Postmortem microfocus computed tomography for noninvasive autopsies: experience in >250 human fetuses

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Publisher: Elsevier B.V.
Document Type: Clinical report
Length: 752 words

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Key words autopsy; congenital anomalies; diagnosis; microfocus computed tomography; minimally invasive; miscarriage; postmortem; radiology; termination; virtual autopsy Background Noninvasive imaging autopsy alternatives for fetuses weighing Objective This study aimed to describe the range of abnormalities detectable on fetal microfocus computed tomography in a clinical setting and additional findings identified on the antenatal ultrasound and to estimate the invasive autopsy avoidance rate (ie, cases in which imaging was sufficient to deem autopsy unnecessary). Study Design A prospective observational case series of all fetuses referred for microfocus computed tomography imaging at a single institution was conducted for 3 years (2016--2019). Imaging was reported by 2 pediatric radiologists before autopsy, with "decision to proceed" based on the specialist perinatal pathologists' judgment and parental consent. Agreement rates between microfocus computed tomography and antenatal ultrasound were evaluated, and where feasible, diagnostic accuracy for microfocus computed tomography was calculated using autopsy as a reference standard. Results A total of 268 fetuses were included (2--350 grams body weight; 11--24 weeks' gestation), with cause for demise in 122 of 268 (45.5%). Of the 122 fetuses, 64 (52.5%) exhibited fetal anomalies. Although 221 of 268 (82.5%) fetuses had consent for invasive autopsy, only 29 of the 221 (13.1%) underwent this procedure, which implied an autopsy avoidance rate of 192 of 221 (86.9%). Complete agreement was present for all brain, thoracic, and abdominal pathologies, whereas sensitivity and specificity for cardiac anomalies were 66.7% and 91.7%, respectively. Microfocus computed tomography and antenatal ultrasound agreement was found in 219 of 266 cases (81.9%), with partial agreement in 21 of 266 (7.9%) and disagreement in 26 of 266 (10.5%), mostly because of additional cardiac, soft tissue, or genitourinary findings by microfocus computed tomography, which were not seen on the ultrasound. Conclusion Fetal microfocus computed tomography imaging is a viable and useful tool for imaging early gestational fetuses and can avoid the need for invasive autopsy. Confirmation of antenatal diagnoses is achieved in most cases, and additional anomalies may also be detected. Author Affiliation: (a) Department of Clinical Radiology, Great Ormond Street Hospital for Children, London, United Kingdom (b) UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital for Children, London, United Kingdom (c) Department of Paediatric Pathology, Great Ormond Street Hospital for Children, London, United Kingdom (d) National Institute for Health Research Biomedical Research Centre, Great Ormond Street Hospital, London, United Kingdom * Corresponding author: Susan C. Shelmerdine, FRCR. Article History: Received 11 May 2020; Revised 2 July 2020; Accepted 14 July 2020 (footnote) The authors report no conflict of interest. (footnote) S.C.S. is supported by a RCUK/UKRI Innovation Fellowship and Medical Research Council (MRC) Clinical Research Training Fellowship (grant no. MR/R002118/1). This award is jointly funded by the Royal College of Radiologists (RCR). I.C.S. is funded by a National Institute for Health Research (NIHR) Clinical Doctoral Research Fellowship (ICA-CDRF-2017-03-53). O.J.A. is funded by an NIHR Career Development Fellowship (NIHR-CDF-2017-10-037). (footnote) This article presents independent research funded by the MRC, RCR, and NIHR, and the views expressed in this article are those of the authors and do not necessarily reflect the views of the NHS, MRC, RCR, NIHR, or the Department of Health, United Kingdom. (footnote) The funders of the study had no role in the study design, data collection, data analysis, data interpretation, or writing of the report. The corresponding author and the chief investigator (S.C.S. and O.J.A., respectively) had full access to all the data in the study and final responsibility for the decision to submit for publication. (footnote) Ethical board approval was granted by the local research ethics committee (London--Camberwell St Giles Research Ethics Committee, reference CE13/LO/1494, awarded December 4, 2013; IRAS ID: 131395). All samples were handled in accordance with the Human Tissue Act 2004. Written parental consent was acquired for all postmortem imaging and subsequent autopsy, where performed. (footnote) Cite this article as: Shelmerdine SC, Simcock IC, Hutchinson JC, et al. Postmortem microfocus computed tomography for noninvasive autopsies: experience in 250 human fetuses. Am J Obstet Gynecol 2021;224:103.e1-15. Byline: Susan C. Shelmerdine, FRCR [susan.shelmerdine@gosh.nhs.uk] (a,b,d,*), Ian C. Simcock, MSc (a,b,d), John Ciaran Hutchinson, FRCPath (c), Anna Guy, MSc (a), Michael T. Ashworth, FRCPath (c), Neil J. Sebire, MD (b,c,d), Owen J. Arthurs, PhD (a,b,d)

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Gale Document Number: GALE|A648966092