1
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Michaud K, Jacobsen C, Basso C, Banner J, Blokker BM, de Boer HH, Dedouit F, O'Donnell C, Giordano C, Magnin V, Grabherr S, Suvarna SK, Wozniak K, Parsons S, van der Wal AC. Application of postmortem imaging modalities in cases of sudden death due to cardiovascular diseases-current achievements and limitations from a pathology perspective : Endorsed by the Association for European Cardiovascular Pathology and by the International Society of Forensic Radiology and Imaging. Virchows Arch 2023; 482:385-406. [PMID: 36565335 PMCID: PMC9931788 DOI: 10.1007/s00428-022-03458-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 11/11/2022] [Accepted: 11/15/2022] [Indexed: 12/25/2022]
Abstract
Postmortem imaging (PMI) is increasingly used in postmortem practice and is considered a potential alternative to a conventional autopsy, particularly in case of sudden cardiac deaths (SCD). In 2017, the Association for European Cardiovascular Pathology (AECVP) published guidelines on how to perform an autopsy in such cases, which is still considered the gold standard, but the diagnostic value of PMI herein was not analyzed in detail. At present, significant progress has been made in the PMI diagnosis of acute ischemic heart disease, the most important cause of SCD, while the introduction of postmortem CT angiography (PMCTA) has improved the visualization of several parameters of coronary artery pathology that can support a diagnosis of SCD. Postmortem magnetic resonance (PMMR) allows the detection of acute myocardial injury-related edema. However, PMI has limitations when compared to clinical imaging, which severely impacts the postmortem diagnosis of myocardial injuries (ischemic versus non-ischemic), the age-dating of coronary occlusion (acute versus old), other potentially SCD-related cardiac lesions (e.g., the distinctive morphologies of cardiomyopathies), aortic diseases underlying dissection or rupture, or pulmonary embolism. In these instances, PMI cannot replace a histopathological examination for a final diagnosis. Emerging minimally invasive techniques at PMI such as image-guided biopsies of the myocardium or the aorta, provide promising results that warrant further investigations. The rapid developments in the field of postmortem imaging imply that the diagnosis of sudden death due to cardiovascular diseases will soon require detailed knowledge of both postmortem radiology and of pathology.
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Affiliation(s)
- Katarzyna Michaud
- University Center of Legal Medicine Lausanne - Geneva, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
| | - Christina Jacobsen
- Section of Forensic Pathology, Department of Forensic Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Cristina Basso
- Cardiovascular Pathology Unit, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Jytte Banner
- Section of Forensic Pathology, Department of Forensic Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | - Hans H de Boer
- Department of Forensic Medicine, Victorian Institute of Forensic Medicine, Monash University, Melbourne, Australia
| | - Fabrice Dedouit
- GRAVIT, Groupe de Recherche en Autopsie Virtuelle et Imagerie Thanatologique, Forensic Department, University Hospital, Rangueil, Toulouse, France
| | - Chris O'Donnell
- Department of Forensic Medicine, Victorian Institute of Forensic Medicine, Monash University, Melbourne, Australia
| | - Carla Giordano
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Virginie Magnin
- University Center of Legal Medicine Lausanne - Geneva, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Geneva University Hospital, University of Geneva, Geneva, Switzerland
| | - Silke Grabherr
- University Center of Legal Medicine Lausanne - Geneva, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Geneva University Hospital, University of Geneva, Geneva, Switzerland
| | - S Kim Suvarna
- Department of Histopathology, Northern General Hospital, The University of Sheffield, Sheffield, UK
| | - Krzysztof Wozniak
- Department of Forensic Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Sarah Parsons
- Department of Forensic Medicine, Victorian Institute of Forensic Medicine, Monash University, Melbourne, Australia
| | - Allard C van der Wal
- Department of Pathology, Amsterdam UMC, Academic Medical Center, Amsterdam, The Netherlands.
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2
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Ex situ heart magnetic resonance imaging and angiography: feasibility study for forensic purposes. FORENSIC IMAGING 2021. [DOI: 10.1016/j.fri.2021.200442] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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3
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Xia ZY, Bruguier C, Dedouit F, Grabherr S, Augsburger M, Liu BB. Oleic Acid (OA), A Potential Dual Contrast Agent for Postmortem MR Angiography (PMMRA): A Pilot Study. Curr Med Sci 2020; 40:786-794. [PMID: 32862391 DOI: 10.1007/s11596-020-2244-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 05/19/2020] [Indexed: 01/31/2023]
Abstract
Choosing proper perfusates as contrast agents is an important aspect for postmortem magnetic resonance angiography (PMMRA). However, in this emerging field, the number of suitable kinds of liquid is still very limited. The objective of this research is to compare MR images of oleic acid (OA) with paraffin oil (PO) in vitro and in ex situ animal hearts, in order to evaluate the feasibility to use OA as a novel contrast agent for PMMRA. In vitro, OA, PO and water (control) were introduced into three tubes separately and T1weighted-spin echo (T1w-SE) and T2w-SE images were acquired on a 1.5T MR scanner. In the second experiment, OA and PO were injected into left coronary artery (LCA) and left ventricle (LV) of ex situ bovine hearts and their T1w-SE, T2w-SE, T1w-multipoint Dixon (T1w-mDixon) and 3DT2w-mDixon images were acquired. The overall results indicate that OA may have a potential to be used as a dual (T1 and T2 based) contrast agent for PMMRA when proper sequence parameters are utilized. However, as the pilot study was based on limited number of animal hearts, more researches using OA in cadavers are needed to validate our findings.
