Intrauterine fetal MR versus postmortem MR imaging after therapeutic termination of pregnancy: evaluation of the concordance in the detection of brain abnormalities at early gestational stage
- 41 Downloads
Background and purpose
Fetal postmortem MR Imaging (pmMRI) has been recently used as an adjuvant tool to conventional brain autopsy after termination of pregnancy (TOP). Our purpose was to compare the diagnostic performance of intrauterine MRI (iuMRI) and pmMRI in the detection of brain anomalies in fetuses at early gestational age (GA).
Material and methods
We retrospectively collected 53 fetuses who had undergone iuMRI and pmMRI for suspected brain anomalies. Two pediatric neuroradiologists reviewed iuMRI and pmMRI examinations separately and then together. We used Cohen’s K to assess the agreement between pmMRI and iuMRI. Using the combined evaluation iuMRI+pMRI as the reference standard, we calculated the “correctness ratio.” We used Somers’ D to assess the cograduation between postmortem image quality and time elapsed after fetus expulsion.
Our data showed high agreement between iuMRI and pmMRI considering all the categories together, for both observers (K1 0.84; K2 0.86). The correctness ratio of iuMRI and pmMRI was 79% and 45% respectively. The major disagreements between iuMRI and pmMRI were related to postmortem changes as the collapse of liquoral structures and distorting phenomena. We also found a significant cograduation between the time elapsed from expulsion and pmMRI contrast resolution and distortive phenomena (both p < 0.001).
Our study demonstrates an overall high concordance between iuMRI and pmMRI in detecting fetal brain abnormalities at early GA. Nevertheless, for the correct interpretation of pmMRI, the revision of fetal examination seems to be crucial, in particular when time elapsed from expulsion is longer than 24 h.
• IuMRI and pmMRI showed overall high concordance in detecting fetal brain abnormalities at early GA.
• PmMRI corroborated the antemortem diagnosis and it could be a valid alternative to conventional brain autopsy, only when the latter cannot be performed.
• Some caution should be taken in interpreting pmMR images when performed after 24 h from fetal death.
KeywordsFetuses Magnetic resonance imaging Brain Termination of pregnancy Counseling
Central nervous system
Intrauterine magnetic resonance imaging
Posterior cranial fossa
Postmortem magnetic resonance imaging
Termination of pregnancy
We are grateful to Professor Paul D. Griffiths for his advice in preparing the manuscript.
The authors state that this work has not received any funding.
Compliance with ethical standards
The scientific guarantor of this publication is Andrea Righini, chief of the Neuroradiology Department.
Conflict of interest
The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.
Statistics and biometry
No complex statistical methods were necessary for this paper. One of the authors has statistical expertise.
Written informed consent was obtained from all subjects in this study.
Institutional review board approval was obtained.
Study subjects or cohorts overlap
One study case has been previously reported in Prenatal Magnetic Resonance Imaging of Atypical Partial Rhombencephalosynapsis with involvement of the Anterior Vermis: Two Case Reports. Izzo G, Conte G, Cesaretti C, Parazzini C, Bulfamante G, Righini A. Neuropediatrics. 2015 Dec;46(6):416–9.
• diagnostic or prognostic study
• performed at one institution
- 5.Addison S, Arthurs OJ, Thayyil S (2014) Post-mortem MRI as an alternative to non forensic conventional brain autopsy in fetuses and children: from research into clinical practice. Br J Radiol. https://doi.org/10.1259/bjr.20130621
- 8.Thayyil S, Sebire NJ, Chitty LS et al (2011) Post mortem magnetic resonance imaging in the fetuses, infant and child : a comparative study with conventional conventional brain autopsy (MaRIAS protocol). BMC Pediatr. https://doi.org/10.1186/1471-2431-11-120
- 9.Lequin MH, Huisman TA (2012) Postmortem MR imaging in the fetal and neonatal period. Magn Reson Imaging Clin N Am 20:129–143Google Scholar
- 10.Whitby EH, Paley MN, Cohen M, Griffiths PD (2005) Postmortem MR imaging of the fetus: an adjunct or a replacement for conventional conventional brain autopsy? Semin Fetal Neonatal Med 10:475–483Google Scholar
- 11.Breeze AC, Cross JJ, Hackett GA et al (2006) Use of a confidence scale in reporting postmortem fetal magnetic resonance imaging. Ultrasound Obstet Gynecol 28:918–924Google Scholar
- 16.Griffiths PD, Varient D, Evans M et al (2003) Postmortem MR imaging of the fetal and stillborn central nervous system. AJNR Am J Neuroradiol 24:22–27Google Scholar
- 23.Montaldo P, Addison S, Oliveira V et al (2016) Quantification of maceration changes using post mortem MRI in fetuses. BMC Med Imaging. https://doi.org/10.1186/s12880-016-0137-9
- 29.Sebire NJ (2006) Towards the minimally invasive conventional brain autopsy? Ultrasound Obstet Gynecol 28:865–867Google Scholar
- 30.Breeze AC, Jessop FA, Set PA et al (2011) Minimally-invasive fetal autopsy using magnetic resonance imaging and percutaneus organ biopsies: clinical value and comparison to conventional autopsy. Ultrasound Obstet Gynecol 37:317–323Google Scholar