of 400 cases underwent PMMR using a 1.5 T Siemens Avanto MR scanner before conventional autopsy. PMMR images and autopsy findings were reported blinded to the other data, respectively.
  
  
  RESULTS
  A total of 400 cases were reported, with 277 (69%) fetuses (185 ≤24 weeks' gestation and 92 >24 weeks' gestation) and 123 children (42 newborns aged <1 month, 53 infants ≤12 months and 28 children ≤16 years). Musculoskeletal (MSK) abnormalities were found at autopsy in 47/400 (11.7%). Overall sensitivity and specificity (with 95% confidence interval) of PMMR for MSK pathology were 51.1% (37.0, 65.0) and 98.2% (96.2, 99.2), with positive and negative predictive values of 79.3% (61.6, 90.2) and 93.8% (90.8, 95.9), respectively. Overall accuracy between PMMR and autopsy for MSK abnormalities was 92.7% (89.7, 94.9). In some cases, PMMR detected MSK abnormalities not routinely examined for or detected at traditional autopsy.
  
  
  CONCLUSIONS
  Minimally invasive autopsy has good diagnostic accuracy for the exclusion of MSK abnormalities, but sensitivity is relatively poor. When PMMR is used with clinical examination and skeletal radiographs, all skeletal and soft tissue abnormalities of clinical significance are likely to be detected, even if not directly relevant to the cause of death.
authors.affiliation: Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK; Institute of Child Health, UCL, London, UK.
authors.forename: Owen J
authors.initials: OJ
authors.lastname: Arthurs
authors.forename: Sudhin
authors.initials: S
authors.lastname: Thayyil
authors.forename: Shea
authors.initials: S
authors.lastname: Addison
authors.forename: Angie
authors.initials: A
authors.lastname: Wade
authors.forename: Rod
authors.initials: R
authors.lastname: Jones
authors.forename: Wendy
authors.initials: W
authors.lastname: Norman
authors.forename: Rosemary
authors.initials: R
authors.lastname: Scott
authors.forename: Nicola J
authors.initials: NJ
authors.lastname: Robertson
authors.forename: Lyn S
authors.initials: LS
authors.lastname: Chitty
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Taylor
authors.forename: Neil J
authors.initials: NJ
authors.lastname: Sebire
authors.forename: Amaka C
authors.initials: AC
authors.lastname: Offiah
mesh_terms: D000293:Adolescent; D001344:Autopsy; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008279:Magnetic Resonance Imaging; D008297:Male; D009139:Musculoskeletal Abnormalities / Q000175:diagnosis*