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TABLE 1
Summary of published data concerning the diagnostic accuracy of postmortem magnetic resonance imaging
GA
(mean–SD or Analyzed ND MRI vs Accuracy Sensitivity Specificity
Author, y Study protocol n range) organs autopsy (%) (%) (%) (%) Conclusion
Brookes et al, 1.5-T vs autopsy, prospective, 20 15e39 Overall / 90 / / Total agreement was obtained in
199657 unselected fetuses, reporter not 8 of 20 cases. Autopsy provided
mentioned, design unclear more information in 8 of 20
cases. MRI provided more
information in 4 of 20 cases. In
90% of cases, the 2
examinations had similar clinical
significance.
Woodward et al, 1.5-T (3D) vs autopsy, prospective, 26 13e39 Overall / / 79b / MRI provided 79% detection of
199759 unselected fetuses, reported by 3 major malformations; 10 of 11
radiologists, blinded minor malformations were not
detected.
Huisman et al, 1.5-T vs autopsy, prospective, 10 14e32 / / / / / MRI confirmed every prenatal
200263 TOP, reported by 1 pediatric diagnosis for termination. All MRI
neuroradiologist and 1 general findings were confirmed by
radiologist, blinded autopsy. Autopsy provided
additional information relevant
for counseling in 2 cases.
Alderliesten et al, 1.0-T vs autopsy, prospective, 25 16e40 Overall / 68a 56a 93a MRI had higher acceptance, but
200364 unselected fetuses and neonates, the accuracy was insufficient to
reported by a single radiologist, recommend it as an alternative.
blinded
Griffiths et al, 1.5-T vs autopsy of the brain, 40 24 (14e42) Brain 0 vs 20 97 100 92 MRI would be useful for CNS
200365 prospective, unselected, reported postmortem examination.
by 1 pediatric neuroradiologist and
1 neonatal radiologist, unblinded
Breeze et al, 1.5-T vs autopsy, prospective, 30 16e39 Brain / / 88 96 MRI provided high confidence for
200668 unselected, reported by 1 pediatric CNS diagnoses but low
neuroradiologist and 2 pediatric confidence for the diagnoses of
radiologists, unblinded cardiac and abdominal
abnormalities.
Heart 25 100
Lungs 63 87
Kang. Fetal postmortem imaging. Am J Obstet Gynecol 2020. (continued)
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TABLE 1
Summary of published data concerning the diagnostic accuracy of postmortem magnetic resonance imaging (continued)
GA
(mean–SD or Analyzed ND MRI vs Accuracy Sensitivity Specificity
Author, y Study protocol n range) organs autopsy (%) (%) (%) (%) Conclusion
Widjaja et al, 1.5-T vs autopsy for spine 41 14e42 Spine / / 100 97 MRI and autopsy were
200670 examination, prospective, 31 concordant in 10 of 11 abnormal
normal and 10 abnormal fetuses, cases. They were discordant for
reported by 2 neuroradiologists a case of diastematomyelia
and 1 fetal/neonatal radiologist, shown at MRI but not diagnosed
design unclear at autopsy.
Hagmann et al, 1.5-T vs autopsy for kidney 37 Unclear Kidney / / / / MRI identified 5 of 5 abnormal
200773 examinations, unclear design kidneys and 1 false positive.
Cohen et al, 1.5T vs autopsy for the 100 13e41 Brain / 60 / / MRI added valuable information
200876 examination of the brain, in 24 of 90 cases. Autopsy was
retrospective, unselected fetuses, superior to PMMRI in 12 of 90
reported by 1 neuroradiologist, cases,
design unclear
Thayyil et al, 9.4-T vs 1.5-T vs autopsy, 17 11e22 Brain 24 vs 76 100 1/1 3/3 9.4-T MRI was feasible for small
200978 prospective, unselected fetuses, fetuses <20 wk GA compared
reported by 4 specialist with 1.5-T PMMRI, which was
radiologists (CNS, cardiac, chest, not diagnostic in 78% of cases.
abdomen and musculoskeletal),
blinded
Body 35 vs 0 100 4/4 7/7
Votino et al, 1.5-T vs 3.T vs 9.4-T vs autopsy 24 11e22 Four / / 67 80 Seven of 8 major cardiac defects
MONTH 2020 American Journal of Obstetrics & Gynecology
201283 for fetal heart examination, chambers were identified using 9.4-T MRI
prospective, TOP and miscarriage in fetuses <20 wk GA.
