title: Diagnostic accuracy of post-mortem MRI for thoracic abnormalities in fetuses and children.
abstract: OBJECTIVE
  To compare the diagnostic accuracy of post-mortem magnetic resonance imaging (PMMR) specifically for non-cardiac thoracic pathology in fetuses and children, compared with conventional autopsy.
  
  
  METHODS
  Institutional ethics approval and parental consent was obtained. A total of 400 unselected fetuses and children underwent PMMR before conventional autopsy, reported blinded to the other dataset.
  
  
  RESULTS
  Of 400 non-cardiac thoracic abnormalities, 113 (28 %) were found at autopsy. Overall sensitivity and specificity (95 % confidence interval) of PMMR for any thoracic pathology was poor at 39.6 % (31.0, 48.9) and 85.5 % (80.7, 89.2) respectively, with positive predictive value (PPV) 53.7 % (42.9, 64.0) and negative predictive value (NPV) 77.0 % (71.8, 81.4). Overall agreement was 71.8 % (67.1, 76.2). PMMR was most sensitive at detecting anatomical abnormalities, including pleural effusions and lung or thoracic hypoplasia, but particularly poor at detecting infection.
  
  
  CONCLUSIONS
  PMMR currently has relatively poor diagnostic detection rates for the commonest intra-thoracic pathologies identified at autopsy in fetuses and children, including respiratory tract infection and diffuse alveolar haemorrhage. The reasonable NPV suggests that normal thoracic appearances at PMMR exclude the majority of important thoracic lesions at autopsy, and so could be useful in the context of minimally invasive autopsy for detecting non-cardiac thoracic abnormalities.
  
  
  CONCLUSIONS
  • PMMR has relatively poor diagnostic detection rates for common intrathoracic pathology • The moderate NPV suggests that normal PMMR appearances exclude most important abnormalities • Lung sampling at autopsy remains the "gold standard" for pulmonary pathology.
authors.affiliation: Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK, owen.arthurs@gosh.nhs.uk.
authors.forename: Owen J
authors.initials: OJ
authors.lastname: Arthurs
authors.forename: Sudhin
authors.initials: S
authors.lastname: Thayyil
authors.forename: Oystein E
authors.initials: OE
authors.lastname: Olsen
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 J
authors.initials: RJ
authors.lastname: Scott
authors.forename: Nicola J
authors.initials: NJ
authors.lastname: Robertson
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Taylor
authors.forename: Lyn S
authors.initials: LS
authors.lastname: Chitty
authors.forename: Neil J
authors.initials: NJ
authors.lastname: Sebire
authors.forename: Catherine M
authors.initials: CM
authors.lastname: Owens
mesh_terms: D000293:Adolescent; D001344:Autopsy; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D005260:Female; D005315:Fetal Diseases / Q000175:diagnosis*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D011247:Pregnancy; D012372:ROC Curve; D015203:Reproducibility of Results; D013896:Thoracic Diseases / Q000151:congenital / Q000175:diagnosis* / Q000196:embryology