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Bruch GM, Grabherr S, Bruguier C, Fischer FT, Soto R, Magnin V, Genet P. Development of a protocol for standardized use of a water-soluble contrast agent with polyethylene glycol in post-mortem CT angiography. Int J Legal Med 2024; 138:1437-1446. [PMID: 38568229 PMCID: PMC11164774 DOI: 10.1007/s00414-024-03218-y] [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: 12/27/2023] [Accepted: 03/19/2024] [Indexed: 06/12/2024]
Abstract
Computed tomography angiography (PMCTA) is increasingly used in postmortem cases. Standardized validated protocols permit to compare different PMCTA images and make it more easily to defend a case in court. In addition to the well-known technique by Grabherr et al. (2011) which is using paraffin oil as a carrier substance, water-soluble polyethylene glycol 200 (PEG200) can be used in combination with the contrast agent Accupaque® 300. As to date, there exists no standardized protocol for the use of this contrast agent mixture, the aim of this study was to develop a protocol using it. Between 2012 and 2022, 23 PMCTA with PEG200 and Accupaque®300 were performed at the University Centre of Legal Medicine Lausanne (Switzerland) and the Institute of Forensic Medicine Munich (Germany). The images obtained were evaluated regarding the opacification of the vessels and possible artefacts. The best image quality was obtained with a mixing ratio of 1:15 (Accupaque®300:PEG200) and a perfusion volume of 1000 ml in the arterial, 1400 ml in the venous and 350 ml in the dynamic phase. The infusion rates described by Grabherr et al. were confirmed for the three phases. Overall, the opacification of the vessels was diagnostically sufficient. In 13 cases no opacification of the right coronary artery was observed due to a stratification artefact. By using the PMCTA protocol with PEG200 as a carrier, a good overall image quality can be achieved. This protocol offers the possibility to standardize PMCTA with PEG200.
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Affiliation(s)
- G M Bruch
- Institut Für Rechtsmedizin, Ludwig-Maximillians-Universität München, Nussbaumstr. 26, D - 80336, Munich, Deutschland.
- Centre Universitaire Romand de Médecine Légale, Centre Hospitalier Universitaire Vaudois, Chemin de La Vulliette 4, CH - 1000, Lausanne 25, Schweiz.
- Université de Genève, Rue du Général-Dufour 24, CH - 1211, Geneva 4, Schweiz.
| | - S Grabherr
- Centre Universitaire Romand de Médecine Légale, Centre Hospitalier Universitaire Vaudois, Chemin de La Vulliette 4, CH - 1000, Lausanne 25, Schweiz
- Centre Universitaire Romand de Médecine Légale, Hôpitaux Universitaires de Genève, Rue Michel-Servet 1, CH - 1211, Geneva 4, Schweiz
| | - C Bruguier
- Centre Universitaire Romand de Médecine Légale, Centre Hospitalier Universitaire Vaudois, Chemin de La Vulliette 4, CH - 1000, Lausanne 25, Schweiz
| | - F T Fischer
- Institut Für Rechtsmedizin, Ludwig-Maximillians-Universität München, Nussbaumstr. 26, D - 80336, Munich, Deutschland
| | - R Soto
- Centre Universitaire Romand de Médecine Légale, Centre Hospitalier Universitaire Vaudois, Chemin de La Vulliette 4, CH - 1000, Lausanne 25, Schweiz
- Centre Universitaire Romand de Médecine Légale, Hôpitaux Universitaires de Genève, Rue Michel-Servet 1, CH - 1211, Geneva 4, Schweiz
| | - V Magnin
- Centre Universitaire Romand de Médecine Légale, Centre Hospitalier Universitaire Vaudois, Chemin de La Vulliette 4, CH - 1000, Lausanne 25, Schweiz
- Centre Universitaire Romand de Médecine Légale, Hôpitaux Universitaires de Genève, Rue Michel-Servet 1, CH - 1211, Geneva 4, Schweiz
| | - P Genet
- Centre Universitaire Romand de Médecine Légale, Centre Hospitalier Universitaire Vaudois, Chemin de La Vulliette 4, CH - 1000, Lausanne 25, Schweiz
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2
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Beardmore S, Adeley J, Brookes A, Robinson C, Davendralingam N, Joseph J, McManoman B, Morgan B. Impact of changing from autopsy to post-mortem CT in an entire HM Coroner region due to a shortage of available pathologists. Clin Radiol 2023; 78:797-803. [PMID: 37827590 DOI: 10.1016/j.crad.2023.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 05/31/2023] [Accepted: 08/13/2023] [Indexed: 10/14/2023]
Abstract
A significant problem facing routine medicolegal coroner-referred autopsies is a shortfall of pathologists prepared to perform them. This was particularly acute in Lancashire, where the coroner decided to initiate a service that relied on post-mortem computed tomography (PMCT). This involved training anatomical pathology technologists (APTs) to perform external examinations, radiographers to perform scans, and radiologists to interpret them. The service started in 2018 and now examines over 1,500 cases per year. This study outlines the PMCT process using NHS staff, with CT equipment and logistics managed by the commercial sector. It compares the demographics and outcomes of PM investigations for two 6-month periods: the autopsy service prior to 2018, and then the PMCT service. These data were then compared with previous UK PMCT data. Referrals for adult non-suspicious deaths were made in 913 cases of which 793 (87%) had PMCT between 01/10/2018 and 31/03/2019. Fifty-six cases had autopsy after PMCT, so 81% of cases potentially avoided autopsy. The PMCT service did not delay release of bodies to the next-of-kin. Comparing the cause of death given shows no difference in the proportions of natural and unnatural deaths. There was an increase in diagnosis of coronary artery disease for PMCT, with less respiratory diagnoses, a feature not previously demonstrated. These data suggest PMCT is a practical solution for potentially failing autopsy services. By necessity, this involves changes in diagnoses, as PMCT and autopsy have different strengths and weakness, but the ability to pick up unnatural death appears unaffected.
