For a study, researchers sought to compare the diagnostic accuracy of postmortem magnetic resonance imaging (MRI) with Computed tomography (CT) guided biopsy (Virtopsy®) to that of the traditional autopsy. Only cases originally referred for a traditional autopsy were included in the study. Computed tomography (CT) and MRI imaging were used to examine the tissues post-mortem, and the resulting images were used to direct the tissue sampling. The results of the virtopsy were compared to those of a traditional autopsy in order to ascertain the most likely ultimate cause of death and main diseases. The major result was the rate at which the 2 approaches reached the same conclusion on the cause of death. Secondary outcomes included the number of large clinical lesions missed by virtopsy and the number of biopsies taken with CT guidance sufficient for histological analysis. A total of 101 cases were included (84 fetuses and 17 newborns). In 91 out of 122 cases (90.1%), the underlying cause of death was confirmed by both the virtopsy and the autopsy (95% CI 82.7 to 94.5). For identifying the cause of death, virtopsy had a sensitivity of 96.6% (95% CI 90.6-298.8) and a specificity of 41.7% (95% CI 19.3-68.0). While virtopsy successfully detected abnormalities in 45 cases (44.6%, 95% CI 35.2 to 54.3%), in 32 cases (31.7%, 95% CI 23.4 to 41.3%), substantial pathological findings were missed. In 506 of 956 biopsies (52.7%), the tissue samples obtained were sufficient for pathological comments using computed tomography guidance, and in 5 of 30 cases (16.1%) were the cause of death was unknown before the autopsy, the CT-guided tissue sampling provided significant diagnostic value over postmortem imaging alone. Biopsies showed infection-related tissue alterations in 19 of 20 infect-related fatalities (95%). Examination of the placenta revealed infection in every fetus. While Virtopsy showed a good concordance with a traditional autopsy for determining the cause of death, it was less reliable for assessing severe diseases. There was little additional diagnostic benefit from a CT-guided biopsy.

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