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Postmortem microfocus computed tomography for noninvasive autopsies: experience in >250 human fetuses

BACKGROUND: Noninvasive imaging autopsy alternatives for fetuses weighing <500 grams are limited. Microfocus computed tomography has been reported as a viable option in small case series with the potential to avoid an invasive autopsy. Implementation of postmortem microfocus computed tomography i...

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Autores principales: Shelmerdine, Susan C., Simcock, Ian C., Hutchinson, John Ciaran, Guy, Anna, Ashworth, Michael T., Sebire, Neil J., Arthurs, Owen J.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7805479/
https://www.ncbi.nlm.nih.gov/pubmed/32682860
http://dx.doi.org/10.1016/j.ajog.2020.07.019
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author Shelmerdine, Susan C.
Simcock, Ian C.
Hutchinson, John Ciaran
Guy, Anna
Ashworth, Michael T.
Sebire, Neil J.
Arthurs, Owen J.
author_facet Shelmerdine, Susan C.
Simcock, Ian C.
Hutchinson, John Ciaran
Guy, Anna
Ashworth, Michael T.
Sebire, Neil J.
Arthurs, Owen J.
author_sort Shelmerdine, Susan C.
collection PubMed
description BACKGROUND: Noninvasive imaging autopsy alternatives for fetuses weighing <500 grams are limited. Microfocus computed tomography has been reported as a viable option in small case series with the potential to avoid an invasive autopsy. Implementation of postmortem microfocus computed tomography in a large cohort as part of routine clinical service has yet been unreported, and realistic “autopsy prevention rates” are unknown. OBJECTIVE: This study aimed to describe the range of abnormalities detectable on fetal microfocus computed tomography in a clinical setting and additional findings identified on the antenatal ultrasound and to estimate the invasive autopsy avoidance rate (ie, cases in which imaging was sufficient to deem autopsy unnecessary). STUDY DESIGN: A prospective observational case series of all fetuses referred for microfocus computed tomography imaging at a single institution was conducted for 3 years (2016–2019). Imaging was reported by 2 pediatric radiologists before autopsy, with “decision to proceed” based on the specialist perinatal pathologists’ judgment and parental consent. Agreement rates between microfocus computed tomography and antenatal ultrasound were evaluated, and where feasible, diagnostic accuracy for microfocus computed tomography was calculated using autopsy as a reference standard. RESULTS: A total of 268 fetuses were included (2–350 grams body weight; 11–24 weeks’ gestation), with cause for demise in 122 of 268 (45.5%). Of the 122 fetuses, 64 (52.5%) exhibited fetal anomalies. Although 221 of 268 (82.5%) fetuses had consent for invasive autopsy, only 29 of the 221 (13.1%) underwent this procedure, which implied an autopsy avoidance rate of 192 of 221 (86.9%). Complete agreement was present for all brain, thoracic, and abdominal pathologies, whereas sensitivity and specificity for cardiac anomalies were 66.7% and 91.7%, respectively. Microfocus computed tomography and antenatal ultrasound agreement was found in 219 of 266 cases (81.9%), with partial agreement in 21 of 266 (7.9%) and disagreement in 26 of 266 (10.5%), mostly because of additional cardiac, soft tissue, or genitourinary findings by microfocus computed tomography, which were not seen on the ultrasound. CONCLUSION: Fetal microfocus computed tomography imaging is a viable and useful tool for imaging early gestational fetuses and can avoid the need for invasive autopsy. Confirmation of antenatal diagnoses is achieved in most cases, and additional anomalies may also be detected.
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spelling pubmed-78054792021-01-22 Postmortem microfocus computed tomography for noninvasive autopsies: experience in >250 human fetuses Shelmerdine, Susan C. Simcock, Ian C. Hutchinson, John Ciaran Guy, Anna Ashworth, Michael T. Sebire, Neil J. Arthurs, Owen J. Am J Obstet Gynecol Original Research BACKGROUND: Noninvasive imaging autopsy alternatives for fetuses weighing <500 grams are limited. Microfocus computed tomography has been reported as a viable option in small case series with the potential to avoid an invasive autopsy. Implementation of postmortem microfocus computed tomography in a large cohort as part of routine clinical service has yet been unreported, and realistic “autopsy prevention rates” are unknown. OBJECTIVE: This study aimed to describe the range of abnormalities detectable on fetal microfocus computed tomography in a clinical setting and additional findings identified on the antenatal ultrasound and to estimate the invasive autopsy avoidance rate (ie, cases in which imaging was sufficient to deem autopsy unnecessary). STUDY DESIGN: A prospective observational case series of all fetuses referred for microfocus computed tomography imaging at a single institution was conducted for 3 years (2016–2019). Imaging was reported by 2 pediatric radiologists before autopsy, with “decision to proceed” based on the specialist perinatal pathologists’ judgment and parental consent. Agreement rates between microfocus computed tomography and antenatal ultrasound were evaluated, and where feasible, diagnostic accuracy for microfocus computed tomography was calculated using autopsy as a reference standard. RESULTS: A total of 268 fetuses were included (2–350 grams body weight; 11–24 weeks’ gestation), with cause for demise in 122 of 268 (45.5%). Of the 122 fetuses, 64 (52.5%) exhibited fetal anomalies. Although 221 of 268 (82.5%) fetuses had consent for invasive autopsy, only 29 of the 221 (13.1%) underwent this procedure, which implied an autopsy avoidance rate of 192 of 221 (86.9%). Complete agreement was present for all brain, thoracic, and abdominal pathologies, whereas sensitivity and specificity for cardiac anomalies were 66.7% and 91.7%, respectively. Microfocus computed tomography and antenatal ultrasound agreement was found in 219 of 266 cases (81.9%), with partial agreement in 21 of 266 (7.9%) and disagreement in 26 of 266 (10.5%), mostly because of additional cardiac, soft tissue, or genitourinary findings by microfocus computed tomography, which were not seen on the ultrasound. CONCLUSION: Fetal microfocus computed tomography imaging is a viable and useful tool for imaging early gestational fetuses and can avoid the need for invasive autopsy. Confirmation of antenatal diagnoses is achieved in most cases, and additional anomalies may also be detected. Elsevier 2021-01 /pmc/articles/PMC7805479/ /pubmed/32682860 http://dx.doi.org/10.1016/j.ajog.2020.07.019 Text en © 2020 The Author(s) http://creativecommons.org/licenses/by/4.0/ This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Original Research
Shelmerdine, Susan C.
Simcock, Ian C.
Hutchinson, John Ciaran
Guy, Anna
Ashworth, Michael T.
Sebire, Neil J.
Arthurs, Owen J.
Postmortem microfocus computed tomography for noninvasive autopsies: experience in >250 human fetuses
title Postmortem microfocus computed tomography for noninvasive autopsies: experience in >250 human fetuses
title_full Postmortem microfocus computed tomography for noninvasive autopsies: experience in >250 human fetuses
title_fullStr Postmortem microfocus computed tomography for noninvasive autopsies: experience in >250 human fetuses
title_full_unstemmed Postmortem microfocus computed tomography for noninvasive autopsies: experience in >250 human fetuses
title_short Postmortem microfocus computed tomography for noninvasive autopsies: experience in >250 human fetuses
title_sort postmortem microfocus computed tomography for noninvasive autopsies: experience in >250 human fetuses
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7805479/
https://www.ncbi.nlm.nih.gov/pubmed/32682860
http://dx.doi.org/10.1016/j.ajog.2020.07.019
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