Diagnostic accuracy and limitations of post-mortem MRI for neurological abnormalities in fetuses and children

O J Arthurs; S Thayyil; S S Pauliah; T S Jacques; W K Chong; R Gunny; D Saunders; S Addison; P Lally; E Cady; R Jones; W Norman; R Scott; N J Robertson; A Wade; L Chitty; A M Taylor; N J Sebire; Magnetic Resonance Imaging Autopsy Study (MaRIAS) Collaborative Group

doi:10.1016/j.crad.2015.04.008

Diagnostic accuracy and limitations of post-mortem MRI for neurological abnormalities in fetuses and children

Clin Radiol. 2015 Aug;70(8):872-80. doi: 10.1016/j.crad.2015.04.008. Epub 2015 Jun 6.

Authors

O J Arthurs¹, S Thayyil², S S Pauliah², T S Jacques³, W K Chong⁴, R Gunny⁴, D Saunders⁴, S Addison², P Lally², E Cady⁵, R Jones⁶, W Norman⁶, R Scott⁷, N J Robertson⁸, A Wade⁹, L Chitty¹⁰, A M Taylor⁶, N J Sebire¹¹; Magnetic Resonance Imaging Autopsy Study (MaRIAS) Collaborative Group

Collaborators

Magnetic Resonance Imaging Autopsy Study (MaRIAS) Collaborative Group:
Shea Addison, Michael Ashworth, Alan Bainbridge, Jocelyn Brookes, Lyn Chitty, W K Kling Chong, Andrew Cook, Enrico de Vita, Roxana Gunny, Brian Harding, Tom Jacques, Rod Jones, Mark Lythgoe, Marion Malone, Wendy Norman, Oystein Olsen, Catherine M Owens, Amaka C Offiah, Nicola Robertson, Tony Risdon, Neil Sebire, Rosemary Scott, Dawn Saunders, Silvia Schievano, Angie Scales, Andrew Taylor, Sudhin Thayyil, Angie Wade

Affiliations

¹ Paediatric Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK; UCL Institute of Child Health, London, UK. Electronic address: owen.arthurs@gosh.nhs.uk.
² Perinatal Neurology and Neonatology, Imperial College London, London, UK.
³ Department of Histopathology, UCL Institute of Child Health & Great Ormond Street Hospital for Children, London, UK.
⁴ Paediatric Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK; UCL Institute of Child Health, London, UK.
⁵ Medical Physics and Bioengineering, University College London Hospitals NHS Foundation Trust, London, UK.
⁶ Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, London, UK; Cardiorespiratory Division, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.
⁷ Department of Histopathology, University College London Hospital NHS Trust, UK.
⁸ Academic Neonatology, UCL Institute for Women's Health, London, UK.
⁹ Paediatric Epidemiology and Biostatistics Unit, UCL Institute of Child Health, London, UK.
¹⁰ Genetics and Genomic Medicine, UCL Institute of Child Health, London, UK; Clinical Genetics, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK; UCLH NHS Foundation Trusts, London, UK.
¹¹ UCL Institute of Child Health, London, UK; Department of Histopathology, UCL Institute of Child Health & Great Ormond Street Hospital for Children, London, UK.

PMID: 26050535
DOI: 10.1016/j.crad.2015.04.008

Abstract

Aim: To compare the diagnostic accuracy of non-invasive cerebral post-mortem magnetic resonance imaging (PMMRI) specifically for cerebral and neurological abnormalities in a series of fetuses and children, compared to conventional autopsy.

Materials and methods: Institutional ethics approval and parental consent was obtained. Pre-autopsy cerebral PMMRI was performed in a sequential prospective cohort (n = 400) of fetuses (n = 277; 185 ≤ 24 weeks and 92 > 24 weeks gestation) and children <16 years (n = 123) of age. PMMRI and conventional autopsy findings were reported blinded and independently of each other.

Results: Cerebral PMMRI had sensitivities and specificities (95% confidence interval) of 88.4% (75.5 to 94.9), and 95.2% (92.1 to 97.1), respectively, for cerebral malformations; 100% (83.9 to 100), and 99.1% (97.2 to 99.7) for major intracranial bleeds; and 87.5% (80.1 to 92.4) and 74.1% (68 to 79.4) for overall brain pathology. Formal neuropathological examination was non-diagnostic due to maceration/autolysis in 43/277 (16%) fetuses; of these, cerebral PMMRI imaging provided clinically important information in 23 (53%). The sensitivity of PMMRI for detecting significant ante-mortem ischaemic injury was only 68% (48.4 to 82.8) overall.

Conclusions: PMMRI is an accurate investigational technique for identifying significant neuropathology in fetuses and children, and may provide important information even in cases where autolysis prevents formal neuropathological examination; however, PMMRI is less sensitive at detecting hypoxic-ischaemic brain injury, and may not detect rarer disorders not encountered in this study.

Trial registration: ClinicalTrials.gov NCT01417962.

Publication types

Comparative Study
Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Autopsy / methods*
Brain / abnormalities*
Brain Diseases / diagnosis*
Child
Child, Preschool
Fetus / abnormalities*
Humans
Hypoxia-Ischemia, Brain / diagnosis
Infant
Infant, Newborn
Intracranial Hemorrhages / diagnosis
Magnetic Resonance Imaging / methods*
Prospective Studies
Sensitivity and Specificity

Associated data

ClinicalTrials.gov/NCT01417962

Abstract

Publication types

MeSH terms

Associated data

Grants and funding