MS 16 - Virtual autopsy imaging in children: the role of pathologist vs radiologist, one big happy family?
on Mar 4th
16:00 - 17:30
1. To learn about the multidisciplinary nature of perinatal autopsy, with reference to the scientific contribution of radiology and pathology.
2. To learn about the limitations of both conventional autopsy, and conventional imaging techniques.
3. To appreciate the role that novel imaging and pathology techniques have to play in future service provision.
In this session, we intend to present a multidisciplinary approach to state-of-the art virtopsy imaging in children. We have contributions from radiologists and pathologists, working in harmony to achieve the best possible outcome for bereaved parents, with a conjoint, highly accurate but sympathetic approach. Advances in postmortem imaging and tissue sampling techniques will be outlined to provide a comprehensive autopsy service in the most clinically appropriate setting, whilst respecting the bereaved parents' wishes.
1. To learn about novel minimally invasive autopsy techniques.
2. To understand how imaging fits into a modern clinical autopsy service.
The approach to standard paediatric autopsy has changed little over many years, remaining predominantly based on external examination, dissection and subsequent organ examination and then histological evaluation. Minimally invasive autopsy is a new approach encompassing external examination, non-invasive comprehensive cross-sectional postmortem imaging, and limited tissue sampling to permit the most appropriate tissue sampling techniques necessary to reach a final diagnosis or cause of death which is more acceptable to parents and families.
1. To learn about the recent advances in cross-sectional imaging in a post-mortem setting.
2. To learn about the advantages and disadvantages of conventional PMCT and PMMR techniques.
Postmortem (PM) magnetic resonance imaging (MRI) has high diagnostic accuracy for the majority of perinatal and paediatric diagnoses, when accompanied by other non-invasive investigations, and compared to traditional autopsy. Comprehensive whole body imaging using PM MRI performs particularly well for cardiac, neurological and abdominal diagnoses, but less well for thoracic and skeletal abnormalities. PM MRI performs better than PM CT in the same individual, although ventilated PMCT and CT angiography have been proposed to increase PMCT diagnostic detection rates. However, both modalities become increasingly non-diagnostic with reducing foetal size, typically below 500g body weight or at early foetal gestations. Postmortem ultrasound is yet to be assessed in a comprehensive trial.
1. To learn how novel techniques like micro-CT can be used in the perinatal autopsy setting.
2. To appreciate how micro-CT works.
3. To learn what high resolution imaging can offer within a clinical setting.
Microfocus computed tomography has been proposed as an alternative to MR or CT in small specimen foetal imaging. Diagnostic accuracy is high for excised foetal hearts and kidneys, with appropriate tissue and image optimisation parameters. Whole body foetal autopsy may be possible with micro-CT in future. However, several issues remain to be addressed for widespread implementation of micro-CT scanning, including tissue colouration, distortion due to fixation, data storage of large files, and comprehensive reconstruction and post-processing.