1st Department of Obstetrics and Gynaecology, "Iuliu Haţieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania.
Department of Pathology, "Iuliu Haţieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania.
Prenat Diagn. 2019 Jun;39(7):505-518. doi: 10.1002/pd.5457. Epub 2019 May 15.
The aim of this study was to establish the diagnostic accuracy of high-field magnetic resonance imaging (MRI) at 7 Tesla (T) compared with that of stereomicroscopic autopsy for assessing first trimester fetuses.
Nine consecutive cases of first trimester fetuses resulting from spontaneous and therapeutic pregnancy termination were considered. The cases were divided into two groups according to gestational age: the Embryo Group with cases of nine to 10 gestational weeks (GWs) and the Fetus Group with cases of 13 GWs. The first group was scanned using three-dimensional fast imaging with steady state precession (3D FISP), and the second group was scanned using a two-dimensional (2D) turbo spin-echo high-resolution T2-weighted imaging (T2 WI) protocol. A radiologist and two embryologists interpreted the images. All cases were evaluated by invasive autopsy, with pathologist blinded to the imaging results. In total, the database included 270 items for evaluation (9 cases × 30 structures/case).
The global agreement between fetal high-field virtopsy and microscopic or stereomicroscopic autopsy was evaluated using 225 evaluation items visible by both methods. Overall, using microscopic examination and stereomicroscopic autopsy as the gold standard, fetal high-field virtopsy had a sensitivity of 94.6% [95% CI, 87.2-98.3] and a specificity of 97.6% [95% CI, 95-98.8]. The positive predictive value (PPV) was 93% [95% CI, 85.7-96.6], and the negative predictive value (NPV) was 98.2% [95% CI, 95.7-99.4]. Cohen kappa coefficient of agreement was k = 0.92 [95% CI, 0.82-0.97], and the McNemar test showed p = 1.00.
Virtual autopsy using high-field MRI at 7 T can be considered a safe alternative approach to stereomicroscopic autopsy for the assessment of fetal structural anomalies at the end of the first trimester of pregnancy.
本研究旨在评估 7 特斯拉（T）高磁场磁共振成像（MRI）在评估早期妊娠胎儿方面的诊断准确性，并与立体显微镜尸检进行比较。
连续纳入 9 例因自然和治疗性妊娠终止而导致的早期妊娠胎儿，根据妊娠周数（GW）分为胚胎组（9-10 GW）和胎儿组（13 GW）。胚胎组采用三维稳态进动快速成像（3D FISP）扫描，胎儿组采用二维（2D）涡轮自旋回波高分辨率 T2 加权成像（T2 WI）协议扫描。由一名放射科医生和两名胚胎学家对图像进行解读。所有病例均经有创尸检评估，病理学家对图像结果不知情。总共对 270 项进行评估（9 例×30 项/例）。
使用 225 项两种方法均可显示的评估项目，评估胎儿高场虚拟尸检与显微镜或立体显微镜尸检的整体一致性。总体而言，以显微镜检查和立体显微镜尸检为金标准，胎儿高场虚拟尸检的灵敏度为 94.6%[95%可信区间（CI），87.2-98.3]，特异性为 97.6%[95% CI，95-98.8]。阳性预测值（PPV）为 93%[95% CI，85.7-96.6]，阴性预测值（NPV）为 98.2%[95% CI，95.7-99.4]。一致性的 Cohen kappa 系数为 k=0.92[95% CI，0.82-0.97]，McNemar 检验显示 p=1.00。
7 T 高磁场 MRI 虚拟尸检可作为评估妊娠早期胎儿结构异常的一种安全替代方法，与立体显微镜尸检相比。
