传统与虚拟尸检联合 MRI 在晚发性死胎与胎儿畸形表型特征分析中的应用。
Conventional vs virtual autopsy with postmortem MRI in phenotypic characterization of stillbirths and fetal malformations.
机构信息
Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India.
Department of Radio Diagnosis, All India Institute of Medical Sciences, New Delhi, India.
出版信息
Ultrasound Obstet Gynecol. 2018 Feb;51(2):236-245. doi: 10.1002/uog.17468.
OBJECTIVE
To compare virtual autopsy using postmortem magnetic resonance imaging (MRI) with conventional autopsy with respect to phenotypic characterization of stillbirths and malformed fetuses, and acceptability to parents.
METHODS
This was a prospective diagnostic evaluation study, conducted from June 2013 to June 2015, including stillbirths and pregnancies terminated owing to fetal malformation at ≥ 20 weeks' gestation, for which parental consent to both conventional autopsy and postmortem MRI was obtained. Cases of maternal and obstetric cause of fetal demise were excluded. Whole-body postmortem MRI (at 1.5 T) was performed prior to conventional autopsy. Taking conventional autopsy as the diagnostic gold standard, postmortem MRI findings alone, or in conjunction with other minimally invasive prenatal and postmortem investigations, were assessed and compared for diagnostic accuracy.
RESULTS
Parental consent for both conventional autopsy and postmortem MRI was obtained in 52 cases of which 43 were included in the analysis. In 35 (81.4%) cases, the final diagnosis based on virtual autopsy with postmortem MRI was in agreement with that of conventional autopsy. With conventional autopsy as the reference standard, sensitivity, specificity, positive and negative predictive values of postmortem MRI were, respectively: 77.7%, 99.8%, 97.4% and 98.0% for whole-body assessment; 93.1%, 99.0%, 87.1% and 99.5% for the nervous system; 61.0%, 100.0%, 100.0% and 96.7% for the cardiovascular system; 91.1%, 100.0%, 100.0% and 98.0% for the pulmonary system; 80.6%, 99.8%, 96.7% and 98.7% for the abdomen; 96.2%, 99.7%, 96.2% and 99.7% for the renal system; and 66.7%, 100.0%, 100.0% and 97.2% for the musculoskeletal system. Virtual autopsy was acceptable to 96.8% of families as compared with conventional autopsy to 82.5%.
CONCLUSIONS
Virtual autopsy using postmortem MRI and other minimally invasive investigations can be an acceptable alternative to conventional autopsy when the latter is refused by the parents. Postmortem MRI is more acceptable to parents and can provide additional diagnostic information on brain and spinal cord malformations. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
目的
比较磁共振成像（MRI）虚拟尸检与传统尸检在描述死产儿和畸形胎儿表型方面的差异，并评估其对父母的可接受性。
方法
这是一项前瞻性诊断评估研究，于 2013 年 6 月至 2015 年 6 月进行，纳入的研究对象为妊娠 20 周以上因胎儿畸形而终止妊娠的死产儿或死胎，且均获得了父母对传统尸检和死后 MRI 的同意。排除了因母体和产科原因导致的胎儿死亡。所有病例均在 1.5T 磁共振仪上行全身死后 MRI，然后在传统尸检前进行。以传统尸检为诊断金标准，评估并比较单纯采用 MRI 或联合其他微创产前和死后检查的尸检结果的诊断准确性。
结果
共 52 例病例的父母均同意进行传统尸检和死后 MRI 检查，其中 43 例纳入分析。在 35 例（81.4%）病例中，基于死后 MRI 的虚拟尸检最终诊断与传统尸检一致。以传统尸检为参考标准，MRI 的敏感度、特异度、阳性预测值和阴性预测值分别为：全身评估时为 77.7%、99.8%、97.4%和 98.0%；神经系统时为 93.1%、99.0%、87.1%和 99.5%；心血管系统时为 61.0%、100.0%、100.0%和 96.7%；呼吸系统时为 91.1%、100.0%、100.0%和 98.0%；腹部时为 80.6%、99.8%、96.7%和 98.7%；泌尿系统时为 96.2%、99.7%、96.2%和 99.7%；骨骼肌肉系统时为 66.7%、100.0%、100.0%和 97.2%。与传统尸检相比，虚拟尸检更受 96.8%的家庭欢迎。
结论
当父母拒绝传统尸检时，使用死后 MRI 及其他微创检查的虚拟尸检可作为一种可接受的替代方法。与传统尸检相比，死后 MRI 更受父母欢迎，可为脑和脊髓畸形提供更多的诊断信息。版权所有©2017ISUOG。由 John Wiley & Sons Ltd 出版。
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