Comparison of diagnostic performance for perinatal and paediatric post-mortem imaging: CT versus MRI.
OBJECTIVE
To compare the diagnostic yield of whole-body post-mortem computed tomography (PMCT) imaging to post-mortem magnetic resonance (PMMR) imaging in a prospective study of fetuses and children.


METHODS
We compared PMCT and PMMR to conventional autopsy as the gold standard for the detection of (a) major pathological abnormalities related to the cause of death and (b) all diagnostic findings in five different body organ systems.


RESULTS
Eighty two cases (53 fetuses and 29 children) underwent PMCT and PMMR prior to autopsy, at which 55 major abnormalities were identified. Significantly more PMCT than PMMR examinations were non-diagnostic (18/82 vs. 4/82; 21.9 % vs. 4.9 %, diff 17.1 % (95 % CI 6.7, 27.6; p < 0.05)). PMMR gave an accurate diagnosis in 24/55 (43.64 %; 95 % CI 31.37, 56.73 %) compared to 18/55 PMCT (32.73 %; 95 % CI 21.81, 45.90). PMCT was particularly poor in fetuses <24 weeks, with 28.6 % (8.1, 46.4 %) more non-diagnostic scans. Where both PMCT and PMMR were diagnostic, PMMR gave slightly higher diagnostic accuracy than PMCT (62.8 % vs. 59.4 %).


CONCLUSIONS
Unenhanced PMCT has limited value in detection of major pathology primarily because of poor-quality, non-diagnostic fetal images. On this basis, PMMR should be the modality of choice for non-invasive PM imaging in fetuses and children.


CONCLUSIONS
• Overall 17.1 % more PMCT examinations than PMMR were non-diagnostic • 28.6 % more PMCT were non-diagnostic than PMMR in fetuses <24 weeks • PMMR detected almost a third more pathological abnormalities than PMCT • PMMR gave slightly higher diagnostic accuracy when both were diagnostic.
Great Ormond Street Hospital NHS Foundation Trust, London, UK. owen.arthurs@gosh.nhs.uk.|Institute of Child Health, UCL, London, UK. owen.arthurs@gosh.nhs.uk.
Owen J
OJ
Arthurs
Great Ormond Street Hospital NHS Foundation Trust, London, UK.
Anna
A
Guy
Perinatal Neurology and Neonatology, Imperial College London, London, UK.
Sudhin
S
Thayyil
Paediatric Epidemiology and Biostatistics Unit, UCL Institute of Child health, London, UK.
Angie
A
Wade
Cardiorespiratory Division, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.|Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, London, UK.
Rod
R
Jones
Cardiorespiratory Division, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.|Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, London, UK.
Wendy
W
Norman
University College London Hospital NHS Foundation Trust, London, UK.
Rosemary
R
Scott
Academic Neonatology, UCL Institute for Women's Health, London, UK.
Nicola J
NJ
Robertson
Great Ormond Street Hospital NHS Foundation Trust, London, UK.|Institute of Child Health, UCL, London, UK.
Thomas S
TS
Jacques
Great Ormond Street Hospital NHS Foundation Trust, London, UK.
W K 'Kling'
WK
Chong
Great Ormond Street Hospital NHS Foundation Trust, London, UK.
Roxanna
R
Gunny
Great Ormond Street Hospital NHS Foundation Trust, London, UK.
Dawn
D
Saunders
Great Ormond Street Hospital NHS Foundation Trust, London, UK.
Oystein E
OE
Olsen
Great Ormond Street Hospital NHS Foundation Trust, London, UK.|Cardiorespiratory Division, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.|Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, London, UK.
Catherine M
CM
Owens
University of Sheffield Academic Unit of Child Health, Sheffield Children's NHS Foundation Trust, Room C4, Stephenson Wing, Western Bank, S10 2TH, Sheffield, UK.|Department of Radiology, Sheffield Children's NHS Foundation Trust, Sheffield, UK.
Amaka C
AC
Offiah
Great Ormond Street Hospital NHS Foundation Trust, London, UK.|University College London Hospital NHS Foundation Trust, London, UK.|Genetics and Genomic Medicine, UCL Institute of Child Health, London, UK.
Lyn S
LS
Chitty
Cardiorespiratory Division, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.|Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, London, UK.
Andrew M
AM
Taylor
Great Ormond Street Hospital NHS Foundation Trust, London, UK.|Institute of Child Health, UCL, London, UK.
Neil J
NJ
Sebire
D000293:Adolescent; D001344:Autopsy / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005333:Fetus / Q000000981:diagnostic imaging*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D011247:Pregnancy; D011446:Prospective Studies; D015203:Reproducibility of Results; D014057:Tomography, X-Ray Computed / Q000379:methods*; D051598:Whole Body Imaging / Q000379:methods*
CT; Fetus; MRI; Perinatal; Post-mortem