• Owen J Arthurs, Sudhin Thayyil, Oystein E Olsen, Shea Addison, Angie Wade, Rod Jones, Wendy Norman, Rosemary J Scott, Nicola J Robertson, Andrew M Taylor, Lyn S Chitty, Neil J Sebire, Catherine M Owens, and Magnetic Resonance Imaging Autopsy Study (MaRIAS) Collaborative Group.
• Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK, owen.arthurs@gosh.nhs.uk.
• Eur Radiol. 2014 Nov 1; 24 (11): 2876-84.

ObjectivesTo compare the diagnostic accuracy of post-mortem magnetic resonance imaging (PMMR) specifically for non-cardiac thoracic pathology in fetuses and children, compared with conventional autopsy.MethodsInstitutional ethics approval and parental consent was obtained. A total of 400 unselected fetuses and children underwent PMMR before conventional autopsy, reported blinded to the other dataset.ResultsOf 400 non-cardiac thoracic abnormalities, 113 (28 %) were found at autopsy. Overall sensitivity and specificity (95 % confidence interval) of PMMR for any thoracic pathology was poor at 39.6 % (31.0, 48.9) and 85.5 % (80.7, 89.2) respectively, with positive predictive value (PPV) 53.7 % (42.9, 64.0) and negative predictive value (NPV) 77.0 % (71.8, 81.4). Overall agreement was 71.8 % (67.1, 76.2). PMMR was most sensitive at detecting anatomical abnormalities, including pleural effusions and lung or thoracic hypoplasia, but particularly poor at detecting infection.ConclusionsPMMR currently has relatively poor diagnostic detection rates for the commonest intra-thoracic pathologies identified at autopsy in fetuses and children, including respiratory tract infection and diffuse alveolar haemorrhage. The reasonable NPV suggests that normal thoracic appearances at PMMR exclude the majority of important thoracic lesions at autopsy, and so could be useful in the context of minimally invasive autopsy for detecting non-cardiac thoracic abnormalities.Key Points• PMMR has relatively poor diagnostic detection rates for common intrathoracic pathology • The moderate NPV suggests that normal PMMR appearances exclude most important abnormalities • Lung sampling at autopsy remains the "gold standard" for pulmonary pathology.

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