<20 wk GA reported by 1 fetal MRI
specialist, blinded
Outflow tracts 75 100
b
Thayyil et al, 1.5-T plus MIA vs autopsy, 277 Unclear Overall 25 vs NA 49 / / MRI associated with ancillary
2013c,85 prospective, unselected, each examinations had high accuracy,
system reported by 4 specialists and could be an alternative to
radiologist, blinded conventional autopsy.
Expert Review
185 24 35 vs NA 43b
92 >24 5 vs NA 63b
Sandaite et al, 3-T vs autopsy for fetal heart, 24 12e34 Heart / / 75 / 3-T MRI would be a valid
201489 prospective, fetuses with cardiac diagnostic tool for CHD in fetuses
defects, reported by a cardiac beyond 16 wk GA.
radiologist, blinded
Kang. Fetal postmortem imaging. Am J Obstet Gynecol 2020. (continued)
3
Expert Review
4 American Journal of Obstetrics & Gynecology MONTH 2020
TABLE 1
Summary of published data concerning the diagnostic accuracy of postmortem magnetic resonance imaging (continued)
GA
(mean–SD or Analyzed ND MRI vs Accuracy Sensitivity Specificity
Author, y Study protocol n range) organs autopsy (%) (%) (%) (%) Conclusion
Arthurs et al, 1.5-T vs autopsy for MSK disease, 277 Unclear MSK 5 vs NA 94 59 99 MRI had good accuracy for
2014c,90 prospective, unselected, single exclusion of MSK abnormalities
reporter pediatric radiologist, but sensitivities are poor.
blinded
185 24 7 vs NA 94 69 100
92 >24 1 vs NA 92 17 98
Taylor et al, 1.5-T (3D T1 and T2) vs autopsy for 275 Unclear Heart 14 vs NA 94 83 95 Using 3D cardiac MRI as an
2014c,91 fetal heart, prospective, adjuvant might increase the yield
unselected, single reporter from invasive autopsy.
pediatric cardiovascular MR
radiologist, blinded
184 24 20 vs NA 95 82 96
91 >24 1 vs NA 93 83 94
Arthurs et al, 1.5-T vs autopsy, for fetal thorax 277 All Thorax 10 vs NA 81 33 93 MRI had poor detection rates for
2014c,94 prospective, unselected, reported intrathoracic pathologies
by several experienced perinatal/ (infections).
pediatric radiologists, blinded
185 24 15 vs NA 82 30 96
92 >24 0 vs NA 79 38 88
Arthurs et al, 1.5-T vs autopsy for fetal brain, 275 All Brain 12 vs 16 75 79 72 MRI had high accuracy for brain
2015c,95 prospective, unselected, reported abnormalities. MRI should be
by 1 of 3 pediatric performed routinely even when
neuroradiologists, blinded consent for classical autopsy has
been obtained.
183 24 19 vs 19 75 87 69
92 >24 9 vs 0 75 71 77
Arthurs et al 1.5-T vs autopsy for fetal 277 all Abdomen 10 vs 1 89 73 92 MRI had good overall accuracy,
2015c,96, abdomen, prospective, particularly for the detection of
unselected, reported by 1 of 2 renal abnormalities, but poor
pediatric/perinatal radiologists, diagnostic accuracy for intestinal
blinded abnormalities.
