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Shimbashi S, Takeuchi A, Yoshimiya M, Jin S, Matoba K, Hyodoh H. Postmortem contrast-enhanced computed tomography via direct large-vessel puncture. Leg Med (Tokyo) 2024; 69:102448. [PMID: 38640871 DOI: 10.1016/j.legalmed.2024.102448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 03/06/2024] [Accepted: 04/15/2024] [Indexed: 04/21/2024]
Abstract
The aim of this study was to assess the usefulness of postmortem contrast-enhanced CT (PMeCT) performed via direct large-vessel puncture when routine postmortem CT suggests a vascular lesion as the cause of death. PMeCT was performed in 9 cases (4 male, 5 female) with a mean age of 76 years (range 52-92) at the time of death. The mean time elapsed since death was 29.1 h (12.0-72.0). The location of the target vessel for puncture was determined based on the CT table position and a grid placed on the body surface. An 18-G spinal needle was advanced to the puncture site, and the needle tip was confirmed to have reached the intended blood vessel. Using negative pressure with a 20-ml syringe, the needle tip was advanced until reverse bleeding was confirmed. Diluted contrast medium was injected slowly to ensure its dispersion within the blood vessels. Following confirmation of no extravasation, additional doses of diluted contrast agent were injected in 3-4 divided doses, with CT scans obtained at each step to track the distribution of contrast agent over time. PMeCT was successful in all cases, revealing cardiac tamponade in 7 (ascending aortic dissection, n = 6; cardiac rupture, n = 1), thoracic aortic aneurysm rupture, n = 1, and iliac artery aneurysm rupture, n = 1. There were no cases of procedure-related extravasation (pseudo-lesions). When postmortem CT reveals pericardial hematoma or bleeding in the thoracic or abdominal cavity, PMeCT can identify the source of bleeding.
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Affiliation(s)
- Shogo Shimbashi
- University of Fukui School of Medical Sciences, Department of Forensic Medicine, Japan.
| | - Akiko Takeuchi
- Hokkaido University, Faculty of Medicine, Center for Cause of Death Investigation, Japan.
| | - Motoo Yoshimiya
- University of Fukui School of Medical Sciences, Department of Forensic Medicine, Japan.
| | - Shigeki Jin
- Hokkaido University, Faculty of Medicine, Department of Forensic Medicine, Japan.
| | - Kotaro Matoba
- Hokkaido University, Faculty of Medicine, Department of Forensic Medicine, Japan.
| | - Hideki Hyodoh
- University of Fukui School of Medical Sciences, Department of Forensic Medicine, Japan; Hokkaido University, Faculty of Medicine, Department of Forensic Medicine, Japan.
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2
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Schädler J, Azeke AT, Ondruschka B, Steurer S, Lütgehetmann M, Fitzek A, Möbius D. Concordance between MITS and conventional autopsies for pathological and virological diagnoses. Int J Legal Med 2024; 138:431-442. [PMID: 37837537 PMCID: PMC10861633 DOI: 10.1007/s00414-023-03088-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 09/04/2023] [Indexed: 10/16/2023]
Abstract
In pandemics or to further study highly contagious infectious diseases, new strategies are needed for the collection of post-mortem tissue samples to identify the pathogen as well as its morphological impact. In this study, an ultrasound-guided minimally invasive tissue sampling (MITS) protocol was developed and validated for post-mortem use. The histological and microbiological qualities of post-mortem specimens were evaluated and compared between MITS and conventional autopsy (CA) in a series of COVID-19 deaths. Thirty-six ultrasound-guided MITS were performed. In five cases more, specimens for histological and virological examination were also obtained and compared during the subsequently performed CA. Summary statistics and qualitative interpretations (positive, negative) were calculated for each organ tissue sample from MITS and CA, and target genes were determined for both human cell count (beta-globin) and virus (SARS-CoV-2 specific E gene). There are no significant differences between MITS and CA with respect to the detectability of viral load in individual organs, which is why MITS can be of utmost importance and an useful alternative, especially during outbreaks of infectious diseases.
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Affiliation(s)
- Julia Schädler
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Akhator Terence Azeke
- Department of Anatomic Pathology, Irrua Specialist Teaching Hospital, Irrua, Nigeria
| | - Benjamin Ondruschka
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stefan Steurer
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marc Lütgehetmann
- Institute of Medical Microbiology, Virology, and Hygiene, University Medical Center, Hamburg-Eppendorf, Hamburg, Germany
| | - Antonia Fitzek
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Dustin Möbius
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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3
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Lee H, Lee S, Baek T, Cha JG, Yang KM. Natural Death. FORENSIC IMAGING 2022. [DOI: 10.1007/978-3-030-83352-7_11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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4
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Wang Y, Liu N, Yang M, Tian Z, Dong H, Lu Y, Zou D. Application and Prospect of Postmortem Imaging Technology in Forensic Cardiac Pathology: A Systemic Review. JOURNAL OF FORENSIC SCIENCE AND MEDICINE 2022. [DOI: 10.4103/jfsm.jfsm_129_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
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6
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Russo A, Reginelli A, Pignatiello M, Montella M, Toni G, Cappabianca S, Grassi R. Sirenomelia: The role of post - Mortem diagnostic imaging. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2021. [DOI: 10.1016/j.epsc.2021.101921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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7
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Möbius D, Fitzek A, Hammer N, Heinemann A, Ron A, Schädler J, Zwirner J, Ondruschka B. Ultrasound in legal medicine-a missed opportunity or simply too late? A narrative review of ultrasonic applications in forensic contexts. Int J Legal Med 2021; 135:2363-2383. [PMID: 34292383 PMCID: PMC8295453 DOI: 10.1007/s00414-021-02661-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 07/02/2021] [Indexed: 01/15/2023]
Abstract
Objectives Conventional autopsies remain the gold standard of postmortem healthcare quality assurance and help gathering extended knowledge on diseases. In answer to constantly declining autopsy rates non- or minimally invasive autopsy methods were introduced. Ultrasound is a well-established tool for imaging commonly used in clinical practice. This narrative review aims to summarize the current literature regarding the feasibility and validity of ultrasound in a forensic context. Material and methods A PubMed database search was carried out. Abstracts were scanned for pre-defined ex- and inclusion criteria, followed by a snowball search procedure applied to the primarily included articles. Results Forty-five publications met our inclusion criteria. The selected articles concern the feasibility of ultrasound in pre- or postmortem settings, forensic age estimation, and minimally invasive approaches. For imaging, ultrasound was deemed a reliable tool for the examination of epiphyses und superficial wounds, with limitations regarding internal organs and image quality due to postmortem changes. Ultrasound-guided minimally invasive approaches yielded higher success rates for adequate tissue sampling. Many investigations were carried out in low- and middle-income countries focusing on infectious diseases. Conclusion Ultrasound seems a promising but underutilized imaging tool in legal medicine to date. Promising approaches on its feasibility have been conducted. Especially for minimally invasive methods, ultrasound offered significant improvements on qualified biopsy sampling and thus appropriate diagnostics. Moreover, ultrasonic evaluation of epiphyses for age estimation offered valuable results. Nevertheless, further assessment of ultrasonic feasibility in forensic contexts is needed.
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Affiliation(s)
- Dustin Möbius
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Antonia Fitzek
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Niels Hammer
- Institute of Macroscopic and Clinical Anatomy, University of Graz, Graz, Austria.,Department of Orthopedic and Trauma Surgery, University of Leipzig, Leipzig, Germany.,Fraunhofer IWU, Dresden, Germany
| | - Axel Heinemann
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alexandra Ron
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Julia Schädler
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Johann Zwirner
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Anatomy, University of Otago, Dunedin, New Zealand
| | - Benjamin Ondruschka
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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8
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Szeligowski T. At the limits of patient autonomy: an ethical re-evaluation of coroner's postmortems. JOURNAL OF MEDICAL ETHICS 2021; 47:medethics-2020-106921. [PMID: 33504628 DOI: 10.1136/medethics-2020-106921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 12/28/2020] [Accepted: 01/05/2021] [Indexed: 06/12/2023]
Abstract
Patient autonomy is one of the four pillars of modern medical ethics. In some cases, however, its value is not absolute and autonomy may be overridden by sufficiently important matters of public interest. Coroner's autopsies represent an example of when the wishes of the deceased and their family may come in conflict with the benefits of knowledge gained from understanding the cause of death. Current legislation governing coroner's autopsies relies on the assumption of their obvious public benefit, hence consent for them need not be sought. This interpretation has attracted controversy, as exemplified by the case of Rotsztein vs HM Senior Coroner and a recent study questioning the prevalent use of invasive autopsy. However, this issue has received little recent attention in ethical literature. In this essay, the ethical nature of coroner's autopsies in cases of natural deaths with unexplained causes is examined as a balance between patient autonomy and the value of knowledge gained from them. This is done by analysing a case which under current legislation warrants coroner's autopsy, however, its ethical justification remains contentious. This discussion is expanded by discussion of non-invasive alternatives and comparison to another situation which balances individual autonomy with public benefits-organ donation. The conclusion of this analysis is a moral middle ground in which objection to invasive autopsy could be respected once issues of overriding public interest are excluded, or at least non-invasive alternatives should be considered, with coroners left responsible for demonstrating specific public needs that could override objection.
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Saegeman V, Cohen MC, Burton JL, Martinez MJ, Rakislova N, Offiah AC, Fernandez-Rodriguez A. Microbiology in minimally invasive autopsy: best techniques to detect infection. ESGFOR (ESCMID study group of forensic and post-mortem microbiology) guidelines. Forensic Sci Med Pathol 2021; 17:87-100. [PMID: 33464531 PMCID: PMC7814172 DOI: 10.1007/s12024-020-00337-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2020] [Indexed: 12/20/2022]
Abstract
This manuscript aims to: 1) provide specific guidelines on PMM techniques in the setting of minimally invasive autopsy (MIA), both for pathologists collecting samples and for microbiologists advising pathologists and interpreting the results and 2) introduce standardization in PMM sampling at MIA. Post-mortem microbiology (PMM) is crucial to identify the causative organism in deaths due to infection. MIA including the use of post-mortem (PM) computed tomography (CT) and PM magnetic resonance imaging (MRI), is increasingly carried out as a complement or replacement for the traditional PM. In this setting, mirroring the traditional autopsy, PMM aims to: detect infectious organisms causing sudden unexpected deaths; confirm clinically suspected but unproven infection; evaluate the efficacy of antimicrobial therapy; identify emergent pathogens; and recognize medical diagnostic errors. Meaningful interpretation of PMM results requires careful evaluation in the context of the clinical history, macroscopic and microscopic findings.
