Purpose or Case Report: At our institution there is not possible to perform a perinatal autopsy. Also, there is usually parental resistance to this procedure, especially in cases of stillbirths or perinatal deaths. To address this issue, in 2018, we introduced a protocol of Postmortem Perinatal MRI (PPMRI) in cases where no known or suspected cause of death was identified in antenatal studies, and the gestational age exceeded 22 weeks. This communication aims to share our experience with the utilization of PPMRI, either as a standalone diagnostic tool or as part of a minimally invasive autopsy protocol.
Methods & Materials: We conducted a retrospective review of cases from 2018 to 2023. All PPMRI scans were performed within 24 hours following delivery using a 1.5 Tesla scanner. The imaging protocol included isovolumetric coronal T1 and T2 sequences for the whole body, sagittal T1 and T2 volumetric isotropic sequences for the brain, and a coronal oblique T2 short-axis sequence for the heart. Additionally, axial magnetic susceptibility and steady-state axial gradient echo sequences were obtained for the brain. The PPMRI data were analyzed by two pediatric radiologists and two neuroradiologists who reached a consensus on the findings.
Results: We have performed 22 PPMRI scans in cases with no known or suspected cause of death in antenatal studies. These cases included 21 stillborn fetuses and one death during childbirth. The average gestational age at the time of the PPMRI was 34 weeks, with a range between 19 and 40 weeks. In all cases, typical postmortem changes were observed in the PPMRI scans. Nine cases were solely assessed with PPMRI, revealing no specific cause of death or pathological findings. The remaining 13 cases were subjected to a minimally invasive autopsy, with six PPMRI scans showing pathological findings. In seven cases, the cause of death was identified, primarily through histopathological analysis of the umbilical cord and placenta.
Conclusions: The underutilization of conventional perinatal autopsies has compelled us to develop alternative diagnostic approaches. Our initial experience indicates that PPMRI alone is not the primary diagnostic modality. Multidisciplinary protocols, such as minimally invasive autopsies, offer greater diagnostic certainty and represent a promising approach in addressing the challenges associated with perinatal postmortem examinations.