185 24 15 vs 3 91 77 95
>24
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92 0 vs 0 85 65 89
Kang. Fetal postmortem imaging. Am J Obstet Gynecol 2020. (continued)
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TABLE 1
Summary of published data concerning the diagnostic accuracy of postmortem magnetic resonance imaging (continued)
GA
(mean–SD or Analyzed ND MRI vs Accuracy Sensitivity Specificity
Author, y Study protocol n range) organs autopsy (%) (%) (%) (%) Conclusion
Vullo et al, 1.5-T vs autopsy, prospective, 15 21e38 / / / / / Concordant findings were
2016102 stillbirth, reported by 2 obtained in all 8 normal cases
radiologists, blinded and all 7 abnormal cases with
MRI.
Arthurs et al, 1.5-T vs CT, prospective, 53 All Overall 5 vs 2 59 43 100 CT had limited value in
201698 unselected, reported by 3 postmortem imaging. MRI
neuroradiologists, 1 cardiac should be the modality of choice
radiologist, 3 body radiologists, 1 for fetal postmortem imaging.
MSK radiologist, blinded
Brain 15 vs NA 64 79 58
Heart 8 vs NA 92 100 90
Thorax 15 vs NA 82 38 92
Abdomen 11 vs NA 92 67 97
MSK 4 vs NA 94 50 100
35 24 Overall 11 vs NA 52 40 100
(19.352.55)
Brain 23 vs NA 59 83 52
Heart 11 vs NA 87 100 86
MONTH 2020 American Journal of Obstetrics & Gynecology
Thorax 23 vs NA 82 20 96
Abdomen 17 vs NA 90 40 100
MSK 6 vs NA 94 60 100
18 >24 Overall 0 vs NA 72 50 100
(33.145.24)
Brain 0 vs NA 72 75 70
Heart 0 vs NA 100 100 100
Thorax 0 vs NA 83 67 87
Expert Review
Abdomen 0 vs NA 94 100 93
MSK 0 vs NA 94 0 100
Kang. Fetal postmortem imaging. Am J Obstet Gynecol 2020. (continued)
5
Expert Review
6 American Journal of Obstetrics & Gynecology MONTH 2020
TABLE 1
Summary of published data concerning the diagnostic accuracy of postmortem magnetic resonance imaging (continued)
GA
(mean–SD or Analyzed ND MRI vs Accuracy Sensitivity Specificity
Author, y Study protocol n range) organs autopsy (%) (%) (%) (%) Conclusion
b b b
Kang et al, 1.5-T vs 3-T vs autopsy, 92 12e41 Overall 10 vs 11 77 52 87 3-T MRI had better confidence
2017104 prospective, unselected score and overall diagnostic
population, reported by 1 perinatal accuracy than 1.5-T MRI,
and 1 pediatric radiologist with particularly for the thorax, heart,
consensus, blinded and abdomen of fetuses < 20
wk.
Brain 6 vs 42 81b 83b 90b
Heart 12 vs 7 81b 48b 95b
Thorax 10 vs 4 81b 44b 90b
Abdomen 18 vs 1 67b 56b 73b
MSK 7 vs 4 81b 58b 89b
32 20 Overall 30 vs NA 55b
35b
65b
Brain 19 vs NA 56b 100b 50b
Heart 37 vs NA 52b 23b 79b
Thorax 32 vs NA 54b 13b 50b
Abdomen 48 vs NA 39b 50b 32b
b b
MSK 21 vs NA 68 50 75b
60 >20 Overall 0 vs NA 87b 62b 97b
Brain 0 vs NA 92b 81b 100b
Heart 0 vs NA 94b 75b 100b
Thorax 0 vs 0 93b 70b 98b
b b
Abdomen 2 vs 0 82 60 93b
MSK 0 vs 0 87b 63b 96b
Kang. Fetal postmortem imaging. Am J Obstet Gynecol 2020. (continued)
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TABLE 1
Summary of published data concerning the diagnostic accuracy of postmortem magnetic resonance imaging (continued)
GA
(mean–SD or Analyzed ND MRI vs Accuracy Sensitivity Specificity
Author, y Study protocol n range) organs autopsy (%) (%) (%) (%) Conclusion
Ashwin et al, 1.5-T vs autopsy, prospective, 201 25.17.7 Overall 7 vs 3 90 92 83 MRI could be reported by a single
2017103 unselected, single reporter after radiologist after a learning
training period, blinded period.
