UOG Journal Club: October 2012  Postmortem examination of human fetal hearts at or below 20 weeks’ gestation: a comparison...
Most                                                     High % can common                                                ...
Impact of early prenatal diagnosis of CHD         Option of pregnancy         termination         Planned birth         Im...
Termination of pregnancy after early    prenatal diagnosis of CHD   Accurate               Proper  postmortem            p...
Postmortem diagnosis• Conventional/invasive autopsy   – Gold standard for postmortem diagnosis   – Parents acceptance is p...
Postmortem examination of human fetal hearts at or below 20 weeks’gestation: a comparison of high-field MRI at 9.4 T with ...
SubjectsFetuses ≤ 20 weeks, with any abnormality on prenatalultrasound; parents opted for termination of pregnancy(TOP) (n...
MethodsFetuses were cryopreserved at −20ºC until MRI andstereomicroscopic invasive autopsy.The MRI scans were performed wi...
MRI postmortem evaluationMRI performed by three different operators blindedto the prenatal scan findingsSingle radiologist...
Invasive autopsyInvasive autopsies were conducted and/or supervised by asingle pathologist with 20 years’ experience in fe...
Results: image quality        1.5 T                    3.0 T                            9.4 T   Ability to visualize diffe...
Results: sensitivity in detecting CHD                                      1.5 T 3.0 T       9.4 T  AutopsyRetro-esophagea...
Key findingsFor the postmortem examination of the fetal heart before 20weeks’ gestation:1.5 T or 3.0 T MRI seem to be limi...
LimitationsSmall sample size  • Only a small variety of CHD was examinedSome fetuses were frozen/thawed before MRI  • This...
Discussion points• Is first-trimester ultrasound diagnosis of fetal congenital heart disease  accurate enough to help pare...
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UOG Journal Club: Postmortem examination of human fetal hearts at or below 20 weeks’ gestation

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This Journal Club presentation provides a summary and discussion of the following free access article published in UOG:

Postmortem examination of human fetal hearts at or below 20 weeks' gestation: a comparison of high-field MRU at 9.4 T with lower-field MRI magnets and stereomicroscopic autopsy
C. Votino, J. Jani, M. Verhoye, B. Bessieries, Y. Fierens, V. Segers, A. Vorsselmans, X. Kang, T. Cos, W. Fouldon, J. de Mey, M. Cannie.
Volume 40, Issue 4, Date: October 2012, pages 437-444

It can be accessed here: http://onlinelibrary.wiley.com/doi/10.1002/uog.11191/abstract

Published in: Health & Medicine
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UOG Journal Club: Postmortem examination of human fetal hearts at or below 20 weeks’ gestation

