title: The role of post-mortem MRI in the neonatal intensive care unit.
abstract: Post-mortem examination can provide important information about the cause of death and play a significant role in the bereavement process. Autopsies reveal previous unknown medical problems approximately 20 to 30% of the time. A non-invasive magnetic resonance imaging-based post-mortem examination (PM-MRI) may provide an alternative for families who do not consent to an autopsy.
  
  
  
  This study was a prospective observational study of recently expired neonates and infants. Subjects underwent a full body MRI scan (brain, chest, abdomen and pelvis) followed by conventional autopsy if the family desired to have one. MRI results were compared with autopsy findings and the ante-mortem clinical diagnosis. A follow-up survey was conducted to investigate family perceptions of the PM-MRI process.
  
  
  
  Thirty-one infants underwent full PM-MRI. Of 31 infants, 19 (61%) had complete agreement between the clinician's impression and PM-MRI. Twenty-four infants also had conventional autopsy, with 14/24 (58%) infants having PM-MRI results consistent with autopsy findings. PM-MRI was superior at detection of free intraperitoneal/intrathoracic air and hepatic iron overload. Whole-body PM-MRI did not have the resolution to detect focal/microscopic injury, vascular remodeling and some forms of brain injury. Of those families who remembered the PM-MRI findings, the majority felt that the information was useful.
  
  
  
  PM-MRI studies may provide an important adjunct to conventional autopsy and a substitute when the latter is not possible for personal or religious reasons. Clinicians should be aware of, and communicate with the family, the resolution limits of the whole-body PM-MRI to detect certain types of injury.
authors.affiliation: Department of Pediatrics, Southern Illinois University School of Medicine, Springfield, IL, USAs.
authors.forename: K Z
authors.initials: KZ
authors.lastname: Leadbetter
authors.affiliation: Edward Mallinckrodt Department of Pediatrics, Division of Newborn Medicine, Washington University School of Medicine, St Louis, MO, USA.
authors.forename: Z A
authors.initials: ZA
authors.lastname: Vesoulis
authors.affiliation: Department of Pathology & Immunology, Division of Anatomic and Molecular Pathology, Washington University School of Medicine, St Louis, MO, USA.
authors.forename: F V
authors.initials: FV
authors.lastname: White
authors.affiliation: Department of Pathology & Immunology, Division of Neuropathology, Washington University School of Medicine, St Louis, MO, USA.
authors.forename: R E
authors.initials: RE
authors.lastname: Schmidt
authors.affiliation: Edward Mallinckrodt Department of Radiology, Division of Diagnostic Radiology, Washington University School of Medicine, St Louis, MO, USA.
authors.forename: G
authors.initials: G
authors.lastname: Khanna
authors.affiliation: Edward Mallinckrodt Department of Radiology, Division of Diagnostic Radiology, Washington University School of Medicine, St Louis, MO, USA.
authors.forename: J S
authors.initials: JS
authors.lastname: Shimony
authors.affiliation: Edward Mallinckrodt Department of Pediatrics, Division of Newborn Medicine, Washington University School of Medicine, St Louis, MO, USA.
authors.forename: A M
authors.initials: AM
authors.lastname: Mathur
mesh_terms: D001344:Autopsy; D002423:Cause of Death; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D008279:Magnetic Resonance Imaging; D008297:Male; D008923:Missouri; D011446:Prospective Studies; D051598:Whole Body Imaging / Q000379:methods*