Sandrini Camilla, Rossetti Lucia, Zambelli Vanessa, Zanarotti Roberta, Bettinazzi Franca, Soldá Roberta, Di Pace Concetta, Hoxha Stiljan, Ribichini Flavio Luciano, Faggian Giuseppe, Lombardi Claudio, Luciani Giovanni Battista
Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy.
School of Medicine and Surgery, University of Milano Bicocca, Monza, Italy.
Front Pediatr. 2019 Mar 22;7:92. doi: 10.3389/fped.2019.00092. eCollection 2019.
Early prenatal diagnosis of congenital heart disease is feasible. Conventional autopsy is the current gold standard method for post-mortem confirmation. Radiologic techniques alternative to conventional autopsy, such as post-mortem micro-computed tomography, have been proposed in case of limited diagnostic accuracy (i.e., early termination of pregnancy, samples of small dimension or of low weight). The aim of the present study was to define accuracy of micro-computed tomography for post-mortem diagnosis of congenital heart disease in gross anatomy samples. Fetal heart underwent prenatal echocardiography and post-mortem evaluation by 9 μm resolution micro-computed tomography and conventional autopsy. For each case, 25 indices of cardiac anatomy were studied by post-mortem micro-computed tomography and conventional autopsy; these were used to compare the two post mortem techniques. Ten samples were examined (gestational age between 12 + 4 and 21 + 6 weeks of gestation). Considering comparable indices, agreement between post-mortem micro-computed tomography and conventional autopsy was of 100% and sensitivity and specificity were of 100%. In "challenging specimens," post-mortem micro-computed tomography diagnoses more indices as compared to conventional autopsy and 84% of "not-diagnostic" indices at conventional autopsy would be diagnostic at post-mortem micro-computed tomography. Micro-computed tomography can be a valid diagnostic alternative to conventional autopsy for post-mortem evaluation of human fetal heart. In addition, it may prove superior to conventional autopsy particularly in cases coming from early termination of pregnancy or in samples of small dimension or of low weight.
先天性心脏病的早期产前诊断是可行的。传统尸检是目前用于死后确诊的金标准方法。对于诊断准确性有限的情况（即早期终止妊娠、小尺寸或低体重样本），已提出采用诸如死后微型计算机断层扫描等替代传统尸检的放射学技术。本研究的目的是确定微型计算机断层扫描在大体解剖样本中对先天性心脏病进行死后诊断的准确性。对胎儿心脏进行产前超声心动图检查，并通过9微米分辨率的微型计算机断层扫描和传统尸检进行死后评估。对于每个病例，通过死后微型计算机断层扫描和传统尸检研究25个心脏解剖指标；这些指标用于比较两种死后检查技术。检查了10个样本（妊娠周数在12 + 4至21 + 6周之间）。考虑到可比指标，死后微型计算机断层扫描与传统尸检之间的一致性为100%，敏感性和特异性均为100%。在“具有挑战性的标本”中，与传统尸检相比，死后微型计算机断层扫描诊断出的指标更多，并且传统尸检中84%的“未诊断”指标在死后微型计算机断层扫描中可被诊断。微型计算机断层扫描可以作为传统尸检的有效替代方法，用于人类胎儿心脏的死后评估。此外，它可能尤其在早期终止妊娠的病例或小尺寸或低体重样本中优于传统尸检。
