Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium.
Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.
Ultrasound Obstet Gynecol. 2019 Dec;54(6):791-799. doi: 10.1002/uog.20217.
To compare the diagnostic rate and accuracy of 3-Tesla (T) postmortem magnetic resonance imaging (PM-MRI) and postmortem ultrasound (PM-US) in an unselected fetal population.
We performed prospectively, in a blinded manner, 3-T PM-MRI and PM-US on 160 unselected fetuses at 13-41 weeks of gestation. All imaging was reported according to a prespecified template, for five anatomical regions: brain, thorax, heart, abdomen and spine. The rates of non-diagnostic results for PM-US and PM-MRI were compared and, for results that were diagnostic, we calculated sensitivity, specificity and concordance rates for each anatomical region, using conventional autopsy as the reference standard.
3-T PM-MRI performed significantly better than did PM-US overall and in particular for fetuses ≥ 20 weeks' gestation. Specifically, the non-diagnostic rates for PM-MRI vs PM-US were 4.4% vs 26.9% (7/160 vs 43/160; P < 0.001) for the brain, 5.2% vs 17.4% (8/155 vs 27/155; P < 0.001) for the thorax, 3.8% vs 30.6% (6/157 vs 48/157; P < 0.001) for the heart and 3.2% vs 23.6% (5/157 vs 37/157; P < 0.001) for the abdomen. For the spine, both techniques showed an equally low non-diagnostic rate. When both postmortem imaging techniques were diagnostic, they had similar accuracy, with no difference in sensitivity or specificity, and similar concordance with autopsy (PM-US, 79.5-96.5%; PM-MRI, 81.6-99.1%).
PM-MRI performed significantly better than PM-US in this unselected population, due mainly to a lower non-diagnostic rate. PM-MRI should remain the first-line imaging investigation for perinatal autopsy, but PM-US could be considered if MRI is not available, albeit with a higher non-diagnostic rate. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
比较在未经选择的胎儿人群中，3 特斯拉（T）磁共振成像（PM-MRI）和 PM-US 的诊断率和准确性。
我们前瞻性地、盲法地对 160 例 13-41 孕周未经选择的胎儿进行了 3T PM-MRI 和 PM-US。所有成像均按照预定模板进行报告，用于 5 个解剖区域：脑、胸、心、腹部和脊柱。比较 PM-US 和 PM-MRI 非诊断结果的发生率，对于诊断结果，我们使用常规尸检作为参考标准，计算每个解剖区域的敏感性、特异性和一致性率。
3T PM-MRI 的总体表现明显优于 PM-US，尤其是对于≥20 孕周的胎儿。具体而言，PM-MRI 与 PM-US 的非诊断率分别为 4.4%和 26.9%（7/160 和 43/160；P<0.001）用于脑，5.2%和 17.4%（8/155 和 27/155；P<0.001）用于胸，3.8%和 30.6%（6/157 和 48/157；P<0.001）用于心，3.2%和 23.6%（5/157 和 37/157；P<0.001）用于腹部。对于脊柱，两种技术的非诊断率都较低。当两种 PM 成像技术均具有诊断价值时，它们具有相似的准确性，敏感性和特异性无差异，与尸检的一致性也相似（PM-US，79.5-96.5%；PM-MRI，81.6-99.1%）。
在未经选择的人群中，PM-MRI 的表现明显优于 PM-US，主要原因是非诊断率较低。PM-MRI 应仍然是围产尸检的一线成像检查方法，但如果 MRI 不可用，PM-US 也可以考虑，尽管其非诊断率较高。版权所有 © 2019 ISUOG。由 John Wiley & Sons Ltd 出版。
