Barber Joy L, Sebire Neil J, Chitty Lyn S, Taylor Andrew M, Arthurs Owen J
Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK, WC1N 3JH.
Int J Legal Med. 2015 May;129(3):531-6. doi: 10.1007/s00414-014-1125-7. Epub 2014 Dec 5.
Aim of this study was to investigate whether lung assessment on post-mortem magnetic resonance imaging (PMMR) can reliably differentiate between live birth and stillbirth.
We retrospectively assessed PMMR imaging features of a group of late foetal terminations following fetocide and stillbirths (without witnessed breathing) and early infant deaths (breathed spontaneously before death). PMMR images were reviewed for evidence of lung aeration and other features, blinded to the clinical and autopsy data.
Nineteen infant deaths (mean age 3.0 ± 6.5 post-natal weeks) and 23 foetal terminations or stillbirths (mean age 32.6 ± 10.2-week gestation) were compared. Subjective appearances of lung aeration on PMMR were the best indicator of live birth, with a sensitivity of 89.5% (95% confidence interval 68.6, 97.1%) and specificity of 95.6% (79.0, 99.2%) and positive and negative predictive values of 94.4% and 91.7%, respectively.
Lung aeration on PMMR appears to have high overall accuracy for confirmation of live birth versus intrauterine foetal death but now requires validating in a larger cohort of perinatal deaths.
本研究旨在调查尸检磁共振成像（PMMR）对肺的评估能否可靠地区分活产和死产。
我们回顾性评估了一组在胎儿死亡后晚期引产、死产（无呼吸迹象）及早期婴儿死亡（死前自发呼吸）的PMMR成像特征。在不知晓临床和尸检数据的情况下，对PMMR图像进行检查，以寻找肺通气及其他特征的证据。
比较了19例婴儿死亡（平均出生后3.0±6.5周）和23例引产或死产（平均妊娠32.6±10.2周）。PMMR上肺通气的主观表现是活产的最佳指标，敏感性为89.5%（95%置信区间68.6, 97.1%），特异性为95.6%（79.0, 99.2%），阳性预测值和阴性预测值分别为94.4%和91.7%。
PMMR上的肺通气对于确认活产与宫内胎儿死亡似乎具有较高的总体准确性，但目前需要在更大的围产期死亡队列中进行验证。