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Affiliation(s)
- Zhi-Yuan Xia
- Institute of Evidence Law and Forensic Science, China University of Political Science and Law (CUPL), Key Laboratory of Evidence Law and Forensic Science, Ministry of Education, Beijing, 100088, China.
| | - Christine Bruguier
- University Center of Legal Medicine, Lausanne-Geneva (CURML), Lausanne, CH1000, Switzerland
| | - Fabrice Dedouit
- Service de Médecine Légale, Hôpital de Rangueil, Toulouse, 50032, France
| | - Silke Grabherr
- University Center of Legal Medicine, Lausanne-Geneva (CURML), Lausanne, CH1000, Switzerland
| | - Marc Augsburger
- University Center of Legal Medicine, Lausanne-Geneva (CURML), Lausanne, CH1000, Switzerland
| | - Bei-Bei Liu
- Dian Research Center for Postmortem Imaging & Angiography, Beijing, 100192, China
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4
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Michaud K, Genet P, Sabatasso S, Grabherr S. Postmortem imaging as a complementary tool for the investigation of cardiac death. Forensic Sci Res 2019; 4:211-222. [PMID: 31489387 PMCID: PMC6713140 DOI: 10.1080/20961790.2019.1630944] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 06/06/2019] [Accepted: 06/10/2019] [Indexed: 12/26/2022] Open
Abstract
In the past 2 decades, modern radiological methods, such as multiple detector computed tomography (MDCT), MDCT-angiography, and cardiac magnetic resonance imaging (MRI) were introduced into postmortem practice for investigation of sudden death (SD), including cases of sudden cardiac death (SCD). In forensic cases, the underlying cause of SD is most frequently cardiovascular with coronary atherosclerotic disease as the leading cause. There are many controversies about the role of postmortem imaging in establishing the cause of death and especially the value of minimally invasive autopsy techniques. This paper discusses the state of the art for postmortem radiological evaluation of the heart compared to classical postmortem examination, especially in cases of SCD. In SCD cases, postmortem CT is helpful to estimate the heart size and to visualize haemopericardium and calcified plaques and valves, as well as to identify and locate cardiovascular devices. Angiographic methods are useful to provide a detailed view of the coronary arteries and to analyse them, especially regarding the extent and location of stenosis and obstruction. In postsurgical cases, it allows verification and documentation of the patency of stents and bypass grafts before opening the body. Postmortem MRI is used to investigate soft tissues such as the myocardium, but images are susceptible to postmortem changes and further work is necessary to increase the understanding of these radiological aspects, especially of the ischemic myocardium. In postsurgery cases, the value of postmortem imaging of the heart is reportedly for the diagnostic and documentation purposes. The implementation of new imaging methods into routine postmortem practice is challenging, as it requires not only an investment in equipment but, more importantly, investment in the expertise of interpreting the images. Once those requirements are implemented, however, they bring great advantages in investigating cases of SCD, as they allow documentation of the body, orientation of sampling for further analyses and gathering of other information that cannot be obtained by conventional autopsy such as a complete visualization of the vascular system using postmortem angiography.Key pointsThere are no established guidelines for the interpretation of postmortem imaging examination of the heartAt present, postmortem imaging methods are considered as less accurate than the autopsy for cardiac deathsPostmortem imaging is useful as a complementary tool for cardiac deathsThere is still a need to validate postmortem imaging in cardiac deaths by comparing with autopsy findings.
