Post mortem MRI may reduce need for pediatric autopsy
medwireNews: Post mortem magnetic resonance imaging (MRI) could be a feasible alternative to autopsy for determining cause of death in carefully selected fetuses, infants, and children, research indicates.
The study, published in The Lancet, is the first to directly compare pediatric minimally invasive autopsy and conventional autopsy results, and suggests imaging could combat the decline in the rate of post mortems in recent years.
"Minimally invasive autopsy could help more families and clinicians to understand the cause of a child's death… while minimising the distress caused to parents at such an upsetting time," said lead author Sudhin Thayyil (University College London, UK) in a press release.
Overall, conventional autopsy was judged to be unnecessary in 41% of 400 unselected patients, the team reports, with 99.4% concordance between the results of double-blinded minimally invasive and conventional autopsy in these cases.
Although cause of death or major pathologic lesion detected in the 277 fetuses and 123 children by post mortem MRI was in agreement with conventional autopsy findings in 89.3% of cases, this rate significantly varied with age.
Concordance was reported in results for 94.6% of 185 fetuses aged 24 weeks or younger and 95.7% of 92 older fetuses, 81.0% of 42 newborn infants, 84.9% of infants aged over 1 month but less than 1 year old, and 53.6% of 28 children aged 1 to 16 years old.
The researchers explain that the significantly lower concordance between MRI and autopsy findings for older children than fetuses was largely due to undetected infection of the heart or lungs, whereas deaths in younger cases were largely due to structural abnormalities that were visible on MRI.
And MRI was able to identify clinically significant brain lesions in 30% of 43 cases where conventional neuropathology was incomplete due to autolysis.
When MRI was combined with ancillary post mortem investigations, such as blood or placental analysis and genetic or metabolic tests, additional clinically significant information was detected in 38.9% of fetuses and 9.8% of children.
Post mortem MRI followed by targeted laparoscopic examination "might detect most clinically significant pathological abnormalities with little disruption to the body," the researchers believe.
They say that the "next step is to establish rigorous criteria which would allow doctors to judge when a minimally invasive autopsy might be appropriate.
"Information provided by autopsies is important, not just for determining an individual's cause of death but because it can sometimes answer more detailed questions about recurrence risks, implications for other family members, advancing medical research and knowledge," Thayyil et al add.
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By Lynda Williams, Senior medwireNews Reporter