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Open Access Study protocol

Post mortem magnetic resonance imaging in the fetus, infant and child: A comparative study with conventional autopsy (MaRIAS Protocol)

Sudhin Thayyil1*, Neil J Sebire2, Lyn S Chitty2, Angie Wade3, Oystein Olsen4, Roxana S Gunny4, Amaka Offiah5, Dawn E Saunders4, Catherine M Owens4, WK 'Kling' Chong4, Nicola J Robertson1 and Andrew M Taylor6

Author Affiliations

1 Institute for Women's Health, University College London, London, UK

2 Institute of Child Health, University College London, London, UK

3 Centre for Paediatric Epidemiology and Biostatistics, Institute of Child Health, University College London, London, UK

4 Great Ormond Street Hospital for Children, London, UK

5 Sheffield Children's Hospital, Sheffield

6 Institute of Cardiovascular Science, University College London, London, UK

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BMC Pediatrics 2011, 11:120  doi:10.1186/1471-2431-11-120

Published: 22 December 2011

Abstract

Background

Minimally invasive autopsy by post mortem magnetic resonance (MR) imaging has been suggested as an alternative for conventional autopsy in view of the declining consented autopsy rates. However, large prospective studies rigorously evaluating the accuracy of such an approach are lacking. We intend to compare the accuracy of a minimally invasive autopsy approach using post mortem MR imaging with that of conventional autopsy in fetuses, newborns and children for detection of the major pathological abnormalities and/or determination of the cause of death.

Methods/Design

We recruited 400 consecutive fetuses, newborns and children referred for conventional autopsy to one of the two participating hospitals over a three-year period. We acquired whole body post mortem MR imaging using a 1.5 T MR scanner (Avanto, Siemens Medical Solutions, Enlargen, Germany) prior to autopsy. The total scan time varied between 90 to 120 minutes. Each MR image was reported by a team of four specialist radiologists (paediatric neuroradiology, paediatric cardiology, paediatric chest & abdominal imaging and musculoskeletal imaging), blinded to the autopsy data. Conventional autopsy was performed according to the guidelines set down by the Royal College of Pathologists (UK) by experienced paediatric or perinatal pathologists, blinded to the MR data. The MR and autopsy data were recorded using predefined categorical variables by an independent person.

Discussion

Using conventional post mortem as the gold standard comparator, the MR images will be assessed for accuracy of the anatomical morphology, associated lesions, clinical usefulness of information and determination of the cause of death. The sensitivities, specificities and predictive values of post mortem MR alone and MR imaging along with other minimally invasive post mortem investigations will be presented for the final diagnosis, broad diagnostic categories and for specific diagnosis of each system.

Clinical Trial Registration

NCT01417962

NIHR Portfolio Number: 6794

Keywords:
Autopsy; post mortem magnetic resonance imaging; stillbirth; sudden infant death; diagnostic study; minimally invasive autopsy