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Affiliation(s)
- Katarzyna Michaud
- Lausanne University Hospital and University of Lausanne, University Center of Legal Medicine Lausanne-Geneva, Lausanne, Switzerland
| | - Pia Genet
- Lausanne University Hospital and University of Lausanne, University Center of Legal Medicine Lausanne-Geneva, Lausanne, Switzerland.,Geneva University Hospital, University Center of Legal Medicine Lausanne-Geneva, Geneva, Switzerland
| | - Sara Sabatasso
- Geneva University Hospital, University Center of Legal Medicine Lausanne-Geneva, Geneva, Switzerland
| | - Silke Grabherr
- Lausanne University Hospital and University of Lausanne, University Center of Legal Medicine Lausanne-Geneva, Lausanne, Switzerland.,Geneva University Hospital, University Center of Legal Medicine Lausanne-Geneva, Geneva, Switzerland
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Fais P, Mazzotti MC, Montisci M, Palazzo C, Leone O, Cecchetto G, Viel G, Pelotti S. Post-mortem thermal angiography: a pilot study on swine coronary circulation. Int J Legal Med 2018; 133:571-581. [PMID: 30218174 DOI: 10.1007/s00414-018-1935-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 09/07/2018] [Indexed: 10/28/2022]
Abstract
Thermal imaging (TI) allows the detection of thermal patterns emitted from objects as a function of their temperature in the long-infrared spectrum and produces visible images displaying temperature differences. The aim of this pilot study was to test TI to visualize the coronary circulation of swine hearts. Thirty swine hearts were prepared for ex situ coronarography, and thermal images were acquired through a FlirOne thermal camera (FLIR Systems®) paired with a Google Android Smartphone. Coronary arteries were cannulated, namely the anterior interventricular artery, the circumflex branch of the left coronary artery, and the right coronary artery. The heart was cooled, and contrast medium (CM) consisting of distilled water heated to 40 °C was injected in a coronary vessel, while thermal images were captured. These steps were repeated for each coronary vessel and under experimentally simulated coronary heart disease. Thermal imaging coronarography (TIC) allowed a clear representation of the morphology and course of the coronary vessels and of experimentally simulated coronary heart disease, moreover, demonstrated to be easy to perform during or after autopsies on ex situ hearts, non-destructive, reproducible, and cheap. On the basis of these preliminary results, TIC might allow a subsequent more focused and comprehensive cardiopathological examination of the heart, which remains mandatory for the definitive diagnosis of coronary heart disease. Although these preliminary results seem encouraging, further systematic studies on human hearts, both normal and pathological, are necessary for estimating the sensitivity and specificity of the proposed method and to draw any definitive conclusion.
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Affiliation(s)
- Paolo Fais
- DIMEC, Department of Medical and Surgical Sciences, University of Bologna, 40126, Bologna, Italy
| | - Maria Carla Mazzotti
- DIMEC, Department of Medical and Surgical Sciences, University of Bologna, 40126, Bologna, Italy
| | - Massimo Montisci
- Legal Medicine and Toxicology, University Hospital of Padova, Via Falloppio, 50, 35121, Padova, Italy
| | - Chiara Palazzo
- DIMEC, Department of Medical and Surgical Sciences, University of Bologna, 40126, Bologna, Italy
| | - Ornella Leone
- Department of Pathology, Sant'Orsola-Malpighi University Hospital, Bologna, Italy
| | - Giovanni Cecchetto
- Legal Medicine and Toxicology, University Hospital of Padova, Via Falloppio, 50, 35121, Padova, Italy
| | - Guido Viel
- Legal Medicine and Toxicology, University Hospital of Padova, Via Falloppio, 50, 35121, Padova, Italy.
| | - Susi Pelotti
- DIMEC, Department of Medical and Surgical Sciences, University of Bologna, 40126, Bologna, Italy
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6
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Colleter R, Dedouit F, Duchesne S, Gérard P, Dercle L, Poilpré P, Gendrot V, Rousseau H, Crubézy É, Telmon N, Mokrane FZ. Study of a seventeenth-century French artificial mummy: autopsical, native, and contrast-injected CT investigations. Int J Legal Med 2018; 132:1405-1413. [PMID: 29594348 DOI: 10.1007/s00414-018-1830-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 03/21/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND A lead coffin was fortuitously discovered in a church called "Eglise des Toussaints" in Rennes (French Brittany). A collaborative taskforce investigated this extraordinary discovery. A multi-disciplinary team of experts from the National Institute for Preventive Archeological Research (INRAP) and Rangueil University Hospital of Toulouse was created, including anthropologists, archeologists, forensic pathologists, radiologists, and pathologists. The inscription on the lead coffin specified that the body belonged to "Messer Louys de Bruslon, Lord of Plessis," a nobleman who died on November 1, 1661. Multiple holes were visible in the lead coffin, and deterioration threatened the mummy. We opened the lead coffin and discovered an excellently preserved mummy, except for mostly skeletonized upper and lower limbs. The mummy was conserved in several layers of shrouds. Vegetal embalming material covered the head and filled the face, the thorax, and the abdomen. The embalmers had removed all thoracic and abdominal organs and conserved some pelvic organs (e.g., the bladder). METHODS Multi-slice computed tomography (MSCT) scanner evaluated the mummy, at each step of our analysis. The excellent preservation of abdominal vascular axes led us to perform a CT angiography using Angiofil®, an oily contrast agent developed for postmortem imaging, before an autopsy. RESULTS Sub-diaphragmatic arteries, including the abdominal aorta and iliac arteries, were excellently preserved. The vascular contrast agent filled all arteries. The native CT, CT angiography, and autopsy did not detect any vascular lesion. CONCLUSION Our study, based on rare archeological material, allowed a complete examination of an excellently preserved seventeenth-century mummy, using MSCT, angiography, and an autopsy. We did not detect any arterial lesion and proposed a comprehensive description of the embalmment process.
