title: Diagnostic accuracy and limitations of post-mortem MRI for neurological abnormalities in fetuses and children.
abstract: OBJECTIVE
  To compare the diagnostic accuracy of non-invasive cerebral post-mortem magnetic resonance imaging (PMMRI) specifically for cerebral and neurological abnormalities in a series of fetuses and children, compared to conventional autopsy.
  
  
  METHODS
  Institutional ethics approval and parental consent was obtained. Pre-autopsy cerebral PMMRI was performed in a sequential prospective cohort (n = 400) of fetuses (n = 277; 185 ≤ 24 weeks and 92 > 24 weeks gestation) and children <16 years (n = 123) of age. PMMRI and conventional autopsy findings were reported blinded and independently of each other.
  
  
  RESULTS
  Cerebral PMMRI had sensitivities and specificities (95% confidence interval) of 88.4% (75.5 to 94.9), and 95.2% (92.1 to 97.1), respectively, for cerebral malformations; 100% (83.9 to 100), and 99.1% (97.2 to 99.7) for major intracranial bleeds; and 87.5% (80.1 to 92.4) and 74.1% (68 to 79.4) for overall brain pathology. Formal neuropathological examination was non-diagnostic due to maceration/autolysis in 43/277 (16%) fetuses; of these, cerebral PMMRI imaging provided clinically important information in 23 (53%). The sensitivity of PMMRI for detecting significant ante-mortem ischaemic injury was only 68% (48.4 to 82.8) overall.
  
  
  CONCLUSIONS
  PMMRI is an accurate investigational technique for identifying significant neuropathology in fetuses and children, and may provide important information even in cases where autolysis prevents formal neuropathological examination; however, PMMRI is less sensitive at detecting hypoxic-ischaemic brain injury, and may not detect rarer disorders not encountered in this study.
authors.affiliation: Paediatric Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK; UCL Institute of Child Health, London, UK. Electronic address: owen.arthurs@gosh.nhs.uk.
authors.forename: O J
authors.initials: OJ
authors.lastname: Arthurs
authors.affiliation: Perinatal Neurology and Neonatology, Imperial College London, London, UK.
authors.forename: S
authors.initials: S
authors.lastname: Thayyil
authors.affiliation: Perinatal Neurology and Neonatology, Imperial College London, London, UK.
authors.forename: S S
authors.initials: SS
authors.lastname: Pauliah
authors.affiliation: Department of Histopathology, UCL Institute of Child Health & Great Ormond Street Hospital for Children, London, UK.
authors.forename: T S
authors.initials: TS
authors.lastname: Jacques
authors.affiliation: Paediatric Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK; UCL Institute of Child Health, London, UK.
authors.forename: W K
authors.initials: WK
authors.lastname: Chong
authors.affiliation: Paediatric Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK; UCL Institute of Child Health, London, UK.
authors.forename: R
authors.initials: R
authors.lastname: Gunny
authors.affiliation: Paediatric Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK; UCL Institute of Child Health, London, UK.
authors.forename: D
authors.initials: D
authors.lastname: Saunders
authors.affiliation: Perinatal Neurology and Neonatology, Imperial College London, London, UK.
authors.forename: S
authors.initials: S
authors.lastname: Addison
authors.affiliation: Perinatal Neurology and Neonatology, Imperial College London, London, UK.
authors.forename: P
authors.initials: P
authors.lastname: Lally
authors.affiliation: Medical Physics and Bioengineering, University College London Hospitals NHS Foundation Trust, London, UK.
authors.forename: E
authors.initials: E
authors.lastname: Cady
authors.affiliation: Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, London, UK; Cardiorespiratory Division, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.
authors.forename: R
authors.initials: R
authors.lastname: Jones
authors.affiliation: Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, London, UK; Cardiorespiratory Division, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.
authors.forename: W
authors.initials: W
authors.lastname: Norman
authors.affiliation: Department of Histopathology, University College London Hospital NHS Trust, UK.
authors.forename: R
authors.initials: R
authors.lastname: Scott
authors.affiliation: Academic Neonatology, UCL Institute for Women's Health, London, UK.
authors.forename: N J
authors.initials: NJ
authors.lastname: Robertson
authors.affiliation: Paediatric Epidemiology and Biostatistics Unit, UCL Institute of Child Health, London, UK.
authors.forename: A
authors.initials: A
authors.lastname: Wade
authors.affiliation: Genetics and Genomic Medicine, UCL Institute of Child Health, London, UK; Clinical Genetics, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK; UCLH NHS Foundation Trusts, London, UK.
authors.forename: L
authors.initials: L
authors.lastname: Chitty
authors.affiliation: Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, London, UK; Cardiorespiratory Division, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.
authors.forename: A M
authors.initials: AM
authors.lastname: Taylor
authors.affiliation: UCL Institute of Child Health, London, UK; Department of Histopathology, UCL Institute of Child Health & Great Ormond Street Hospital for Children, London, UK.
authors.forename: N J
authors.initials: NJ
authors.lastname: Sebire
mesh_terms: D000293:Adolescent; D001344:Autopsy / Q000379:methods*; D001921:Brain / Q000002:abnormalities*; D001927:Brain Diseases / Q000175:diagnosis*; D002648:Child; D002675:Child, Preschool; D005333:Fetus / Q000002:abnormalities*; D006801:Humans; D020925:Hypoxia-Ischemia, Brain / Q000175:diagnosis; D007223:Infant; D007231:Infant, Newborn; D020300:Intracranial Hemorrhages / Q000175:diagnosis; D008279:Magnetic Resonance Imaging / Q000379:methods*; D011446:Prospective Studies; D012680:Sensitivity and Specificity