University Hospital of Leuven, Herestraat 49, 3000, Leuven, Belgium.
Department of Radiology, Heilig-Hart Hospital of Mol, Leuven, Belgium.
Pediatr Radiol. 2023 May;53(5):929-941. doi: 10.1007/s00247-022-05559-5. Epub 2022 Dec 29.
Postmortem fetal magnetic resonance imaging (MRI) has been on the rise since it was proven to be a good alternative to conventional autopsy. Since the fetal brain is sensitive to postmortem changes, extensive tissue fixation is required for macroscopic and microscopic assessment. Estimation of brain maceration on MRI, before autopsy, may optimize histopathological resources.
The aim of the study is to develop an MRI-based postmortem fetal brain maceration score and to correlate it with brain maceration as assessed by autopsy.
This retrospective single-center study includes 79 fetuses who had postmortem MRI followed by autopsy. Maceration was scored on MRI on a numerical severity scale, based on our brain-specific maceration score and the whole-body score of Montaldo. Additionally, maceration was scored on histopathology with a semiquantitative severity scale. Both the brain-specific and the whole-body maceration imaging scores were correlated with the histopathological maceration score. Intra- and interobserver agreements were tested for the brain-specific maceration score.
The proposed brain-specific maceration score correlates well with fetal brain maceration assessed by autopsy (τ = 0.690), compared to a poorer correlation of the whole-body method (τ = 0.452). The intra- and interobserver agreement was excellent (correlation coefficients of 0.943 and 0.864, respectively).
We present a brain-specific postmortem MRI maceration score that correlates well with the degree of fetal brain maceration seen at histopathological exam. The score is reliably reproduced by different observers with different experience.
死后胎儿磁共振成像（MRI）已得到广泛应用，因为它是传统尸检的良好替代方法。由于胎儿大脑对外死后变化敏感，因此需要广泛的组织固定进行宏观和微观评估。在尸检前，通过 MRI 对脑软化进行评估，可能会优化组织病理学资源。
本研究旨在建立一种基于 MRI 的胎儿脑软化死后评分，并与尸检评估的脑软化程度相关联。
本回顾性单中心研究纳入了 79 例接受过死后 MRI 检查并随后进行尸检的胎儿。根据我们的脑特异性软化评分和蒙塔尔多的全身评分，在 MRI 上对脑软化进行数值严重程度评分。此外，还通过半定量严重程度评分在组织病理学上对脑软化进行评分。脑特异性和全身软化成像评分均与组织病理学软化评分相关联。测试了脑特异性软化评分的观察者内和观察者间的一致性。
与全身法（τ=0.452）相比，提出的脑特异性软化评分与尸检评估的胎儿脑软化程度相关性更好（τ=0.690）。观察者内和观察者间的一致性非常好（相关系数分别为 0.943 和 0.864）。
我们提出了一种基于 MRI 的脑死后软化评分，与组织病理学检查中所见的胎儿脑软化程度密切相关。该评分由不同经验的不同观察者可靠地重现。
