Use of a confidence scale in reporting postmortem fetal magnetic resonance imaging
Article first published online: 23 NOV 2006
Copyright © 2006 ISUOG. Published by John Wiley & Sons, Ltd.
Ultrasound in Obstetrics & Gynecology
Volume 28, Issue 7, pages 918–924, December 2006
How to Cite
Breeze, A. C. G., Cross, J. J., Hackett, G. A., Jessop, F. A., Joubert, I., Lomas, D. J., Set, P. A. K., Whitehead, A. L., Lees, C. C. and for the Cambridge Post-mortem MRI Study Group (2006), Use of a confidence scale in reporting postmortem fetal magnetic resonance imaging. Ultrasound Obstet Gynecol, 28: 918–924. doi: 10.1002/uog.3886
- Issue published online: 23 NOV 2006
- Article first published online: 23 NOV 2006
- Manuscript Accepted: 23 OCT 2006
- congenital anomaly;
- feasibility studies;
- fetal death;
- magnetic resonance imaging;
- pregnancy loss
Postmortem magnetic resonance imaging (MRI) may be an alternative to conventional autopsy. However, it is unclear how confident radiologists are in reporting such studies. We sought to determine the confidence with which radiologists report on various fetal organs by developing a scale to express their confidence of normality and abnormality, and to place this in the context of a pathological diagnosis of whether the organ was in fact normal or abnormal.
Thirty fetuses, aged 16–39 gestational weeks and weighing 61–3270 g, underwent postmortem MRI prior to conventional autopsy. MRI studies were reported by two radiologists with access to the clinical and sonographic history: a neuroradiologist, reporting head and neck, and a pediatric radiologist, reporting thorax, abdomen and pelvis. Radiologists used a scale (0 = definitely abnormal, 100 = definitely normal, 50 = unable to comment) to indicate their confidence of anatomical structures being normal or abnormal, using a checklist. Conventional autopsies were performed by pediatric pathologists blinded to the MRI findings, and these were considered the reference standard.
Most normal fetal organs had high scores on postmortem MRI, with median confidence scores above 80. However, the atrioventricular valves, duodenum, bowel rotation and pancreas proved more difficult to assess, with median scores of 50, 60, 60 and 62.5, respectively. Abnormal cardiac atria and ventricles, kidneys, cerebral hemispheres and corpus callosum were always detected with high or moderate degrees of confidence (median scores of 2.5, 5, 0, 0 and 30 respectively). However, in two cases with abnormal cardiac outflow tracts, both cases scored 50. Kappa values, assessing agreement between MRI diagnoses of abnormality and autopsy, were high for the brain (0.83), moderate for the lungs (0.56) and fair for the heart (0.33).
This scoring system represents an attempt to define the confidence of radiologists to report varying degrees of normality and abnormality following z ex-utero fetal MRI. While most fetal anatomy is clearly visualized on postmortem MRI, radiologists may lack confidence reporting such studies and there are particular problems with assessment of some cardiac and gastrointestinal structures, both normal and abnormal. Copyright © 2006 ISUOG. Published by John Wiley & Sons, Ltd.