Post-mortem MRI versus conventional autopsy in fetuses and children: a prospective validation study

Background Post-mortem MRI is a potential diagnostic alternative to conventional autopsy, but few large prospective studies have compared its accuracy with that of conventional autopsy. We assessed the accuracy of whole-body, post-mortem MRI for detection of major pathological lesions associated with death in a prospective cohort of fetuses and children. Methods In this prospective validation study, we did pre-autopsy, post-mortem, whole-body MRI at 1.5 T in an unselected population of fetuses (<= 24 weeks' or >24 weeks' gestation) and children (aged <16 years) at two UK centres in London between March 1, 2007 and Sept 30, 2011. With conventional autopsy as the diagnostic gold standard, we assessed MRI findings alone, or in conjunction with other minimally invasive post-mortem investigations (minimally invasive autopsy), for accuracy in detection of cause of death or major pathological abnormalities. A radiologist and pathologist who were masked to the autopsy findings indicated whether the minimally invasive autopsy would have been adequate. The primary outcome was concordance rate between minimally invasive and conventional autopsy. Findings We analysed 400 cases, of which 277 (69%) were fetuses and 123 (31%) were children. Cause of death or major pathological lesion detected by minimally invasive autopsy was concordant with conventional autopsy in 357 (89.3%, 95% CI 85.8-91.9) cases: 175 (94.6%, 90.3-97.0) of 185 fetuses at 24 weeks' gestation or less, 88 (95.7%, 89.3-98.3) of 92 fetuses at more than 24 weeks' gestation, 34 (81.0%, 67.7-90.0) of 42 newborns aged 1 month or younger, 45 (84.9%, 72.9-92.1) of 53 infants aged older than 1 month to 1 year or younger, and 15 (53.6%, 35.8-70.5) of 28 children aged older than 1 year to 16 years or younger. The dedicated radiologist or pathologist review of the minimally invasive autopsy showed that in 165 (41%) cases a full autopsy might not have been needed; in these cases, concordance between autopsy and minimally invasive autopsy was 99.4% (96.6-99.9). Interpretation Minimally invasive autopsy has accuracy similar to that of conventional autopsy for detection of cause of death or major pathological abnormality after death in fetuses, newborns, and infants, but was less accurate in older children. If undertaken jointly by pathologists and radiologists, minimally invasive autopsy could be an acceptable alternative to conventional autopsy in selected cases.