Brain 17 vs NA 92 94 90
Heart 10 vs NA 93 60 97
Thorax 5 vs NA 94 82 95
Abdomen 7 vs NA 89 90 89
MSK 1 vs NA 91 67 99
Shruthi et al, 3D 1.5-T vs autopsy, prospective, 43 20 Whole body / / 78 100 MRI could be an acceptable
201836 fetuses 20 wk GA, exclusion of alternative to conventional
ND autopsies, reported by 3 fetal autopsy. Postmortem MRI was
radiologists with <1-y experience more acceptable to parents and
in postmortem MRI, blinded can provide additional diagnostic
information on brain and spinal
cord malformations.
Brain 93 99
Heart 61 100
Lungs 91 100
MONTH 2020 American Journal of Obstetrics & Gynecology
Abdomen 81 100
Kidney 96 100
MSK 67 100
Kang et al, 3-T MRI vs postmortem ultrasound 160 13e41 Brain 4 vs 64 82 79 84 MRI provided more diagnostic
2019110 vs autopsy, prospective, examination. When MRI and
unselected population, reported by postmortem ultrasound were
1 pediatric and 1 fetal radiologist, both diagnostic, they offered
blinded similar diagnostic accuracy.
Heart 4 vs 0 90 65 100
Expert Review
Thorax 5 vs 0 85 41 99
Abdomen 3 vs 0 82 58 92
Spine 0 vs 0 99 83 100
Kang. Fetal postmortem imaging. Am J Obstet Gynecol 2020. (continued)
7
Expert Review
8 American Journal of Obstetrics & Gynecology MONTH 2020
TABLE 1
Summary of published data concerning the diagnostic accuracy of postmortem magnetic resonance imaging (continued)
GA
(mean–SD or Analyzed ND MRI vs Accuracy Sensitivity Specificity
Author, y Study protocol n range) organs autopsy (%) (%) (%) (%) Conclusion
Staicu et al, 7-T MRI vs stereomicroscopic 9 9e13 Overall / / 95 98 7-T MRI could be considered a
2019111 autopsy, prospective, unselected safe alternative to autopsy.
populations, reported by 1
pediatric/fetal radiologist and 2
embryologists, blinded.
Brain 100 100
Face 100 100
Thorax plus 100 94
heart
Digestive 77 100
Urogenital 100 100
Skeleton 100 95
Shelmerdine et al, 1.5 eT postmortem MRI vs 81 14e41 Overall 16 94 79 98 Where postmortem MRI and
2019113 prenatal ultrasound vs autopsy, prenatal ultrasound were
retrospective review, unselected concordant, there was little
population, reported by 1 of 2 additional yield from autopsy
pediatric radiologists
Brain 2 85 80 89
Heart 9 92 43 97
Thorax 1 97 80 100
Abdomen 1 96 80 100
MSK 2 97 90 100
3D, three-dimensional; CHD, coronary heart disease; CNS, central nervous system; CT, computed tomography; GA, gestational age; MIA, minimally invasive autopsy; MRI, magnetic resonance imaging; MSK, musculoskeletal; n, number of cases; NA, not applicable;
ND, nondiagnostic; PM, postmortem; SD, standard deviation; TOP, termination of pregnancy.
a
Only major malformations were included for analysis; b Inclusion of ND MRI; c Different study but same patient cohort.
Kang. Fetal postmortem imaging. Am J Obstet Gynecol 2020.
