Post-mortem magnetic resonance imaging with computed tomography-guided biopsy for foetuses and infants: a prospective, multicentre, cross-sectional study.
Autopsy
Biopsy
Foetus
Infant
Magnetic resonance imaging
Minimally invasive
Post-mortem
Radiology
Virtopsy
Virtual autopsy
Journal
BMC pediatrics
ISSN: 1471-2431
Titre abrégé: BMC Pediatr
Pays: England
ID NLM: 100967804
Informations de publication
Date de publication:
03 08 2022
03 08 2022
Historique:
received:
10
05
2022
accepted:
25
07
2022
entrez:
2
8
2022
pubmed:
3
8
2022
medline:
5
8
2022
Statut:
epublish
Résumé
Post-mortem imaging has been suggested as an alternative to conventional autopsy in the prenatal and postnatal periods. Noninvasive autopsies do not provide tissue for histological examination, which may limit their clinical value, especially when infection-related morbidity and mortality are suspected. We performed a prospective, multicentre, cross-sectional study to compare the diagnostic performance of post-mortem magnetic resonance imaging with computed tomography-guided biopsy (Virtopsy®) with that of conventional autopsy in foetuses and infants. Cases referred for conventional autopsy were eligible for enrolment. After post-mortem imaging using a computed tomography scanner and a magnetic resonance imaging unit, computed tomography-guided tissue sampling was performed. Virtopsy results were compared with conventional autopsy in determining the likely final cause of death and major pathologies. The primary outcome was the proportion of cases for which the same cause of death was determined by both methods. Secondary outcomes included the proportion of false positive and false negative major pathological lesions detected by virtopsy and the proportion of computed tomography-guided biopsies that were adequate for histological examination. Overall, 101 cases (84 fetuses, 17 infants) were included. Virtopsy and autopsy identified the same cause of death in 91 cases (90.1%, 95% CI 82.7 to 94.5). The sensitivity and specificity of virtopsy for determining the cause of death were 96.6% (95% CI 90.6 to 98.8) and 41.7% (95% CI 19.3 to 68.0), respectively. In 32 cases (31.7%, 95% CI 23.4 to 41.3), major pathological findings remained undetected by virtopsy, and in 45 cases (44.6%, 95% CI 35.2 to 54.3), abnormalities were diagnosed by virtopsy but not confirmed by autopsy. Computed tomography-guided tissue sampling was adequate for pathological comments in 506 of 956 biopsies (52.7%) and added important diagnostic value in five of 30 cases (16.1%) with an unclear cause of death before autopsy compared with postmortem imaging alone. In 19 of 20 infective deaths (95%), biopsies revealed infection-related tissue changes. Infection was confirmed by placental examination in all fetal cases. Virtopsy demonstrated a high concordance with conventional autopsy for the detection of cause of death but was less accurate for the evaluation of major pathologies. Computed tomography-guided biopsy had limited additional diagnostic value. ClinicalTrials.gov (NCT01888380).
Sections du résumé
BACKGROUND
Post-mortem imaging has been suggested as an alternative to conventional autopsy in the prenatal and postnatal periods. Noninvasive autopsies do not provide tissue for histological examination, which may limit their clinical value, especially when infection-related morbidity and mortality are suspected.
METHODS
We performed a prospective, multicentre, cross-sectional study to compare the diagnostic performance of post-mortem magnetic resonance imaging with computed tomography-guided biopsy (Virtopsy®) with that of conventional autopsy in foetuses and infants. Cases referred for conventional autopsy were eligible for enrolment. After post-mortem imaging using a computed tomography scanner and a magnetic resonance imaging unit, computed tomography-guided tissue sampling was performed. Virtopsy results were compared with conventional autopsy in determining the likely final cause of death and major pathologies. The primary outcome was the proportion of cases for which the same cause of death was determined by both methods. Secondary outcomes included the proportion of false positive and false negative major pathological lesions detected by virtopsy and the proportion of computed tomography-guided biopsies that were adequate for histological examination.
