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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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Blokker BM, Weustink AC, Wagensveld IM, von der Thüsen JH, Pezzato A, Dammers R, Bakker J, Renken NS, den Bakker MA, van Kemenade FJ, Krestin GP, Hunink MGM, Oosterhuis JW. Conventional Autopsy versus Minimally Invasive Autopsy with Postmortem MRI, CT, and CT-guided Biopsy: Comparison of Diagnostic Performance. Radiology 2018; 289:658-667. [PMID: 30251930 DOI: 10.1148/radiol.2018180924] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose To compare the diagnostic performance of minimally invasive autopsy with that of conventional autopsy. Materials and Methods For this prospective, single-center, cross-sectional study in an academic hospital, 295 of 2197 adult cadavers (mean age: 65 years [range, 18-99 years]; age range of male cadavers: 18-99 years; age range of female cadavers: 18-98 years) who died from 2012 through 2014 underwent conventional autopsy. Family consent for minimally invasive autopsy was obtained for 139 of the 295 cadavers; 99 of those 139 cadavers were included in this study. Those involved in minimally invasive autopsy and conventional autopsy were blinded to each other's findings. The minimally invasive autopsy procedure combined postmortem MRI, CT, and CT-guided biopsy of main organs and pathologic lesions. The primary outcome measure was performance of minimally invasive autopsy and conventional autopsy in establishing immediate cause of death, as compared with consensus cause of death. The secondary outcome measures were diagnostic yield of minimally invasive autopsy and conventional autopsy for all, major, and grouped major diagnoses; frequency of clinically unsuspected findings; and percentage of answered clinical questions. Results Cause of death determined with minimally invasive autopsy and conventional autopsy agreed in 91 of the 99 cadavers (92%). Agreement with consensus cause of death occurred in 96 of 99 cadavers (97%) with minimally invasive autopsy and in 94 of 99 cadavers (95%) with conventional autopsy (P = .73). All 288 grouped major diagnoses were related to consensus cause of death. Minimally invasive autopsy enabled diagnosis of 259 of them (90%) and conventional autopsy 224 (78%); 200 (69%) were found with both methods. At clinical examination, the cause of death was not suspected in 17 of the 99 cadavers (17%), and 124 of 288 grouped major diagnoses (43%) were not established. There were 219 additional clinical questions; 189 (86%) were answered with minimally invasive autopsy and 182 (83%) were answered with conventional autopsy (P = .35). Conclusion The performance of minimally invasive autopsy in the detection of cause of death was similar to that of conventional autopsy; however, minimally invasive autopsy has a higher yield of diagnoses. © RSNA, 2018 Online supplemental material is available for this article. See also the editorial by Krombach in this issue.
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Affiliation(s)
- Britt M Blokker
- From the Departments of Pathology (B.M.B., A.C.W., I.M.W., J.H.v.d.T., M.A.d.B., F.J.v.K., J.W.O.), Radiology and Nuclear Medicine (B.M.B., A.C.W., I.M.W., A.P., G.P.K., M.G.M.H., J.W.O.), Neurosurgery, Brain Tumor Center (R.D.), Intensive Care Adults (J.B.), and Clinical Epidemiology (M.G.M.H.), Erasmus MC University Medical Center, 's-Gravendijkwal 230, 3015 CE, Rotterdam, the Netherlands; Center for Health Decision Science, Harvard T. H. Chan School of Public Health, Harvard University, Boston, Mass (M.G.M.H.); Department of Pulmonary and Critical Care, Columbia University Medical Center, New York, NY (J.B.); Department of Radiology, Reinier de Graaf Gasthuis, Delft, the Netherlands (N.S.R.); and Department of Pathology, Maasstad Ziekenhuis, Rotterdam, the Netherlands (M.A.d.B.)