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Affiliation(s)
- S Beardmore
- Royal Preston Hospital, Lancashire Teaching Hospitals NHS Foundation Trust, Sharoe Green Lane North, Fulwood, Preston, Lancashire, PR2 9HT, UK
| | - J Adeley
- HM Senior Coroner Lancashire and Blackburn with Darwen, Coroner's Court, 2 Faraday Court, Faraday Drive, Preston, Lancashire, PR2 9NB, UK
| | - A Brookes
- Royal Preston Hospital, Lancashire Teaching Hospitals NHS Foundation Trust, Sharoe Green Lane North, Fulwood, Preston, Lancashire, PR2 9HT, UK
| | - C Robinson
- Imaging Department, University Hospitals of Leicester, Leicester Royal Infirmary, Leicester, LE2 7LX, UK
| | - N Davendralingam
- Imaging Department, King's College Hospital, Denmark Hill, SE5 9RS, UK
| | - J Joseph
- Royal Preston Hospital, Lancashire Teaching Hospitals NHS Foundation Trust, Sharoe Green Lane North, Fulwood, Preston, Lancashire, PR2 9HT, UK
| | - B McManoman
- Royal Preston Hospital, Lancashire Teaching Hospitals NHS Foundation Trust, Sharoe Green Lane North, Fulwood, Preston, Lancashire, PR2 9HT, UK
| | - B Morgan
- Department of Life Sciences, University of Leicester, Radiology Department, Leicester Royal Infirmary, Infirmary Square, Leicester, LE2 7LX, UK.
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James J, Robinson C, Mason C, Richards C, West K, Morgan B. Impact of the COVID-19 pandemic on a post-mortem CT service for adult non-suspicious death. Clin Radiol 2023; 78:822-831. [PMID: 37827592 DOI: 10.1016/j.crad.2023.03.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 03/14/2023] [Accepted: 03/23/2023] [Indexed: 10/14/2023]
Abstract
Due to the COVID-19 pandemic, the post-mortem computed tomography (PMCT) service was expanded from three to seven cases per day to help mortuary services and avoid invasive autopsy. Additional targeted angiography and pulmonary ventilation procedures were stopped and triage rules relaxed to allow more indications to be scanned, including those requiring toxicology. A service evaluation was performed for the first 3-months of the COVID-19 pandemic compared to the equivalent period the previous year to study the impact of these changes. It was found that, despite the increase in deaths regionally, coronial referrals remained about 100 per month, a reduction in referral rate. The number undergoing PMCT rose from 28% to 74% of cases. Turnaround time remained the same. For cases triaged to PMCT, the need for subsequent autopsy increased from 7.9% to 15.8%. No significant changes were seen in diagnosis rates, including cardiac or respiratory. There was an increase in patients with coronary death without severe coronary calcification who underwent autopsy after PMCT. These may have been diagnosed by targeted coronary angiography. Fifty-three cases requiring toxicology/biochemistry had PMCT, with 38 having PMCT only. In 8/11 (72.7%) cases with normal PMCT and toxicology as the key diagnostic test, autopsy was performed prior to results. This suggests the pathology team were reluctant to risk an "unascertained" outcome. This study shows that it is possible to increase PMCT services by widening referral criteria and by limiting the use of enhanced imaging techniques, without significantly changing diagnosis rates of key diseases; however, selectively restarting targeted angiography may help avoid autopsy in some cases.
