A pragmatic evidence-based approach to post-mortem perinatal imaging

Susan C Shelmerdine,Celine Lewis,Ian C Simcock,J Ciaran Hutchinson,Thivya Sekar,Neil J Sebire,Owen J Arthurs

doi:10.1186/s13244-021-01042-1

Abstract

Post-mortem imaging has a high acceptance rate amongst parents and healthcare professionals as a non-invasive method for investigating perinatal deaths. Previously viewed as a ‘niche’ subspecialty, it is becoming increasingly requested, with general radiologists now more frequently asked to oversee and advise on appropriate imaging protocols. Much of the current literature to date has focussed on diagnostic accuracy and clinical experiences of individual centres and their imaging techniques (e.g. post-mortem CT, MRI, ultrasound and micro-CT), and pragmatic, evidence-based guidance for how to approach such referrals in real-world practice is lacking. In this review, we summarise the latest research and provide an approach and flowchart to aid decision-making for perinatal post-mortem imaging. We highlight key aspects of the maternal and antenatal history that radiologists should consider when protocolling studies (e.g. antenatal imaging findings and history), and emphasise important factors that could impact the diagnostic quality of post-mortem imaging examinations (e.g. post-mortem weight and time interval). Considerations regarding when ancillary post-mortem image-guided biopsy tests are beneficial are also addressed, and we provide key references for imaging protocols for a variety of cross-sectional imaging modalities.

Highlights

Following the loss of a baby, autopsy is the single most useful investigation after death, yielding additional information or diagnosis in 40–70% of cases [1, 2], of which up to 50% may not have been clinically suspected [3–5]
Post-mortem ultrasound and Magnetic resonance imaging (MRI) are useful for imaging larger foetuses (> 20-week gestation), but unenhanced Computed tomography (CT) is usually unhelpful in this clinical context, due to limited intrinsic soft tissue detail
This ‘all-or-nothing’ approach is slowly being supplemented in some specialist centres with the choice of a ‘less invasive autopsy’ (LIA) which involves performing post-mortem imaging and proceeding with minimally invasive tissue sampling where necessary

Summary

Key points

Alternatives to a standard ‘invasive’ autopsy may include less invasive alternatives such as using only post-mortem imaging (termed a ‘non-invasive autopsy’) or the addition of image-guided organ biopsies (known as a ‘minimally invasive autopsy’). Gestational losses (< 20-week gestation) require specialist high-resolution imaging (e.g. micro-CT or high-field MRI) due to small foetal size. Post-mortem ultrasound and MRI are useful for imaging larger foetuses (> 20-week gestation), but unenhanced CT is usually unhelpful in this clinical context, due to limited intrinsic soft tissue detail

Background

Findings

Conclusions