| | - Annick C Weustink
- From the Departments of Pathology (B.M.B., A.C.W., I.M.W., J.H.v.d.T., M.A.d.B., F.J.v.K., J.W.O.), Radiology and Nuclear Medicine (B.M.B., A.C.W., I.M.W., A.P., G.P.K., M.G.M.H., J.W.O.), Neurosurgery, Brain Tumor Center (R.D.), Intensive Care Adults (J.B.), and Clinical Epidemiology (M.G.M.H.), Erasmus MC University Medical Center, 's-Gravendijkwal 230, 3015 CE, Rotterdam, the Netherlands; Center for Health Decision Science, Harvard T. H. Chan School of Public Health, Harvard University, Boston, Mass (M.G.M.H.); Department of Pulmonary and Critical Care, Columbia University Medical Center, New York, NY (J.B.); Department of Radiology, Reinier de Graaf Gasthuis, Delft, the Netherlands (N.S.R.); and Department of Pathology, Maasstad Ziekenhuis, Rotterdam, the Netherlands (M.A.d.B.)
| | - Ivo M Wagensveld
- From the Departments of Pathology (B.M.B., A.C.W., I.M.W., J.H.v.d.T., M.A.d.B., F.J.v.K., J.W.O.), Radiology and Nuclear Medicine (B.M.B., A.C.W., I.M.W., A.P., G.P.K., M.G.M.H., J.W.O.), Neurosurgery, Brain Tumor Center (R.D.), Intensive Care Adults (J.B.), and Clinical Epidemiology (M.G.M.H.), Erasmus MC University Medical Center, 's-Gravendijkwal 230, 3015 CE, Rotterdam, the Netherlands; Center for Health Decision Science, Harvard T. H. Chan School of Public Health, Harvard University, Boston, Mass (M.G.M.H.); Department of Pulmonary and Critical Care, Columbia University Medical Center, New York, NY (J.B.); Department of Radiology, Reinier de Graaf Gasthuis, Delft, the Netherlands (N.S.R.); and Department of Pathology, Maasstad Ziekenhuis, Rotterdam, the Netherlands (M.A.d.B.)
| | - Jan H von der Thüsen
- From the Departments of Pathology (B.M.B., A.C.W., I.M.W., J.H.v.d.T., M.A.d.B., F.J.v.K., J.W.O.), Radiology and Nuclear Medicine (B.M.B., A.C.W., I.M.W., A.P., G.P.K., M.G.M.H., J.W.O.), Neurosurgery, Brain Tumor Center (R.D.), Intensive Care Adults (J.B.), and Clinical Epidemiology (M.G.M.H.), Erasmus MC University Medical Center, 's-Gravendijkwal 230, 3015 CE, Rotterdam, the Netherlands; Center for Health Decision Science, Harvard T. H. Chan School of Public Health, Harvard University, Boston, Mass (M.G.M.H.); Department of Pulmonary and Critical Care, Columbia University Medical Center, New York, NY (J.B.); Department of Radiology, Reinier de Graaf Gasthuis, Delft, the Netherlands (N.S.R.); and Department of Pathology, Maasstad Ziekenhuis, Rotterdam, the Netherlands (M.A.d.B.)
| | - Andrea Pezzato
- From the Departments of Pathology (B.M.B., A.C.W., I.M.W., J.H.v.d.T., M.A.d.B., F.J.v.K., J.W.O.), Radiology and Nuclear Medicine (B.M.B., A.C.W., I.M.W., A.P., G.P.K., M.G.M.H., J.W.O.), Neurosurgery, Brain Tumor Center (R.D.), Intensive Care Adults (J.B.), and Clinical Epidemiology (M.G.M.H.), Erasmus MC University Medical Center, 's-Gravendijkwal 230, 3015 CE, Rotterdam, the Netherlands; Center for Health Decision Science, Harvard T. H. Chan School of Public Health, Harvard University, Boston, Mass (M.G.M.H.); Department of Pulmonary and Critical Care, Columbia University Medical Center, New York, NY (J.B.); Department of Radiology, Reinier de Graaf Gasthuis, Delft, the Netherlands (N.S.R.); and Department of Pathology, Maasstad Ziekenhuis, Rotterdam, the Netherlands (M.A.d.B.)
