Journal
CIRCULATION
Volume 129, Issue 19, Pages 1937-1944Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1161/CIRCULATIONAHA.113.005641
Keywords
autopsy; cardiovascular diseases; child; death; sudden; fetus; magnetic resonance imaging; pathology
Funding
- Policy Research Program in the United Kingdom Department of Health [0550004]
- British Heart Foundation [CI/05/010]
- Wellbeing of Women and Stillbirth and Neonatal Death charities [RG 1248]
- Foundation for the Study of Infant Deaths [232/13]
- National Institute for Health Research
- National Institute for Health Research clinician scientist award
- Great Ormond Street Children's Charity
- United Kingdom Department of Health's National Institute for Health Research Biomedical Research Centres funding scheme
- Great Ormond Street Hospital Childrens Charity [V1227, V1303] Funding Source: researchfish
- National Institute for Health Research [NIHR/CS/010/022, SRF/01/018, NF-SI-0513-10141] Funding Source: researchfish
- Wellbeing of Women [RG1248] Funding Source: researchfish
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Background Perinatal and pediatric autopsies have declined worldwide in the past decade. We compared the diagnostic accuracy of postmortem, cardiovascular magnetic resonance (CMR) imaging with conventional autopsy and histopathology assessment in fetuses and children. Methods and Results We performed postmortem magnetic resonance imaging in 400 fetuses and children, using a 1.5-T Siemens Avanto magnetic resonance scanner before conventional autopsy. A pediatric CMR imager reported the CMR images, masked to autopsy information. The pathologists were masked to the information from CMR images. 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 with no conventional autopsy performed and 1 with insufficient CMR sequences performed. Thirty-eight CMR data sets were nondiagnostic (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% (58.2-83.7%) and 96.2% (93.5-97.8%) for detecting any cardiac pathology, with positive and negative predictive values of 72.7% (58.2-83.7%) and 96.2% (93.5-97.8%), respectively. Higher sensitivity of 92.6% (76.6-97.9%), specificity of 99.1% (97.4-99.7%), positive predictive value of 89.3% (72.8-96.3%), and negative predictive value of 99.4% (97.8-99.8%) were seen for major structural heart disease. Conclusions Postmortem CMR imaging may be a useful alternative to conventional cardiac autopsy in fetuses and children for detecting cardiac abnormalities. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT01417962.
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