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

Meeting name: IPR 2016 Conjoint Meeting & Exhibition , 2016

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

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

Ductus Arteriosus calcification is a poorly comprehended pathology occasionally reported on chest radiographs, more commonly on CT. The purpose of this educational abstract is to present the concepts surrounding ductal arteriosus (DA) calcification and reviews the literature to date. We retrospectively searched the main medical literature (PubMed, MEDLINE, CINAHL and Google scholar databases) using the following keywords: “ductus arteriosus”, “ligamentum arteriosum”, “calcification”, “ductal”, “patent ductus arteriosus”, “children”, “paediatric”. Articles regarding ductus arteriosus calcification were further evaluated for citations. Sixteen articles were found which dated back over nearly a century. Of these eight concerned a paediatric population and very few had histological confirmation. The majority highlighted that ductal calcification is more prevalent than previously thought. Ductal calcification was initially reported on the chest roentgen-ray in 1931 by Weiss. The increasing prevalence has been compounded by the use of the greater spatial resolution offered by modern CT scanners. A study in 2012 showed up to a third of children have ductal calcification on CT, with peak incidence is towards the end of the first decade in girls. There is conflicting opinion regarding the pathophysiology of ductal calcification, which may be either ductal aneurysmal thrombus regression, or more likely ligamentum arteriosum intimal and medial wall calcification. This literature review illustrates the general paucity of histological data and suggests that the autopsy evidence favours intimal and medial wall calcification. Read More

Meeting name: IPR 2016 Conjoint Meeting & Exhibition , 2016

Authors: Chopra Mark, Barrett Hannah, Hutchinson J., Kiho Liina, Arthurs Owen

Keywords: Ductus arteriosus calcification, ligamentum arteriosum

Ductus Arteriosus calcification is a relatively common, typically unreported feature on plain film radiography. The more recent literature quotes a prevalence on unenhanced CT of between 37-61% of children and a peak at the age of 6-10 years. Adult studies have shown that calcification of the ligamentum arteriosum can occur alone or be associated with atherosclerotic and/or granulomatous calcification. We report two cases in whom they were identified as incidental findings on forensic post mortem CT, for whom we obtained histological confirmation. Case 1: An 8 month old child who died in non-suspicious circumstances had incidental ductal arteriosus calcification reported on post mortem CT, following unremarkable skeletal survey. Intimal mural calcification was reported on histology at autopsy. Case 2: A 19 month old child who died of aspiration underwent full skeletal survey and PMCT as part of the pre-autopsy imaging assessment. The skeletal survey revealed incidental ductus arteriosus calcification, initially reported as PDA clip, with correlation at CT. Intimal and medial mural calcification was reported on histology at autopsy. These cases showed that ductal calcification was intimal and medial in nature. This is consistent with the current literature regarding mural calcification rather than thrombus regression calcification. Read More

Meeting name: IPR 2016 Conjoint Meeting & Exhibition , 2016

Authors: Chopra Mark, Barrett Hannah, Hutchinson J., Kiho Liina, Arthurs Owen

Keywords: Ductus arteriosus calcification, Post mortem, Non-accidental injury

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

Meeting name: SPR 2017 Annual Meeting & Categorical Course , 2017

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

Keywords: Postmortem, micro-CT, musculoskeletal

Retention of embryonic tissue for teaching and research has become complex for medicolegal reasons following numerous organ retention issues. Virtual datasets of embryos would allow anatomical diagnosis and are both less controversial and simpler to obtain and store. Several imaging techniques are now available (High field MRI and micro-CT) which alleviate the need to dissect the tissue to create serial sections, thus maintaining tissue integrity. We present a series of images from phenotypically normal and abnormal mouse embryos (length 4-5mm) obtained using micro-CT. Three mouse embryos were immersed in potassium triiodide for 24 hours prior to being individually immobilised using non-nutrient agar. Images were acquired using a Nikon XTH225 micro-CT scanner, reconstructed using proprietary software and post-processed using VG StudioMAX. Excellent internal contrast was demonstrated in all specimens, with all organ systems delineated. Excellent views of normal central nervous system, respiratory system, cardiovascular system, genitourinary and digestive tract systems were also obtained at micrometer resolution. Specific abnormalities identified include a possible VSD (0.24mm), exencephaly and foreface disruption. Micro-CT technology can be used to create datasets of embryos at high resolution (up to 3.7 micrometers achieved), which can then be re-dissected, 3D printed or indefinitely stored and could provide a solution to current issues affecting the use of embryonic tissue for diagnosis, teaching and research. Read More

Meeting name: IPR 2016 Conjoint Meeting & Exhibition , 2016

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

Keywords: Micro-CT, Fetal, phenotype