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Affiliation(s)
- J James
- Imaging Department, University Hospitals of Leicester, Leicester Royal Infirmary, Leicester LE2 7LX, UK
| | - C Robinson
- Imaging Department, University Hospitals of Leicester, Leicester Royal Infirmary, Leicester LE2 7LX, UK
| | - C Mason
- The Coroner's Court, Town Hall, Town Hall Square, Leicester, UK
| | - C Richards
- Histopathology Department, University Hospitals of Leicester, Leicester Royal Infirmary, Leicester LE2 7LX, UK
| | - K West
- Histopathology Department, University Hospitals of Leicester, Leicester Royal Infirmary, Leicester LE2 7LX, UK
| | - B Morgan
- Department of Life Sciences, University of Leicester, Radiology Department, Leicester Royal Infirmary, Infirmary Square, Leicester LE2 7LX, UK.
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Funayama K, Koyama A, Katsuragi-Go R, Aoyama T, Watanabe H, Takahashi N, Takatsuka H. Bleeding-Source Exploration in Subdural Hematoma: Observational Study on the Usefulness of Postmortem Computed Tomography Angiography. Diagnostics (Basel) 2023; 13:2286. [PMID: 37443680 DOI: 10.3390/diagnostics13132286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 06/29/2023] [Accepted: 07/04/2023] [Indexed: 07/15/2023] Open
Abstract
In a few cases, postmortem computed tomography angiography (PMCTA) is effective in postmortem detection of cortical artery rupture causing subdural hematoma (SDH), which is difficult to detect at autopsy. Here, we explore the usefulness and limitations of PMCTA in detecting the sites of cortical arterial rupture for SDH. In 6 of 10 cases, extravascular leakage of contrast material at nine different places enabled PMCTA to identify cortical arterial rupture. PMCTA did not induce destructive arterial artifacts, which often occur during autopsy. We found that, although not in all cases, PMCTA could show the site of cortical arterial rupture causing subdural hematoma in some cases. This technique is beneficial for cases of SDH autopsy, as it can be performed nondestructively and before destructive artifacts from the autopsy occur.
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Affiliation(s)
- Kazuhisa Funayama
- Division of Legal Medicine, Department of Community Preventive Medicine, Graduate School of Medicine and Dental Sciences, Niigata University, Niigata 951-8510, Japan
- Center of Cause of Death Investigation, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8510, Japan
| | - Akihide Koyama
- Division of Legal Medicine, Department of Community Preventive Medicine, Graduate School of Medicine and Dental Sciences, Niigata University, Niigata 951-8510, Japan
- Center of Cause of Death Investigation, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8510, Japan
| | - Rieka Katsuragi-Go
- Division of Legal Medicine, Department of Community Preventive Medicine, Graduate School of Medicine and Dental Sciences, Niigata University, Niigata 951-8510, Japan
- Center of Cause of Death Investigation, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8510, Japan
| | - Takashi Aoyama
- Division of Legal Medicine, Department of Community Preventive Medicine, Graduate School of Medicine and Dental Sciences, Niigata University, Niigata 951-8510, Japan
| | - Hiraku Watanabe
- Division of Legal Medicine, Department of Community Preventive Medicine, Graduate School of Medicine and Dental Sciences, Niigata University, Niigata 951-8510, Japan
| | - Naoya Takahashi
- Center of Cause of Death Investigation, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8510, Japan
- Department of Radiological Technology, Graduate School of Health Sciences, Niigata University, Niigata 951-8518, Japan
| | - Hisakazu Takatsuka
- Division of Legal Medicine, Department of Community Preventive Medicine, Graduate School of Medicine and Dental Sciences, Niigata University, Niigata 951-8510, Japan
- Center of Cause of Death Investigation, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8510, Japan
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5
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Michaud K, Jacobsen C, Basso C, Banner J, Blokker BM, de Boer HH, Dedouit F, O'Donnell C, Giordano C, Magnin V, Grabherr S, Suvarna SK, Wozniak K, Parsons S, van der Wal AC. Application of postmortem imaging modalities in cases of sudden death due to cardiovascular diseases-current achievements and limitations from a pathology perspective : Endorsed by the Association for European Cardiovascular Pathology and by the International Society of Forensic Radiology and Imaging. Virchows Arch 2023; 482:385-406. [PMID: 36565335 PMCID: PMC9931788 DOI: 10.1007/s00428-022-03458-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 11/11/2022] [Accepted: 11/15/2022] [Indexed: 12/25/2022]
Abstract
