title: Clinical utility of postmortem microcomputed tomography of the fetal heart: diagnostic imaging vs macroscopic dissection.
abstract: OBJECTIVE
  Congenital cardiac malformations are commonly identified at perinatal autopsy, which can be challenging in fetuses of early gestation and in macerated fetuses. Our objective was to examine fetal complex congenital heart disease by microcomputed tomography (micro-CT), using standard autopsy as the gold standard.
  
  
  METHODS
  In this ethically approved study, ex-vivo isolated fetal heart and fetal heart-lung blocks underwent iodine preparation prior to micro-CT, and were fixed in formalin after the micro-CT examination. Images were acquired using a microfocus-CT scanner with individual specimen image optimization. Twenty-one indices assessed normally at autopsy were evaluated for each dataset. Cardiac dissection was performed using a dissecting microscope within 24 h of the micro-CT examination.
  
  
  RESULTS
  We examined six fetal hearts, comprising five with complex congenital cardiac malformations at a gestational age of 17-23 weeks and an anatomically normal heart of 23 weeks' gestation for reference. All specimens demonstrated excellent internal contrast at micro-CT examination, and the correct overall diagnosis was made in all cases. There was agreement for 114/126 indices assessed on micro-CT and at autopsy dissection (overall concordance of 95.8% (95% CI, 90.5-98.2%)). Micro-CT was particularly useful in the assessment of ventricular morphology in macerated fetuses.
  
  
  CONCLUSIONS
  Micro-CT of small ex-vivo fetal specimens can provide highly accurate three-dimensional rendering of complex congenital fetal heart disease. This approach represents a significant advance in postmortem imaging and confirms the potential of this technology for non-invasive examination of small fetuses and organs.
authors.affiliation: Institute of Child Health, UCL, London, UK.|Department of Histopathology, UCL Institute of Child Health & Great Ormond Street Hospital for Children, London, UK.
authors.forename: J C
authors.initials: JC
authors.lastname: Hutchinson
authors.affiliation: Institute of Child Health, UCL, London, UK.|Paediatric Radiology, Great Ormond Street Hospital for Children NHS Trust, London, UK.
authors.forename: O J
authors.initials: OJ
authors.lastname: Arthurs
authors.affiliation: Department of Histopathology, UCL Institute of Child Health & Great Ormond Street Hospital for Children, London, UK.
authors.forename: M T
authors.initials: MT
authors.lastname: Ashworth
authors.affiliation: Nikon Metrology, Tring, UK.
authors.forename: A T
authors.initials: AT
authors.lastname: Ramsey
authors.affiliation: Institute of Child Health, UCL, London, UK.|Department of Histopathology, UCL Institute of Child Health & Great Ormond Street Hospital for Children, London, UK.
authors.forename: W
authors.initials: W
authors.lastname: Mifsud
authors.affiliation: Department of Radiology, Studio Diagnostico Eco, Vimercate, Milan, Italy.
authors.forename: C M
authors.initials: CM
authors.lastname: Lombardi
authors.affiliation: Institute of Child Health, UCL, 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: D001344:Autopsy / Q000379:methods; D004210:Dissection; D005260:Female; D005318:Fetal Heart / Q000000981:diagnostic imaging* / Q000473:pathology; D006330:Heart Defects, Congenital / Q000175:diagnosis*; D006801:Humans; D008297:Male; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D055114:X-Ray Microtomography
keywords: autopsy; congenital heart disease; histopathology; micro-CT; perinatal