Owen J Arthurs1,2, Anna Guy3, Sudhin Thayyil4, Angie Wade5, Rod Jones6,7, Wendy Norman6,7, Rosemary Scott8, Nicola J Robertson9, Thomas S Jacques3,10, W K 'Kling' Chong3, Roxanna Gunny3, Dawn Saunders3, Oystein E Olsen3, Catherine M Owens3,6,7, Amaka C Offiah11,12, Lyn S Chitty3,8,13, Andrew M Taylor6,7, Neil J Sebire3,10. 1. Great Ormond Street Hospital NHS Foundation Trust, London, UK. owen.arthurs@gosh.nhs.uk. 2. Institute of Child Health, UCL, London, UK. owen.arthurs@gosh.nhs.uk. 3. Great Ormond Street Hospital NHS Foundation Trust, London, UK. 4. Perinatal Neurology and Neonatology, Imperial College London, London, UK. 5. Paediatric Epidemiology and Biostatistics Unit, UCL Institute of Child health, London, UK. 6. Cardiorespiratory Division, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK. 7. Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, London, UK. 8. University College London Hospital NHS Foundation Trust, London, UK. 9. Academic Neonatology, UCL Institute for Women's Health, London, UK. 10. Institute of Child Health, UCL, London, UK. 11. University of Sheffield Academic Unit of Child Health, Sheffield Children's NHS Foundation Trust, Room C4, Stephenson Wing, Western Bank, S10 2TH, Sheffield, UK. 12. Department of Radiology, Sheffield Children's NHS Foundation Trust, Sheffield, UK. 13. Genetics and Genomic Medicine, UCL Institute of Child Health, London, UK.
Abstract
OBJECTIVES: To compare the diagnostic yield of whole-body post-mortem computed tomography (PMCT) imaging to post-mortem magnetic resonance (PMMR) imaging in a prospective study of fetuses and children. METHODS: We compared PMCT and PMMR to conventional autopsy as the gold standard for the detection of (a) major pathological abnormalities related to the cause of death and (b) all diagnostic findings in five different body organ systems. RESULTS: Eighty two cases (53 fetuses and 29 children) underwent PMCT and PMMR prior to autopsy, at which 55 major abnormalities were identified. Significantly more PMCT than PMMR examinations were non-diagnostic (18/82 vs. 4/82; 21.9 % vs. 4.9 %, diff 17.1 % (95 % CI 6.7, 27.6; p < 0.05)). PMMR gave an accurate diagnosis in 24/55 (43.64 %; 95 % CI 31.37, 56.73 %) compared to 18/55 PMCT (32.73 %; 95 % CI 21.81, 45.90). PMCT was particularly poor in fetuses <24 weeks, with 28.6 % (8.1, 46.4 %) more non-diagnostic scans. Where both PMCT and PMMR were diagnostic, PMMR gave slightly higher diagnostic accuracy than PMCT (62.8 % vs. 59.4 %). CONCLUSION: Unenhanced PMCT has limited value in detection of major pathology primarily because of poor-quality, non-diagnostic fetal images. On this basis, PMMR should be the modality of choice for non-invasive PM imaging in fetuses and children. KEY POINTS: • Overall 17.1 % more PMCT examinations than PMMR were non-diagnostic • 28.6 % more PMCT were non-diagnostic than PMMR in fetuses <24 weeks • PMMR detected almost a third more pathological abnormalities than PMCT • PMMR gave slightly higher diagnostic accuracy when both were diagnostic.
OBJECTIVES: To compare the diagnostic yield of whole-body post-mortem computed tomography (PMCT) imaging to post-mortem magnetic resonance (PMMR) imaging in a prospective study of fetuses and children. METHODS: We compared PMCT and PMMR to conventional autopsy as the gold standard for the detection of (a) major pathological abnormalities related to the cause of death and (b) all diagnostic findings in five different body organ systems. RESULTS: Eighty two cases (53 fetuses and 29 children) underwent PMCT and PMMR prior to autopsy, at which 55 major abnormalities were identified. Significantly more PMCT than PMMR examinations were non-diagnostic (18/82 vs. 4/82; 21.9 % vs. 4.9 %, diff 17.1 % (95 % CI 6.7, 27.6; p < 0.05)). PMMR gave an accurate diagnosis in 24/55 (43.64 %; 95 % CI 31.37, 56.73 %) compared to 18/55 PMCT (32.73 %; 95 % CI 21.81, 45.90). PMCT was particularly poor in fetuses <24 weeks, with 28.6 % (8.1, 46.4 %) more non-diagnostic scans. Where both PMCT and PMMR were diagnostic, PMMR gave slightly higher diagnostic accuracy than PMCT (62.8 % vs. 59.4 %). CONCLUSION: Unenhanced PMCT has limited value in detection of major pathology primarily because of poor-quality, non-diagnostic fetal images. On this basis, PMMR should be the modality of choice for non-invasive PM imaging in fetuses and children. KEY POINTS: • Overall 17.1 % more PMCT examinations than PMMR were non-diagnostic • 28.6 % more PMCT were non-diagnostic than PMMR in fetuses <24 weeks • PMMR detected almost a third more pathological abnormalities than PMCT • PMMR gave slightly higher diagnostic accuracy when both were diagnostic.
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