Postmortem imaging (PMI) is increasingly used in postmortem practice and is considered a potential alternative to a conventional autopsy, particularly in case of sudden cardiac deaths (SCD). In 2017, the Association for European Cardiovascular Pathology (AECVP) published guidelines on how to perform an autopsy in such cases, which is still considered the gold standard, but the diagnostic value of PMI herein was not analyzed in detail. At present, significant progress has been made in the PMI diagnosis of acute ischemic heart disease, the most important cause of SCD, while the introduction of postmortem CT angiography (PMCTA) has improved the visualization of several parameters of coronary artery pathology that can support a diagnosis of SCD. Postmortem magnetic resonance (PMMR) allows the detection of acute myocardial injury-related edema. However, PMI has limitations when compared to clinical imaging, which severely impacts the postmortem diagnosis of myocardial injuries (ischemic versus non-ischemic), the age-dating of coronary occlusion (acute versus old), other potentially SCD-related cardiac lesions (e.g., the distinctive morphologies of cardiomyopathies), aortic diseases underlying dissection or rupture, or pulmonary embolism. In these instances, PMI cannot replace a histopathological examination for a final diagnosis. Emerging minimally invasive techniques at PMI such as image-guided biopsies of the myocardium or the aorta, provide promising results that warrant further investigations. The rapid developments in the field of postmortem imaging imply that the diagnosis of sudden death due to cardiovascular diseases will soon require detailed knowledge of both postmortem radiology and of pathology.
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Affiliation(s)
- Katarzyna Michaud
- University Center of Legal Medicine Lausanne - Geneva, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
| | - Christina Jacobsen
- Section of Forensic Pathology, Department of Forensic Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Cristina Basso
- Cardiovascular Pathology Unit, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Jytte Banner
- Section of Forensic Pathology, Department of Forensic Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | - Hans H de Boer
- Department of Forensic Medicine, Victorian Institute of Forensic Medicine, Monash University, Melbourne, Australia
| | - Fabrice Dedouit
- GRAVIT, Groupe de Recherche en Autopsie Virtuelle et Imagerie Thanatologique, Forensic Department, University Hospital, Rangueil, Toulouse, France
| | - Chris O'Donnell
- Department of Forensic Medicine, Victorian Institute of Forensic Medicine, Monash University, Melbourne, Australia
| | - Carla Giordano
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Virginie Magnin
- University Center of Legal Medicine Lausanne - Geneva, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Geneva University Hospital, University of Geneva, Geneva, Switzerland
| | - Silke Grabherr
- University Center of Legal Medicine Lausanne - Geneva, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Geneva University Hospital, University of Geneva, Geneva, Switzerland
| | - S Kim Suvarna
- Department of Histopathology, Northern General Hospital, The University of Sheffield, Sheffield, UK
| | - Krzysztof Wozniak
- Department of Forensic Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Sarah Parsons
- Department of Forensic Medicine, Victorian Institute of Forensic Medicine, Monash University, Melbourne, Australia
| | - Allard C van der Wal
- Department of Pathology, Amsterdam UMC, Academic Medical Center, Amsterdam, The Netherlands.
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6
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Application of postmortem MRI for identification of medulla oblongata contusion as a cause of death: a case report. Int J Legal Med 2023; 137:115-121. [PMID: 36303078 DOI: 10.1007/s00414-022-02909-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 10/19/2022] [Indexed: 01/10/2023]
Abstract
Whiplash injury is common in traffic accidents, and severe whiplash is characterized by cervical spinal cord injuries with cervical dislocation or fracture, that can be diagnosed by postmortem computed tomography (PMCT), postmortem magnetic resonance (PMMR), or conventional autopsy. However, for cervical spinal cord injury without fracture and dislocation, PMMR can be more informative because it provides higher resolution of soft tissues. We report the case of a 29-year-old male who died immediately following a traffic accident, in which the vehicle hit an obstacle at a high speed, causing deformation of the bumper and severe damage of the vehicle body. PMCT indicated no significant injuries or diseases related to death, but PMMR showed patchy abnormal signals in the medulla oblongata, and the lower edge of the cerebellar tonsil was herniated out of the foramen magnum. The subsequent pathological and histological results confirmed that death was caused by medulla oblongata contusion combined with cerebellar tonsillar herniation. Our description of this case of a rare but fatal whiplash injury in which there was no fracture or dislocation provides a better understanding of the potentially fatal consequences of cervical spinal cord whiplash injury without fracture or dislocation and of the underlying lethal mechanisms. Compared with PMCT, PMMR provides important diagnostic information in forensic practice for the identification of soft tissue injuries, and is therefore an important imaging modality for diagnosis of whiplash injury when there is no fracture or dislocation.
