Whole-body non-forensic fetal virtopsy using postmortem magnetic resonance imaging at 7 Tesla vs classical autopsy.

IF 6.1 1区医学 Q1 ACOUSTICS

Ultrasound in Obstetrics & Gynecology Pub Date : 2024-11-01 Epub Date: 2024-10-07 DOI:10.1002/uog.29106

A Staicu, C Albu, R Popa-Stanila, C Bondor, L Chiriac, D Eniu, I Goidescu, A R Florian, M Surcel, G Cruciat, D Muresan, I Rotar

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引用次数: 0

Abstract

Objective: To determine the diagnostic accuracy of virtual autopsy using whole-body postmortem ultra-high field magnetic resonance imaging (MRI) at 7 Tesla (T), using a short T2-weighted imaging (T2-WI) protocol, compared with classical autopsy, for detecting structural abnormalities in small second-trimester fetuses.

Methods: Thirty consecutive fetuses at 13-19 weeks' gestation (weight, 17-364 g) were included following spontaneous pregnancy loss or termination of pregnancy. After fixation in 10% formaldehyde solution (48 h to 1 week), all fetuses were scanned using a two-dimensional turbo high-resolution T2-WI protocol with multislice relaxation time, followed by an invasive autopsy. The diagnostic accuracy of virtual autopsy vs classical autopsy was calculated for 990 anatomical structures (30 fetuses × 33 items). Sensitivity, specificity, positive and negative predictive values and Cohen's κ coefficient of agreement, with their 95% CIs, as well as the McNemar test, were used to evaluate the accuracy and agreement of the two diagnostic methods. Analysis was stratified by anatomical segment (nervous, pulmonary, cardiovascular, digestive, renal, facial and skeletal) and across three gestational-age intervals (13-14, 15-16 and 17-19 weeks).

Results: Considering classical autopsy as the gold standard, virtual autopsy had a sensitivity of 92.04% (95% CI, 85.42-96.29%) and a specificity of 97.87% (95% CI, 94.64-99.42%), with a positive predictive value of 96.30% (95% CI, 90.78-98.56%) and a negative predictive value of 95.34% (95% CI, 91.61-97.45%), achieving a diagnostic accuracy of 95.68% (95% CI, 92.73-97.68%) for detecting structural abnormalities in second-trimester fetuses. Cohen's κ for virtual vs classical autopsy was 0.907. The diagnostic ability of virtual autopsy at 7 T for malformed fetuses was superior to that of classical autopsy for analyzing the nervous system in small fetuses with pronounced autolysis, equivalent to that of classical autopsy when analyzing pulmonary, cardiovascular and renal systems and inferior when evaluating the fetal intestines. The sensitivity of virtual autopsy at 7 T for describing structural abnormalities increased with gestational age.

Conclusion: Virtual fetal autopsy using 7-T MRI and a turbo high-resolution T2-WI protocol with multislice relaxation time is a feasible postmortem diagnostic tool for the identification of fetal structural anomalies. © 2024 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

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使用 7 特斯拉死后磁共振成像技术进行全身非法医胎儿虚拟解剖与传统尸检对比。

目的目的：与传统尸检相比，利用 7 特斯拉（T）的全身死后超高场磁共振成像（MRI），采用短 T2 加权成像（T2-WI）方案，确定虚拟尸检在检测二胎小胎儿结构异常方面的诊断准确性：方法：连续纳入30名妊娠13-19周（体重17-364克）的自然流产或终止妊娠胎儿。所有胎儿在10%甲醛溶液中固定（48小时至1周）后，使用多层弛豫时间二维涡轮高分辨率T2-WI方案进行扫描，然后进行有创尸检。对990个解剖结构（30个胎儿×33个项目）计算了虚拟尸检与传统尸检的诊断准确性。灵敏度、特异性、阳性和阴性预测值、Cohen's κ 一致系数及其 95% CIs 以及 McNemar 检验用于评估两种诊断方法的准确性和一致性。分析按解剖部位（神经、肺、心血管、消化、肾、面部和骨骼）和三个胎龄间隔（13-14周、15-16周和17-19周）进行分层：将传统尸检作为金标准，虚拟尸检的敏感性为 92.04%（95% CI，85.42-96.29%），特异性为 97.87%（95% CI，94.64-99.42%），阳性预测值为 96.30%（95% CI，90.78-98.56%），阴性预测值为 95.34%（95% CI，91.61-97.45%），检测二胎胎儿结构异常的诊断准确率为 95.68%（95% CI，92.73-97.68%）。虚拟尸检与传统尸检的 Cohen's κ 为 0.907。7 T 虚拟尸检对畸形胎儿的诊断能力优于传统尸检，可分析有明显尸解的小胎儿的神经系统，与传统尸检分析肺、心血管和肾脏系统的诊断能力相当，而评估胎儿肠道的诊断能力较差。7T虚拟解剖对胎儿结构异常的敏感性随胎龄的增加而增加：结论：使用 7 T 磁共振成像和具有多层弛豫时间的涡轮高分辨率 T2-WI 方案进行虚拟胎儿尸检是鉴定胎儿结构异常的可行尸检诊断工具。© 2024 The Author(s).妇产科超声》由 John Wiley & Sons Ltd 代表国际妇产科超声学会出版。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Ultrasound in Obstetrics & Gynecology 医学-妇产科学

CiteScore

12.30

自引率

14.10%

发文量

891

审稿时长

1 months

期刊介绍： Ultrasound in Obstetrics & Gynecology (UOG) is the official journal of the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) and is considered the foremost international peer-reviewed journal in the field. It publishes cutting-edge research that is highly relevant to clinical practice, which includes guidelines, expert commentaries, consensus statements, original articles, and systematic reviews. UOG is widely recognized and included in prominent abstract and indexing databases such as Index Medicus and Current Contents.