Can MRI be an Option for Necropsy in Neonatal Deaths?
ABSTRACT & COMMENTARY
Synopsis: Magnetic resonance imaging was done on infants who subsequently had autopsies. In 90% of cases, findings with two examinations were considered to provide similar clinical information.
Source: Brooks JAS, et al. Non-invasive perinatal necropsy by magnetic resonance imaging. Lancet 1996;348:1139-1141.
Necropsies are performed in fewer than 60% of neonatal deaths in the United Kingdom, despite their potential value to physicians and families. To study whether non-invasive postmortem MRI could provide diagnostic information, Brooks and associates from the Department of Medical Imaging at the Middlesex Hospital in London performed postmortem MRIs of the head and bodies of 20 newborns who subsequently had conventional necropsies. There was broad agreement between MRI and necropsy findings. In only two of 20 cases did necropsy provide more important clinical diagnostic information than MRI. In 18 of 20 cases, MRI derived diagnostic information of similar clinical significance. MRI was considered especially valuable for detecting abnormalities of the central nervous system (CNS), which account for about 20% of fatal congenital abnormalities.
COMMENT BY LISA J. STATES, MD
Many cases of perinatal death do not have necropsies, even though the information may be of importance to attending physicians and of possible future prognostic significance for the families. The reasons for denial on the part of the family may be because of cultural or religious beliefs. Physicians may also be reluctant to broach the subject with grieving families. The authors report that considerably fewer than two-thirds of perinatal deaths have autopsies in the United Kingdom, a figure that is probably higher than in the United States. For example, at Yale-New Haven Hospital, only one-third of perinatal deaths receive necropsies. Even when perinatal necropsies are done, because of the lack of pathologists familiar with perinatal pathology, substantial numbers do not reach quality standards.
The authors clearly describe a technique for post-mortem imaging that is non-invasive and can be performed in one hour. The information acquired by MRI was found to be comparable to necropsy. The technique was not adequate for cardiovascular anomalies, which account for about 4% of perinatal deaths, and, obviously, histologic examination is not possible with MRI. MRI can, however, accurately detect abnormalities of the CNS, musculoskeletal system, kidneys, and the thorax. In addition, MRI can more accurately detect fluid or blood in the pleura, pericardium, and peritoneum.
A similar study by Woodward et al confirms and supports the findings of the preceding authors using a faster MRI technique called 3D fast spin-echo imaging.1 This technique can acquire all the necessary imaging information in 10-12 minutes, and images can be reconstructed in any plane. As with the other technique, cardiac anomalies were difficult to detect. Gastrointestinal atresias were also difficult to characterize. This decrease in imaging time will also effect a decrease in cost.
Not addressed are the costs of MRI postmortem studies. In most hospitals in the United States, families are not assessed for cost of necropsy but might be charged for MRI.
MRI may be of special value in cases of perinatal death where conventional necropsy is denied or not possible. MRI can provide useful information for counseling parents about the risk for recurrence of anomalies in future pregnancies. (Dr. States is Assistant Professor of Diagnostic Radiology and Pediatrics at the Children’s Hospital at Yale-New Haven Medical Center.)
Reference
1. Woodward PJ, et al. Postmortem fetal MR imaging: Comparison with findings at autopsy. AJR 1997; 168:41-46.
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