These guidelines were developed by a multidisciplinary team with experts in various fields of microbiology and pathology on behalf of the ESGFOR (ESCMID – European Society of Clinical Microbiology and Infectious Diseases - Study Group of Forensic and Post-mortem Microbiology, in collaboration with the ESP -European Society of Pathology-) based on a literature search and the author’s expertise. Microbiological sampling methods for MIA are presented for various scenarios: adults, children, developed and developing countries. Concordance between MIA and conventional invasive autopsy is substantial for children and adults and moderate for neonates and maternal deaths. Networking and closer collaboration among microbiologists and pathologists is vital to maximize the yield of PMM in MIA.
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Affiliation(s)
- Veroniek Saegeman
- Clinical Laboratory, Sint-Niklaas, and Infection Control Department, AZ Nikolaas, University Hospitals Leuven, Moerlandstraat 1Herestraat 49, 91003000, Leuven, Belgium
| | - Marta C Cohen
- FT. Histopathology Department. Western Bank, Sheffield Children's Hospital NHS, Sheffield, S10 2TH, UK
| | | | - Miguel J Martinez
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Barcelona, Spain
- Department of Microbiology, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Natalia Rakislova
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Barcelona, Spain
- Department of Pathology, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Amaka C Offiah
- Department of Oncology and Metabolism, Department of Radiology, Academic Unit of Child Health, Sheffield Children's NHS FT, University of Sheffield, Sheffield, UK
| | - Amparo Fernandez-Rodriguez
- Microbiology Laboratory, Biology Department, Instituto Nacional de Toxicología y Ciencias Forenses, Las Rozas de Madrid, Madrid, Spain.
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10
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Jessika C, Anna Laura S, Stefano D, Giuliano GB, Marco B, Riccardo B, Riccardo R, Enrico S. Diagnosing coronary thrombosis using multiphase post-mortem CT angiography (MPMCTA): A case study. MEDICINE, SCIENCE, AND THE LAW 2021; 61:77-81. [PMID: 33591864 DOI: 10.1177/0025802420923175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
While post-mortem angiography (PMA) is gradually establishing its role in Forensic Radiology, the available literature in Italy lacks a solid foundation, particularly regarding its use in criminal court proceedings. An illustrative example of multiphase post-mortem CT angiography (MPMCTA) is presented here to encourage the systematic implementation of PMA methods. To demonstrate concordance between MPMCTA and the reference standard (autopsy and histology) in a case of acute coronary thrombosis, we report a case where MPMCTA, autopsy, histological and toxicological analyses were performed on a previously healthy 51-year-old man. MPMCTA detected a right coronary artery filling defect that could be ascribed to coronary thrombosis, which was later confirmed by autopsy and histological examinations.
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Affiliation(s)
- Camatti Jessika
- Department of Biomedical, Metabolic and Neural Sciences, Institute of Legal Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Santunione Anna Laura
- Department of Biomedical, Metabolic and Neural Sciences, Institute of Legal Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Draisci Stefano
- Department of Adult and Neonatal-Gynaecological Medical Surgical Sciences, Section of Diagnostic Imaging, University of Modena and Reggio Emilia, Modena, Italy
| | - Gangi Bruno Giuliano
- Department of Biomedical, Metabolic and Neural Sciences, Institute of Legal Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Bisceglia Marco
- Department of Biomedical, Metabolic and Neural Sciences, Institute of Legal Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Bini Riccardo
- Department of Biomedical, Metabolic and Neural Sciences, Institute of Legal Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Renzi Riccardo
- Department of Biomedical, Metabolic and Neural Sciences, Institute of Legal Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Silingardi Enrico
- Department of Biomedical, Metabolic and Neural Sciences, Institute of Legal Medicine, University of Modena and Reggio Emilia, Modena, Italy
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11
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Tiantong Y, Yucong W, Haibiao Z, Ran L, Haidong Z, Dong Z, Xu W. Application of virtopsy in forensic pathology. JOURNAL OF FORENSIC SCIENCE AND MEDICINE 2021. [DOI: 10.4103/jfsm.jfsm_67_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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12
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Paratz ED, Costello B, Rowsell L, Morgan N, Smith K, Thompson T, Semsarian C, Pflaumer A, James P, Stub D, La Gerche A, Zentner D, Parsons S. Can post-mortem coronary artery calcium scores aid diagnosis in young sudden death? Forensic Sci Med Pathol 2020; 17:27-35. [PMID: 33190173 DOI: 10.1007/s12024-020-00335-z] [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] [Accepted: 10/19/2020] [Indexed: 12/16/2022]
Abstract
This study sought to explore the feasibility and utility of post-mortem coronary artery calcium (CAC) scoring in identifying patients with ischemic heart disease as cause of sudden death. 100 deceased patients aged 18-50 years underwent post-mortem examination in the setting of sudden death. At post-mortem, fifty cases were determined to have ischemic heart disease, and fifty had death attributed to trauma or unascertained causes. The CAC score was calculated in a blinded manner from post-mortem CTs performed on all cases. CAC scores were assessable in 97 non-decomposed cases (feasibility 97%). The median CAC score was 88 Agatston units [IQR 0-286] in patients deceased from ischemic heart disease vs 0 [IQR 0-0] in patients deceased from other causes (p < 0.0001). Presence of any coronary calcification differed significantly between ischemic heart disease and non-ischemic groups (adjusted odds ratio 10.7, 95% CI 3.2-35.5). All cases with a CAC score > 100 (n = 22) had ischemic heart disease as the cause of death. Fifteen cases had a CAC score of zero but severe coronary disease at post-mortem examination. Post-mortem CAC scoring is highly feasible. An elevated CAC score in cases 18-50 years old with sudden death predicts ischemic heart disease at post-mortem examination. However, a CAC score of zero does not exclude significant coronary artery disease. Post-mortem CAC score may be considered as a further assessment tool to help predict likely cause of death when there is an objection to or unavailability of post-mortem examination.
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Affiliation(s)
- Elizabeth D Paratz
- Baker Heart and Diabetes Institute, 75 Commercial Rd, Prahran, VIC, 3181, Australia. .,Alfred Hospital, 55 Commercial Rd, Prahran, VIC, 3181, Australia. .,St Vincent's Hospital Melbourne, 41 Victoria Pde, Fitzroy, VIC, 3065, Australia.
| | - Ben Costello
- Baker Heart and Diabetes Institute, 75 Commercial Rd, Prahran, VIC, 3181, Australia.,St Vincent's Hospital Melbourne, 41 Victoria Pde, Fitzroy, VIC, 3065, Australia
| | - Luke Rowsell
- Baker Heart and Diabetes Institute, 75 Commercial Rd, Prahran, VIC, 3181, Australia
| | - Natalie Morgan
- Victorian Institute of Forensic Medicine, 65 Kavanagh St, Southbank, VIC, 3006, Australia
| | - Karen Smith
- , Ambulance Victoria, 375 Manningham Rd, Doncaster, VIC, 3108, Australia.,Department of Community Emergency Health and Paramedic Practice, Monash University, Melbourne, VIC, Australia.,Murdoch Children's Research Institute, Royal Children's Hospital, Flemington Rd, Parkville, VIC, 3052, Australia
| | - Tina Thompson
- Royal Melbourne Hospital, 300 Grattan St, Parkville, VIC, 3050, Australia
| | - Chris Semsarian
- Centenary Institute and The University of Sydney, Missenden Rd, Sydney, NSW, 2050, Australia
| | - Andreas Pflaumer
- Royal Children's Hospital, 50 Flemington Rd, Parkville Melbourne, VIC, 3052, Australia.,Department of Paediatrics, Melbourne University, Parkville, VIC, 3010, Australia.,Murdoch Children's Research Institute, Royal Children's Hospital, Flemington Rd, Parkville, VIC, 3052, Australia
| | - Paul James
- Peter MacCallum Cancer Centre, 305 Grattan St, Parkville, VIC, 3050, Australia
| | - Dion Stub
- Baker Heart and Diabetes Institute, 75 Commercial Rd, Prahran, VIC, 3181, Australia.,Alfred Hospital, 55 Commercial Rd, Prahran, VIC, 3181, Australia.,Department of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, 3004, Australia
| | - André La Gerche
- Baker Heart and Diabetes Institute, 75 Commercial Rd, Prahran, VIC, 3181, Australia.,Alfred Hospital, 55 Commercial Rd, Prahran, VIC, 3181, Australia.,St Vincent's Hospital Melbourne, 41 Victoria Pde, Fitzroy, VIC, 3065, Australia
| | - Dominica Zentner
- Royal Melbourne Hospital, 300 Grattan St, Parkville, VIC, 3050, Australia.,Royal Melbourne Hospital Clinical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, 3000, Australia
| | - Sarah Parsons
- Victorian Institute of Forensic Medicine, 65 Kavanagh St, Southbank, VIC, 3006, Australia.,Department of Forensic Medicine, Monash University, 65 Kavanagh St, Southbank, VIC, 3006, Australia
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13
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Hueck U, Muggenthaler H, Hubig M, Heinrich A, Güttler F, Wagner R, Mall G, Teichgräber U. Forensic postmortem computed tomography in suspected unnatural adult deaths. Eur J Radiol 2020; 132:109297. [PMID: 33035918 DOI: 10.1016/j.ejrad.2020.109297] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 09/04/2020] [Accepted: 09/18/2020] [Indexed: 01/16/2023]
Abstract
PURPOSE Our study sought to evaluate validity of forensic postmortem CT in establishing cause of death (COD) in suspected unnatural adult death based on the reference standard of autopsy. METHODS In our prospective, single-center study, 64 of 94 consecutive corpses (70.7 % male, mean age: 47.4 years) who underwent CT and autopsy between November 2013 and April 2019 were included in the analysis. Primary objective was agreement between CT and autopsy on primary COD using kappa statistics. Secondary objectives were competing COD and specific pathological findings. RESULTS Agreement on primary COD between forensic CT and autopsy without or in consideration of toxicological and histological findings was strong (85.9 % [55 of 64 corpses]; κ = 0.83 [95 %CI: 0.74 to 0.93] and 95.3 % [61 of 64 corpses]; κ = 0.94 [95 %CI: 0.84-1.04], respectively, McNemar p = 0.03). Sensitivity and specificity of CT in identification of acute heart failure, intracranial bleeding, burns and heat shocks, gunshot wounds, polytrauma, cranio-cerebral trauma, and strangulation or hanging was 100 %, each. Acute respiratory failure was detected with a sensitivity and specificity of 100 % and 96.8 %, cuts and stab wounds with 95.2 % and 100 %, and intoxication, pneumonia, or gastrointestinal bleeding with 60.0 % and 100 %, respectively. Agreement on competing COD was moderate (51.6 %, [33 of 64 corpses]; κ = 0.47 [95 %CI: 0.40 to 0.53], p < 0.001). CONCLUSIONS Forensic postmortem CT, complemented by external, toxicological, and histological examination was sufficiently valid to assess primary COD in the majority of suspected unnatural deaths with few restrictions.