RESULTS
Overall, 101 cases (84 fetuses, 17 infants) were included. Virtopsy and autopsy identified the same cause of death in 91 cases (90.1%, 95% CI 82.7 to 94.5). The sensitivity and specificity of virtopsy for determining the cause of death were 96.6% (95% CI 90.6 to 98.8) and 41.7% (95% CI 19.3 to 68.0), respectively. In 32 cases (31.7%, 95% CI 23.4 to 41.3), major pathological findings remained undetected by virtopsy, and in 45 cases (44.6%, 95% CI 35.2 to 54.3), abnormalities were diagnosed by virtopsy but not confirmed by autopsy. Computed tomography-guided tissue sampling was adequate for pathological comments in 506 of 956 biopsies (52.7%) and added important diagnostic value in five of 30 cases (16.1%) with an unclear cause of death before autopsy compared with postmortem imaging alone. In 19 of 20 infective deaths (95%), biopsies revealed infection-related tissue changes. Infection was confirmed by placental examination in all fetal cases.
CONCLUSIONS
Virtopsy demonstrated a high concordance with conventional autopsy for the detection of cause of death but was less accurate for the evaluation of major pathologies. Computed tomography-guided biopsy had limited additional diagnostic value.
TRIAL REGISTRATION
ClinicalTrials.gov (NCT01888380).
Identifiants
pubmed: 35918685
doi: 10.1186/s12887-022-03519-4
pii: 10.1186/s12887-022-03519-4
pmc: PMC9347089
doi:
Banques de données
ClinicalTrials.gov
['NCT01888380']
Types de publication
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
464Investigateurs
Christoph M Rüegger
(CM)
Claudia Knöpfli
(C)
Hans Ulrich Bucher
(HU)
Jean-Claude Fauchère
(JC)
Brigitte M Koller
(BM)
Rosa M Martinez
(RM)
Steffen Ross
(S)
Christine Bartsch
(C)
Dominic Gascho
(D)
Peter K Bode
(PK)
Elisabeth Bruder
(E)
Christian Haslinger
(C)
Leonhard Schäffer
(L)
Kevin Schmid
(K)
Bernhard Frey
(B)
Lisa Hofer
(L)
Leonhard Held
(L)
Informations de copyright
© 2022. The Author(s).
Références
Prenat Diagn. 2020 Jan;40(1):28-37
pubmed: 31525275
Ultrasound Obstet Gynecol. 2011 Mar;37(3):317-23
pubmed: 20878677
Arch Dis Child. 1960 Dec;35:544-7
pubmed: 13726619
Turk Patoloji Derg. 2013;29(2):122-6
pubmed: 23661349
Semin Fetal Neonatal Med. 2017 Jun;22(3):167-175
pubmed: 28325580
BMC Pediatr. 2011 Dec 22;11:120
pubmed: 22192497
Ultrasound Obstet Gynecol. 2016 Nov;48(5):596-601
pubmed: 27781316
Arch Dis Child Educ Pract Ed. 2016 Feb;101(1):54-6
pubmed: 26453243
Radiology. 2018 Dec;289(3):658-667
pubmed: 30251930
BMC Pediatr. 2014 Jan 20;14:15
pubmed: 24438163
Fetal Pediatr Pathol. 2009;28(3):139-50
pubmed: 19365742
Radiology. 2006 Dec;241(3):847-53
pubmed: 17053198
Arch Dis Child. 1981 Aug;56(8):606-15
pubmed: 7023390
Arch Dis Child. 2011 Jul;96(7):681-7
pubmed: 20515965
Forensic Sci Int. 2007 Mar 2;166(2-3):199-203
pubmed: 16814505
Ultrasound Obstet Gynecol. 2019 Nov;54(5):661-669
pubmed: 30620444
J Forensic Sci. 2014 Mar;59(2):517-21
pubmed: 24313538
Am J Obstet Gynecol. 2020 Oct;223(4):493-515
pubmed: 32376319
Eur J Radiol. 2010 Jul;75(1):e142-8
pubmed: 19910149
J Forensic Leg Med. 2008 Aug;15(6):382-7
pubmed: 18586209
PLoS Med. 2017 Jun 20;14(6):e1002317
pubmed: 28632739
Am J Obstet Gynecol. 2021 Jan;224(1):103.e1-103.e15
pubmed: 32682860
Clin Radiol. 2015 Aug;70(8):872-80
pubmed: 26050535
Histopathology. 2016 Dec;69(6):1047-1054
pubmed: 27417415
Acta Radiol. 2015 Oct;56(10):1264-72
pubmed: 25392155
PLoS One. 2014 Feb 25;9(2):e89419
pubmed: 24586764
Virchows Arch. 2008 Feb;452(2):201-7
pubmed: 18087719
Lancet. 2013 Jul 20;382(9888):223-33
pubmed: 23683720
Pediatr Radiol. 2016 Aug;46(9):1363-9
pubmed: 27412272