Assessing the Diagnostic Yield of Post-Mortem Magnetic Resonance Imaging (MRI) for Detecting Cardiac Anomalies in Fetal and Perinatal Deaths: Protocol for a Systematic Review and Meta-Analysis

Cardiac anomalies represent one of the most common categories of congenital malformations, affecting approximately 8-12 per 1000 live births, and are a leading cause of fetal and perinatal mortality. In this context, accurate diagnosis of cardiac anomalies is crucial for genetic counselling, recurrence risk assessment, and parental understanding. Conventional autopsy, though considered the gold standard, faces challenges such as parental refusal and limited availability of paediatric pathologists. Post-mortem imaging, including magnetic resonance imaging (MRI), computed tomography (CT), and ultrasound, often termed "virtopsy," is increasingly proposed as a non-invasive alternative. However, its diagnostic yield specifically for cardiac anomalies in fetal and perinatal deaths remains to be systematically evaluated. Despite increasing use of post-mortem imaging, there is limited comprehensive evidence regarding its diagnostic yield specifically for cardiac anomalies in fetal and perinatal deaths. This systematic review and meta-analysis aims to synthesize available evidence to determine the diagnostic accuracy of various post-mortem MRI for detecting cardiac anomalies in this population. The findings are anticipated to have significant clinical implications by contributing to the development of clinical practice guidelines for the use of post-mortem imaging in the evaluation of cardiac anomalies. The findings are expected to inform clinical guidelines, support healthcare policy and resource planning, enhance family counselling practices, and highlight the need for specialized training in post-mortem imaging interpretation.