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Affiliation(s)
- Rozenn Colleter
- INRAP National Institute of Preventive Archaeological Research (INRAP, France), 37 rue du Bignon, CS 67737, 35577, Cesson-Sévigné, France
- AMIS Laboratory: University of Toulouse, French National Center for Scientific Research, UMR 5288, 37 allées Jules Guesde, 31073, Toulouse, France
| | - Fabrice Dedouit
- AMIS Laboratory: University of Toulouse, French National Center for Scientific Research, UMR 5288, 37 allées Jules Guesde, 31073, Toulouse, France
- Unit of Forensic and Anthropological Imaging, Centre Universitaire Romand de Médecine Légale (CURML), Chemin de la Vulliette 4, CH-1000, Lausanne 25, Switzerland
| | - Sylvie Duchesne
- INRAP National Institute of Preventive Archaeological Research (INRAP, France), 37 rue du Bignon, CS 67737, 35577, Cesson-Sévigné, France
- AMIS Laboratory: University of Toulouse, French National Center for Scientific Research, UMR 5288, 37 allées Jules Guesde, 31073, Toulouse, France
| | - Patrice Gérard
- AMIS Laboratory: University of Toulouse, French National Center for Scientific Research, UMR 5288, 37 allées Jules Guesde, 31073, Toulouse, France
| | - Laurent Dercle
- Gustave Roussy Institute, Université Paris-Saclay, F-94805, Villejuif, France
- New York Presbyterian Hospital, Columbia University, New York City, NY, USA
| | - Pierre Poilpré
- INRAP National Institute of Preventive Archaeological Research (INRAP, France), 37 rue du Bignon, CS 67737, 35577, Cesson-Sévigné, France
| | - Véronique Gendrot
- French Regional Archaeological Service, Bretagne Avenue Charles Foulon, 35700, Rennes, France
- French National Center for Scientific Research, UMR 6566, Rennes, France
| | - Hervé Rousseau
- Radiology Department, Rangueil University Hospital, 1 Avenue du Professeur Jean Poulhes, 31059 Cedex, Toulouse, France
| | - Éric Crubézy
- AMIS Laboratory: University of Toulouse, French National Center for Scientific Research, UMR 5288, 37 allées Jules Guesde, 31073, Toulouse, France
| | - Norbert Telmon
- AMIS Laboratory: University of Toulouse, French National Center for Scientific Research, UMR 5288, 37 allées Jules Guesde, 31073, Toulouse, France
- Forensic Department, Rangueil University Hospital, 1 avenue du Professeur Jean Poulhes, 31059 Cedex, Toulouse, France
| | - Fatima-Zohra Mokrane
- AMIS Laboratory: University of Toulouse, French National Center for Scientific Research, UMR 5288, 37 allées Jules Guesde, 31073, Toulouse, France.
- New York Presbyterian Hospital, Columbia University, New York City, NY, USA.
- Radiology Department, Rangueil University Hospital, 1 Avenue du Professeur Jean Poulhes, 31059 Cedex, Toulouse, France.
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Post-mortem MR angiography: quantitative investigation and intravascular retention of perfusates in ex situ porcine hearts. Int J Legal Med 2018; 132:579-587. [PMID: 29344721 PMCID: PMC5807516 DOI: 10.1007/s00414-017-1763-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 12/12/2017] [Indexed: 11/13/2022]
Abstract
As the implementation of minimally invasive imaging techniques in both forensic and pathological practice increases, research in this area focuses on addressing recognised diagnostic weaknesses of current approaches. Assessment of sudden cardiac death (SCD) can be considered one such area in which post-mortem imaging still shows diagnostic weaknesses. We hypothesise that magnetic resonance imaging (MRI) with an angiographic adjunct may improve the visualisation and interpretation of cardiac pathologies in a post-mortem setting. To systematically investigate this hypothesis, selected perfusates (paraffin oil, Gadovist®;-doped physiological solution and polyethylene glycol (PEG)) were injected into the left anterior descending (LAD) artery of ex situ porcine hearts to assess the visualisation of perfusates in MRI as well as their intravascular retention over 12 h. Morphological images were acquired and quantitative T1 maps were generated from inversion recovery data. Visualisation of vascular structure and image quality were assessed using signal-to-noise and contrast-to-noise ratios. Intravascular retention was assessed both visually and statistically using a volume of interest (VOI) approach to analyse significant changes in signal intensity in and around the filled LAD artery, as well as changes in the longitudinal relaxation time (T1) in adjacent myocardium. In addition to presenting possible mechanisms explaining perfusate extravasation given the increased permeability of post-mortem vessels, the potential diagnostic consequences of this phenomenon and the importance of contrast stability and extended intravascular retention are discussed. In light of our findings and these considerations, paraffin oil emerged as the preferred perfusate for use in post-mortem MR angiography.
