验尸成像已被建议作为产前和产后常规尸检的替代方法。非侵入性尸检不提供组织学检查的组织,这可能会限制它们的临床价值,特别是当怀疑感染相关的发病率和死亡率时。
我们做了一个前瞻性的,多中心,横断面研究,以比较在胎儿和婴儿中采用计算机断层扫描引导活检(Virtopsy®)的死后磁共振成像与常规尸检的诊断性能。进行常规尸检的病例符合登记条件。在使用计算机断层扫描扫描仪和磁共振成像单元进行尸检成像后,我们进行了计算机断层扫描引导的组织采样.将病毒检查结果与常规尸检进行比较,以确定可能的最终死亡原因和主要病理。主要结果是通过两种方法确定相同死亡原因的病例比例。次要结果包括通过病毒检查检测到的假阳性和假阴性主要病理病变的比例,以及足以进行组织学检查的计算机断层扫描引导活检的比例。
总的来说,101例(84例胎儿,包括17名婴儿)。病毒检查和尸检在91例中确定了相同的死亡原因(90.1%,95%CI82.7至94.5)。病毒检测对死因的敏感性和特异性分别为96.6%(95%CI90.6~98.8)和41.7%(95%CI19.3~68.0),分别。32例(31.7%,95%CI23.4至41.3),主要病理发现仍未被病毒检查发现,45例(44.6%,95%CI35.2至54.3),异常通过病毒检查法诊断,但未通过尸检证实。在956例活检中的506例(52.7%)中,计算机断层扫描引导的组织采样足以进行病理学评论,并且在30例中的5例(16.1%)中增加了重要的诊断价值,与仅验尸成像相比,尸检前死亡原因不明确。在20例感染性死亡中,有19例(95%),活检显示感染相关组织改变.所有胎儿病例均通过胎盘检查证实感染。
Virtopsy在检测死因方面与常规尸检高度一致,但在评估主要病理方面不太准确。计算机断层扫描引导活检的额外诊断价值有限。
ClinicalTrials.gov(NCT01888380)。
Post-mortem imaging has been suggested as an alternative to conventional autopsy in the prenatal and postnatal periods. Noninvasive autopsies do not provide tissue for histological examination, which may limit their clinical value, especially when infection-related morbidity and mortality are suspected.
We performed a prospective, multicentre, cross-sectional
study to compare the diagnostic performance of post-mortem magnetic resonance imaging with computed tomography-guided biopsy (Virtopsy®) with that of conventional autopsy in foetuses and infants. Cases referred for conventional autopsy were eligible for enrolment. After post-mortem imaging using a computed tomography scanner and a magnetic resonance imaging unit, computed tomography-guided tissue sampling was performed. Virtopsy results were compared with conventional autopsy in determining the likely final cause of death and major pathologies. The primary outcome was the proportion of cases for which the same cause of death was determined by both methods. Secondary outcomes included the proportion of false positive and false negative major pathological lesions detected by virtopsy and the proportion of computed tomography-guided biopsies that were adequate for histological examination.
Overall, 101 cases (84 fetuses, 17 infants) were included. Virtopsy and autopsy identified the same cause of death in 91 cases (90.1%, 95% CI 82.7 to 94.5). The sensitivity and specificity of virtopsy for determining the cause of death were 96.6% (95% CI 90.6 to 98.8) and 41.7% (95% CI 19.3 to 68.0), respectively. In 32 cases (31.7%, 95% CI 23.4 to 41.3), major pathological findings remained undetected by virtopsy, and in 45 cases (44.6%, 95% CI 35.2 to 54.3), abnormalities were diagnosed by virtopsy but not confirmed by autopsy. Computed tomography-guided tissue sampling was adequate for pathological comments in 506 of 956 biopsies (52.7%) and added important diagnostic value in five of 30 cases (16.1%) with an unclear cause of death before autopsy compared with postmortem imaging alone. In 19 of 20 infective deaths (95%), biopsies revealed infection-related tissue changes. Infection was confirmed by placental examination in all fetal cases.
Virtopsy demonstrated a high concordance with conventional autopsy for the detection of cause of death but was less accurate for the evaluation of major pathologies. Computed tomography-guided biopsy had limited additional diagnostic value.
ClinicalTrials.gov (NCT01888380).