Quantification of maceration changes using post mortem MRI in fetuses.
BACKGROUND
Post mortem imaging is playing an increasingly important role in perinatal autopsy, and correct interpretation of imaging changes is paramount. This is particularly important following intra-uterine fetal death, where there may be fetal maceration. The aim of this study was to investigate whether any changes seen on a whole body fetal post mortem magnetic resonance imaging (PMMR) correspond to maceration at conventional autopsy.


METHODS
We performed pre-autopsy PMMR in 75 fetuses using a 1.5 Tesla Siemens Avanto MR scanner (Erlangen, Germany). PMMR images were reported blinded to the clinical history and autopsy data using a numerical severity scale (0 = no maceration changes to 2 = severe maceration changes) for 6 different visceral organs (total 12). The degree of maceration at autopsy was categorized according to severity on a numerical scale (1 = no maceration to 4 = severe maceration). We also generated quantitative maps to measure the liver and lung T2.


RESULTS
The mean PMMR maceration score correlated well with the autopsy maceration score (R(2) = 0.93). A PMMR score of ≥4.5 had a sensitivity of 91%, specificity of 64%, for detecting moderate or severe maceration at autopsy. Liver and lung T2 were increased in fetuses with maceration scores of 3-4 in comparison to those with 1-2 (liver p = 0.03, lung p = 0.02).


CONCLUSIONS
There was a good correlation between PMMR maceration score and the extent of maceration seen at conventional autopsy. This score may be useful in interpretation of fetal PMMR.
Centre for Perinatal Neuroscience, Imperial College London, Du Cane Road, London, W12 0HS, UK. p.montaldo@imperial.ac.uk.
P
P
Montaldo
Centre for Perinatal Neuroscience, Imperial College London, Du Cane Road, London, W12 0HS, UK.
S
S
Addison
Centre for Perinatal Neuroscience, Imperial College London, Du Cane Road, London, W12 0HS, UK.
V
V
Oliveira
Centre for Perinatal Neuroscience, Imperial College London, Du Cane Road, London, W12 0HS, UK.
P J
PJ
Lally
Institute of Child Health, University College London, London, UK.
A M
AM
Taylor
Institute of Child Health, University College London, London, UK.|Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK.
N J
NJ
Sebire
Centre for Perinatal Neuroscience, Imperial College London, Du Cane Road, London, W12 0HS, UK.
S
S
Thayyil
Institute of Child Health, University College London, London, UK.|Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK.
O J
OJ
Arthurs
D001344:Autopsy; D005313:Fetal Death; D005333:Fetus / Q000473:pathology*; D006801:Humans; D008099:Liver / Q000473:pathology; D008168:Lung / Q000473:pathology; D008279:Magnetic Resonance Imaging / Q000295:instrumentation / Q000379:methods*
Autopsy; Fetuses; Intrauterine death; MRI; Maceration; Pathology