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Renard Y, Hossu G, Chen B, Krebs M, Labrousse M, Perez M. A guide for effective anatomical vascularization studies: useful ex vivo methods for both CT and MRI imaging before dissection. J Anat 2017; 232:15-25. [PMID: 29023687 DOI: 10.1111/joa.12718] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2017] [Indexed: 01/10/2023] Open
Abstract
The objective of this study was to develop a simple and useful injection protocol for imaging cadaveric vascularization and dissection. Mixtures of contrast agent and cast product should provide adequate contrast for two types of ex vivo imaging (MRI and CT) and should harden to allow gross dissection of the injected structures. We tested the most popular contrast agents and cast products, and selected the optimal mixture composition based on their availability and ease of use. All mixtures were first tested in vitro to adjust dilution parameters of each contrast agent and to fine-tune MR imaging acquisition sequences. Mixtures were then injected in 24 pig livers and one human pancreas for MR and computed tomography (CT) imaging before anatomical dissection. Colorized latex, gadobutrol and barite mixture met the above objective. Mixtures composed of copper sulfate (CuSO4 ) gadoxetic acid (for MRI) and iodine (for CT) gave an inhomogeneous signal or extravasation of the contrast agent. Agar did not harden sufficiently for gross dissection but appears useful for CT and magnetic resonance imaging (MRI) studies without dissection. Silicone was very hard to inject but achieved the goals of the study. Resin is particularly difficult to use but could replace latex as an alternative for corrosion instead of dissection. This injection protocol allows CT and MRI images to be obtained of cadaveric vascularization and anatomical casts in the same anatomic specimen. Post-imaging processing software allow easy 3D reconstruction of complex anatomical structures using this technique. Applications are numerous, e.g. surgical training, teaching methods, postmortem anatomic studies, pathologic studies, and forensic diagnoses.
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Affiliation(s)
- Yohann Renard
- Department of Anatomy, Faculty of Medicine and University Hospital, University of Lorraine, Nancy, France.,Department of Anatomy, Faculty of Medicine and University Hospital, University of Reims Champagne-Ardenne, Reims, France.,IADI, INSERM U947, University of Lorraine, Nancy, France
| | - Gabriela Hossu
- IADI, INSERM U947, University of Lorraine, Nancy, France.,INSERM CIT1433, CIC-IT, University Hospital of Nancy, Nancy, France
| | - Bailiang Chen
- IADI, INSERM U947, University of Lorraine, Nancy, France.,INSERM CIT1433, CIC-IT, University Hospital of Nancy, Nancy, France
| | - Marine Krebs
- Department of Anatomy, Faculty of Medicine and University Hospital, University of Lorraine, Nancy, France
| | - Marc Labrousse
- Department of Anatomy, Faculty of Medicine and University Hospital, University of Reims Champagne-Ardenne, Reims, France
| | - Manuela Perez
- Department of Anatomy, Faculty of Medicine and University Hospital, University of Lorraine, Nancy, France.,IADI, INSERM U947, University of Lorraine, Nancy, France
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9
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Postmortale Magnetresonanztomographie-Angiographie nach Multiphasen-Computertomographie-Angiographie. Rechtsmedizin (Berl) 2017. [DOI: 10.1007/s00194-017-0188-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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10
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Grabherr S, Egger C, Vilarino R, Campana L, Jotterand M, Dedouit F. Modern post-mortem imaging: an update on recent developments. Forensic Sci Res 2017; 2:52-64. [PMID: 30483621 PMCID: PMC6197109 DOI: 10.1080/20961790.2017.1330738] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 05/05/2017] [Indexed: 12/25/2022] Open
Abstract
Modern post-mortem investigations use an increasing number of digital imaging methods, which can be collected under the term "post-mortem imaging". Most methods of forensic imaging are from the radiology field and are therefore techniques that show the interior of the body with technologies such as X-ray or magnetic resonance imaging. To digitally image the surface of the body, other techniques are regularly applied, e.g. three-dimensional (3D) surface scanning (3DSS) or photogrammetry. Today's most frequently used techniques include post-mortem computed tomography (PMCT), post-mortem magnetic resonance imaging (PMMR), post-mortem computed tomographic angiography (PMCTA) and 3DSS or photogrammetry. Each of these methods has specific advantages and limitations. Therefore, the indications for using each method are different. While PMCT gives a rapid overview of the interior of the body and depicts the skeletal system and radiopaque foreign bodies, PMMR allows investigation of soft tissues and parenchymal organs. PMCTA is the method of choice for viewing the vascular system and detecting sources of bleeding. However, none of those radiological methods allow a detailed digital view of the body's surface, which makes 3DSS the best choice for such a purpose. If 3D surface scanners are not available, photogrammetry is an alternative. This review article gives an overview of different imaging techniques and explains their applications, advantages and limitations. We hope it will improve understanding of the methods.
