Diagnostic yield of post-mortem magnetic resonance imaging for cardiac anomalies in fetal and perinatal deaths: a systematic review and meta-analysis

OBJECTIVES: Post-mortem magnetic resonance imaging (pmMRI) has emerged as a promising, non-invasive alternative to conventional autopsy for detecting cardiac anomalies in fetal and perinatal deaths and we aimed to systematically evaluate the diagnostic accuracy of pmMRI in detecting cardiac anomalies in fetal and perinatal deaths. METHODS: A systematic search of electronic databases and grey literature was conducted following PRISMA 2020 guidelines to analyse studies comparing pmMRI findings to conventional autopsy. Data extraction and quality assessment were independently performed by two reviewers using the QUADAS-2 tool. Meta-analysis was conducted using a bivariate random-effects model to calculate pooled sensitivity, specificity, and diagnostic odds ratios (DOR). RESULTS: Sixteen studies were included in the systematic review, and 12 studies (n=1810 fetuses) were meta-analyzed. The pooled sensitivity and specificity of pmMRI for detecting cardiac anomalies were 76 % (95 % CI: 71-80 %) and 96 % (95 % CI: 95-97 %), respectively. The diagnostic odds ratio was 55.35 (95 % CI: 22.73-134.79), with an area under the SROC curve of 0.89, indicating excellent diagnostic performance. Subgroup analyses showed comparable sensitivity between 1.5 and 3 T scanners, though specificity was slightly higher for 1.5 T. Diagnostic accuracy was generally better in larger fetuses and when higher field strength MRI (9.4 T) was used. CONCLUSIONS: pmMRI demonstrates high specificity and moderate sensitivity for detecting cardiac anomalies in fetal and perinatal deaths and may serve as a valuable non-invasive adjunct to conventional autopsy. Standardization of imaging protocols and further research into high-field pmMRI integration are recommended to optimize diagnostic reliability.