Prodhomme Olivier,  Baud Catherine,  Saguintaah Magali,  Bolivar Perrin Julie,  David Stephanie,  Taleb Arrada Ikram,  Couture Alain

Final Pr. ID: Poster #: SCI-011

To present the technique and the images obtain by postmortem ultrasound in the particular setting of fetal death and discuss its abilities and limitations.
To compare the diagnostic yields of joint analysis of ultrasound and X-Ray compared to autopsy in the setting of fetal death.
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Authors:  Prodhomme Olivier , Baud Catherine , Saguintaah Magali , Bolivar Perrin Julie , David Stephanie , Taleb Arrada Ikram , Couture Alain

Keywords:  Ultrasonography, Postmortem, Fetus, Fetal death, Postmortem Imaging

Davis James

Final Pr. ID: Poster #: EDU-104

Stillbirth is a sad complication of pregnancy. Establishing the cause of death in intrauterine fetal demise (IUFD) is important to bring psychological closure to the family and crucial for reproductive counseling. The gold standard to establish the cause of IUFD is perinatal autopsy. However, perinatal autopsy rates are falling worldwide, largely attributed to patients and physicians discomfort with death and discussion of postmortem examinations as well as social and religious reasons. There is a lack of experience with minimally invasive perinatal autopsy in the United States and even more limited publications in the subject. Our main goal was to investigate the added value of postmortem MRI to conventional autopsy in the clinical setting. Our program has had successes and failures, of which learning opportunities exist for other institutions that desire to implement similar programs. This paper will discuss the timeline of our progress and share examples of potential roadblocks and keys to success in implementing such a program. Read More

Authors:  Davis James

Keywords:  Postmortem, MRI, Fetal

Gupta Neetika,  Snyder Elizabeth,  Victoria Teresa,  Arthurs Owen,  Miller Elka

Final Pr. ID: Poster #: EDU-007

The purpose of this exhibit is to describe the expected physiological post-mortem changes in the fetus and children using different imaging modalities. These post-mortem changes are affected by a variety of antemortem and postmortem factors, amongst all, the age of the fetus or child, the organ system in question, and the extent of fluid shifts and tissue changes are the most crucial and help to guide the imaging modality of choice in post-mortem period. It is imperative to understand organ-system-specific post-mortem changes for satisfactory reporting of post-mortem imaging in children. When in doubt, a review of perimortem clinical details and a correlation with antemortem/antenatal imaging findings may assist in reaching the final diagnosis. Read More

Authors:  Gupta Neetika , Snyder Elizabeth , Victoria Teresa , Arthurs Owen , Miller Elka

Keywords:  Postmortem Imaging, Physiological changes, Expected changes

Hutchinson J.,  Haig Ian,  Sebire Neil,  Arthurs Owen

Final Pr. ID: Poster #: CR-008

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. Read More

Authors:  Hutchinson J. , Haig Ian , Sebire Neil , Arthurs Owen

Keywords:  Micro-CT, Fetal, Anomalies, Congenital, Postmortem

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

Final Pr. ID: Poster #: EDU-102

Illustrate pathologies encountered in our early experience of whole body fetal micro-CT, with respect to congenital skeletal anomalies. Read More

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

Keywords:  Postmortem, micro-CT, musculoskeletal

Pérez-marrero Lizbet,  Castoldi Maria Francesca,  Fuentealba Isabel,  Stecher Ximena,  Schonstedt Valeria,  Cisternas Daniela,  Castiblanco Adriana,  Repetto Gabriela,  Legarraga Paulette,  Schultz Marcela

Final Pr. ID: Poster #: SCI-011

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. Read More

Authors:  Pérez-marrero Lizbet , Castoldi Maria Francesca , Fuentealba Isabel , Stecher Ximena , Schonstedt Valeria , Cisternas Daniela , Castiblanco Adriana , Repetto Gabriela , Legarraga Paulette , Schultz Marcela

Keywords:  Postmortem Perinatal MRI, perinatal autopsy, stillbirths