Ahmad Mohammad Usman, Sharif Kamal Ali, Qayyum Haisum, Ehsanullah Bushra, Balyasnikova Svetlana, Wale Anita, Shanmuganandan Arun, Siddiqui Muhammed Rafay Sameem, Athanasiou Thanos, Kemp Graham John
School of Medicine, University of Liverpool, Liverpool, UK.
Institute of Translational Medicine, University of Liverpool, Liverpool, UK.
Postgrad Med J. 2017 Nov;93(1105):671-678. doi: 10.1136/postgradmedj-2017-134945. Epub 2017 Jul 6.
The post mortem examination or autopsy is a trusted method of identifying the cause of death. Patients and their families may oppose an autopsy for a variety of reasons, including fear of mutilation or owing to religious and personal beliefs. Imaging alternatives to autopsy have been explored, which may provide a viable alternative.
To explore the possibility of using MRI virtopsy to establish the cause of death as an alternative to the traditional post mortem examination or autopsy.
Systematic review was carried out of all studies, without language restriction, identified from Medline, Cochrane (1960-2016) and Embase (1991-2016) up to December 2016. Further searches were performed using the bibliographies of articles and abstracts. All studies reporting the diagnosis of the cause of death by both MRI virtopsy and traditional autopsy were included.
Five studies with 107 patients, contributed to a summative quantitative outcome in adults. The combined sensitivity of MRI virtopsy was 0.82 (95% CI 0.56 to 0.94) with a diagnostic odds ratio (DOR) of 11.1 (95% CI 2.2 to 57.0). There was no significant heterogeneity between studies (Q=1.96, df=4, p=0.75, I=0). Eight studies, with 953 patients contributed to a summative quantitative outcome in children. The combined sensitivity of MRI virtopsy was 0.73 (95% CI 0.59 to 0.84) with a DOR of 6.44 (95% CI 1.36 to 30.51). There was significant heterogeneity between studies (Q=34.95, df=7, p<0.01, I=80).
MRI virtopsy may offer a viable alternative to traditional autopsy. By using MRI virtopsy, a potential cost reduction of at least 33% is feasible, and therefore ought to be considered in eligible patients.
尸检是确定死因的可靠方法。患者及其家属可能因多种原因反对尸检，包括害怕身体被毁损或出于宗教和个人信仰。人们已经探索了尸检的影像学替代方法，这可能提供一种可行的选择。
探讨使用磁共振虚拟解剖（MRI virtopsy）来确定死因，作为传统尸检的替代方法的可能性。
对截至2016年12月从Medline、Cochrane（1960 - 2016）和Embase（1991 - 2016）中检索到的所有研究进行系统评价，不限语言。使用文章和摘要的参考文献进行进一步检索。纳入所有报告通过MRI虚拟解剖和传统尸检诊断死因的研究。
五项研究共107例患者，得出了成人的汇总定量结果。MRI虚拟解剖的综合敏感性为0.82（95%可信区间0.56至0.94），诊断比值比（DOR）为11.1（95%可信区间2.2至57.0）。各研究间无显著异质性（Q = 1.96，自由度 = 4，p = 0.75，I² = 0）。八项研究共953例患者，得出了儿童的汇总定量结果。MRI虚拟解剖的综合敏感性为0.73（95%可信区间0.59至0.84），DOR为6.44（95%可信区间1.36至30.51）。各研究间存在显著异质性（Q = 34.95，自由度 = 7，p < 0.01，I² = 80）。
MRI虚拟解剖可能为传统尸检提供一种可行的替代方法。通过使用MRI虚拟解剖，至少降低33%的潜在成本是可行的，因此对于符合条件的患者应予以考虑。