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Wang B, Chen ZM, Zhang L, Zhou DD, Zhu WA, Wang Z, Wang L, Gao YB, Liu G, Chen WL, Cheng G, Huang F, Cheng ZH, Zhang HM. Development of a novel technique with a pigtail catheter and high-pressure injector for coronary postmortem computed tomography angiography. AUST J FORENSIC SCI 2022. [DOI: 10.1080/00450618.2022.2157045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Bo Wang
- College of Basic Medical Sciences, Jilin University, Changchun, Jilin, China
| | - Zhi-Ming Chen
- College of Basic Medical Sciences, Jilin University, Changchun, Jilin, China
| | - Lei Zhang
- The First Hospital, Jilin University, Changchun, Jilin, China
| | - Dan-Dan Zhou
- The First Hospital, Jilin University, Changchun, Jilin, China
| | - Wan-an Zhu
- The First Hospital, Jilin University, Changchun, Jilin, China
| | - Zhuo Wang
- The First Hospital, Jilin University, Changchun, Jilin, China
| | - Lijun Wang
- Public Security Judicial Identification Center, Changchun City Public Security Bureau, Changchun, Jilin, China
| | - Yan-Bin Gao
- Public Security Judicial Identification Center, Changchun City Public Security Bureau, Changchun, Jilin, China
| | - Gang Liu
- Institute of Forensic Science, Department of Public Security of Jilin Province, Changchun, Jilin, China
| | - Wei-Long Chen
- Institute of Forensic Science, Department of Public Security of Jilin Province, Changchun, Jilin, China
| | - Gen Cheng
- Neusoft Medical Systems Co., Ltd, Shenyang, Liaoning, China
| | - Feng Huang
- Shanghai Neusoft Medical Technology Co., Ltd, Shanghai, China
| | - Zhi-Hua Cheng
- The First Hospital, Jilin University, Changchun, Jilin, China
| | - Hui-Mao Zhang
- The First Hospital, Jilin University, Changchun, Jilin, China
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Glengarry J, Lynch M, Heath K, O'Donnell C. Lethal hemorrhage from iliac vein rupture complicating inferior vena cava thrombosis demonstrated by post-mortem CT angiography. Forensic Sci Med Pathol 2022; 18:485-490. [PMID: 35895248 DOI: 10.1007/s12024-022-00507-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2022] [Indexed: 12/14/2022]
Abstract
Spontaneous iliac vein rupture is a rare cause of retroperitoneal hemorrhage that may present to the forensic pathologist. It has been reported in association with venous thrombosis, anatomical variants such as May-Thurner syndrome, and as a complication of a long-term indwelling IVC filter. It has a female predominance and most often occurs due to rupture of the left iliac vein. This is the first report of the use of post-mortem computed tomography (PMCT) and post-mortem computed tomography angiography (PMCTA) as an adjunct to a conventional autopsy to diagnose rupture of the left iliac vein causing retroperitoneal hemorrhage arising as a complication of an inferior vena cava (IVC) thrombus. We discuss the use of PMCTA as a useful tool in the diagnosis of vascular injury and how it can be used to assist the forensic pathologist. The use of PMCT with PMCTA is an invaluable adjunct to conventional autopsy to diagnose the site of vascular rupture.
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Affiliation(s)
- Joanna Glengarry
- Victorian Institute of Forensic Medicine, 65 Kavanagh Street, Southbank, VIC, 3006, Australia.
