Arthurs, OJ

van Rijn, RR

English

UCL Discovery

EDITORIALPaediatric and perinatal postmortem imaging: mortuivivos docentOwen J. Arthurs & Rick R. van RijnReceived: 3 July 2014 /Accepted: 7 August 2014 /Published online: 20 September 2014# The Author(s) 2014. This article is published with open access at Springerlink.comThe classic autopsy, although widely recognised as thegold standard in postmortem diagnosis, has shown asteady worldwide decline in the past decades [1]. Alarge literature review of adults showed that autopsiescould reveal a major error rate from 8.4% to 24.4% anda class I error rate from 4.1% to 6.7% [2]. At the otherend of the age spectrum, an Irish study in a neonatalintensive care unit showed that unsuspected or uncon-firmed clinical conditions were found in 52% (85/164)of cases, and that in 45 cases information of interest toinheritable conditions was found [3]. While there havebeen other studies with similar findings, the decline inautopsy rates is difficult to prevent. Parental reluctanceto accept an invasive autopsy, rather than clinician re-luctance to offer one, is the most likely cause for this,and has been attributed to a variety of causes, includingreligious beliefs, the fear of unethical practices, the factthat the next of kin believe the deceased should beallowed to rest in peace and an emphasis on individualchoices made in our society (where the greater good ofgaining knowledge may be perceived to be of lesserimportance). Finally, economics plays a certain role inthis problem, as the conventional autopsy can be bothtime-consuming and expensive.In recent years, there has been growing attention in thepostmortem use of radiologic imaging techniques in children,either as an adjunct to or a replacement for the conventionalautopsy. There have been many publications, mainly (but notsolely) aimed at forensic and adult postmortem radiology. Inthis field, a close collaboration between radiologists and pa-thologists, each bringing their own special set of skills andknowledge, is essential to take this work forward [4].The paediatric radiology community is likely to becomemore involved in cross-sectional postmortem imaging as itgains momentum and acceptability in guiding pathologists inhow best to perform an autopsy, and in some cases whereimaging is the onlyformofautopsy performed due toparentalwishes.We believe now is an appropriate time to focus the paedi-atric radiology community on the current status of the paedi-atric and perinatal postmortem examination. We had threeaims for this special edition of Pediatric Radiology.The first aim was to invite international leading authors inthe field to give an up-to-date consensus view of differentaspects of postmortem imaging, in particular discriminatingpathology from normal postmortem findings. This includesnormalpostmortemradiographical,CTandMRIfindings,andadiscussionpaperregardingwhenfoetalpostmortemimagingcan be most useful.Thesecondaimwastoevaluatewhatthecurrentchallengesand/or barriers are to postmortem imaging around the world.We invited five contributors from different countries to giveshort descriptions of their views, which we hope you will findstimulating.Our third aim was to evaluate how a postmortem imagingservice could be established and run within different legalO. J. Arthurs (*)Department of Radiology,Great Ormond Street Hospital for Children NHS Foundation Trust,Great Ormond Street, London, UK WC1N 3JHe-mail: owen.arthurs@gosh.nhs.ukO. J. ArthursInstitute of Child Health, University College London, London, UKR. R. van RijnDepartment of Radiology,Emma Children’s Hospital - Academic Medical Centre,Amsterdam, The NetherlandsR. R. van RijnDepartment of Forensic Medicine, Netherlands Forensic Institute,The Hague, The NetherlandsPediatr Radiol (2015) 45:476–477DOI 10.1007/s00247-014-3155-1confines, and what the future of postmortem imaging inchildren is likely to hold.We sincerely hope that this current range of articles onpostmortemimaging will not onlyincreaseawareness but willalso stimulate interest in a new and exciting field of paediatricimaging.Acknowledgments O. J. Arthurs is funded by an NIHR ClinicianScientist Fellow award. The views expressed are those of the author(s)and not necessarily those of the NHS, the NIHR or the Department ofHealth.Conflicts of interest NoneOpen Access This article is distributed under the terms of the CreativeCommons Attribution License, which permits any use, distribution andreproduction in any medium, provided the original author(s) and thesource are credited.References1. ShojaniaKG,BurtonEC(2008)Thevanishingnonforensicautopsy.NEngl J Med 358:873–8752. ShojaniaKG,BurtonEC,McDonaldKMetal(2003)Changesinratesof autopsy-detected diagnostic errors over time: a systematic review.JAMA 289:2849–28563. Hickey L, Murphy A, Devaney D et al (2012) The value of neonatalautopsy. Neonatology 101:68–734. Arthurs OJ, van Rijn RR, Taylor AM et al (2014) Paediatric andperinatal post mortem imaging: the need for a subspecialty approach.Pediatr Radiol doi:10.1007/s00247-014-3132-8Pediatr Radiol (2015) 45:476–477 477

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