Post-Mortem Cardiovascular Magnetic Resonance Imaging in Fetuses and Children: A Masked Comparison Study with Conventional Autopsy
Background—Perinatal and pediatric autopsies have declined worldwide in the past decade. We compared the diagnostic accuracy of post-mortem, cardiovascular magnetic resonance (CMR) imaging with conventional autopsy and histopathology assessment in fetuses and children.
Methods and Results—We performed post-mortem MR imaging in 400 fetuses and children, using a 1.5 Tesla Siemens Avanto MR scanner (Erlangen, Germany) before conventional autopsy. A pediatric CMR imager reported the CMR images, masked to autopsy information. The pathologists were masked to the information from CMR. The institutional research ethics committee approved the study and parental consent was obtained. Assuming a diagnostic accuracy of 50%, 400 cases were required for a 5% precision of estimate. Three cases were excluded from analysis - 2 no conventional autopsy performed and 1 insufficient CMR sequences performed. Thirty-eight CMR datasets were non-diagnostic (37 in fetuses ≤24 weeks; 1 in a fetus >24 weeks). In the remaining 359 cases, 44 cardiac abnormalities were noted at autopsy. Overall sensitivity and specificity (95% Confidence Interval) of CMR was 72.7% (58.2 to 83.7) and 96.2% (93.5 to 97.8) for detecting any cardiac pathology, with positive (PPV) and negative predictive values (NPV) of 72.7% (58.2 to 83.7) and 96.2% (93.5 to 97.8), respectively. Higher sensitivity 92.6% (76.6 to 97.9), specificity 99.1% (97.4 to 99.7), PPV 89.3% (72.8 to 96.3), and NPV 99.4% (97.8 to 99.8) were seen for major structural heart disease.
Conclusions—Post-mortem CMR imaging may be a useful alternative to conventional cardiac autopsy in fetuses and children for detecting cardiac abnormalities.
Clinical Trial Registration Information—ClinicalTrials.gov. Identifier: NCT01417962.
- death, sudden
- cardiovascular magnetic resonance imaging
- magnetic resonance imaging
- congenital heart disease
- Received August 12, 2013.
- Revision received January 17, 2014.
- Accepted February 7, 2014.