| | - Matthew Lynch
- Victorian Institute of Forensic Medicine, 65 Kavanagh Street, Southbank, VIC, 3006, Australia
| | - Karen Heath
- Forensic Science SA, 21 Divett Place, Adelaide, SA, 5000, Australia
| | - Chris O'Donnell
- Victorian Institute of Forensic Medicine, 65 Kavanagh Street, Southbank, VIC, 3006, Australia
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Porzionato A, Macchi V, Stecco C, Boscolo-Berto R, Loukas M, Tubbs RS, De Caro R. Clinical Anatomy and Medical Malpractice-A Narrative Review with Methodological Implications. Healthcare (Basel) 2022; 10:1915. [PMID: 36292362 PMCID: PMC9601975 DOI: 10.3390/healthcare10101915] [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: 08/28/2022] [Revised: 09/25/2022] [Accepted: 09/27/2022] [Indexed: 11/04/2022] Open
Abstract
Anatomical issues are intrinsically included in medico-legal methodology, however, higher awareness would be needed about the relevance of anatomy in addressing medico-legal questions in clinical/surgical contexts. Forensic Clinical Anatomy has been defined as "the practical application of Clinical Anatomy to the ascertainment and evaluation of medico-legal problems". The so-called individual anatomy (normal anatomy, anatomical variations, or anatomical modifications due to development, aging, para-physiological conditions, diseases, or surgery) may acquire specific relevance in medico-legal ascertainment and evaluation of cases of supposed medical malpractice. Here, we reviewed the literature on the relationships between anatomy, clinics/surgery, and legal medicine. Some methodological considerations were also proposed concerning the following issues: (1) relevant aspects of individual anatomy may arise from the application of methods of ascertainment, and they may be furtherly ascertained through specific anatomical methodology; (2) data about individual anatomy may help in the objective application of the criteria of evaluation (physio-pathological pathway, identification-evaluation of errors, causal value, damage estimation) and in final judgment about medical responsibility/liability. Awareness of the relevance of individual anatomy (risk of iatrogenic lesions, need for preoperative diagnostic procedures) should be one of the principles guiding the clinician; medico-legal analyses can also take advantage of its contribution in terms of ascertainment/evaluation.
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Affiliation(s)
- Andrea Porzionato
- Section of Anatomy, Department of Neuroscience, University of Padova, Via Gabelli, 65, 35127 Padova, Italy
| | - Veronica Macchi
- Section of Anatomy, Department of Neuroscience, University of Padova, Via Gabelli, 65, 35127 Padova, Italy
| | - Carla Stecco
- Section of Anatomy, Department of Neuroscience, University of Padova, Via Gabelli, 65, 35127 Padova, Italy
| | - Rafael Boscolo-Berto
- Section of Anatomy, Department of Neuroscience, University of Padova, Via Gabelli, 65, 35127 Padova, Italy
| | - Marios Loukas
- Department of Anatomical Sciences, True Blue Campus, St. George’s University, St. George 1473, Grenada
| | - Ronald Shane Tubbs
- Department of Anatomical Sciences, True Blue Campus, St. George’s University, St. George 1473, Grenada
- Department of Neurosurgery, Tulane University, New Orleans, LA 70112, USA
| | - Raffaele De Caro
- Section of Anatomy, Department of Neuroscience, University of Padova, Via Gabelli, 65, 35127 Padova, Italy
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10
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State of the Art on the Role of Postmortem Computed Tomography Angiography and Magnetic Resonance Imaging in the Diagnosis of Cardiac Causes of Death: A Narrative Review. Tomography 2022; 8:961-973. [PMID: 35448711 PMCID: PMC9025017 DOI: 10.3390/tomography8020077] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 03/22/2022] [Accepted: 03/30/2022] [Indexed: 11/17/2022] Open
Abstract
The need of a minimally invasive approach, especially in cases of cultural or religious oppositions to the internal examination of the body, has led over the years to the introduction of postmortem CT (PMCT) methodologies within forensic investigations for the comprehension of the cause of death in selected cases (e.g., traumatic deaths, acute hemorrhages, etc.), as well as for personal identification. The impossibility to yield clear information concerning the coronary arteries due to the lack of an active circulation to adequately distribute contrast agents has been subsequently overcome by the introduction of coronary-targeted PMCT Angiography (PMCTA), which has revealed useful in the detection of stenoses related to calcifications and/or atherosclerotic plaques, as well as in the suspicion of thrombosis. In parallel, due to the best ability to study the soft tissues, cardiac postmortem MR (PMMR) methodologies have been further implemented, which proved suitable for the detection and aging of infarcted areas, and for cardiomyopathies. Hence, the purpose of the present work to shed light on the state of the art concerning the value of both coronary-targeted PMCTA and PMMR in the diagnosis of coronary artery disease and/or myocardial infarction as causes of death, further evaluating their suitability as alternatives or complementary approaches to standard autopsy and histologic investigations.
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11
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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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12
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Lux C, Klinger M, Sauer P, Verhoff MA, Kettner M. Postmortem fluorescence angiography of the explanted human heart. Int J Legal Med 2021; 136:245-249. [PMID: 34839382 PMCID: PMC8813811 DOI: 10.1007/s00414-021-02730-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 10/18/2021] [Indexed: 11/26/2022]
Abstract
Within the scope of this technical report, the feasibility of indocyanine green (ICG) as a fluorescent agent for postmortem angiography of the heart is tested. The study included 4 deceased persons with no respective medical history of heart diseases. The basic patterns of findings in ICG fluorescence angiography associated with healthy hearts are presented. The method can easily be integrated into a workflow without restricting the macroscopic or histologic diagnostics. This paper represents the fundamental technical and analytical basis for upcoming studies concerning the possibilities and limitations of fluorescence angiography in the diagnosis of heart pathology.
