Acceptance, reliability and confidence of diagnosis of fetal and neonatal virtuopsy compared with conventional autopsy: a prospective study

OBJECTIVES

To compare prospectively maternal acceptance of fetal and neonatal virtuopsy with that of conventional autopsy and to determine the confidence with which magnetic resonance (MR) virtuopsy can be used to diagnose normality/abnormality of various fetal anatomical structures.

METHODS

MR and/or computed tomography virtuopsy and conventional autopsy were offered to 96 women (102 fetuses/neonates) following termination of pregnancy (TOP), intrauterine fetal death (IUFD) or neonatal death. Multivariable logistic regression analysis was used to investigate the effect on maternal acceptance of virtuopsy and/or conventional autopsy of the age of the mother, gestational age at TOP or delivery after IUFD, order of pregnancy, parity, religion, type of caregiver obtaining consent and reason for death. When parents consented to both MR virtuopsy and conventional autopsy of fetuses ≥ 20 weeks of gestation or neonates, the confidence with which MR virtuopsy could be used to diagnose normality/abnormality of various anatomical structures was determined on a scale in which conventional autopsy was considered gold standard. On autopsy we classified fetuses/neonates as having either 'normal' or 'abnormal' anatomical structures; these groups were analyzed separately. At virtuopsy, we indicated confidence of diagnosis of normality/abnormality of every anatomical structure in each of these two groups defined at autopsy, using a scale from 0 (definitely abnormal) to 100 (definitely normal).

RESULTS

Of the 96 women, 99% (n = 95) consented to virtuopsy and 61.5% (n = 59) to both conventional autopsy and virtuopsy; i.e. 36 (37.5%) consented to virtuopsy alone. Maternal acceptance of conventional autopsy was independently positively related to singleton pregnancy, non-Moslem mother, earlier gestation at TOP or delivery afer IUFD and a maternal-fetal medicine specialist obtaining consent. Thirty-three fetuses ≥ 20 weeks of gestation had both conventional autopsy and MR virtuopsy, of which 19 had a full autopsy including the brain. In fetuses with normal anatomical structures at conventional autopsy, MR virtuopsy was associated with high diagnostic confidence (scores > 80) for the brain, skeleton, thoracic organs except the heart, abdominal organs except the pancreas, ureters, bladder and genitals. In fetuses with abnormal anatomical structures at autopsy, MR virtuopsy detected the anomalies with high confidence (scores < 20) for these same anatomical structures. However, in three cases, virtuopsy diagnosed brain anomalies additional to those observed at conventional autopsy.

CONCLUSION

MR virtuopsy is accepted by nearly all mothers while conventional autopsy is accepted by about two-thirds of mothers, in whom refusal depends mainly on factors over which we have no control. Although conventional autopsy remains the gold standard, the high acceptance of virtuopsy makes it an acceptable alternative when the former is declined.

Hepatic rhabdomyosarcoma in an adult: a rare primary malignant liver tumor. Case report and literature review

Rhabdomyosarcomas are malignant tumors that display features of striated muscle differentiation. They are the most common soft-tissue sarcomas among children and young adults. In mature adults however there are very rare. The liver as a primary site in adults has only been described in 12 cases. We report a case of a primary alveolar rhabdomyosarcoma of the liver in a 59 year old female, confirmed by histological examination using immunohistochemical analysis (positive actin, desmin, vimentin and myogenin staining) and fluorescent in situ hybridization (FISH) analysis (positivity for PAX3/FOXO1A fusion). The patient underwent primary surgical resection, but presented a few weeks after surgery already with recurrent disease in the abdomen and bone metastasis. Despite initial good response to chemotherapy (doxorubicin/ifosfamide) and stable disease at 12 months after diagnosis, the patient died 31 months after the first presentation secondary to complicated abundant abdominal recurrent disease. We further present a review of the literature on published similar cases since 1979.

Unenhanced brain CT is useful to decide on further imaging in suspected venous sinus thrombosis

AIM

To assess the value of unenhanced brain computed tomography (CT) in the diagnosis of cerebral venous sinus thrombosis (CVST).

MATERIALS AND METHODS

Unenhanced brain CT images of 26 patients with proven CVST were mixed with 26 age and sex-matched images from patients without CVST. Four readers reviewed the 52 brain CT images and were asked to score the examinations for the absence or presence of CVST on a scale from 0 to 4. The mean density in the different venous sinuses was measured by one radiologist.

RESULTS

The sensitivity of unenhanced brain CT for the diagnosis of CVST was 73%. There were no false-positive readings. A receiver-operating characteristic (ROC) analysis on these data resulted in an area under the curve of 0.86. Density measurements proved to be helpful, but could not detect all cases of CVST.

CONCLUSION

Unenhanced brain CT is a valid initial radiological examination in the diagnosis of CVST. Due to the absence of false-positives in the present series, unenhanced CT can be used to decide whether further imaging with CT angiography or magnetic resonance angiography is required.

MRI findings of hepatobiliairy fascioliasis

Hepatobiliary fascioliasis is an uncommon disease. Depending on the stage of the disease it can present with a wide variability of clinical symptoms. Knowledge of the specific radiological findings of the disease is crucial to shorten the time to final diagnosis, which is usually long. We report a case of hepatobiliary fascioliasis in a 26-year-old woman with intermittent abdominal discomfort showing non specific findings at computed tomography and ultrasound. A hypothesis of an infectious disorder was formulated based on MRI findings and a recent history of travelling. Final diagnosis was confirmed by subsequent serology testing.

Primary cardiac lymphoma

Primary cardiac lymphoma is rare. It can present with a wide variability of clinical symptoms frequently leading to a delay in diagnosis. We report a case of a primary cardiac lymphoma in a 85 year old woman. The MRI showed a large mass in the right atrio-ventricular groove and infiltration of the interventricular septum and left ventricular wall with subtle contrast enhancement, isointense aspect on T1 weighted and hyperintense aspect on T2 weighted sequences. Mostly the radiological signs are non specific. Calcification, hemorrhage, a diffuse infiltrative pattern with infiltration of the valves and coronary arteries and a left atrial localization can suggest the diagnosis.