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TABLE 2
Current 3-T postmortem MRI Magnetom Avanto (Siemens, Erlangen, Germany) parameters used in our center
Parameter 2D T2 spin echo 3D T2 spin echo
Voxel dimension (mm) 0.470.581.2 0.450.450.45
TE (ms) 80 210
TR (ms) 1000e17,000 1500
Averages 5 1e5
Intersection gap (mm) 0 0
A knee-coil (16 channels) or a body coil (32 channels) is selected depending on the size of the body part studied.
2D, two-dimensional; 3D, dimensional; TE, echo time; TR, repetition time.
Kang. Fetal postmortem imaging. Am J Obstet Gynecol 2020.
mortem examinations still have an help guide clinicians through this lower quality autopsy and increased
important role to play.37 complex process. waiting times for the full autopsy
However, because of the worldwide report.38 The fetal condition may also
declining consent rate for invasive au- Challenges of Conventional Autopsy challenge the pathologist’s skills
topsy, different noninvasive postmor- The current gold standard for fetal particularly in cases of maceration39 or
tem imaging techniques have emerged. postmortem examination is invasive when the fetus is small.30 However,
The selection of procedures to propose autopsy, which comprises an external the main challenge of conventional
in cases of fetal loss may become un- examination, systematic dissections of autopsy is the low and declining con-
clear. Therefore, in this study, we pro- internal organs including the brain, sent rate, which is approximately 5%
vide an overview of all possible and histopathologic analysis. Unfor- e60% worldwide.40-46 Cultural and
postmortem imaging techniques and tunately, experienced qualified fetal religious beliefs and the invasiveness
suggest a clinical decision pathway to pathologists are scarce, which leads to of the technique have been proffered
FIGURE 1
Severe cystic encephalopathy at 34 weeks
Coronal view of the brain in a fetus of 34-week gestational age with severe cystic encephalopathy (arrow) using 3-T postmortem magnetic resonance
imaging T2 spin-echo sequences (A) compared with postmortem ultrasound (B).
Kang. Fetal postmortem imaging. Am J Obstet Gynecol 2020.
FIGURE 4
Bicornuate uterus at 23 weeks
Coronal view of the pelvis of a fetus of 23-week gestational age fetus showing a bicornuate uterus (arrows showing each uterine horn) using 3-T
postmortem magnetic resonance imaging (A) and ultrasound (B).
Kang. Fetal postmortem imaging. Am J Obstet Gynecol 2020.
FIGURE 6
Tetralogy of Fallot at 32 weeks
Axial and coronal view of the heart of a fetus of 32-week gestational age terminated for Tetralogy of Fallot and microdeletion 22q11 using 3-T
postmortem magnetic resonance imaging (A, C) and ultrasound (B, D) showing thymus agenesis in which a blood clot related to termination (open
arrow), pulmonary artery atresia (arrow), and right-sided aorta crossing ventricular septal defect are seen (*).
Kang. Fetal postmortem imaging. Am J Obstet Gynecol 2020.
specific features after external in- and may have value in the diagnosis of because it offers high-resolution images
spections.130-132 complex cardiac malformations after without disruption and handling.136,137
Fetal postmortem computed tomog- intracardiac injection of contrast, but the Recently, new applications of micro-
raphy (CT) scan has excellent diagnostic diagnostic accuracy of this method is yet CT in medicine have been investigated,
value for musculoskeletal abnormal- to be confirmed.134,135 including human fetal postmortem ex-
ities,98,133 with only a 0.3% reduction in amination following preparation with
detection rate compared with an x-ray Postmortem Microfocus Computed formalin and potassium triiodide stain-
examination.130 However, without Tomography ing.138-145 The first studies evaluated the
contrast, it yields a low success rate for Microfocus computed tomography (mi- feasibility of micro-CT for the exami-
the examination of the brain and thor- cro-CT) is a newly described technology nation of isolated organs, such as the
acoabdominal organs compared with offering submicron voxel-level resolu- heart and kidneys, and demonstrated
postmortem MRI.98 Whole-body fetal tion. It has been used for small animal very good agreement with invasive au-
postmortem CT angiography is feasible studies, in archeology, and in industry topsy results.138-140 Whole-body fetal
TABLE 3
Summary of published data concerning the diagnostic accuracy of postmortem ultrasound
Accuracy Sensitivity Specificity
Author, year Study protocol n GA Analyzed organs ND (%) (%) (%) (%) Conclusion
Votino et al, Ultrasound vs autopsy, prospective, 88 11e40 Brain 5 / 91 87 Ultrasound was feasible from 11 wk
2018125 unselected population, single reporter, of GA with high sensitivity and
unblinded specificity
Thoraxa 2 89 93
Abdomen 2 86 95
Tuchtan et al, Ultrasound vs autopsy, prospective, 75 15e38 Brain / / 82 98 Ultrasound showed high sensitivity
2018127 unselective population, single reporter, and specificity for fetal structural
blinded abnormalities with exception of
congenital cardiac structures.