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Affiliation(s)
- Constantin Lux
- Institute of Legal Medicine, Goethe University, Kennedyallee 104, 60596, Frankfurt am Main, Germany.
| | - Miriam Klinger
- Institute of Legal Medicine, Goethe University, Kennedyallee 104, 60596, Frankfurt am Main, Germany
| | - Patrick Sauer
- Institute of Legal Medicine, Goethe University, Kennedyallee 104, 60596, Frankfurt am Main, Germany
| | - Marcel A Verhoff
- Institute of Legal Medicine, Goethe University, Kennedyallee 104, 60596, Frankfurt am Main, Germany
| | - Mattias Kettner
- Institute of Legal Medicine, Goethe University, Kennedyallee 104, 60596, Frankfurt am Main, Germany
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13
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14
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Impact of increasing levels of adaptive statistical iterative reconstruction on image quality in oil-based postmortem CT angiography in coronary arteries. Int J Legal Med 2021; 135:1869-1878. [PMID: 33629138 PMCID: PMC8354936 DOI: 10.1007/s00414-021-02530-1] [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: 07/08/2020] [Accepted: 02/03/2021] [Indexed: 01/03/2023]
Abstract
Introduction Postmortem multi-detector computed tomography (PMCT) has become an important part in forensic imaging. Modern reconstruction techniques such as iterative reconstruction (IR) are frequently used in postmortem CT angiography (PMCTA). The image quality of PMCTA depends on the strength of IR. For this purpose, we aimed to investigate the impact of different advanced IR levels on the objective and subjective PMCTA image quality. Material and methods We retrospectively analyzed the coronary arteries of 27 human cadavers undergoing whole-body postmortem CT angiography between July 2017 and March 2018 in a single center. Iterative reconstructions of the coronary arteries were processed in five different level settings (0%; 30%; 50%; 70%; 100%) by using an adaptive statistical IR method. We evaluated the objective (contrast-to-noise ratio (CNR)) and subjective image quality in several anatomical locations. Results Our results demonstrate that the increasing levels of an IR technique have relevant impact on the image quality in PMCTA scans in forensic postmortem examinations. Higher levels of IR have led to a significant reduction of image noise and therefore to a significant improvement of objective image quality (+ 70%). However, subjective image quality is inferior at higher levels of IR due to plasticized image appearance. Conclusion Objective image quality in PMCTA progressively improves with increasing level of IR with the best CNR at the highest IR level. However, subjective image quality is best at low to medium levels of IR. To obtain a “classic” image appearance with optimal image quality, PMCTAs should be reconstructed at medium levels of IR.
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15
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A review on the evolution and characteristics of post-mortem imaging techniques. FORENSIC IMAGING 2020. [DOI: 10.1016/j.fri.2020.200420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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16
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Xia ZY, Bruguier C, Dedouit F, Grabherr S, Augsburger M, Liu BB. Oleic Acid (OA), A Potential Dual Contrast Agent for Postmortem MR Angiography (PMMRA): A Pilot Study. Curr Med Sci 2020; 40:786-794. [PMID: 32862391 DOI: 10.1007/s11596-020-2244-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 05/19/2020] [Indexed: 01/31/2023]
Abstract
Choosing proper perfusates as contrast agents is an important aspect for postmortem magnetic resonance angiography (PMMRA). However, in this emerging field, the number of suitable kinds of liquid is still very limited. The objective of this research is to compare MR images of oleic acid (OA) with paraffin oil (PO) in vitro and in ex situ animal hearts, in order to evaluate the feasibility to use OA as a novel contrast agent for PMMRA. In vitro, OA, PO and water (control) were introduced into three tubes separately and T1weighted-spin echo (T1w-SE) and T2w-SE images were acquired on a 1.5T MR scanner. In the second experiment, OA and PO were injected into left coronary artery (LCA) and left ventricle (LV) of ex situ bovine hearts and their T1w-SE, T2w-SE, T1w-multipoint Dixon (T1w-mDixon) and 3DT2w-mDixon images were acquired. The overall results indicate that OA may have a potential to be used as a dual (T1 and T2 based) contrast agent for PMMRA when proper sequence parameters are utilized. However, as the pilot study was based on limited number of animal hearts, more researches using OA in cadavers are needed to validate our findings.