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Affiliation(s)
- U Hueck
- Department of Radiology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - H Muggenthaler
- Department of Forensic Medicine, Jena University Hospital, Jena, Am Klinikum 1, 07747, Jena, Germany
| | - M Hubig
- Department of Forensic Medicine, Jena University Hospital, Jena, Am Klinikum 1, 07747, Jena, Germany
| | - A Heinrich
- Department of Radiology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - F Güttler
- Department of Radiology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - R Wagner
- Department of Forensic Medicine, Jena University Hospital, Jena, Am Klinikum 1, 07747, Jena, Germany
| | - G Mall
- Department of Forensic Medicine, Jena University Hospital, Jena, Am Klinikum 1, 07747, Jena, Germany
| | - U Teichgräber
- Department of Radiology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany.
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14
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Evaluation of an acetated Ringer-based contrast material mixture for postmortem computed tomography angiography. Diagn Interv Imaging 2020; 101:489-497. [DOI: 10.1016/j.diii.2020.01.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 01/15/2020] [Accepted: 01/15/2020] [Indexed: 11/19/2022]
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15
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Chainchel Singh MK, Abdul Rashid SN, Abdul Hamid S, Mahmood MS, Feng SS, Mohd Nawawi H, Omar E. Correlation and assessment of coronary artery luminal stenosis: Post-mortem computed tomography angiogram versus histopathology. Forensic Sci Int 2020; 308:110171. [PMID: 32032870 DOI: 10.1016/j.forsciint.2020.110171] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 11/05/2019] [Accepted: 01/24/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND Post-mortem Computed Tomography (PMCT) allows non-invasive or minimally invasive detection of findings that may or may not be visible during conventional autopsy, however, it does not allow the investigator to draw any conclusions regarding patency of the vessel's lumen. To address this deficiency, Post-mortem Computed Tomography Angiography (PMCTA) utilizing different contrast media and techniques have been introduced with various studies looking at the correlation between PMCTA, autopsy (gross) findings and coronary artery histology in diagnosing coronary artery disease. OBJECTIVES The aim of this study is to investigate the sensitivity and specificity of PMCTA in diagnosing coronary artery stenosis using water-based contrast media introduced though the vessels of the neck, compared to the gold standard of diagnosis i.e. gross and histological evaluation of the coronary artery. METHOD This was a cross sectional study of 158 arterial sections involving 37 subjects recruited from the National Institute of Forensic Medicine (IPFN), Hospital Kuala Lumpur (HKL). An unenhanced PMCT was performed followed by PMCTA using water-based contrast media introduced though the vessels of the neck. Coronary artery stenosis was determined using multiplanar reconstructionD while the degree of stenosis was determined by calculating the percentage of luminal diameter divided by the diameter of the vessel internal elastic. RESULTS The analysis of PMCTA and histopathology examinations revealed a sensitivity of 61.5%, specificity of 91.7%; positive predictive value (PPV) of 40.0% and negative predictive value (NPV) of 96.4%. CONCLUSION PMCTA utilizing water-based contrast introduced though the vessels of the neck yielded similar results as other methods and techniques of PMCTA. We would therefore conclude that PMCTA utilizing this technique could be used to assess the degree of calcification and the presence of significant stenosis.
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Affiliation(s)
- Mansharan Kaur Chainchel Singh
- Institute for Pathology, Laboratory and Forensic Medicine (I-PPerForM), Universiti Teknologi MARA (UiTM), Sg Buloh, Selangor, Malaysia; Faculty of Medicine, Universiti Teknologi MARA (UiTM), Sg Buloh, Selangor, Malaysia; National Institute of Forensic Medicine (IPFN), Hospital Kuala Lumpur, Malaysia.
| | - Saiful Nizam Abdul Rashid
- Imaging Department, Desa Park Medical City, Kuala Lumpur, Malaysia; Faculty of Medicine and Health Sciences, Universiti Putra Malaysia (UPM), Serdang, Selangor, Malaysia
| | - Suzana Abdul Hamid
- Faculty of Medicine and Health Sciences, Universiti Putra Malaysia (UPM), Serdang, Selangor, Malaysia
| | - Mohd Shah Mahmood
- National Institute of Forensic Medicine (IPFN), Hospital Kuala Lumpur, Malaysia
| | - Siew Sheue Feng
- National Institute of Forensic Medicine (IPFN), Hospital Kuala Lumpur, Malaysia
| | - Hapizah Mohd Nawawi
- Institute for Pathology, Laboratory and Forensic Medicine (I-PPerForM), Universiti Teknologi MARA (UiTM), Sg Buloh, Selangor, Malaysia; Faculty of Medicine, Universiti Teknologi MARA (UiTM), Sg Buloh, Selangor, Malaysia
| | - Effat Omar
- Institute for Pathology, Laboratory and Forensic Medicine (I-PPerForM), Universiti Teknologi MARA (UiTM), Sg Buloh, Selangor, Malaysia; Faculty of Medicine, Universiti Teknologi MARA (UiTM), Sg Buloh, Selangor, Malaysia
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Takeuchi S, Yamaguchi Y, Yoshino H. Non-contrast computed tomography of type A acute aortic dissection in patients with out-of-hospital cardiopulmonary arrest: a case series. EUROPEAN HEART JOURNAL-CASE REPORTS 2019; 3:1-5. [PMID: 31911991 PMCID: PMC6939809 DOI: 10.1093/ehjcr/ytz218] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Revised: 08/30/2019] [Accepted: 11/12/2019] [Indexed: 11/17/2022]
Abstract
Background The prognosis of patients admitted for acute aortic dissection (AAD) has remarkably improved. However, we must also consider out-of-hospital cardiopulmonary arrest (OHCPA) patients while assessing the prognosis. In recent years, autopsy imaging has become more common as an alternative to conventional autopsy. Therefore, we reviewed our OHCPA patients with type A AAD using acute phase non-contrast computed tomography (CT). Case summary Here, we report a case series of three patients who developed OHCPA and were diagnosed with type A AAD using non-contrast CT. Although the direct causes of death varied in each case, we could easily determine the direct causes of death from clinical course of the condition and from non-contrast CT. Discussion Although non-contrast CT does not completely replace autopsy, if its convenience and non-invasiveness make it possible for more patients to undergo the procedure, the real prognosis (including morbidity and mortality) may be better understood. Therefore, we considered it significant to use non-contrast CT for investigating the cause of sudden death.
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Affiliation(s)
- Shinsuke Takeuchi
- Division of Cardiology, Second Department of Internal Medicine, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka-shi, Tokyo 181-8611, Japan
| | - Yoshihiro Yamaguchi
- Department of Trauma and Critical Care Medicine, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka-shi, Tokyo 181-8611, Japan
| | - Hideaki Yoshino
- Division of Cardiology, Second Department of Internal Medicine, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka-shi, Tokyo 181-8611, Japan
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17
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Latten BG, Bakers FC, Hofman PA, zur Hausen A, Kubat B. The needle in the haystack: Histology of post-mortem computed tomography guided biopsies versus autopsy derived tissue. Forensic Sci Int 2019; 302:109882. [DOI: 10.1016/j.forsciint.2019.109882] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 06/12/2019] [Accepted: 07/15/2019] [Indexed: 10/26/2022]
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Ampanozi G, Halbheer D, Ebert LC, Thali MJ, Held U. Postmortem imaging findings and cause of death determination compared with autopsy: a systematic review of diagnostic test accuracy and meta-analysis. Int J Legal Med 2019; 134:321-337. [PMID: 31455980 DOI: 10.1007/s00414-019-02140-y] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 08/06/2019] [Indexed: 01/06/2023]
Abstract
BACKGROUND The aim of this study was to evaluate the sensitivity of postmortem computed tomography (PMCT), postmortem magnetic resonance imaging (PMMR) and PMCT angiography (PMCTA) compared with autopsy in cases of adult death investigations. METHODS For this systematic review and meta-analysis, Embase, PubMed, Scopus, Web of Science and Medline were searched for eligible studies in October 2016; a follow-up literature search was conducted in March 2018. Studies referring to PMCT, PMCTA and/or PMMR of more than 3 cases with subsequent autopsy were included. Data were extracted from published texts in duplicate. The extracted outcomes were categorized as follows: soft tissue and organ findings, skeletal injuries, haemorrhages, abnormal gas accumulations and causes of death. The summary measure was sensitivity, if 3 or more studies were available. To combine studies, a random effects model was used. Variability and heterogeneity within the meta-analysis was assessed. RESULTS Of 1053 studies, 66 were eligible, encompassing a total of 4213 individuals. For soft tissue and organ findings, there was a high pooled sensitivity with PMCTA (0.91, 95% CI 0.81-0.96), without evidence for between-study variability (Cochrane's Q test p = 0.331, I2 = 24.5%). The pooled sensitivity of PMCT+PMMR was very high in skeletal injuries (0.97, CI 0.87-0.99), without evidence for variability (p = 0.857, I2 = 0.0%). In detecting haemorrhages, the pooled sensitivity for PMCT+PMMR was the highest (0.88, 95% CI 0.35-0.99), with strong evidence of heterogeneity (p < 0.05, I2 > 50%). Pooled sensitivity for the correct cause of death was the highest for PMCTA with 0.79 (95% CI 0.52-0.93), again with evidence of heterogeneity (p = 0.062, I2 > 50%). CONCLUSION Distinct postmortem imaging modalities can achieve high sensitivities for detecting various findings and causes of death. This knowledge should lead to a reasoned use of each modality. Both forensic evidence and in-hospital medical quality would be enhanced.
