MRI Autopsies Offer Alternative to Conventional Methods

Autopsies that are minimally invasive by employing magnetic resonance imaging (MRI) technology and other strategies such as blood tests can determine the cause of death in infants and fetuses just as effectively as conventional autopsies.

The new findings, published May 16, 2013, in the British medical journal the Lancet, were presented by investigators from University College London (UK) and Great Ormond Street Hospital (London, UK). The study was led by Dr. Sudhin Thayyil, a consultant neonatologist, and Prof. Andrew Taylor, a consultant radiologist, both from Great Ormond Street Hospital. The study was the first of its kind to analyze the effectiveness of minimally invasive autopsy methods compared with traditional methods on a large-scale.

Autopsies can help to validate the cause of death in a child and establish the risk of susceptibility in siblings and family members. However, consent rates for fetal and neonatal autopsies have declined in the United Kingdom, in spite of a greater number of parents being offered the alternative. Although postmortem MRI is becoming more common in the United Kingdom, and is more acceptable to parents and next of kin, few large studies have studied its effectiveness compared to a traditional autopsy.

The researchers examined outcomes from 400 fetuses, children, and infants who were scheduled for an autopsy and conducted both standard and minimally invasive autopsies for each one. They wanted to determine whether the cause of death concluded by the two autopsy methods was the same. Minimally invasive autopsy determined, among infants and fetuses under the age of one, the same cause of death as the standard autopsy for 92% of the cases observed.

For children between one and 16 years of age, the minimally invasive autopsy techniques were not as accurate; only marginally over half (54%) of the two types of autopsies on children in this age group had the same causes of death. The researchers think this is because MRI scans are unable to detect the infections that were more likely to be the cause of death for children among this age group. When an autopsy is not performed, it is typically because the parents have not given their consent. The investigators think minimally invasive technique could provide a more acceptable choice to traditional autopsy in fetuses and some children.

The study compared the accuracy of a standard autopsy (open dissection) with that of whole-body, postmortem MRI with or without other minimally invasive methods. These included blood samples taken by needle, genetic and metabolic tests, and visual examination of the body, abut did not include tissue biopsies. Cause of death was determined in 400 cases of fetuses and children under 16 by conventional autopsy, MRI scans alone, and MRI scans combined with other noninvasive tests (minimally invasive autopsy).

The findings of a minimally invasive autopsy were found to correlate with those of a standard autopsy in 357 (90%) cases, with the most accurate results for fetuses, newborns, and infants. Imaging was less effective in determining the cause of or major factor in death in older children, largely because MRI scans were unable to detect signs of infection inside their bodies.

Dr. Thayyil, said, “This study has important implications for the way child autopsies are likely to be done in the future. Concerns about falling autopsy rates have been raised since the 1970s; however, attempts to improve these rates have been largely unsuccessful. Minimally invasive autopsy could help more families and clinicians to understand the cause of a child’s death and its implications for other family members, while minimizing the distress caused to parents at such an upsetting time.”

Prof. Taylor, concluded, “Autopsies not only help us to establish the cause of death, but they often play an important role in advancing medical research and knowledge. If we can find ways to continue to carry them out using less invasive methods, such as postmortem MRI, we can boost our understanding of the many ways in which the body can go wrong, with the hope of finding better ways to prevent, treat and cure life-threatening conditions in the future.”

Related Links:
University College London
Great Ormond Street Hospital