Effect of minimally invasive autopsy and ethnic background on acceptance of clinical postmortem investigation in adults

Objectives Autopsy rates worldwide have dropped significantly over the last five decades. Imaging based autopsies are increasingly used as alternatives to conventional autopsy (CA). The aim of this study was to investigate the effect of the introduction of minimally invasive autopsy, consisting of CT, MRI and tissue biopsies on the overall autopsy rate (of CA and minimally invasive autopsy) and the autopsy rate among different ethnicities. Methods We performed a prospective single center before-after study. The intervention was the introduction of m

Post-mortem tissue biopsies obtained at minimally invasive autopsy: An RNA-quality analysis

Introduction: Bereaved relatives often refuse to give consent for post-mortem investigation of deceased cancer patients, mainly because of the mutilation due to conventional au

Hospital implementation of minimally invasive autopsy: A prospective cohort study of clinical performance and costs

Objectives Autopsy rates worldwide have dropped significantly over the last decades and imaging-based autopsies are increasingly used as an alternative to conventional autopsy. Our aim was to evaluate the clinical performance and cost of minimally invasive autopsy. Methods This study was part of a prospective cohort study evaluating a newly implemented minimally invasive autopsy consisting of MRI, CT, and biopsies. We calculated diagnostic yield and clinical utility—defined as the percentage successfully answered clinical questions—of minimally invasive autopsy. We performed minimally invasive autopsy in 46 deceased (30 men, 16 women; mean age 62.9±17.5, min-max: 18–91). Results Ninety-six major diagnoses were found with the minimally invasive autopsy of which 47/96 (49.0%) were new diagnoses. CT found 65/96 (67.7%) major diagnoses and MRI found 82/ 96 (85.4%) major diagnoses. Eighty-four clinical questions were asked in all cases. Seventy-one (84.5%) of these questions could be answered with minimally invasive autopsy. CT successfully answered 34/84 (40.5%) clinical questions; in 23/84 (27.4%) without the need for biopsies, and in 11/84 (13.0%) a biopsy was required. MRI successfully answered 60/84 (71.4%) clinical questions, in 27/84 (32.1%) without the need for biopsies, and in 33/ 84 (39.8%) a biopsy was required. The mean cost of a minimally invasive autopsy was €1296 including brain biopsies and €1087 without brain biopsies. Mean cost of CT was €187 and of MRI €284. Conclusions A minimally invasive autopsy, consisting of CT, MRI and CT-guided biopsies, performs well in answering clinical questions and detecting major diagnoses. However, the diagnostic yield and clinical utility were quite low for postmortem CT and MRI as standalone modalities

MIA : the Minimally Invasive Autopsy

The autopsy is important to keep up the high quality of modern medicine, by giving clinicians feedback on diagnostics and therapies, and providing for medical training and medical research. Nevertheless, autopsy rates have been declining in many Western countries. From 1977 through 2011, the clinical autopsy rates in The Netherlands declined by 0.7% per calendar year, from 31.4% to 7.7%. In our hospital, the main reason for clinicians to not request autopsy and for next-of-kin to not allow autopsy was their assumption that autopsy would not show anything other than what was already known through pre-mortem diagnostics. Also, in 16.1% of cases, the next-of-kin feared for disfigurement of the deceased’s body. Therefore, autopsy methods should be developed that require less mutilation of the deceased’s body. According to the literature, a minimally invasive autopsy technique using imaging and biopsies usually performs better than non-invasive methods. We performed a prospective, single center, blinded cross-sectional study that compared the diagnostic performance of a minimally invasive autopsy (unenhanced whole-body CT and MRI scans, and image-guided biopsies) and conventional autopsy on 99 cases: the methods performed equally well. We found that post-mortem tissue biopsies were useful for molecular translational research; that our MRI scans combined with targeted heart-biopsies sufficed for establishing a cardiac cause of death; and that the post-mortem investigations diagnosed clinically unsuspected causes of death in 17% of the cases, emphasizing the necessity of performing post-mortems. In the future, for MIA to be implemented in clinical practice, radiologists need in-depth understanding of normal post-mortem processes for correct acquisition and interpretation of the post-mortem scans