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Affiliation(s)
- Garyfalia Ampanozi
- Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, 8057, Zurich, Switzerland.
| | - Delaja Halbheer
- Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, 8057, Zurich, Switzerland
| | - Lars C Ebert
- Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, 8057, Zurich, Switzerland
| | - Michael J Thali
- Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, 8057, Zurich, Switzerland
| | - Ulrike Held
- Horten Centre, University of Zurich, Pestalozzistrasse 24, 8091, Zurich, Switzerland.,Epidemiology, Biostatistics and Prevention Institute, Department of Biostatistics, University of Zurich, Hirschengraben 84, 8001, Zurich, Switzerland
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Wagensveld IM, Hunink MGM, Wielopolski PA, van Kemenade FJ, Krestin GP, Blokker BM, Oosterhuis JW, Weustink AC. Hospital implementation of minimally invasive autopsy: A prospective cohort study of clinical performance and costs. PLoS One 2019; 14:e0219291. [PMID: 31310623 PMCID: PMC6634385 DOI: 10.1371/journal.pone.0219291] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 06/20/2019] [Indexed: 12/04/2022] Open
Abstract
Objectives Autopsy rates worldwide have dropped significantly over the last decades and imaging-based autopsies are increasingly used as an alternative to conventional autopsy. Our aim was to evaluate the clinical performance and cost of minimally invasive autopsy. Methods This study was part of a prospective cohort study evaluating a newly implemented minimally invasive autopsy consisting of MRI, CT, and biopsies. We calculated diagnostic yield and clinical utility—defined as the percentage successfully answered clinical questions—of minimally invasive autopsy. We performed minimally invasive autopsy in 46 deceased (30 men, 16 women; mean age 62.9±17.5, min-max: 18–91). Results Ninety-six major diagnoses were found with the minimally invasive autopsy of which 47/96 (49.0%) were new diagnoses. CT found 65/96 (67.7%) major diagnoses and MRI found 82/96 (85.4%) major diagnoses. Eighty-four clinical questions were asked in all cases. Seventy-one (84.5%) of these questions could be answered with minimally invasive autopsy. CT successfully answered 34/84 (40.5%) clinical questions; in 23/84 (27.4%) without the need for biopsies, and in 11/84 (13.0%) a biopsy was required. MRI successfully answered 60/84 (71.4%) clinical questions, in 27/84 (32.1%) without the need for biopsies, and in 33/84 (39.8%) a biopsy was required. The mean cost of a minimally invasive autopsy was €1296 including brain biopsies and €1087 without brain biopsies. Mean cost of CT was €187 and of MRI €284. Conclusions A minimally invasive autopsy, consisting of CT, MRI and CT-guided biopsies, performs well in answering clinical questions and detecting major diagnoses. However, the diagnostic yield and clinical utility were quite low for postmortem CT and MRI as standalone modalities.
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Affiliation(s)
- Ivo M. Wagensveld
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Department of Pathology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- * E-mail:
| | - M. G. Myriam Hunink
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Department of Clinical Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Centre for Health Decision Science, Harvard T.H. Chan School of Public Health, Harvard University, Boston, United States of America
| | - Piotr A. Wielopolski
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | | | - Gabriel P. Krestin
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Britt M. Blokker
- Department of Pathology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - J. Wolter Oosterhuis
- Department of Pathology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Annick C. Weustink
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Department of Pathology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
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Diagnostic Accuracy of Postmortem CT of Children: A Retrospective Single-Center Study. AJR Am J Roentgenol 2019; 212:1335-1347. [PMID: 30917029 DOI: 10.2214/ajr.18.20534] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE. The objective of our study was to determine the diagnostic accuracy of postmortem CT in children compared with standard autopsy. MATERIALS AND METHODS. This single-center retrospective study reviewed un-enhanced whole-body postmortem CT examinations of children less than 16 years old with corresponding autopsy reports irrespective of the clinical indication for referral for postmortem CT. Perinatal deaths were excluded. Postmortem CT was reported by experienced postmortem radiologists who were blinded to autopsy findings, with the primary outcome being concordance for the main pathologic diagnosis or findings leading to a cause of death. Autopsy performed by pediatric pathologists was the reference standard. RESULTS. One hundred thirty-six patients (74 [54.4%] male and 62 [45.6%] female patients) were included. The mean age of the 136 patients was 2 years 1 month (range, 2 days-14.7 years). A cause of death at autopsy was found for 77 of the 136 (56.6%) patients. Postmortem CT depicted a correct cause of death in 55 of 77 (71.4%) patients; (55/136 overall [40.4%]), with the majority attributable to traumatic brain or body injuries. For major pathologic findings, diagnostic accuracy rates were a sensitivity of 71.4% (95% CI, 60.5-80.3%), specificity of 81.4% (95% CI, 69.6-89.3%), positive predictive value of 83.3% (95% CI, 72.6-90.4%), negative predictive value of 68.6% (95% CI, 57.0-78.2%), and concordance rate of 75.7% (95% CI, 67.9-82.2%). The sensitivity of postmortem CT versus autopsy was highest for intracranial (75.6%; 95% CI, 60.7-86.2%) and musculoskeletal (98.4%; 95% CI, 91.4-99.7%) abnormalities and lowest for cardiac (31.3%; 95% CI, 14.2-55.6%) and abdominal (53.8%; 95% CI, 29.1-78.6%) findings. CONCLUSION. Postmortem CT gives an acceptable diagnostic concordance rate with autopsy of 71.4%, although identification of the cause of death overall was low at 40.4%. The highest accuracy rates were for intracranial and musculoskeletal abnormalities.
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Abstract
Autopsies are of key importance for the understanding of the anatomy, pathophysiology and pathomorphology. In forensic medicine, the virtual autopsy is a standard instrument in autopsy practice. The advantage of postmortem imaging is the generation of a three-dimensional pre-autopsy snapshot of the body from head to toe with excellent visualization of skeletal pathologies and air inclusions. When angiography is performed, pathologies of the cardiovascular system can additionally be evaluated. The shortcomings of postmortem imaging are the low soft tissue contrast with CT imaging, the lack of haptic, olfactory and color impressions. Another limitation is the access to CT and particularly to magnetic resonance imaging (MRI) facilities and the necessary experience with the peculiarities of postmortem imaging. To date, postmortem imaging can supplement but not replace the traditional autopsy. Nevertheless, postmortem imaging adds valuable technical capabilities to the traditional autopsy. The ability to achieve valid results for the cause of death and additional diagnoses must be evaluated systematically for postmortem imaging, in particular in addition to CT or MR guided biopsies. This article gives an overview of the current state of the technology and encourages its development for application in pathology departments.
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La Russa R, Catalano C, Di Sanzo M, Scopetti M, Gatto V, Santurro A, Viola RV, Panebianco V, Frati P, Fineschi V. Postmortem computed tomography angiography (PMCTA) and traditional autopsy in cases of sudden cardiac death due to coronary artery disease: a systematic review and meta-analysis. Radiol Med 2018; 124:109-117. [PMID: 30259270 DOI: 10.1007/s11547-018-0943-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 09/11/2018] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Several studies have been performed to assess the efficacy of postmortem computed tomography angiography (PMCTA) in solving cases of sudden cardiac death, even in comparison with the traditional autopsy. However, the results were often inconsistent and inconclusive. Therefore, a global discussion on the subject through a systematic review of the literature and a meta-analysis is necessary. METHODS A systematic search of PubMed was performed up to April 23, 2018. Studies exploring the role of PMCTA in cases of sudden cardiac death and the accuracy of this method in diagnosing the cause of death compared to traditional autopsy were included. RESULTS The overall sensitivity and specificity of the seven included studies, using conventional autopsy as a reference standard, were 92% and 95%, respectively. The positive and negative likelihood ratios were, respectively, 20.76 (95% CI 1.16-370.2) and 0.08 (95% CI 0.03-0.17), showing that PMCTA represents a strong indicator of the posttest probability of disease. The diagnostic odds ratio and the area under the curve were, respectively, 261.54 (95% CI 1.87-5760.53) and 0.93 (95% CI 0.90-0.95), indicating a high diagnostic power of the test. CONCLUSION PMCTA demonstrated a high accuracy in the diagnosis of parietal and luminal coronary changes but was less effective in detecting myocardial ischemia and necrosis. Therefore, the only radiological investigation is often insufficient to determine the cause of sudden death and the conventional autopsy remains the gold standard. However, PMCTA can improve the performance of the autopsy, serving as an aid and guide in the sampling phase for histopathological investigations.
