Volume 374, Issue 9688, Pages (August 2009)

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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.

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Volume 374, Issue 9688, Pages 467-475 (August 2009) Post-mortem examination of human fetuses: a comparison of whole-body high-field MRI at 9·4 T with conventional MRI and invasive autopsy Dr Sudhin Thayyil, MD, Jon O Cleary, BSc, Neil J Sebire, MD, Rosemary J Scott, FRCPath, Kling Chong, MD, Roxanna Gunny, FRCR, Catherine M Owens, FRCR, Oystein E Olsen, PhD, Amaka C Offiah, PhD, Harold G Parks, PhD, Lyn S Chitty, PhD, Anthony N Price, PhD, Prof Tarek A Yousry, MD, Nicola J Robertson, PhD, Mark F Lythgoe, PhD, Andrew M Taylor, MD The Lancet Volume 374, Issue 9688, Pages 467-475 (August 2009) DOI: 10.1016/S0140-6736(09)60913-2 Copyright © 2009 Elsevier Ltd Terms and Conditions

Figure 1 Study profile Ab=abnormal. N=normal. ND=non-diagnostic. The Lancet 2009 374, 467-475DOI: (10.1016/S0140-6736(09)60913-2) Copyright © 2009 Elsevier Ltd Terms and Conditions

Figure 2 MRI at 1·5 T and 9·4 T, and histopathological examination of a fetus with myelomeningocele terminated at 19 weeks' gestation (A) Three-dimensional T2-weighted turbo-spin echo of head in coronal plane with MRI at 1·5 T. (B) Three-dimensional T2-weighted turbo-spin echo of head in coronal plane with MRI at 9·4 T. (C) Histopathological examination of the brain showing a healthy multilayered cortex (1=cortical plate; 2=subplate; 3=intermediate zone; 4=subventricular zone; 5=ganglionic eminence). (D) Three-dimensional T2-weighted turbo-spin echo of the body in coronal plane with MRI 1·5 T. (E) Three-dimensional T2-weighted turbo-spin echo of body in coronal plane with MRI 9·4 T. (F) Sagital view showing the cerebellar descent and Chiari-2 malformation with MRI at 9·4 T. Features of Chiari 2 and myelomeningocele were seen with MRI at 1·5 T and 9·4 T, and at autopsy. The Lancet 2009 374, 467-475DOI: (10.1016/S0140-6736(09)60913-2) Copyright © 2009 Elsevier Ltd Terms and Conditions

Figure 3 High-field (9·4 T) MRI of a fetus with congenital diaphragmatic hernia and coarctation of the aorta terminated at 16 weeks' gestation (weight 64 g) (A) Coronal view of the chest and abdomen, showing left congenital diaphragmatic hernia with stomach, intestine, and spleen in right chest. Right ventricle shows substantial hypertrophy, and lungs are hypoplastic. Left ventricle was very small. No coarctation was seen, however the arch was small. (B) and (C) are axial views of the brain showing a pontine haematoma (PH). (D) Coronal view showing early normal development of corpus callosum (CC). (E) MRI at 9·4 T and (F) histology showing multilayered cortex. Corpus callosum could not be assessed at autopsy because of the poor preservation of brain. Formal neuropathological examination that was done by a paediatric neuropathologist showed a healthy brain, and no haematoma was seen. Results of a cardiac examination by a paediatric cardiac pathologist were in complete agreement with the MRI findings. CP=cortical plate. SP=subplate. IZ=intermediate zone. SVZ=subventricular zone. G=ganglionic eminence and ventricular zone. The Lancet 2009 374, 467-475DOI: (10.1016/S0140-6736(09)60913-2) Copyright © 2009 Elsevier Ltd Terms and Conditions

Figure 4 Fetus with skeletal dysplasia terminated at 22 weeks' gestation (A) Coronal, (B) sagital, and (C) axial images obtained with three-dimensional T2-weighted MRI at 9·4 T. (D) Coronal, (E) sagital, and (F) axial images obtained with three-dimensional T2-weighted MRI at 1·5 T. Images at 9·4 T showed healthy cartilage and internal organs. The Lancet 2009 374, 467-475DOI: (10.1016/S0140-6736(09)60913-2) Copyright © 2009 Elsevier Ltd Terms and Conditions

Figure 5 Tissue contrast of visceral organs with MRI at 9·4 T and 1·5 T Squares represent mean values, and error bars represent SE. BP=blood pool in right ventricle. Myo=myocardium. Peff=pericardial effusion. Cart=cartilage (head of humerus). Bone=humeral metaphysis. Musc=muscle (upper arm). Pl=pleural effusion. Liv=liver. Adre=adrenal. Cort=renal cortex. Pelvis=renal pelvis. GM=germinal matrix. WM=white matter (periventricular region). Thal=thalamus. *p<0·05 (Mann-Whitney U test). The Lancet 2009 374, 467-475DOI: (10.1016/S0140-6736(09)60913-2) Copyright © 2009 Elsevier Ltd Terms and Conditions