Shelmerdine Susan C, Davendralingam Natasha, Palm Liina, Minden Tom, Cary Nat, Sebire Neil J, Arthurs Owen J
Department of Clinical Radiology, Great Ormond Street Hospital for Children, NHS Foundation Trust, London WC1N 3JH, UK.
UCL Great Ormond Street Institute of Child Health, London, UK.
AJR Am J Roentgenol. 2019 Jun;212(6):1335-1347. doi: 10.2214/AJR.18.20534. Epub 2019 Mar 27.
The objective of our study was to determine the diagnostic accuracy of postmortem CT in children compared with standard autopsy. This single-center retrospective study reviewed un-enhanced whole-body postmortem CT examinations of children less than 16 years old with corresponding autopsy reports irrespective of the clinical indication for referral for postmortem CT. Perinatal deaths were excluded. Postmortem CT was reported by experienced postmortem radiologists who were blinded to autopsy findings, with the primary outcome being concordance for the main pathologic diagnosis or findings leading to a cause of death. Autopsy performed by pediatric pathologists was the reference standard. One hundred thirty-six patients (74 [54.4%] male and 62 [45.6%] female patients) were included. The mean age of the 136 patients was 2 years 1 month (range, 2 days-14.7 years). A cause of death at autopsy was found for 77 of the 136 (56.6%) patients. Postmortem CT depicted a correct cause of death in 55 of 77 (71.4%) patients; (55/136 overall [40.4%]), with the majority attributable to traumatic brain or body injuries. For major pathologic findings, diagnostic accuracy rates were a sensitivity of 71.4% (95% CI, 60.5-80.3%), specificity of 81.4% (95% CI, 69.6-89.3%), positive predictive value of 83.3% (95% CI, 72.6-90.4%), negative predictive value of 68.6% (95% CI, 57.0-78.2%), and concordance rate of 75.7% (95% CI, 67.9-82.2%). The sensitivity of postmortem CT versus autopsy was highest for intracranial (75.6%; 95% CI, 60.7-86.2%) and musculoskeletal (98.4%; 95% CI, 91.4-99.7%) abnormalities and lowest for cardiac (31.3%; 95% CI, 14.2-55.6%) and abdominal (53.8%; 95% CI, 29.1-78.6%) findings. Postmortem CT gives an acceptable diagnostic concordance rate with autopsy of 71.4%, although identification of the cause of death overall was low at 40.4%. The highest accuracy rates were for intracranial and musculoskeletal abnormalities.
我们研究的目的是确定儿童尸检CT相对于标准尸检的诊断准确性。这项单中心回顾性研究回顾了16岁以下儿童的未增强全身尸检CT检查，并对照了相应的尸检报告，无论尸检CT转诊的临床指征如何。围产期死亡病例被排除。尸检CT由对尸检结果不知情的经验丰富的尸检放射科医生报告，主要结果是主要病理诊断或导致死亡原因的结果的一致性。儿科病理学家进行的尸检是参考标准。共纳入136例患者（74例[54.4%]男性和62例[45.6%]女性）。136例患者的平均年龄为2岁1个月（范围为2天至14.7岁）。136例患者中有77例（56.6%）在尸检时发现了死亡原因。尸检CT在77例患者中的55例（71.4%）中正确显示了死亡原因；（总体为55/136例[40.4%]），大多数归因于颅脑或身体创伤。对于主要病理结果，诊断准确率为：敏感性71.4%（95%CI，60.5 - 80.3%），特异性81.4%（95%CI，69.6 - 89.3%），阳性预测值83.3%（95%CI，72.6 - 90.4%），阴性预测值68.6%（95%CI，57.0 - 78.2%），一致性率为（95%CI，67.9 - 82.2%）。尸检CT相对于尸检的敏感性在颅内（75.6%；95%CI，60.7 - 86.2%）和肌肉骨骼（98.4%；95%CI，91.4 - 99.7%）异常方面最高，在心脏（31.3%；95%CI，14.2 - 55.6%）和腹部（53.8%；95%CI，29.1 - 78.6%）发现方面最低。尸检CT与尸检的诊断一致性率为71.4%，可以接受，尽管总体上死亡原因的识别率较低，为40.4%。颅内和肌肉骨骼异常的准确率最高。
