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Final ID: Poster #: CR-008

Micro-CT in perinatal autopsy: changing diagnoses at early gestation.

Purpose or Case Report: Autopsy examination of early miscarriages (<20 weeks’ gestation) can be technically challenging, with an associated error rate due to small size. Imaging is increasingly used to guide the autopsy process and post mortem MRI (PMMRI) at 1.5T shows excellent correlation with autopsy findings over 18gw / 500g bodyweight, however, its diagnostic accuracy is reduced below these thresholds. We have evaluated the use of Micro-CT, which has been used in animal imaging and industry for many years. We present a radiological / pathological correlation of a case from the first clinical use of micro-CT in perinatal autopsy practice, under an ethically approved study with full consent.

A termination of pregnancy was performed at approximately 14gw for presumed sacrococcygeal teratoma. Standard CT and 1.5T PMMRI was non-diagnostic for every organ system. Following immersion of the fetus in potassium triiodide and formalin for 48 hours, a micro-CT scan was performed using a Nikon XTH225 micro-CT scanner, reconstructed using proprietary software (CT Pro 3D, Nikon Metrology) and post-processed using VG Studio MAX (Volume Graphics GmbH).

Views of all organ systems were obtained that were used to guide subsequent unblinded autopsy. Micro-CT demonstrated multiple abnormalities, including amniotic membranes in contact with the fetal skin, multiple disruptions of the abdomen and limbs, and externalisation of internal organs including the kidneys and liver. These were confirmed at the subsequent autopsy and a final diagnosis of ADAM complex (amniotic deformity, adhesions, mutilations) was made.

This case report demonstrates the potential of micro-CT to provide detailed PM imaging of entire fetuses whilst maintaining tissue integrity, allowing pre-autopsy identification of multiple congenital abnormalities in cases where 1.5T PMMRI and standard CT fail to achieve diagnostic resolutions.
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Results:
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  • Hutchinson, J.  ( Great Ormond Street Hospital , London , United Kingdom )
  • Haig, Ian  ( Nikon Metrology , Tring , United Kingdom )
  • Sebire, Neil  ( Great Ormond Street Hospital , London , United Kingdom )
  • Arthurs, Owen  ( Great Ormond Street Hospital , London , United Kingdom )
Session Info:

Electronic Exhibits - Case Reports

Fetal Imaging / Neonatal

Scientific Exhibits - Case Reports

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Absence of the ductus venosus and the expected but abnormal course of umbilical venous lines.

Blagdon Ryan, Thompson Deborah, Schmit Pierre

Differences of Placental ADC Measurements in Fetuses with and without CNS Abnormalities

Valdez Quintana Melissa, Caro Dominguez Pablo, Grynspan David, Hurteau-miller Julie, Davila Jorge, Moretti Felipe, Miller Elka

More abstracts from these authors:
Non-invasive phenotyping of mouse embryos using micro-CT: implications for perinatal autopsy imaging

Hutchinson J., Peltzer Maria, Darding Maurice, Walczak Henning, Sebire Neil, Arthurs Owen

MicroCT imaging of perinatal skeletal anomalies: a pilot study

Shelmerdine Susan, Hutchinson J., Suich Joseph, Calder Alistair, Sebire Neil, Arthurs Owen

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