Post-Mortem MRI Examination

Post-Mortem MRI Examination

Thayyil S, Cleary JO, Sebire NJ, et al. Post-mortem examination of human fetuses: A comparison of whole-body high-field MRI at 9.4 T with conventional MRI and invasive autopsy. Lancet 2009;374:467-75. Summary | Full Text | PDF

Background: Conventional whole-body MRI at 1.5 T does not provide adequate image quality of small fetuses, thus reducing its potential for use as an alternative to invasive autopsy. High-field whole-body MRI at 9.4 T provides good images of small animals. We therefore compared the diagnostic usefulness of high-field MRI with conventional MRI for post-mortem examination of human fetuses.

Methods: We did whole-body MRI at 9.4 T and 1.5 T on 18 fetuses of less than 22 weeks' gestation, using three-dimensional T(2)-weighted fast-spin echo sequences, before doing invasive autopsy. Images obtained with MRI for each system were compared with the findings of invasive autopsy in a blinded manner. Tissue contrast of 14 different regions was compared on 1.5 T and 9.4 T images that were provided by paediatric radiologists separately and in a random order, and image quality was scored on a four-point scale. The primary endpoint was diagnostic accuracy.

Findings: Spatial resolution, tissue contrast, and image quality of all organ systems were much better with high-field MRI than with conventional MRI. All structural abnormalities that were detected with invasive autopsy and internal examination of visceral organs were also detected with high-field MRI, whereas conventional MRI was not diagnostically useful in 14 (78%) cases.

Interpretation: Whole-body high-field MRI is a feasible option for post-mortem examination of human fetuses, and can provide good tissue characterisation even in small fetuses (5 g). The use of MRI at 9.4 T might be helpful in the development of a minimally invasive perinatal autopsy system.

Comments: This study shows the great potential of high-field whole-body MRI in post-mortem examinations of fetuses. The image quality is simply stunning (again, I would encourage the readers of NeoNotes to take the time to study this article in detail). Although the researchers restricted their examination to fetuses with a gestational age of less than 22 weeks, non-invasive post-mortem MRI examinations could potentially play an important role in preterm and term infants who have died in the NICU when parents struggle with the decision to consent to autopsy. For now, the availability of 9.4 T MRI scanners will be limited to tertiary centers. TMB

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