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Affiliation(s)
- Silke Grabherr
- University Centre of Legal Medicine Lausanne-Geneva, Lausanne, Switzerland
| | - Coraline Egger
- University Centre of Legal Medicine Lausanne-Geneva, Lausanne, Switzerland
| | - Raquel Vilarino
- University Centre of Legal Medicine Lausanne-Geneva, Lausanne, Switzerland
- Service of Legal Medicine, Central Institute of Hospitals, Sion, Switzerland
| | - Lorenzo Campana
- University Centre of Legal Medicine Lausanne-Geneva, Lausanne, Switzerland
| | - Melissa Jotterand
- University Centre of Legal Medicine Lausanne-Geneva, Lausanne, Switzerland
| | - Fabrice Dedouit
- University Centre of Legal Medicine Lausanne-Geneva, Lausanne, Switzerland
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11
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Webb B, Widek T, Neumayer B, Bruguier C, Scheicher S, Sprenger H, Grabherr S, Schwark T, Stollberger R. Temperature dependence of viscosity, relaxation times (T 1, T 2) and simulated contrast for potential perfusates in post-mortem MR angiography (PMMRA). Int J Legal Med 2016; 131:739-749. [PMID: 27900508 PMCID: PMC5388705 DOI: 10.1007/s00414-016-1482-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 10/10/2016] [Indexed: 11/27/2022]
Abstract
Developments in post-mortem imaging increasingly focus on addressing recognised diagnostic weaknesses, especially with regard to suspected natural deaths. Post-mortem MR angiography (PMMRA) may offer additional diagnostic information to help address such weaknesses, specifically in the context of sudden cardiac death. Complete filling of the coronary arteries and acceptable contrast with surrounding tissue are essential for a successful approach to PMMRA. In this work, the suitability of different liquids for inclusion in a targeted PMMRA protocol was evaluated. Factors influencing cooling of paraffinum liquidum + Angiofil® (6 %) in cadavers during routine multiphase post-mortem CT angiography were investigated. The temperature dependence of dynamic viscosity (8–20 °C), longitudinal (T1) and transverse (T2) relaxation (1–23 °C) of the proposed liquids was quadratically modelled. The relaxation behaviour of these liquids and MR scan parameters were further investigated by simulation of a radiofrequency (RF)-spoiled gradient echo (GRE) sequence to estimate potentially achievable contrast between liquids and post-mortem tissue at different temperatures across a forensically relevant temperature range. Analysis of the established models and simulations indicated that based on dynamic viscosity (27–33 mPa · s), short T1 relaxation times (155–207 ms) and a minimal temperature dependence over the investigated range of these parameters, paraffin oil and a solution of paraffin oil + Angiofil® (6 %) would be most suitable for post-mortem reperfusion and examination in MRI.
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Affiliation(s)
- Bridgette Webb
- Ludwig Boltzmann Institute for Clinical Forensic Imaging, Universitätsplatz 4/2., Graz, 8010, Austria.
- Institute of Forensic Medicine, Medical University Graz, Graz, Austria.
- BioTechMed-Graz, Graz, Austria.
| | - Thomas Widek
- Ludwig Boltzmann Institute for Clinical Forensic Imaging, Universitätsplatz 4/2., Graz, 8010, Austria
- BioTechMed-Graz, Graz, Austria
| | - Bernhard Neumayer
- Ludwig Boltzmann Institute for Clinical Forensic Imaging, Universitätsplatz 4/2., Graz, 8010, Austria
- BioTechMed-Graz, Graz, Austria
| | - Christine Bruguier
- University Center of Legal Medicine, Lausanne-Geneva, University of Lausanne, Lausanne, Switzerland
| | - Sylvia Scheicher
- Ludwig Boltzmann Institute for Clinical Forensic Imaging, Universitätsplatz 4/2., Graz, 8010, Austria
- BioTechMed-Graz, Graz, Austria
| | - Hanna Sprenger
- Ludwig Boltzmann Institute for Clinical Forensic Imaging, Universitätsplatz 4/2., Graz, 8010, Austria
- BioTechMed-Graz, Graz, Austria
| | - Silke Grabherr
- University Center of Legal Medicine, Lausanne-Geneva, University of Lausanne, Lausanne, Switzerland
| | - Thorsten Schwark
- Ludwig Boltzmann Institute for Clinical Forensic Imaging, Universitätsplatz 4/2., Graz, 8010, Austria
- Institute of Forensic Medicine, Medical University Graz, Graz, Austria
| | - Rudolf Stollberger
- BioTechMed-Graz, Graz, Austria
- Institute of Medical Engineering, Graz University of Technology, Graz, Austria
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12
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Schwendener N, Jackowski C, Persson A, Warntjes MJ, Schuster F, Riva F, Zech WD. Detection and differentiation of early acute and following age stages of myocardial infarction with quantitative post-mortem cardiac 1.5T MR. Forensic Sci Int 2016; 270:248-254. [PMID: 27836412 DOI: 10.1016/j.forsciint.2016.10.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Revised: 09/26/2016] [Accepted: 10/16/2016] [Indexed: 11/25/2022]
Abstract
Recently, quantitative MR sequences have started being used in post-mortem imaging. The goal of the present study was to evaluate if early acute and following age stages of myocardial infarction can be detected and discerned by quantitative 1.5T post-mortem cardiac magnetic resonance (PMCMR) based on quantitative T1, T2 and PD values. In 80 deceased individuals (25 female, 55 male), a cardiac MR quantification sequence was performed prior to cardiac dissection at autopsy in a prospective study. Focal myocardial signal alterations detected in synthetically generated MR images were MR quantified for their T1, T2 and PD values. The locations of signal alteration measurements in PMCMR were targeted at autopsy heart dissection and cardiac tissue specimens were taken for histologic examinations. Quantified signal alterations in PMCMR were correlated to their according histologic age stage of myocardial infarction. In PMCMR seventy-three focal myocardial signal alterations were detected in 49 of 80 investigated hearts. These signal alterations were diagnosed histologically as early acute (n=39), acute (n=14), subacute (n=10) and chronic (n=10) age stages of myocardial infarction. Statistical analysis revealed that based on their quantitative T1, T2 and PD values, a significant difference between all defined age groups of myocardial infarction can be determined. It can be concluded that quantitative 1.5T PMCMR quantification based on quantitative T1, T2 and PD values is feasible for characterization and differentiation of early acute and following age stages of myocardial infarction.