| | - Ruben Dammers
- From the Departments of Pathology (B.M.B., A.C.W., I.M.W., J.H.v.d.T., M.A.d.B., F.J.v.K., J.W.O.), Radiology and Nuclear Medicine (B.M.B., A.C.W., I.M.W., A.P., G.P.K., M.G.M.H., J.W.O.), Neurosurgery, Brain Tumor Center (R.D.), Intensive Care Adults (J.B.), and Clinical Epidemiology (M.G.M.H.), Erasmus MC University Medical Center, 's-Gravendijkwal 230, 3015 CE, Rotterdam, the Netherlands; Center for Health Decision Science, Harvard T. H. Chan School of Public Health, Harvard University, Boston, Mass (M.G.M.H.); Department of Pulmonary and Critical Care, Columbia University Medical Center, New York, NY (J.B.); Department of Radiology, Reinier de Graaf Gasthuis, Delft, the Netherlands (N.S.R.); and Department of Pathology, Maasstad Ziekenhuis, Rotterdam, the Netherlands (M.A.d.B.)
| | - Jan Bakker
- From the Departments of Pathology (B.M.B., A.C.W., I.M.W., J.H.v.d.T., M.A.d.B., F.J.v.K., J.W.O.), Radiology and Nuclear Medicine (B.M.B., A.C.W., I.M.W., A.P., G.P.K., M.G.M.H., J.W.O.), Neurosurgery, Brain Tumor Center (R.D.), Intensive Care Adults (J.B.), and Clinical Epidemiology (M.G.M.H.), Erasmus MC University Medical Center, 's-Gravendijkwal 230, 3015 CE, Rotterdam, the Netherlands; Center for Health Decision Science, Harvard T. H. Chan School of Public Health, Harvard University, Boston, Mass (M.G.M.H.); Department of Pulmonary and Critical Care, Columbia University Medical Center, New York, NY (J.B.); Department of Radiology, Reinier de Graaf Gasthuis, Delft, the Netherlands (N.S.R.); and Department of Pathology, Maasstad Ziekenhuis, Rotterdam, the Netherlands (M.A.d.B.)
| | - Nomdo S Renken
- From the Departments of Pathology (B.M.B., A.C.W., I.M.W., J.H.v.d.T., M.A.d.B., F.J.v.K., J.W.O.), Radiology and Nuclear Medicine (B.M.B., A.C.W., I.M.W., A.P., G.P.K., M.G.M.H., J.W.O.), Neurosurgery, Brain Tumor Center (R.D.), Intensive Care Adults (J.B.), and Clinical Epidemiology (M.G.M.H.), Erasmus MC University Medical Center, 's-Gravendijkwal 230, 3015 CE, Rotterdam, the Netherlands; Center for Health Decision Science, Harvard T. H. Chan School of Public Health, Harvard University, Boston, Mass (M.G.M.H.); Department of Pulmonary and Critical Care, Columbia University Medical Center, New York, NY (J.B.); Department of Radiology, Reinier de Graaf Gasthuis, Delft, the Netherlands (N.S.R.); and Department of Pathology, Maasstad Ziekenhuis, Rotterdam, the Netherlands (M.A.d.B.)
| | - Michael A den Bakker
- From the Departments of Pathology (B.M.B., A.C.W., I.M.W., J.H.v.d.T., M.A.d.B., F.J.v.K., J.W.O.), Radiology and Nuclear Medicine (B.M.B., A.C.W., I.M.W., A.P., G.P.K., M.G.M.H., J.W.O.), Neurosurgery, Brain Tumor Center (R.D.), Intensive Care Adults (J.B.), and Clinical Epidemiology (M.G.M.H.), Erasmus MC University Medical Center, 's-Gravendijkwal 230, 3015 CE, Rotterdam, the Netherlands; Center for Health Decision Science, Harvard T. H. Chan School of Public Health, Harvard University, Boston, Mass (M.G.M.H.); Department of Pulmonary and Critical Care, Columbia University Medical Center, New York, NY (J.B.); Department of Radiology, Reinier de Graaf Gasthuis, Delft, the Netherlands (N.S.R.); and Department of Pathology, Maasstad Ziekenhuis, Rotterdam, the Netherlands (M.A.d.B.)
