Non-invasive perinatal necropsy by magnetic resonance imaging

Abstract

Background: AT present necropsy is done in less than 60% of cases of perinatal death in the UK, despite the value of the procedure to the bereaved parents and their doctors. This low rate reflects the difficulty in discussing the examination during the acute distress after the death of a baby, and the personal and religious objections of many parents to necropsy. We compared post-mortem magnetic resonance imaging (MRI) of the fetus with internal perinatal necropsy to assess whether MRI examination is a feasible option for the 40% of cases where consent for necropsy is not given or requested.

Methods: We examined 20 stillborn, miscarried, or aborted fetuses by MRI and necropsy. Scanning was done in a 1.5 T system, in accordance with our protocol, immediately before necropsy. The MRI and necropsy findings were compared to assess how much diagnostic information was obtained by each technique.

Findings: In eight of the 20 cases the two examinations were in total agreement about the abnormalities present. In eight cases the necropsy provided more detailed information than MRI examination, but in four cases the MRI information was more extensive than that obtained at necropsy. In two of the latter cases, abnormalities of the central nervous system were seen only on MRI. Thus, in 12 (60%) of the 20 cases studied, MRI had equivalent or better diagnostic sensitivity than internal necropsy examination; in 18 (90%) of the 20 cases the two examinations were of similar clinical significance.

Interpretation: MRI of the stillborn or aborted fetus provides non-invasive access to information previously available only from necropsy.