title: Diffusion-weighted post-mortem magnetic resonance imaging of the human fetal brain in situ.
abstract: OBJECTIVE
  To evaluate perinatal brain apparent diffusion coefficient (ADC) values at postmortem MRI (PMMR) in order to evaluate post mortem changes.
  
  
  METHODS
  Postmortem brain MRI was performed with diffusion gradient values b=0, 500, and 1000s/mm(2) on 43 fetal cases. Mean ADC values were calculated from 7 regions of interest (ROIs) throughout the brain.
  
  
  RESULTS
  43 fetuses were evaluated with median gestational age 36 weeks (range 21-41). Overall, fetal brain ADC varied with maceration score, but not with gestational age or post mortem interval. The best single predictor of brain ADC was maceration score, which accounted for 52% of data variation for frontal cortex (p<0.001) and 44% in basal ganglia (p<0.001), and between 24% and 32% in all five of the other included brain areas. Gestation was only significantly associated with occipital ADC changes and post mortem interval only significantly associated with basal ganglia ADC changes. Median intra-observer and inter-observer variability was 6.0% (95% range 1.0%-18.1%) and 8.0% (95% range 0.2%-33.9%) respectively.
  
  
  CONCLUSIONS
  DWI characteristics in different fetal brain areas following death are multifactorial, with maceration the strongest predictor in most anatomical areas. Deep grey matter areas are also affected by gestation and post mortem interval. With better models, brain ADC may be useful to estimate the degree of maceration where gestation and post mortem interval is unknown.
authors.affiliation: Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, UK. Electronic address: ioapapadopou@gmail.com.
authors.forename: Ioanna
authors.initials: I
authors.lastname: Papadopoulou
authors.affiliation: Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, UK. Electronic address: d.langan@ucl.ac.uk.
authors.forename: Dean
authors.initials: D
authors.lastname: Langan
authors.affiliation: Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, UK; Institute of Child Health, UCL, London, UK. Electronic address: Neil.sebire@gosh.nhs.uk.
authors.forename: Neil J
authors.initials: NJ
authors.lastname: Sebire
authors.affiliation: Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, UK; Institute of Child Health, UCL, London, UK. Electronic address: t.jacques@ucl.ac.uk.
authors.forename: Thomas S
authors.initials: TS
authors.lastname: Jacques
authors.affiliation: Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, UK; Institute of Child Health, UCL, London, UK. Electronic address: owen.arthurs@gosh.nhs.uk.
authors.forename: Owen J
authors.initials: OJ
authors.lastname: Arthurs
mesh_terms: D001344:Autopsy; D001921:Brain / Q000000981:diagnostic imaging* / Q000196:embryology*; D001931:Brain Mapping / Q000379:methods*; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D005313:Fetal Death; D005333:Fetus / Q000000981:diagnostic imaging / Q000196:embryology; D005865:Gestational Age; D006801:Humans; D011180:Postmortem Changes; D011446:Prospective Studies; D050497:Stillbirth
keywords: Autopsy; Diffusion; MRI; Paediatric; Perinatal; Postmortem