| | - Folkert J van Kemenade
- From the Departments of Pathology (B.M.B., A.C.W., I.M.W., J.H.v.d.T., M.A.d.B., F.J.v.K., J.W.O.), Radiology and Nuclear Medicine (B.M.B., A.C.W., I.M.W., A.P., G.P.K., M.G.M.H., J.W.O.), Neurosurgery, Brain Tumor Center (R.D.), Intensive Care Adults (J.B.), and Clinical Epidemiology (M.G.M.H.), Erasmus MC University Medical Center, 's-Gravendijkwal 230, 3015 CE, Rotterdam, the Netherlands; Center for Health Decision Science, Harvard T. H. Chan School of Public Health, Harvard University, Boston, Mass (M.G.M.H.); Department of Pulmonary and Critical Care, Columbia University Medical Center, New York, NY (J.B.); Department of Radiology, Reinier de Graaf Gasthuis, Delft, the Netherlands (N.S.R.); and Department of Pathology, Maasstad Ziekenhuis, Rotterdam, the Netherlands (M.A.d.B.)
| | - Gabriel P Krestin
- From the Departments of Pathology (B.M.B., A.C.W., I.M.W., J.H.v.d.T., M.A.d.B., F.J.v.K., J.W.O.), Radiology and Nuclear Medicine (B.M.B., A.C.W., I.M.W., A.P., G.P.K., M.G.M.H., J.W.O.), Neurosurgery, Brain Tumor Center (R.D.), Intensive Care Adults (J.B.), and Clinical Epidemiology (M.G.M.H.), Erasmus MC University Medical Center, 's-Gravendijkwal 230, 3015 CE, Rotterdam, the Netherlands; Center for Health Decision Science, Harvard T. H. Chan School of Public Health, Harvard University, Boston, Mass (M.G.M.H.); Department of Pulmonary and Critical Care, Columbia University Medical Center, New York, NY (J.B.); Department of Radiology, Reinier de Graaf Gasthuis, Delft, the Netherlands (N.S.R.); and Department of Pathology, Maasstad Ziekenhuis, Rotterdam, the Netherlands (M.A.d.B.)
| | - M G Myriam Hunink
- From the Departments of Pathology (B.M.B., A.C.W., I.M.W., J.H.v.d.T., M.A.d.B., F.J.v.K., J.W.O.), Radiology and Nuclear Medicine (B.M.B., A.C.W., I.M.W., A.P., G.P.K., M.G.M.H., J.W.O.), Neurosurgery, Brain Tumor Center (R.D.), Intensive Care Adults (J.B.), and Clinical Epidemiology (M.G.M.H.), Erasmus MC University Medical Center, 's-Gravendijkwal 230, 3015 CE, Rotterdam, the Netherlands; Center for Health Decision Science, Harvard T. H. Chan School of Public Health, Harvard University, Boston, Mass (M.G.M.H.); Department of Pulmonary and Critical Care, Columbia University Medical Center, New York, NY (J.B.); Department of Radiology, Reinier de Graaf Gasthuis, Delft, the Netherlands (N.S.R.); and Department of Pathology, Maasstad Ziekenhuis, Rotterdam, the Netherlands (M.A.d.B.)
| | - J Wolter Oosterhuis
- From the Departments of Pathology (B.M.B., A.C.W., I.M.W., J.H.v.d.T., M.A.d.B., F.J.v.K., J.W.O.), Radiology and Nuclear Medicine (B.M.B., A.C.W., I.M.W., A.P., G.P.K., M.G.M.H., J.W.O.), Neurosurgery, Brain Tumor Center (R.D.), Intensive Care Adults (J.B.), and Clinical Epidemiology (M.G.M.H.), Erasmus MC University Medical Center, 's-Gravendijkwal 230, 3015 CE, Rotterdam, the Netherlands; Center for Health Decision Science, Harvard T. H. Chan School of Public Health, Harvard University, Boston, Mass (M.G.M.H.); Department of Pulmonary and Critical Care, Columbia University Medical Center, New York, NY (J.B.); Department of Radiology, Reinier de Graaf Gasthuis, Delft, the Netherlands (N.S.R.); and Department of Pathology, Maasstad Ziekenhuis, Rotterdam, the Netherlands (M.A.d.B.)
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