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The role of post-mortem MRI in the neonatal intensive care unit

Journal of Perinatology volume 37, pages 98–103 (2017)Cite this article

Subjects

Abstract

Objective:

Post-mortem examination can provide important information about the cause of death and play a significant role in the bereavement process. Autopsies reveal previous unknown medical problems approximately 20 to 30% of the time. A non-invasive magnetic resonance imaging-based post-mortem examination (PM-MRI) may provide an alternative for families who do not consent to an autopsy.

Study Design:

This study was a prospective observational study of recently expired neonates and infants. Subjects underwent a full body MRI scan (brain, chest, abdomen and pelvis) followed by conventional autopsy if the family desired to have one. MRI results were compared with autopsy findings and the ante-mortem clinical diagnosis. A follow-up survey was conducted to investigate family perceptions of the PM-MRI process.

Results:

Thirty-one infants underwent full PM-MRI. Of 31 infants, 19 (61%) had complete agreement between the clinician’s impression and PM-MRI. Twenty-four infants also had conventional autopsy, with 14/24 (58%) infants having PM-MRI results consistent with autopsy findings. PM-MRI was superior at detection of free intraperitoneal/intrathoracic air and hepatic iron overload. Whole-body PM-MRI did not have the resolution to detect focal/microscopic injury, vascular remodeling and some forms of brain injury. Of those families who remembered the PM-MRI findings, the majority felt that the information was useful.

Conclusions:

PM-MRI studies may provide an important adjunct to conventional autopsy and a substitute when the latter is not possible for personal or religious reasons. Clinicians should be aware of, and communicate with the family, the resolution limits of the whole-body PM-MRI to detect certain types of injury.

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Acknowledgements

This work was supported by the Washington University Institute of Clinical and Translational Sciences KL2 Training Program (NIH/NCATS KL2 TR000450).

Author information

Authors and Affiliations

  1. Department of Pediatrics, Southern Illinois University School of Medicine, Springfield, IL, USAs,

    K Z Leadbetter

  2. Edward Mallinckrodt Department of Pediatrics, Division of Newborn Medicine, Washington University School of Medicine, St Louis, MO, USA

    Z A Vesoulis & A M Mathur

  3. Department of Pathology & Immunology, Division of Anatomic and Molecular Pathology, Washington University School of Medicine, St Louis, MO, USA

    F V White

  4. Department of Pathology & Immunology, Division of Neuropathology, Washington University School of Medicine, St Louis, MO, USA

    R E Schmidt

  5. Edward Mallinckrodt Department of Radiology, Division of Diagnostic Radiology, Washington University School of Medicine, St Louis, MO, USA

    G Khanna & J S Shimony

Authors
  1. K Z Leadbetter
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  2. Z A Vesoulis
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  3. F V White
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  4. R E Schmidt
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  5. G Khanna
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  6. J S Shimony
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  7. A M Mathur
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Corresponding author

Correspondence to Z A Vesoulis.

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The authors declare no conflict of interest.

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Leadbetter, K., Vesoulis, Z., White, F. et al. The role of post-mortem MRI in the neonatal intensive care unit. J Perinatol 37, 98–103 (2017). https://doi.org/10.1038/jp.2016.156

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