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Affiliation(s)
- Raffaele La Russa
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161, Rome, Italy.,IRCCS Neuromed, Via Atinense 18, Pozzilli, 86077, Italy
| | - Carlo Catalano
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University, Viale Regina Elena 324, 00161, Rome, Italy
| | - Mariantonia Di Sanzo
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161, Rome, Italy
| | - Matteo Scopetti
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161, Rome, Italy
| | - Vittorio Gatto
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161, Rome, Italy
| | - Alessandro Santurro
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161, Rome, Italy
| | - Rocco Valerio Viola
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161, Rome, Italy
| | - Valeria Panebianco
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University, Viale Regina Elena 324, 00161, Rome, Italy
| | - Paola Frati
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161, Rome, Italy.,IRCCS Neuromed, Via Atinense 18, Pozzilli, 86077, Italy
| | - Vittorio Fineschi
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161, Rome, Italy. .,IRCCS Neuromed, Via Atinense 18, Pozzilli, 86077, Italy.
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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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Fernández-Rodríguez A, Burton JL, Andreoletti L, Alberola J, Fornes P, Merino I, Martínez MJ, Castillo P, Sampaio-Maia B, Caldas IM, Saegeman V, Cohen MC. Post-mortem microbiology in sudden death: sampling protocols proposed in different clinical settings. Clin Microbiol Infect 2018; 25:570-579. [PMID: 30145399 DOI: 10.1016/j.cmi.2018.08.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Revised: 07/10/2018] [Accepted: 08/11/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Autopsies, including minimally invasive autopsies, are a powerful tool for determination of the cause of death. When a patient dies from an infection, microbiology is crucial to identify the causative organism. Post-mortem microbiology (PMM) aims to detect unexpected infections causing sudden deaths; confirm clinically suspected but unproven infection; evaluate the efficacy of antimicrobial therapy; identify emergent pathogens; and recognize medical errors. Additionally, the analysis of the thanatomicrobiome may help to estimate the post-mortem interval. AIMS The aim was to provide advice in the collection of PMM samples and to propose sampling guidelines for microbiologists advising autopsy pathologists facing different sudden death scenarios. SOURCES A multidisciplinary team with experts in various fields of microbiology and autopsies on behalf of the ESGFOR (ESCMID - European Society of Clinical Microbiology and Infectious Diseases - study group of forensic and post-mortem microbiology and in collaboration with the European Society of Pathology) developed this narrative review based on a literature search using MedLine and Scopus electronic databases supplemented with their own expertise. CONTENT These guidelines address measures to prevent sample contamination in autopsy microbiology; general PMM sampling technique; protocols for PMM sampling in different scenarios and using minimally invasive autopsy; and potential use of the evolving post-mortem microbiome to estimate the post-mortem interval. IMPLICATIONS Adequate sampling is paramount to identify the causative organism. Meaningful interpretation of PMM results requires careful evaluation in the context of clinical history, macroscopic and histological findings. Networking and closer collaboration among microbiologists and autopsy pathologists is vital to maximize the yield of PMM.
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Affiliation(s)
- A Fernández-Rodríguez
- Microbiology Laboratory, Biology Department, Instituto Nacional de Toxicología y Ciencias Forenses, Las Rozas de Madrid, Madrid, Spain.
| | | | - L Andreoletti
- Molecular and Clinical Virology Department, EA-4684 CardioVir, Faculty of Medicine and University Hospital Centre, University of Reims Champagne-Ardenne, Reims, France
| | - J Alberola
- Microbiology Service, University Hospital Dr. Peset Valencia, School of Medicine, University of Valencia, Valencia, Spain
| | - P Fornes
- Pathology Department and Forensic Institute, Academic Hospital, Champagne-Ardenne, Reims, France
| | - I Merino
- Microbiology Department, Hospital Universitario Ramón y Cajal-Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain; Spanish Network for Research in Infectious Diseases (REIPI), Instituto de Salud Carlos III, Madrid, Spain
| | - M J Martínez
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Spain; Department of Microbiology, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | - P Castillo
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Spain; Department of Pathology, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | - B Sampaio-Maia
- Faculdade de Medicina Dentária, i3S - Instituto de Investigação e Inovação em Saúde, INEB - Instituto de Engenharia Biomédica, Universidade do Porto, Porto, Portugal
| | - I M Caldas
- Faculdade de Medicina Dentária da Universidade do Porto, CFE - Centre os Functional Ecology, University of Coimbra, IINFACTS - Institute of Research and Advanced Training in Health Sciences, Department of Sciences, University Institute of Health Sciences (IUCS), CESPU, Gandra, Portugal
| | - V Saegeman
- Clinical Laboratory, AZ Nikolaas, Sint-Niklaas, Belgium
| | - M C Cohen
- Sheffield Children's Hospital NHS FT, Histopathology Department, Sheffield UK
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Willaume T, Farrugia A, Kieffer EM, Charton J, Geraut A, Berthelon L, Bierry G, Raul JS. The benefits and pitfalls of post-mortem computed tomography in forensic external examination: A retrospective study of 145 cases. Forensic Sci Int 2018; 286:70-80. [DOI: 10.1016/j.forsciint.2018.02.030] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 02/26/2018] [Accepted: 02/28/2018] [Indexed: 01/11/2023]
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Sonnemans LJP, Kubat B, Prokop M, Klein WM. Can virtual autopsy with postmortem CT improve clinical diagnosis of cause of death? A retrospective observational cohort study in a Dutch tertiary referral centre. BMJ Open 2018; 8:e018834. [PMID: 29549202 PMCID: PMC5857682 DOI: 10.1136/bmjopen-2017-018834] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE To investigate whether virtual autopsy with postmortem CT (PMCT) improves clinical diagnosis of the immediate cause of death. DESIGN Retrospective observational cohort study. INCLUSION CRITERIA inhospital and out-of-hospital deaths over the age of 1 year in whom virtual autopsy with PMCT and conventional autopsy were performed. EXCLUSION CRITERIA forensic cases, postmortal organ donors and cases with incomplete scanning procedures. Cadavers were examined by virtual autopsy with PMCT prior to conventional autopsy. The clinically determined cause of death was recorded before virtual autopsy and was then adjusted with the findings of virtual autopsy. Using conventional autopsy as reference standard, we investigated the increase in sensitivity for immediate cause of death, type of pathology and anatomical system involved before and after virtual autopsy. SETTING Tertiary referral centre. PARTICIPANTS 86 cadavers that underwent conventional and virtual autopsy between July 2012 and June 2016. INTERVENTION PMCT consisted of brain, cervical spine and chest-abdomen-pelvis imaging. Conventional autopsy consisted of thoracoabdominal examination with/without brain autopsy. PRIMARY AND SECONDARY OUTCOME MEASURES Increase in sensitivity for the immediate cause of death, type of pathology (infection, haemorrhage, perfusion disorder, other or not assigned) and anatomical system (pulmonary, cardiovascular, gastrointestinal, other or not assigned) involved, before and after virtual autopsy. RESULTS Using PMCT, the sensitivity for immediate cause of death increased with 12% (95% CI 2% to 22%) from 53% (41% to 64%) to 64% (53% to 75%), with 18% (9% to 27%) from 65% (54% to 76%) to 83% (73% to 91%) for type of pathology and with 19% (9% to 30%) from 65% (54% to 76%) to 85% (75% to 92%) for anatomical system. CONCLUSION While unenhanced PMCT is an insufficient substitute for conventional autopsy, it can improve diagnosis of cause of death over clinical diagnosis alone and should therefore be considered whenever autopsy is not performed.
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Affiliation(s)
- Lianne J P Sonnemans
- Department of Radiology and Nuclear Medicine, Radboudumc, Nijmegen, The Netherlands
| | - Bela Kubat
- Department of Pathology, Netherlands Forensic Institute, Hague, The Netherlands
- Department of Pathology, Maastricht UMC+, Maastricht, The Netherlands
| | - Mathias Prokop
- Department of Radiology and Nuclear Medicine, Radboudumc, Nijmegen, The Netherlands
| | - Willemijn M Klein
- Department of Radiology and Nuclear Medicine, Radboudumc, Nijmegen, The Netherlands
- Department of Radiology and Nuclear Medicine, Maastricht UMC+, Maastricht, The Netherlands
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De Marco E, Vacchiano G, Frati P, La Russa R, Santurro A, Scopetti M, Guglielmi G, Fineschi V. Evolution of post-mortem coronary imaging: from selective coronary arteriography to post-mortem CT-angiography and beyond. Radiol Med 2018; 123:351-358. [PMID: 29357039 DOI: 10.1007/s11547-018-0855-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 01/08/2018] [Indexed: 12/17/2022]
Abstract
Since the 1970s, remarkable efforts have been made in the post-mortem coronary study, especially by angiography, as an added tool to diagnose heart-related deaths. In more recent times, post-mortem CT (PMCT) and post-mortem CT-angiography (PMCTA) have become an established practice in numerous forensic units, because of the undeniable advantages these diagnostic instruments can offer: data acquisition times are increasingly fast, costs have become lower and, once acquired, data can be re-utilized and re-evaluated at any given time. This review aims to chart the history of post-mortem cardiac imaging, highlighting its evolution both in terms of methodology and technology as well as the contribution that forensic radiology has been able to offer to forensic pathology, not as an alternative to autopsy but as a guide and aid when performing one. Finally, the latest advances in the study of cardiac deaths are explored, namely by cardiac post-mortem MRI (PMMR), able to visualize all the various stages of a myocardial infarction, post-mortem MRI-angiography (PMMRA), useful in investigating coronary artery pathology and post-mortem cardiac micro-CT, able to provide near-histological levels of myocardial, coronary and valvular detail.
