The role of post-mortem MRI in the neonatal intensive care unit

• Published in: Journal of perinatology Vol. 37; no. 1; pp. 98 - 103
• Main Authors: Leadbetter, K Z, Vesoulis, Z A, White, F V, Schmidt, R E, Khanna, G, Shimony, J S, Mathur, A M
• Format: Journal Article
• Language: English
• Published: New York Nature Publishing Group US 01.01.2017; Nature Publishing Group
• Subjects: 631/378; 692/308/53/2421; Abdomen; Autopsies; Autopsy; Cause of Death; Consent; Families & family life; Female; Fetuses; Health aspects; Humans; Immunology; Infant; Infant, Newborn; Intensive care; Intensive Care Units, Neonatal; Magnetic Resonance Imaging; Male; Medicine; Medicine & Public Health; Missouri; Newborn babies; Newborn infants; Observational studies; original-article; Pathology; Pediatric Surgery; Pediatrics; Prospective Studies; Whole Body Imaging - methods; United States > US
• ISSN: 0743-8346; 1476-5543
• DOI: 10.1038/jp.2016.156

Objective: Post-mortem examination can provide important information about the cause of death and play a significant role in the bereavement process. Autopsies reveal previous unknown medical problems approximately 20 to 30% of the time. A non-invasive magnetic resonance imaging-based post-mortem examination (PM-MRI) may provide an alternative for families who do not consent to an autopsy. Study Design: This study was a prospective observational study of recently expired neonates and infants. Subjects underwent a full body MRI scan (brain, chest, abdomen and pelvis) followed by conventional autopsy if the family desired to have one. MRI results were compared with autopsy findings and the ante-mortem clinical diagnosis. A follow-up survey was conducted to investigate family perceptions of the PM-MRI process. Results: Thirty-one infants underwent full PM-MRI. Of 31 infants, 19 (61%) had complete agreement between the clinician’s impression and PM-MRI. Twenty-four infants also had conventional autopsy, with 14/24 (58%) infants having PM-MRI results consistent with autopsy findings. PM-MRI was superior at detection of free intraperitoneal/intrathoracic air and hepatic iron overload. Whole-body PM-MRI did not have the resolution to detect focal/microscopic injury, vascular remodeling and some forms of brain injury. Of those families who remembered the PM-MRI findings, the majority felt that the information was useful. Conclusions: PM-MRI studies may provide an important adjunct to conventional autopsy and a substitute when the latter is not possible for personal or religious reasons. Clinicians should be aware of, and communicate with the family, the resolution limits of the whole-body PM-MRI to detect certain types of injury.