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Affiliation(s)
- Nicole Schwendener
- Institute of Forensic Medicine, University of Bern, Buehlstrasse 20, 3012 Bern, Switzerland
| | - Christian Jackowski
- Institute of Forensic Medicine, University of Bern, Buehlstrasse 20, 3012 Bern, Switzerland
| | - Anders Persson
- Center for Medical Image Science and Visualization, CMIV, Linköping University, SE-58183 Linköping, Sweden; Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Marcel J Warntjes
- Center for Medical Image Science and Visualization, CMIV, Linköping University, SE-58183 Linköping, Sweden; Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Frederick Schuster
- Institute of Forensic Medicine, University of Bern, Buehlstrasse 20, 3012 Bern, Switzerland; Department of Diagnostic, Interventional and Pediatric Radiology, Hospital and University of Bern Inselspital, Freiburgstrasse 10, Bern CH-3010, Switzerland
| | - Fabiano Riva
- Institute of Forensic Medicine, University of Bern, Buehlstrasse 20, 3012 Bern, Switzerland
| | - Wolf-Dieter Zech
- Institute of Forensic Medicine, University of Bern, Buehlstrasse 20, 3012 Bern, Switzerland; Center for Medical Image Science and Visualization, CMIV, Linköping University, SE-58183 Linköping, Sweden; Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
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Mokrane FZ, Colleter R, Duchesne S, Gerard P, Savall F, Crubezy E, Guilbeau-Frugier C, Moreno R, Sewonu A, Rousseau H, Telmon N, Dedouit F. Old hearts for modern investigations: CT and MR for archaeological human hearts remains. Forensic Sci Int 2016; 268:14-24. [PMID: 27665272 DOI: 10.1016/j.forsciint.2016.08.035] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 07/20/2016] [Accepted: 08/29/2016] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Among 800 burials dated between the 15th and 18th centuries and found in the center of Rennes (Brittany, France), a collection of five heart-shaped lead urns was discovered. This material was studied using classical methods (external study, autopsy and histology), and also modern imaging like computed tomography (CT), magnetic resonance (MR) before and after coronary opacification. The aim of this manuscript is to describe different steps of ancient soft tissues study, especially using imaging techniques. METHODS The study gathered various specialists: anthropologists, archeologists, forensic pathologists, radiologists, pathologic physicians, and physicists. Imaging techniques were performed, before and after coronary opacification. Finally, hearts were autopsied and different histological samples were analyzed. RESULTS Only heart n°2 was too damaged to be studied. Heart n°3 was considered as normal using all investigation techniques. The study of Hearts n°s 4 and 5 revealed dilated cardiomyopathy while Heart n°1 showed important signs of diffuse hypertrophic cardiomyopathy. Different fibro lipid plaques were identified using imaging techniques, and were confirmed by histology. CONCLUSIONS The study of archeological soft tissues using modern imaging is possible if the material is well-preserved. This type of research can uncover principal findings, allowing scientists to establish diseases of ancient times.
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Affiliation(s)
- F Z Mokrane
- Service de radiologie Rangueil Toulouse, 1 Avenue du Professeur Jean Poulhès, TSA 30052, 31059 Toulouse Cedex 9, France; Laboratoire A.M.I.S (Anthropobiologie Moléculaire et Imagerie de Synthèse) UMR5288 - Faculté de Médecine Purpan, 37 Allées Jules Guesde 31073, Toulouse Cedex 7, France.