Heart 18 100
Thorax 75 100
Abdomen 68 100
Kang et al, Ultrasound vs autopsy, prospective, 123 13e42 Overall 16 78 75 83 Ultrasound provided diagnostically
2019126 unselected population, 5 reporters, acceptable accuracy for fetal brain
blinded and abdominal organs.
Brain 19 73 62 78
Heart 20 75 50 81
Thorax 17 72 26 81
Abdomen 15 72 61 76
86 20 Overall 12 81 77 90
Brain 19 69 62 74
Heart 17 79 65 83
Thorax 11 76 29 87
Abdomen 14 72 57 77
37 <20 Overall 24 70 67 74
Brain 17 83 NA 83
Heart 27 65 0 77
Thorax 32 65 0 69
Abdomen 19 73 71 73
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Kang. Fetal postmortem imaging. Am J Obstet Gynecol 2020. (continued)
ajog.org Expert Review
93
99
86
97
logic examinations.139,142
Sensitivity
70
32
62
83
Summary of published data concerning the diagnostic accuracy of postmortem ultrasound (continued)
86
83
80
97
31
17
24
Spineb
Heartb
b
Brain
GA, gestational age; MRI, magnetic resonance imaging; n, number of cases; ND, nondiagnostic.
autopsy
reporters, blind
2019110
FIGURE 8
Sequential slice in a volume obtained using microfocus computed tomography in a fetus of 13-week gestational
age terminated for trisomy 18
toward MRI in cases of suspected brain imaging as a first-line examination could postmortem imaging as first-line exami-
malformations.110 also change the a priori risk in the case of nation. Furthermore, as postmortem
Postmortem imaging can also be an discovery of fetal abnormalities, which imaging is more easily accepted, more
adjunct to full or partial autopsy in might encourage parents to be more fetuses would have postmortem exami-
certain cases. Babygrams are recom- accepting of an invasive autopsy. nations, maybe conducted for additional
mended in cases of suspected skeletal We therefore propose a stepwise diag- findings and modifications of recurrence
abnormalities on prenatal ultrasound or nostic approach to fetal postmortem ex- risk, which would lead to better man-
external examinations.130,132 MRI can aminations (Figure 10). This decision tree agement of subsequent pregnancies and
improve the detection of central nervous takes into account parents’ desire, pre- probably a reduction of parental stress.
system abnormalities, particularly when natal history, fetal GA, and locally avail- Furthermore, the cost related to the pre-
maceration is present, and should be able resources. The objective was to vention of future pregnancy loss and the
proposed routinely before autopsy in produce an algorithm based on the best improvement of parental psychological
future guidelines.85,93,95,104,149,150 For currently available evidence, which may status must be considered. Therefore, the
small fetuses <20 weeks and when reduce parental distress by restricting in- efficacy of our proposition and the cost-
complex cardiac malformations are sus- dications for invasive autopsy, thereby effectiveness of postmortem imaging
pected, micro-CT may provide addi- reserving precious resources for cases need to be validated in future prospective
tional findings by scanning the whole where invasive autopsy is strongly indi- studies.