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Affiliation(s)
- Emidio De Marco
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy
| | - Giuseppe Vacchiano
- Department of Law, Economics, Management and Quantitative Methods, University of Sannio, Benevento, Italy
| | - Paola Frati
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy
- Department of Law, Economics, Management and Quantitative Methods, University of Sannio, Benevento, Italy
- Malzoni Clinical-Scientific Institute, Avellino, Italy
| | - Raffaele La Russa
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy
- Department of Law, Economics, Management and Quantitative Methods, University of Sannio, Benevento, Italy
- Malzoni Clinical-Scientific Institute, Avellino, Italy
- IRCCS Neuromed, Pozzilli, Italy
| | - Alessandro Santurro
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy
| | - Matteo Scopetti
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy
| | - Giuseppe Guglielmi
- Department of Radiology, University of Foggia, Viale Luigi Pinto 1, 71100, Foggia, Italy.
| | - Vittorio Fineschi
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy
- Department of Law, Economics, Management and Quantitative Methods, University of Sannio, Benevento, Italy
- Malzoni Clinical-Scientific Institute, Avellino, Italy
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Matoba K, Hyodoh H, Murakami M, Saito A, Matoba T, Ishida L, Fujita E, Yamase M, Jin S. Estimating normal lung weight measurement using postmortem CT in forensic cases. Leg Med (Tokyo) 2017; 29:77-81. [DOI: 10.1016/j.legalmed.2017.10.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 10/25/2017] [Accepted: 10/30/2017] [Indexed: 10/18/2022]
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Wagensveld IM, Blokker BM, Wielopolski PA, Renken NS, Krestin GP, Hunink MG, Oosterhuis JW, Weustink AC. Total-body CT and MR features of postmortem change in in-hospital deaths. PLoS One 2017; 12:e0185115. [PMID: 28953923 PMCID: PMC5617178 DOI: 10.1371/journal.pone.0185115] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 09/05/2017] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To evaluate the frequency of total-body CT and MR features of postmortem change in in-hospital deaths. MATERIALS AND METHODS In this prospective blinded cross-sectional study, in-hospital deceased adult patients underwent total-body postmortem CT and MR followed by image-guided biopsies. The presence of PMCT and PMMR features related to postmortem change was scored retrospectively and correlated with postmortem time interval, post-resuscitation status and intensive care unit (ICU) admittance. RESULTS Intravascular air, pleural effusion, periportal edema, and distended intestines occurred more frequently in patients who were resuscitated compared to those who were not. Postmortem clotting was seen less often in resuscitated patients (p = 0.002). Distended intestines and loss of grey-white matter differentiation in the brain showed a significant correlation with postmortem time interval (p = 0.001, p<0.001). Hyperdense cerebral vessels, intravenous clotting, subcutaneous edema, fluid in the abdomen and internal livores of the liver were seen more in ICU patients. Longer postmortem time interval led to a significant increase in decomposition related changes (p = 0.026). CONCLUSIONS There is a wide variety of imaging features of postmortem change in in-hospital deaths. These imaging features vary among clinical conditions, increase with longer postmortem time interval and must be distinguished from pathologic changes.
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Affiliation(s)
- Ivo M. Wagensveld
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Centre, Rotterdam, Zuid-Holland, The Netherlands
- Department of Pathology, Erasmus University Medical Centre, Rotterdam, Zuid-Holland, The Netherlands
- * E-mail:
| | - Britt M. Blokker
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Centre, Rotterdam, Zuid-Holland, The Netherlands
- Department of Pathology, Erasmus University Medical Centre, Rotterdam, Zuid-Holland, The Netherlands
| | - Piotr A. Wielopolski
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Centre, Rotterdam, Zuid-Holland, The Netherlands
| | - Nomdo S. Renken
- Department of Radiology, Reinier de Graaf Gasthuis, Delft, Zuid-Holland, The Netherlands
| | - Gabriel P. Krestin
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Centre, Rotterdam, Zuid-Holland, The Netherlands
| | - Myriam G. Hunink
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Centre, Rotterdam, Zuid-Holland, The Netherlands
- Centre for Health Decision Science, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, United States of America
| | - J. Wolter Oosterhuis
- Department of Pathology, Erasmus University Medical Centre, Rotterdam, Zuid-Holland, The Netherlands
| | - Annick C. Weustink
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Centre, Rotterdam, Zuid-Holland, The Netherlands
- Department of Pathology, Erasmus University Medical Centre, Rotterdam, Zuid-Holland, The Netherlands
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Kaichi Y, Sakane H, Higashibori H, Honda Y, Tatsugami F, Baba Y, Iida M, Awai K. Relationship between sudden natural death and abdominal fat evaluated on postmortem CT scans. Obes Sci Pract 2017; 3:219-223. [PMID: 28702215 PMCID: PMC5478802 DOI: 10.1002/osp4.99] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 12/17/2016] [Accepted: 12/19/2016] [Indexed: 11/23/2022] Open
Abstract
Objective This study examined the association between sudden natural death and abdominal fat using postmortem computed tomography (CT) scans. Subjects and methods Postmortem CT images at the umbilical level of 241 subjects were used to measure abdominal areas of subcutaneous‐ and visceral fat, the rate of visceral fat and the waist circumference. Of the study subjects, 174 died of sudden natural death (130 men and 44 women), and 67 died of different causes (46 men and 21 women). All were between 40 and 75 years of age. Logistic regression analysis was performed to identify independent abdominal parameters associated with sudden natural death. Results By univariate analysis, the areas of subcutaneous and visceral fat were significantly larger in sudden natural death than who died of different causes (subcutaneous fat, odds ratio [OR] = 1.004, 95% confidence interval [CI] = 1.000–1.007, p = 0.03; visceral fat, OR = 1.008, 95% CI = 1.003–1.013, p < 0.01). Multivariate analysis showed that the area of visceral fat was an independent factor associated with the risk of sudden natural death (OR = 1.008, 95% CI = 1.002–1.015, p = 0.02). Conclusions Postmortem CT revealed that sudden natural death was related to abdominal fat deposits.
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Affiliation(s)
- Y. Kaichi
- Diagnostic Radiology; Hiroshima University; Hiroshima Japan
| | - H. Sakane
- Diagnostic Radiology; Hiroshima University; Hiroshima Japan
| | - H. Higashibori
- Diagnostic Radiology; Hiroshima University; Hiroshima Japan
| | - Y. Honda
- Diagnostic Radiology; Hiroshima University; Hiroshima Japan
| | - F. Tatsugami
- Diagnostic Radiology; Hiroshima University; Hiroshima Japan
| | - Y. Baba
- Diagnostic Radiology; Hiroshima University; Hiroshima Japan
| | - M. Iida
- Diagnostic Radiology; Hiroshima University; Hiroshima Japan
| | - K. Awai
- Diagnostic Radiology; Hiroshima University; Hiroshima Japan
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Diagnostic accuracy of postmortem imaging vs autopsy-A systematic review. Eur J Radiol 2016; 89:249-269. [PMID: 28089245 DOI: 10.1016/j.ejrad.2016.08.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Revised: 07/11/2016] [Accepted: 08/02/2016] [Indexed: 11/23/2022]
Abstract
Background Postmortem imaging has been used for more than a century as a complement to medico-legal autopsies. The technique has also emerged as a possible alternative to compensate for the continuous decline in the number of clinical autopsies. To evaluate the diagnostic accuracy of postmortem imaging for various types of findings, we performed this systematic literature review. Data sources The literature search was performed in the databases PubMed, Embase and Cochrane Library through January 7, 2015. Relevant publications were assessed for risk of bias using the QUADAS tool and were classified as low, moderate or high risk of bias according to pre-defined criteria. Autopsy and/or histopathology were used as reference standard. Findings The search generated 2600 abstracts, of which 340 were assessed as possibly relevant and read in full-text. After further evaluation 71 studies were finally included, of which 49 were assessed as having high risk of bias and 22 as moderate risk of bias. Due to considerable heterogeneity - in populations, techniques, analyses and reporting - of included studies it was impossible to combine data to get a summary estimate of the diagnostic accuracy of the various findings. Individual studies indicate, however, that imaging techniques might be useful for determining organ weights, and that the techniques seem superior to autopsy for detecting gas Conclusions and Implications In general, based on the current scientific literature, it was not possible to determine the diagnostic accuracy of postmortem imaging and its usefulness in conjunction with, or as an alternative to autopsy. To correctly determine the usefulness of postmortem imaging, future studies need improved planning, improved methodological quality and larger materials, preferentially obtained from multi-center studies.
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Post-mortem computed tomography angiography utilizing barium sulfate to identify microvascular structures: a preliminary phantom model and case study. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.jofri.2016.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Fischer H, Heinemann A. Arbeitsgemeinschaft für Forensische Bildgebung der Deutschen Gesellschaft für Rechtsmedizin. Rechtsmedizin (Berl) 2016. [DOI: 10.1007/s00194-016-0096-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Pulmonary thromboembolism on unenhanced postmortem computed tomography: Feasibility and findings. Leg Med (Tokyo) 2016; 20:68-74. [DOI: 10.1016/j.legalmed.2016.04.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 04/16/2016] [Accepted: 04/18/2016] [Indexed: 11/21/2022]
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Sugimoto M, Hyodoh H, Rokukawa M, Kanazawa A, Murakami R, Shimizu J, Okazaki S, Mizuo K, Watanabe S. Freezing effect on brain density in postmortem CT. Leg Med (Tokyo) 2015; 18:62-5. [PMID: 26832379 DOI: 10.1016/j.legalmed.2015.12.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Revised: 12/16/2015] [Accepted: 12/17/2015] [Indexed: 11/30/2022]
Abstract
Two 60-year-old males were found at their homes whose bodies had deteriorated due to putrefaction. To prevent worm invasion and minimize deterioration, dry ice was used prior to the autopsy investigation. Prior to autopsy, postmortem CT demonstrated a decreased density in brain parenchyma at the dry-iced side, and autopsy revealed deteriorated brain parenchyma with frozen effect (presented like sherbet). Moreover, the deteriorated cerebral parenchyma maintained their structure and they were evaluated by cutting. When lower CT density presents in postmortem CT, the freezing effect may need to be considered and the physician should evaluate the cadaver's postmortem condition to prevent misdiagnoses.
