“The Diagnostic Accuracy and Clinical Utility of Post‐Mortem Fetal MRI Compared to Conventional Autopsy: A Systematic Review and Meta‐Analysis”

Post-mortem magnetic resonance imaging (pmMRI) has become an important non-invasive or minimally invasive method for evaluating fetal structural anomalies, providing an alternative to traditional autopsy. This study aimed to assess how pmMRI compares to conventional autopsy in diagnostic accuracy and clinical utility for identifying fetal anomalies. A systematic literature search was conducted across electronic databases, selecting studies that directly compared pmMRI findings to conventional autopsy in fetuses with congenital anomalies or unexplained fetal demise. Using a random-effects model, pooled sensitivity, specificity, and diagnostic odds ratios were calculated, along with summary receiver operating characteristic curves. From 21 eligible studies, data from 15 studies involving 1049 fetuses were pooled. The overall pooled sensitivity of pmMRI was 93%, and specificity was 88%, with a positive likelihood ratio of 6.07 and a negative likelihood ratio of 0.10. The diagnostic odds ratio was 80.03, indicating strong diagnostic performance. System-specific accuracies were also evaluated for the central nervous, thoracic, musculoskeletal, and genitourinary systems. While conventional autopsy remains essential for diagnosing infections and placental pathologies, pmMRI offers a reliable, minimally invasive option, particularly valuable when full autopsy is not feasible or declined.