fetus or only the heart in isolation.139,142 cated. Another advantage of this Before implementing routine post-
In addition to these 2 clinical appli- approach would be a reduction in waiting mortem imaging techniques such as
cations, postmortem imaging may serve times for the full reports. However, the postmortem MRI, postmortem ultra-
as a first-line screening examination that cost-effectiveness of our algorithm and sound, or micro-CT in routine clinical
could be used as a form of triage for fetal virtual autopsy are unknown. In 1 practice, several issues need to be
further invasive autopsy in future study concerning adults’ virtual autopsy, addressed. For instance, these tech-
guidelines. The Magnetic Resonance MRI with CT and biopsies produced an niques first need to be recognized as
Imaging Autopsy Study (MaRIAS) estimated cost of $1497 compared with part of routine fetal postmortem ex-
already suggested a stepwise procedure $2274 for invasive autopsy.151 Therefore, amination by national public health
using minimally invasive autopsy that this algorithm would probably allow a services, thus removing any organiza-
would reduce the indications for autopsy reduction of postmortem examination tional or financial obstacles to acces-
in 40% of cases with more than 99% cost, as it would likely reduce the indica- sibility.93 Although such recognition
agreement with autopsy.85 The use of tion for invasive autopsy with exists in the United Kingdom and in
FIGURE 9
Microfocus computed tomography images of normal anatomy in a fetus of 13-week gestational age
A, Axial view of the brain at the level of the developing thalamus (T) and cerebellum (C) showing the different layers in the cortex (arrow). B, Axial view at
the level of the eyes and choanes. C, Coronal view at the level of the lungs showing normal lung lobulation (3 right lobes and 2 left lobes). The position of
the liver (L) and the stomach (S) demonstrate the normal laterality.
Kang. Fetal postmortem imaging. Am J Obstet Gynecol 2020.
the Netherlands,149,150 in many other report the postmortem imaging and then be used to facilitate parental
countries, invasive autopsy is the only minimally invasive autopsy? Pediatric counseling.
recognized postmortem examination. radiologists have an excellent knowl-
Another important consideration is edge of imaging technology but have Conclusion
the need to minimize the delay be- less experience for earlier-gestation Postmortem imaging techniques, such as
tween the performance of the chosen fetuses and their associated malfor- MRI, have proven their benefit as alter-
adjunctive imaging technique and the mations. Fetal medicine specialists and natives or adjuncts to invasive autopsy.
invasive autopsy. This relative urgency pathologists have in-depth knowledge Postmortem ultrasound is also helpful
is constrained by the availability of of fetal malformations but have less when MRI is not available. The newly
postmortem ultrasound operators and experience in dysmorphology and in described micro-CT opens up a whole
access to MRI machines, which already the diagnoses of genetic disorders. new area of possibilities for the post-
function at maximum capacity in Therefore, we recommend multidis- mortem examination of small fetuses
many centers. One must also consider ciplinary fetal postmortem working and warrants further investigation.
the emotional impact of handling groups, including radiologists, fetal Now is the time for those responsible
deceased fetuses, particularly for the medicine specialists, pathologists, and for clinical commissioning and man-
radiographers and radiologists who geneticists, jointly responsible for agement of public health finance to
are not regularly confronted by such producing a single unified postmor- incorporate postmortem imaging into
situations.149 Finally, who should tem report, whose conclusions would routine clinical practice.
FIGURE 10
Proposed stepwise diagnostic approach for fetal postmortem examination
CT, computed tomography; GA, gestational age; MRI, magnetic resonance imaging; NIPT, Noninvasive prenatal testing; PM, postmortem; US, ultrasound.
Kang. Fetal postmortem imaging. Am J Obstet Gynecol 2020.
Such actions would encourage future 14. Ward K. Microarray technology in obstetrics results. Am J Obstet Gynecol 2016;215:626.
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Clinical utility of chromosomal microarray anal- twin pregnancy: update of The Fetal Medicine
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