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Affiliation(s)
- Miyu Sugimoto
- Department of Legal Medicine, Sapporo Medical University, S1 W17 Chuo-ku, Sapporo 060-8556, Japan
| | - Hideki Hyodoh
- Department of Legal Medicine, Sapporo Medical University, S1 W17 Chuo-ku, Sapporo 060-8556, Japan.
| | - Masumi Rokukawa
- Department of Legal Medicine, Sapporo Medical University, S1 W17 Chuo-ku, Sapporo 060-8556, Japan
| | - Ayumi Kanazawa
- Department of Legal Medicine, Sapporo Medical University, S1 W17 Chuo-ku, Sapporo 060-8556, Japan
| | - Rina Murakami
- Department of Legal Medicine, Sapporo Medical University, S1 W17 Chuo-ku, Sapporo 060-8556, Japan
| | - Junya Shimizu
- Department of Legal Medicine, Sapporo Medical University, S1 W17 Chuo-ku, Sapporo 060-8556, Japan
| | - Shunichiro Okazaki
- Department of Legal Medicine, Sapporo Medical University, S1 W17 Chuo-ku, Sapporo 060-8556, Japan
| | - Keisuke Mizuo
- Department of Legal Medicine, Sapporo Medical University, S1 W17 Chuo-ku, Sapporo 060-8556, Japan
| | - Satoshi Watanabe
- Department of Legal Medicine, Sapporo Medical University, S1 W17 Chuo-ku, Sapporo 060-8556, Japan
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Deep Into the Fibers! Postmortem Diffusion Tensor Imaging in Forensic Radiology. Am J Forensic Med Pathol 2015; 36:153-61. [DOI: 10.1097/paf.0000000000000177] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Heinemann A, Vogel H, Heller M, Tzikas A, Püschel K. Investigation of medical intervention with fatal outcome: the impact of post-mortem CT and CT angiography. Radiol Med 2015; 120:835-45. [PMID: 26286005 PMCID: PMC4545182 DOI: 10.1007/s11547-015-0574-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Accepted: 07/30/2015] [Indexed: 01/22/2023]
Abstract
Post-mortem computed tomography (PMCT) has been proven for its appropriateness to become an integral part of routine pre-autoptic forensic investigations either in the field of forensic investigation of fatal medical error or in hospital quality management. The autoptic investigation of unexpected and peri-interventional deaths can be usefully guided by post-mortem imaging which offers significant added value in the documentation of misplacement of medical devices before dissection with the risk of artificial relocation and the detection of iatrogenic air embolism. Post-mortem CT angiography (PMCTA) augments PMCT in the search for sources of hemorrhages and for the documentation of vascular patency and unimpaired perfusion after general and cardiovascular surgery or transvascular catheter-assisted interventions. Limitations of PMCT and PMCTA in medical error cases are method-related or time-dependent including artifacts by early post-mortem tissue change. Thromboembolic complications including pulmonary embolism, the differentiation of ante- and post-mortem coagulation and the detection of myocardial infarction remain areas with compromised diagnostic efficiency as compared to autopsy. Furthermore, extended survival periods after a complication in question impedes visualization of contrast agent extravasation at vascular leakage sites. PMCT and PMCTA contribute substantially for proving a correct interventional approach and guide forensic or clinical autopsy in the reconstruction of adverse medical events with fatal outcome. Post-mortem imaging could also assume a new role as an alternative in a clinicopathological setting if autopsy is not achievable when the probability in the individual case is acceptable to answer specific questions.
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Affiliation(s)
- Axel Heinemann
- Institute for Legal Medicine, University Medical Center Hamburg-Eppendorf, Butenfeld 34, 22529, Hamburg, Germany,
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Leth PM, Knudsen PT. Unexpected death caused by rupture of a dilated aorta in an adult male with aortic coarctation. Forensic Sci Int 2015; 254:e25-8. [PMID: 26232155 DOI: 10.1016/j.forsciint.2015.07.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2015] [Revised: 07/10/2015] [Accepted: 07/13/2015] [Indexed: 10/23/2022]
Abstract
Aortic coarctation (AC) is a congenital aortic narrowing. We describe for the first time the findings obtained by unenhanced post mortem computed tomography (PMCT) in a case where the death was caused by cardiac tamponade from a ruptured aneurysmal dilatation of the ascending aorta and the aortic arch without dissection combined with aortic coarctation. The patient, a 46-year-old man, was found dead at home. PMCT showed haemopericardium and dilatation of the ascending aorta and the aortic arch. This appearance led to the mistaken interpretation that the images represented a dissecting aneurysm. The autopsy showed instead a thin-walled and floppy dilatation of the ascending aorta and aortic arch with a coarctation just proximal to the ligamentum arteriosum. A longitudinal tear was found in the posterior aortic wall just above the valves. Blood in the surrounding soft tissue intersected with a large haematoma (1000ml) in the pericardial sac. Cardiac hypertrophy (556g) was observed in the patient, though no other cardiovascular abnormalities were found. Histological analysis showed cystic medial necrosis of the ascending aortic wall. A ruptured aneurysmal dilatation of the ascending aorta and the aortic arch without aortic dissection associated with AC is an uncommon cause of haemopericardium that has only been described a few times before. The case is discussed in relation to other reported cases and in the context of the present understanding of this condition.
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Affiliation(s)
- Peter Mygind Leth
- Institute of Forensic Medicine, University of Southern Denmark, Denmark.
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Blokker BM, Wagensveld IM, Weustink AC, Oosterhuis JW, Hunink MGM. Non-invasive or minimally invasive autopsy compared to conventional autopsy of suspected natural deaths in adults: a systematic review. Eur Radiol 2015. [PMID: 26210206 PMCID: PMC4778156 DOI: 10.1007/s00330-015-3908-8] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVES Autopsies are used for healthcare quality control and improving medical knowledge. Because autopsy rates are declining worldwide, various non-invasive or minimally invasive autopsy methods are now being developed. To investigate whether these might replace the invasive autopsies conventionally performed in naturally deceased adults, we systematically reviewed original prospective validation studies. MATERIALS AND METHODS We searched six databases. Two reviewers independently selected articles and extracted data. Methods and patient groups were too heterogeneous for meaningful meta-analysis of outcomes. RESULTS Sixteen of 1538 articles met our inclusion criteria. Eight studies used a blinded comparison; ten included less than 30 appropriate cases. Thirteen studies used radiological imaging (seven dealt solely with non-invasive procedures), two thoracoscopy and laparoscopy, and one sampling without imaging. Combining CT and MR was the best non-invasive method (agreement for cause of death: 70 %, 95%CI: 62.6; 76.4), but minimally invasive methods surpassed non-invasive methods. The highest sensitivity for cause of death (90.9 %, 95%CI: 74.5; 97.6, suspected duplicates excluded) was achieved in recent studies combining CT, CT-angiography and biopsies. CONCLUSION Minimally invasive autopsies including biopsies performed best. To establish a feasible alternative to conventional autopsy and to increase consent to post-mortem investigations, further research in larger study groups is needed. KEY POINTS • Health care quality control benefits from clinical feedback provided by (alternative) autopsies. • So far, sixteen studies investigated alternative autopsy methods for naturally deceased adults. • Thirteen studies used radiological imaging modalities, eight tissue biopsies, and three CT-angiography. • Combined CT, CT-angiography and biopsies were most sensitive diagnosing cause of death.
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Affiliation(s)
- Britt M Blokker
- Department of Pathology, Erasmus University Medical Centre, Rotterdam, The Netherlands.,Department of Radiology, Erasmus University Medical Centre, Rotterdam, The Netherlands.,Department of Clinical Epidemiology, Erasmus University Medical Centre, Room Na-2818, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Ivo M Wagensveld
- Department of Pathology, Erasmus University Medical Centre, Rotterdam, The Netherlands.,Department of Radiology, Erasmus University Medical Centre, Rotterdam, The Netherlands.,Department of Clinical Epidemiology, Erasmus University Medical Centre, Room Na-2818, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Annick C Weustink
- Department of Radiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - J Wolter Oosterhuis
- Department of Pathology, Erasmus University Medical Centre, Rotterdam, The Netherlands.,Department of Radiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - M G Myriam Hunink
- Department of Radiology, Erasmus University Medical Centre, Rotterdam, The Netherlands. .,Department of Clinical Epidemiology, Erasmus University Medical Centre, Room Na-2818, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands. .,Centre for Health Decision Sciences, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA.
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Abstract
Many health care providers believe that the autopsy is no longer relevant in high-technology medicine era. This has fueled a decline in the hospital autopsy rate. Although it seems that advanced diagnostic tests answer all clinical questions, studies repeatedly demonstrate that an autopsy uncovers as many undiagnosed conditions today as in the past. The forensic autopsy rate has also declined, although not as precipitously. Pathologists are still performing a nineteenth century autopsy procedure that remains essentially unchanged. Informatics offers several potential answers that will evolve the low-tech autopsy into the high-tech autopsy.
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Affiliation(s)
- Bruce Levy
- Department of Pathology, University of Illinois at Chicago, MC847, 840 South Wood Street 130 CSN, Chicago, IL 60612, USA.
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Franckenberg S, Schulze C, Bolliger SA, Gascho D, Thali MJ, Flach PM. Postmortem angiography in computed tomography and magnetic resonance imaging in a case of fatal hemorrhage due to an arterio-venous malformation in the brain. Leg Med (Tokyo) 2014; 17:180-3. [PMID: 25572321 DOI: 10.1016/j.legalmed.2014.11.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Revised: 11/25/2014] [Accepted: 11/26/2014] [Indexed: 10/24/2022]
Abstract
Autopsy is the traditional gold standard for determining the cause and manner of death in a forensic death investigation. However, postmortem imaging plays an ever-growing role in preliminary examination, even replacing conventional autopsy in some cases. This case report presents a case of massive intra-axial brain hemorrhage due to an arterio-venous malformation. The cause and manner of death were exclusively determined by postmortem radiology. Based on radiological findings, the autopsy was considered redundant and cancelled by the public prosecutor.