| | - R Colleter
- Laboratoire A.M.I.S (Anthropobiologie Moléculaire et Imagerie de Synthèse) UMR5288 - Faculté de Médecine Purpan, 37 Allées Jules Guesde 31073, Toulouse Cedex 7, France; INRAP 37 rue du Bignon, CS67737, 35577 Cesson-Sévigné Cedex, France
| | - S Duchesne
- Laboratoire A.M.I.S (Anthropobiologie Moléculaire et Imagerie de Synthèse) UMR5288 - Faculté de Médecine Purpan, 37 Allées Jules Guesde 31073, Toulouse Cedex 7, France; INRAP 37 rue du Bignon, CS67737, 35577 Cesson-Sévigné Cedex, France
| | - P Gerard
- Laboratoire A.M.I.S (Anthropobiologie Moléculaire et Imagerie de Synthèse) UMR5288 - Faculté de Médecine Purpan, 37 Allées Jules Guesde 31073, Toulouse Cedex 7, France
| | - F Savall
- Laboratoire A.M.I.S (Anthropobiologie Moléculaire et Imagerie de Synthèse) UMR5288 - Faculté de Médecine Purpan, 37 Allées Jules Guesde 31073, Toulouse Cedex 7, France; Service de médecine légale Rangueil Toulouse 1 Avenue du professeur Jean Poulhès, TSA 30052, 31059 Toulouse Cedex 9, France
| | - E Crubezy
- Laboratoire A.M.I.S (Anthropobiologie Moléculaire et Imagerie de Synthèse) UMR5288 - Faculté de Médecine Purpan, 37 Allées Jules Guesde 31073, Toulouse Cedex 7, France
| | - C Guilbeau-Frugier
- Service d'anatomie pathologique Rangueil Toulouse, 1 Avenue du Professeur Jean Poulhès, TSA 30052, 31059 Toulouse Cedex 9, France
| | - R Moreno
- Service de radiologie Rangueil Toulouse, 1 Avenue du Professeur Jean Poulhès, TSA 30052, 31059 Toulouse Cedex 9, France; INSERM U1048 - Institut des Maladies Moléculaires et Cardiovasculaires (I2MC, INSERM U1048), CHU Rangueil, 1 Avenue Jean Poulhes - Bâtiment L3-BP 84225 31432 Toulouse Cedex 4, France
| | - A Sewonu
- Service de radiologie Rangueil Toulouse, 1 Avenue du Professeur Jean Poulhès, TSA 30052, 31059 Toulouse Cedex 9, France; INSERM U1048 - Institut des Maladies Moléculaires et Cardiovasculaires (I2MC, INSERM U1048), CHU Rangueil, 1 Avenue Jean Poulhes - Bâtiment L3-BP 84225 31432 Toulouse Cedex 4, France
| | - H Rousseau
- Service de radiologie Rangueil Toulouse, 1 Avenue du Professeur Jean Poulhès, TSA 30052, 31059 Toulouse Cedex 9, France; INSERM U1048 - Institut des Maladies Moléculaires et Cardiovasculaires (I2MC, INSERM U1048), CHU Rangueil, 1 Avenue Jean Poulhes - Bâtiment L3-BP 84225 31432 Toulouse Cedex 4, France
| | - N Telmon
- Laboratoire A.M.I.S (Anthropobiologie Moléculaire et Imagerie de Synthèse) UMR5288 - Faculté de Médecine Purpan, 37 Allées Jules Guesde 31073, Toulouse Cedex 7, France; Service de médecine légale Rangueil Toulouse 1 Avenue du professeur Jean Poulhès, TSA 30052, 31059 Toulouse Cedex 9, France
| | - F Dedouit
- Laboratoire A.M.I.S (Anthropobiologie Moléculaire et Imagerie de Synthèse) UMR5288 - Faculté de Médecine Purpan, 37 Allées Jules Guesde 31073, Toulouse Cedex 7, France; Centre universitaire romand de médecine légale, Chemin de la Vulliette 4, CH-1000 Lausanne 25, Switzerland
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Borowska-Solonynko A, Solonynko B, Fudalej M, Żyłkowski J. Postmortem computed tomography with the use of air for blood vessel enhancement—Early experience. Forensic Sci Int 2016; 261:116-22. [DOI: 10.1016/j.forsciint.2016.02.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Revised: 02/06/2016] [Accepted: 02/08/2016] [Indexed: 12/14/2022]
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Rigor mortis at the myocardium investigated by post-mortem magnetic resonance imaging. Forensic Sci Int 2015; 257:93-97. [DOI: 10.1016/j.forsciint.2015.07.039] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 07/17/2015] [Accepted: 07/24/2015] [Indexed: 11/20/2022]
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16
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Application of contrast media in post-mortem imaging (CT and MRI). Radiol Med 2015; 120:824-34. [PMID: 25841652 DOI: 10.1007/s11547-015-0532-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 03/12/2015] [Indexed: 01/17/2023]
Abstract
The application of contrast media in post-mortem radiology differs from clinical approaches in living patients. Post-mortem changes in the vascular system and the absence of blood flow lead to specific problems that have to be considered for the performance of post-mortem angiography. In addition, interpreting the images is challenging due to technique-related and post-mortem artefacts that have to be known and that are specific for each applied technique. Although the idea of injecting contrast media is old, classic methods are not simply transferable to modern radiological techniques in forensic medicine, as they are mostly dedicated to single-organ studies or applicable only shortly after death. With the introduction of modern imaging techniques, such as post-mortem computed tomography (PMCT) and post-mortem magnetic resonance (PMMR), to forensic death investigations, intensive research started to explore their advantages and limitations compared to conventional autopsy. PMCT has already become a routine investigation in several centres, and different techniques have been developed to better visualise the vascular system and organ parenchyma in PMCT. In contrast, the use of PMMR is still limited due to practical issues, and research is now starting in the field of PMMR angiography. This article gives an overview of the problems in post-mortem contrast media application, the various classic and modern techniques, and the issues to consider by using different media.
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