Abstract：
OBJECTIVE: The acceptance of conventional autopsy (CA), the gold standard method for investigating fetal death, often remains problematic. Post-mortem magnetic resonance imaging (PMMRI) is increasingly advocated, particularly for neurologic malformations. However, PMMRI performances to diagnose non-neurologic malformations remain unclear. We aim to clarify whether a full body CA remains needed after prenatal ultrasound (US) and PMMRI in assessing non-neurologic fetal malformations.
METHODS: In this retrospective IRB-approved study, during a 6-year period, all fetuses who underwent PMMRI, prenatal US, and full body CA were included. Body abnormalities were identified in US, PMMRI, and CA reports. US and PMMRI images were all reviewed. All abnormalities were graded as major (2 points) or minor (1 point). Each technique (US, PMMRI, CA) was given a score by adding all grading points. In each fetus, results were compared for both separate and combined US and PMMRI to CA. Sensitivity and specificity were calculated for detecting major abnormalities.
RESULTS: Fifty fetuses were included. The score of CA, US, and PMMRI was respectively 53, 37, and 46. Compared with US-PMMRI, CA added information in 2 cases (4%) with major abnormalities and 7 cases (14%) with minor abnormalities. PMMRI and US were concordant in 36/50 (72%) fetuses. Separate US/PMMRI sensitivities and specificities for detecting major body malformations respectively were 80%/80% and 100%/94%. Combined US-PMMRI had a sensitivity of 90% and a specificity of 94%. Two cardiac malformations (2/6) were only described by CA.
CONCLUSIONS: After prenatal US and PMMRI, few additional fetal body malformations are discovered with CA. Nevertheless, fetal heart autopsy remains mandatory.
CONCLUSIONS: A cardiac conventional autopsy complemented by prenatal ultrasound and post-mortem MRI allows to detect all major fetal body abnormalities. With this efficient and much less invasive approach, a higher acceptance rate of fetal autopsy can be expected.
CONCLUSIONS: • Excepting cardiac malformations, most major fetal body malformations can reliably be identified by prenatal US combined with post-mortem MRI. • In the post-mortem diagnosis of fetal body malformations, a conventional autopsy limited to the fetal heart might replace a full body autopsy after a well-conducted prenatal US and post-mortem MRI.
METHODS: In this retrospective IRB-approved study, during a 6-year period, all fetuses who underwent PMMRI, prenatal US, and full body CA were included. Body abnormalities were identified in US, PMMRI, and CA reports. US and PMMRI images were all reviewed. All abnormalities were graded as major (2 points) or minor (1 point). Each technique (US, PMMRI, CA) was given a score by adding all grading points. In each fetus, results were compared for both separate and combined US and PMMRI to CA. Sensitivity and specificity were calculated for detecting major abnormalities.
RESULTS: Fifty fetuses were included. The score of CA, US, and PMMRI was respectively 53, 37, and 46. Compared with US-PMMRI, CA added information in 2 cases (4%) with major abnormalities and 7 cases (14%) with minor abnormalities. PMMRI and US were concordant in 36/50 (72%) fetuses. Separate US/PMMRI sensitivities and specificities for detecting major body malformations respectively were 80%/80% and 100%/94%. Combined US-PMMRI had a sensitivity of 90% and a specificity of 94%. Two cardiac malformations (2/6) were only described by CA.
CONCLUSIONS: After prenatal US and PMMRI, few additional fetal body malformations are discovered with CA. Nevertheless, fetal heart autopsy remains mandatory.
CONCLUSIONS: A cardiac conventional autopsy complemented by prenatal ultrasound and post-mortem MRI allows to detect all major fetal body abnormalities. With this efficient and much less invasive approach, a higher acceptance rate of fetal autopsy can be expected.
CONCLUSIONS: • Excepting cardiac malformations, most major fetal body malformations can reliably be identified by prenatal US combined with post-mortem MRI. • In the post-mortem diagnosis of fetal body malformations, a conventional autopsy limited to the fetal heart might replace a full body autopsy after a well-conducted prenatal US and post-mortem MRI.
摘要：
目的：接受常规尸检（CA），调查胎儿死亡的金标准方法，往往仍然有问题。尸检磁共振成像(PMMRI)越来越被提倡,尤其是神经系统畸形.然而,PMMRI诊断非神经系统畸形的表现尚不清楚。我们的目的是澄清产前超声（US）和PMMRI评估非神经系统胎儿畸形后是否仍需要全身CA。
方法：在这项经IRB批准的回顾性研究中，在6年的时间里，所有接受过PMMRI的胎儿,产前美国，包括全身CA。在美国发现身体异常，PMMRI,和CA报告。对US和PMMRI图像进行了审查。所有异常均分为主要（2分）或次要（1分）。每种技术(美国，PMMRI,通过添加所有评分点来给CA)评分。在每个胎儿中，比较了单独和联合US和PMMRI与CA的结果。计算检测主要异常的敏感性和特异性。
结果：包括50个胎儿。CA的分数，US,PMMRI分别为53、37和46。与US-PMMRI相比，CA添加信息2例(4%)有主要异常，7例(14%)有次要异常。PMMRI和US在36/50（72％）胎儿中一致。US/PMMRI检测主要畸形的敏感性和特异性分别为80％/80％和100％/94％。联合US-PMMRI的敏感性为90%，特异性为94%。仅CA描述了两个心脏畸形（2/6）。
结论：产前US和PMMRI后，CA很少发现其他胎儿畸形。然而，胎儿心脏尸检仍然是强制性的。
结论：心脏常规尸检辅以产前超声和尸检MRI，可以检测所有主要的胎儿身体异常。有了这种有效且侵入性少得多的方法，可以预期胎儿尸检的接受率更高。
结论：•心脏畸形除外，产前US结合验尸MRI可以可靠地确定大多数主要的胎儿身体畸形。•在胎儿身体畸形的验尸诊断中，在进行了良好的产前US和死后MRI检查后，仅限于胎儿心脏的常规尸检可能会取代全身尸检。
方法：在这项经IRB批准的回顾性研究中，在6年的时间里，所有接受过PMMRI的胎儿,产前美国，包括全身CA。在美国发现身体异常，PMMRI,和CA报告。对US和PMMRI图像进行了审查。所有异常均分为主要（2分）或次要（1分）。每种技术(美国，PMMRI,通过添加所有评分点来给CA)评分。在每个胎儿中，比较了单独和联合US和PMMRI与CA的结果。计算检测主要异常的敏感性和特异性。
结果：包括50个胎儿。CA的分数，US,PMMRI分别为53、37和46。与US-PMMRI相比，CA添加信息2例(4%)有主要异常，7例(14%)有次要异常。PMMRI和US在36/50（72％）胎儿中一致。US/PMMRI检测主要畸形的敏感性和特异性分别为80％/80％和100％/94％。联合US-PMMRI的敏感性为90%，特异性为94%。仅CA描述了两个心脏畸形（2/6）。
结论：产前US和PMMRI后，CA很少发现其他胎儿畸形。然而，胎儿心脏尸检仍然是强制性的。
结论：心脏常规尸检辅以产前超声和尸检MRI，可以检测所有主要的胎儿身体异常。有了这种有效且侵入性少得多的方法，可以预期胎儿尸检的接受率更高。
结论：•心脏畸形除外，产前US结合验尸MRI可以可靠地确定大多数主要的胎儿身体畸形。•在胎儿身体畸形的验尸诊断中，在进行了良好的产前US和死后MRI检查后，仅限于胎儿心脏的常规尸检可能会取代全身尸检。
