临床验尸放射学是一个相对较新的专业领域,在大多数医院中还不常见。随着尸检数量的减少和临床护理质量控制需求的增加,验尸放射学可以提供解决方案,或者至少是互补的。一个由放射科医师组成的工作组,病理学家和其他临床医学专家回顾并评估了有关死后常规X线照相术(CR)的诊断价值的文献,超声检查,计算机断层扫描(PMCT),磁共振成像(PMMRI),和微创尸检(MIA)。建立了证据表,随后制定了荷兰国家基于证据的事后放射学指南。我们在临床验尸环境中对放射学模式进行了评估,包括MIA,以及最近出版的荷兰胎儿死后放射学指南,新生儿,还有孩子.总的来说,对于死后放射学模式,PMMRI是胎儿的选择方式,新生儿,婴儿,而PMCT建议用于年龄较大的儿童。验尸CR和超声检查的作用有限。在大多数情况下,常规尸检仍将是首选的诊断方法。
结论:根据文献综述和临床专业知识,为胎儿的死后放射学制定了基于证据的指南,新生儿,和儿科患者。已知:•验尸调查作为所提供的医疗保健的质量检查,并且对于可靠的流行病学登记是重要的。•事后放射学,有时结合微创技术,被认为是尸检的辅助或替代。新增内容:•我们介绍了荷兰胎儿死后放射学指南,新生儿和儿童。•尸检仍然是参考标准,然而骨骼调查的微创尸检,验尸后计算机断层扫描,或死后磁共振成像可以与其互补。
Clinical post-mortem radiology is a relatively new field of expertise and not common practice in most hospitals yet. With the declining numbers of autopsies and increasing demand for quality control of clinical care, post-mortem radiology can offer a solution, or at least be complementary. A working group consisting of radiologists, pathologists and other clinical medical specialists reviewed and evaluated the literature on the diagnostic value of post-mortem conventional radiography (CR), ultrasonography, computed tomography (PMCT), magnetic resonance imaging (PMMRI), and minimally invasive autopsy (MIA). Evidence tables were built and subsequently a Dutch national evidence-based
guideline for post-mortem radiology was developed. We present this evaluation of the radiological modalities in a clinical post-mortem setting, including MIA, as well as the recently published Dutch
guidelines for post-mortem radiology in foetuses, neonates, and children. In general, for post-mortem radiology modalities, PMMRI is the modality of choice in foetuses, neonates, and infants, whereas PMCT is advised in older children. There is a limited role for post-mortem CR and ultrasonography. In most cases, conventional autopsy will remain the diagnostic method of choice.
CONCLUSIONS: Based on a literature review and clinical expertise, an evidence-based
guideline was developed for post-mortem radiology of foetal, neonatal, and paediatric patients. What is Known: • Post-mortem investigations serve as a quality check for the provided health care and are important for reliable epidemiological registration. • Post-mortem radiology, sometimes combined with minimally invasive techniques, is considered as an adjunct or alternative to autopsy. What is New: • We present the Dutch
guidelines for post-mortem radiology in foetuses, neonates and children. • Autopsy remains the reference standard, however minimal invasive autopsy with a skeletal survey, post-mortem computed tomography, or post-mortem magnetic resonance imaging can be complementary thereof.