OP03.05: Confidence of reporting fetal virtuopsy as compared to conventional necropsy

Abstract

Objectives: Postmortem fetal MRI combined with computer tomography (‘virtuopsy’) may be a more acceptable alternative for parents declining conventional necropsy. We aimed to compare the acceptance of both examinations and to determine the confidence with which virtuopsy can report on various fetal organs. Methods: In 50 cases of in utero fetal death, virtuopsy and necropsy were offered to parents. In cases where parents consented for both examinations and based on an adapted scale by Breeze (UOG 2006; 28:918–924) confidence in virtuopsy was determined on a scale where conventional necropsy is considered the gold standard. Autopsy was classified as either ‘normal’ (N) or ‘abnormal’ (aN) organs; groups were analyzed separately. At virtuopsy, we used a scale (0 = definitely aN, 50 = unable to comment, 100 = definitely N, 0–50 probably aN and 50–100 probably N) to indicate confidence of each anatomical structure in both groups defined at postmortem autopsy. Results: 98%(49/50) of parents resp. 58%(29/50) consented for virtuopsy resp. necropsy and virtuopsy. Gestational age ranged between 15 and 38 weeks, weight ranged between 52 and 3195 g. For fetuses with N/aN organs at necropsy, virtuopsy showed high confidence scores (> 80) resp. (< 20) for detecting anomalies for the brain, skeleton, thoracic organs except the heart, abdominal organs except the pancreas, ureters, bladder and genitals. However, in two cases, virtuopsy diagnosed a brain anomaly where postmortem autopsy was inconclusive. Conclusions: Virtuopsy provided information of comparable diagnostic utility to that obtained by necropsy for the brain, skeleton, thoracic organs except the heart, abdominal organs except the pancreas, ureters, bladder and genitals. Virtuopsy was particularly useful for the brain where practical difficulties with handling unfixed tissues arise. Although necropsy remains the gold standard, the high acceptance of virtuopsy makes it an acceptable alternative when the former is declined.