  1. 1. UOG Journal Club: October 2012 Postmortem examination of human fetal hearts at or below 20 weeks’ gestation: a comparison of high-field MRI at 9.4 T with lower-field MRI magnets and stereomicroscopic autopsyC. Votino, J. Jani, M. Verhoye, M. Verhoye, B. Bessieres, Y. Fierens, V. Segers, A. Vorsselmans, X. Kang, T. Cos, W. Foulon, J. de Mey and M. Cannie. Volume 40, Issue 4, Date: October 2012, pages 437–444 Journal Club slides prepared by Dr Wellington P Martins (UOG Editor for Trainees)
  2. 2. Most High % can common be detectedabnormality by prenatal ≈ 0.8% ultrasound Congenital heart diseaseOne of the (CHD) Improved leading ultrasoundcauses of = 1st infant trimestermortality diagnosis Hoffman and Kaplan S. J Am Coll Cardiol 2002; Lombardi et al. Ultrasound Obstet Gynecol 2007
  3. 3. Impact of early prenatal diagnosis of CHD Option of pregnancy termination Planned birth Improved neonatal outcome Franklin et al. Heart 2002; Thayyil et al. Prenat Diagn 2010
  4. 4. Termination of pregnancy after early prenatal diagnosis of CHD Accurate Proper postmortem pregnancy diagnosis counseling Thayyil et al., Prenat Diagn 2010
  5. 5. Postmortem diagnosis• Conventional/invasive autopsy – Gold standard for postmortem diagnosis – Parents acceptance is poor• Whole body MRI as an alternative – 1.5 T MRI introduced a decade ago • Limited use for CHD in small fetuses • Relatively low resolution – 9.4 T MRI has improved resolution • Diagnostic accuracy almost equivalent to invasive autopsy Cannie et al., Ultrasound Obstet Gynecol 2012; Brookes et al., Lancet 1996
  6. 6. Postmortem examination of human fetal hearts at or below 20 weeks’gestation: a comparison of high-field MRI at 9.4 T with lower-field MRI magnets and stereomicroscopic autopsy Votino et al., UOG 2012 ObjectiveTo compare the diagnostic usefulness of high-field (9.4 T) with lower-field (1.5 T and 3.0 T) MRI against the goldstandard of stereomicroscopic autopsy for the postmortem examination of the fetal heart in fetuses ≤ 20 weeks’ gestation. Votino et al., Ultrasound Obstet Gynecol 2012
  7. 7. SubjectsFetuses ≤ 20 weeks, with any abnormality on prenatalultrasound; parents opted for termination of pregnancy(TOP) (n=22)Fetuses ≤ 20 weeks, spontaneous miscarriage, heart beatdetected when admitted to hospital (n=2).Total = 24 fetuses (14 normal and 10 with CHD) • abnormal four-chamber view (n=9) • abnormal outflow tracts (n=4) • abnormal aortic arch (n=3) • abnormal systemic venous return (n=2) Votino et al., Ultrasound Obstet Gynecol 2012
  8. 8. MethodsFetuses were cryopreserved at −20ºC until MRI andstereomicroscopic invasive autopsy.The MRI scans were performed with:1.5T whole-body magnet: Siemens Avanto3.0T whole-body magnet: Philips Achieva9.4T horizontal bore: Biospec 94/20 USR Votino et al., Ultrasound Obstet Gynecol 2012
  9. 9. MRI postmortem evaluationMRI performed by three different operators blindedto the prenatal scan findingsSingle radiologist evaluated the MRIs • 10 years’ experience in fetal and postmortem MRI • Offline analysis of acquired volumes • Following order: 1.5 T, 3.0 T, and 9.4 T • 1-month delay between readings Votino et al., Ultrasound Obstet Gynecol 2012
  10. 10. Invasive autopsyInvasive autopsies were conducted and/or supervised by asingle pathologist with 20 years’ experience in fetalpathology and 12 years in cardiac fetal pathologyUnaware of results of prenatal scan and MRI findings Votino et al., Ultrasound Obstet Gynecol 2012
  11. 11. Results: image quality 1.5 T 3.0 T 9.4 T Ability to visualize different fetal heart structures (n=24) Situs 4 chamber Outflow tracts Aortic arch Systemic veins1.5 T 62.5% 25.0% 0.0% 0.0% 0.0%3.0 T 70.8% 45.8% 4.2% 0.0% 0.0%9.4 T 100.0% 100.0% 100.0% 83.3% 79.2% Votino et al., Ultrasound Obstet Gynecol 2012
  12. 12. Results: sensitivity in detecting CHD 1.5 T 3.0 T 9.4 T AutopsyRetro-esophageal subclavian artery 0 0 0 1Ventricular septal defect 0 0 1 (20%) 5Atrioventricular septal defect 0 0 1 (50%) 2Transposition of the great arteries 0 0 1 (100%) 1Ventricular hypoplasia 0 0 1 (50%) 2Tetralogy of Fallot 0 0 2 (100%) 29.4 T MRI examination also diagnosed two cases ofventricular septal defect (VSD) not confirmed by invasiveautopsy Votino et al., Ultrasound Obstet Gynecol 2012
  13. 13. Key findingsFor the postmortem examination of the fetal heart before 20weeks’ gestation:1.5 T or 3.0 T MRI seem to be limited9.4 T MRI seems to be able to detect major CHD However, its limited availability makes it less attractive for widespread clinical use Votino et al., Ultrasound Obstet Gynecol 2012
  14. 14. LimitationsSmall sample size • Only a small variety of CHD was examinedSome fetuses were frozen/thawed before MRI • This can possibly interfere with image quality • Could compromise integrity of tissue structure • Improved image quality for the fetal heartOnly non-macerated fetuses were examined • Limited the generalizability of the findings • Ideal conditions will not always be possible Votino et al., Ultrasound Obstet Gynecol 2012
  15. 15. Discussion points• Is first-trimester ultrasound diagnosis of fetal congenital heart disease accurate enough to help parents decide on termination of pregnancy?• Is the postmortem diagnostic confirmation necessary for future pregnancy counselling and management?• Are the current imaging methods accurate/reliable for postmortem investigation of fetal congenital heart diseases?• Is the accuracy of congenital heart disease by postmortem imaging methods better than that obtained by prenatal ultrasound?• Is the conventional postmortem examination currently a well accepted procedure by parents?• Is postmortem examination limited to imaging methods only more or less likely to be accepted by parents? Votino et al., Ultrasound Obstet Gynecol 2012
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