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Affiliation(s)
- Sabine Franckenberg
- Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, 8057 Zurich, Switzerland.
| | - Claudia Schulze
- Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, 8057 Zurich, Switzerland
| | - Stephan A Bolliger
- Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, 8057 Zurich, Switzerland
| | - Dominic Gascho
- Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, 8057 Zurich, Switzerland
| | - Michael J Thali
- Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, 8057 Zurich, Switzerland
| | - Patricia M Flach
- Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, 8057 Zurich, Switzerland
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Ruder TD, Thali MJ, Hatch GM. Essentials of forensic post-mortem MR imaging in adults. Br J Radiol 2014; 87:20130567. [PMID: 24191122 DOI: 10.1259/bjr.20130567] [Citation(s) in RCA: 92] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Post-mortem MR (PMMR) imaging is a powerful diagnostic tool with a wide scope in forensic radiology. In the past 20 years, PMMR has been used as both an adjunct and an alternative to autopsy. The role of PMMR in forensic death investigations largely depends on the rules and habits of local jurisdictions, availability of experts, financial resources, and individual case circumstances. PMMR images are affected by post-mortem changes, including position-dependent sedimentation, variable body temperature and decomposition. Investigators must be familiar with the appearance of normal findings on PMMR to distinguish them from disease or injury. Coronal whole-body images provide a comprehensive overview. Notably, short tau inversion-recovery (STIR) images enable investigators to screen for pathological fluid accumulation, to which we refer as "forensic sentinel sign". If scan time is short, subsequent PMMR imaging may be focussed on regions with a positive forensic sentinel sign. PMMR offers excellent anatomical detail and is especially useful to visualize pathologies of the brain, heart, subcutaneous fat tissue and abdominal organs. PMMR may also be used to document skeletal injury. Cardiovascular imaging is a core area of PMMR imaging and growing evidence indicates that PMMR is able to detect ischaemic injury at an earlier stage than traditional autopsy and routine histology. The aim of this review is to present an overview of normal findings on forensic PMMR, provide general advice on the application of PMMR and summarise the current literature on PMMR imaging of the head and neck, cardiovascular system, abdomen and musculoskeletal system.
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Affiliation(s)
- T D Ruder
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Zurich, Switzerland
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Sieswerda-Hoogendoorn T, Beenen LFM, van Rijn RR. Normal cranial postmortem CT findings in children. Forensic Sci Int 2014; 246:43-9. [PMID: 25437903 DOI: 10.1016/j.forsciint.2014.10.036] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2014] [Revised: 10/21/2014] [Accepted: 10/27/2014] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Postmortem imaging (both CT and MRI) has become a widely used tool the last few years, both for adults and children. If it would be known which findings are normal postmortem changes, interpretation of abnormal findings becomes less ambiguous. Our aim was to describe postmortem intracranial radiological findings on postmortem CT (PMCT) in children, which did not have a relationship with the cause of death, and to determine whether these findings have a relationship with the postmortem interval or with medical interventions. MATERIALS AND METHODS We selected all consecutive pediatric autopsies that were performed at the Netherlands Forensic Institute in the period 1-1-2008 to 31-12-2011, whereby the subject underwent total body PMCT. We collected data on age at death, gender, cause of death determined by forensic autopsy and time between death and PMCT. Normal findings that were scored were: gray-white differentiation of the brain, collapse of the ventricles, air in the orbit, fluid accumulation in the frontal and maxillary sinuses, and air in vessels of head and neck. RESULTS One-hundred-fifty-nine forensic pediatric autopsies were performed in the 4 year study period at the NFI; 77 underwent a total body PMCT, of which 68 were included in the analyses. Fluid accumulation in the sinuses was present 30-40% of the cases in which the sinuses were developed. In 22% of all children intravascular intracranial air, either arterial or venous, was detected. We did not find a relationship between the duration of the postmortem interval and the appearance of any of the findings. Intravenous infusion is not significantly associated with the presence of intravascular air, except for air in the left and right common carotid artery (B=2.9, P=0.05). CONCLUSIONS By demonstrating the intracranial abnormalities that appear postmortem, we have tried to provide more insight in the range of findings that can be seen with pediatric PMCT. As these findings resemble antemortem pathology, it is important that the radiologist who interprets PMCT has knowledge of these normal postmortem findings.
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Affiliation(s)
- T Sieswerda-Hoogendoorn
- Section Forensic Pediatrics, Department of Forensic Medicine, Netherlands Forensic Institute, The Hague, The Netherlands; Department of Radiology, Academic Medical Center/Emma Children's Hospital, Amsterdam, The Netherlands.
| | - L F M Beenen
- Department of Radiology, Academic Medical Center/Emma Children's Hospital, Amsterdam, The Netherlands.
| | - R R van Rijn
- Section Forensic Pediatrics, Department of Forensic Medicine, Netherlands Forensic Institute, The Hague, The Netherlands; Department of Radiology, Academic Medical Center/Emma Children's Hospital, Amsterdam, The Netherlands.
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Post-mortem CT scan with contrast injection and chest compression to diagnose pulmonary embolism. Intensive Care Med 2014; 41:167-8. [PMID: 25351895 DOI: 10.1007/s00134-014-3520-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2014] [Indexed: 10/24/2022]
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Litman KC, Lau H, Kanter MH, Jones JP. E-Autopsy: Using Structured Hybrid Manual/Electronic Mortality Reviews to Identify Quality Improvement Opportunities. Jt Comm J Qual Patient Saf 2014; 40:444-4. [DOI: 10.1016/s1553-7250(14)40057-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Polacco M, Sedati P, Arena V, Pascali VL, Zobel BB, Oliva A, Rossi R. Visualization of myocardial infarction by post-mortem single-organ coronary computed tomography: a feasibility study. Int J Legal Med 2014; 129:517-24. [PMID: 25249224 DOI: 10.1007/s00414-014-1085-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Accepted: 09/03/2014] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Post-mortem imaging is increasingly used in forensic field in cases of natural deaths related to cardiovascular diseases, which represent the most common causes of death in developed countries. While radiological examination is generally considered to be a good complement for conventional autopsy, it was thought to have limited application in cardiovascular pathology. The aim of this study was to investigate the role of post-mortem multidetector coronary artery computed tomography in cases of sudden death in adults. MATERIALS AND METHODS We have enrolled 11 cases, all of whom were negative for macroscopic extra-cardiac lethal findings after standard autopsy procedure. Later, from the same individuals, isolated single-organ post-mortem computed tomography coronarography (PMCTA), using an iodinated non-ionic contrast medium, was achieved. After computed tomography examination, all the isolated hearths were carried to the forensic pathologist, and a conventional histology assessment was performed on them. RESULTS In 7 out of 11 of cadavers, a final diagnosis of myocardial infarction was made after a complete autopsy and histology procedures. Isolated hearts underwent PMCTA scanning and was confirmed in 6/11 cases, with the autopsy findings showing the presence and the localization of occlusions or severe stenoses and the extension of the myocardial hypoxic area by the extravasation of contrast medium as well. CONCLUSION Isolated single-organ PMCTA could be considered a valid and useful tool in addition to traditional autopsy investigation (macroscopic sections and histology) in identifying the cause of death by recognizing the presence and degree of coronary artery disease and myocardial infarction area visualization.
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Affiliation(s)
- Matteo Polacco
- Institute of Public Health, Section of Legal Medicine, Catholic University, Rome, Italy
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Analysis of laryngeal fractures in decomposed bodies using microfocus computed tomography (mfCT). Forensic Sci Med Pathol 2014; 10:607-12. [PMID: 25119240 DOI: 10.1007/s12024-014-9584-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2014] [Indexed: 10/24/2022]
Abstract
Postmortem computed tomography (CT) is now routinely performed in forensic autopsies. Microfocus computed tomography (mfCT) has attracted recent attention because it can provide more detailed information than routine postmortem CT can. This feasibility study evaluated the usefulness of mfCT for examination of the hyoid bone and thyroid cartilage in cases of suspected strangulation, where advanced decomposition precludes detection of petechial hemorrhages and hemorrhages adjacent to fractures. The results show that mfCT was useful for identification of thin fracture lines in the fragile laryngeal structures. We suggest that mfCT should be considered for forensic autopsies in cases of suspected strangulation with advanced decomposition.
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50
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Törő K, Matlakovics B, Dudás I, Karlinger K, Kiss M, Molnár A, Nemeskéri A. The utility of the combination of the corrosion cast method and post mortem MSCT scans. Leg Med (Tokyo) 2014; 16:283-9. [PMID: 25034501 DOI: 10.1016/j.legalmed.2014.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 06/10/2014] [Accepted: 06/11/2014] [Indexed: 10/25/2022]
Abstract
A careful post-mortem investigation is needed to determine the cause of death of patients bearing coronary stents and to describe complications of stent implantation. The main purpose of this study was to combine post mortem methods of CT angiography and corrosion cast preparation for the visualization of coronary stenoses, coronary stents, instent restenosis, and stent occlusion. Injection-corrosion method was combined with post-mortem MSCT angiography to characterize the pathomorphological changes after stent implantation in 6 male cadaver hearts. Multi-slice computed tomography was employed to visualize the coronary artery system. For image post processing, multiplanar reconstructions, maximal intensity projections and three dimensional reconstructions were used. This study was assessing the feasibility of post mortem MSCT for intracoronary stent evaluation. We described a method for characterization of the coronary side branch stenosis caused by stent implantation. Post mortem CT imaging proved to be a feasible and highly reproducible technique for the characterization of pathological changes in the coronary system.
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Affiliation(s)
- Klára Törő
- Semmelweis University Department of Forensic and Insurance Medicine, Hungary.
| | - Balázs Matlakovics
- Semmelweis University Department of Human Morphology and Developmental Biology, Hungary
| | - Ibolyka Dudás
- Semmelweis University Department of Diagnostic Radiology and Oncotherapy, Hungary
| | - Kinga Karlinger
- Semmelweis University Department of Diagnostic Radiology and Oncotherapy, Hungary
| | - Mátyás Kiss
- Semmelweis University Department of Human Morphology and Developmental Biology, Hungary
| | - Agnes Molnár
- Semmelweis University Department of Human Morphology and Developmental Biology, Hungary
| | - Agnes Nemeskéri
- Semmelweis University Department of Human Morphology and Developmental Biology, Hungary
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