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Affiliation(s)
- Zhi-Yuan Xia
- Institute of Evidence Law and Forensic Science, China University of Political Science and Law (CUPL), Key Laboratory of Evidence Law and Forensic Science, Ministry of Education, Beijing, 100088, China.
| | - Christine Bruguier
- University Center of Legal Medicine, Lausanne-Geneva (CURML), Lausanne, CH1000, Switzerland
| | - Fabrice Dedouit
- Service de Médecine Légale, Hôpital de Rangueil, Toulouse, 50032, France
| | - Silke Grabherr
- University Center of Legal Medicine, Lausanne-Geneva (CURML), Lausanne, CH1000, Switzerland
| | - Marc Augsburger
- University Center of Legal Medicine, Lausanne-Geneva (CURML), Lausanne, CH1000, Switzerland
| | - Bei-Bei Liu
- Dian Research Center for Postmortem Imaging & Angiography, Beijing, 100192, China
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17
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The approach of virtual autopsy (VIRTOPSY) by postmortem multi-slice computed tomography (PMCT) in China for forensic pathology. FORENSIC IMAGING 2020. [DOI: 10.1016/j.fri.2020.200361] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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18
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Aquila I, Sicilia F, Ricci P, Antonio Sacco M, Manno M, Gratteri S. Role of post-mortem multi-slice computed tomography in the evaluation of single gunshot injuries. Med Leg J 2019; 87:204-210. [PMID: 31564213 DOI: 10.1177/0025817219848264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Post-mortem multi-slice computed tomography (MSCT) is a new approach in forensic pathology for gunshot injuries. This study determines the role of MSCT in the characterisation of single gunshot injuries. We report three cases. In the first case, an 80-year-old man was found dead in his bedroom with a gun. External examination showed devastating head injuries. In the second case, an 81-year-old man was found dead in his apartment, without a gun. External examination showed gunshot injuries. In the third case, a 56-year-old man was found dead on a road. MSCT and autopsy were performed in all these cases. MSCT not only allowed the determination of entrance and exit wounds but also showed some artefacts. In conclusion, radiology is fundamental for the reconstruction of gunshot injuries, and the manner of death can only be ascertained by autopsy.
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Affiliation(s)
- Isabella Aquila
- Institute of Legal Medicine, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Francesco Sicilia
- Institute of Legal Medicine, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Petrantomo Ricci
- Institute of Legal Medicine, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Matteo Antonio Sacco
- Institute of Legal Medicine, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Maria Manno
- Institute of Legal Medicine, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Santo Gratteri
- Institute of Legal Medicine, University Magna Graecia of Catanzaro, Catanzaro, Italy
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19
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Robinson C, Deshpande A, Rutty G, Morgan B. Post-mortem CT: is coronary angiography required in the presence of a high coronary artery calcium score? Clin Radiol 2019; 74:926-932. [PMID: 31526540 DOI: 10.1016/j.crad.2019.06.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Accepted: 06/14/2019] [Indexed: 12/13/2022]
Abstract
AIM To test whether a high coronary artery score predicts that the subsequent post-mortem computed tomography (PMCT) with angiography (PMCTA) will diagnose significant coronary artery disease (CAD); to test the diagnostic impact of assuming there is significant CAD based on a high coronary artery calcium (CAC) score alone; and (3) to test whether the clinical CAC score threshold (400) is the most accurate to make this prediction. MATERIALS AND METHODS CAC scoring and PMCTA were performed in cases of adult sudden natural death. Angiography was reviewed to determine if there was sufficient CAD to give as the cause of death. Data were analysed to test whether high calcium score predicts significant CAD. RESULTS PMCTA with CAC score was successful in 100/104 PMCT examinations and in 87/100 angiography examinations (87%). Forty-six cases (46%) had a CAC score of >400, the clinical level of severe disease. CAD was given as the cause of death in 31 (67%) of these cases. Angiography was successful in 39 of these cases (84.7%) and showed severe CAD in all but one (97%). Twenty-five (25%) cases were diagnosed with a CAD death without a high CAC score. CONCLUSION Although CAC score can neither diagnose nor exclude death due to CAD, the addition of angiography adds little diagnostic information to a high CAC score. If PMCT investigation is to exclude trauma and provide a medical cause of death on the "balance of probabilities", angiography is not required when the calcium score >400. This could reduce the number of patients requiring angiography by almost 50%.
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Affiliation(s)
- C Robinson
- Imaging Department, University Hospitals of Leicester NHS Trust, Leicester Royal Infirmary, Leicester, UK.
| | - A Deshpande
- Imaging Department, University Hospitals of Leicester NHS Trust, Leicester Royal Infirmary, Leicester, UK
| | - G Rutty
- East Midlands Forensic Pathology Unit, University of Leicester, Leicester, UK
| | - B Morgan
- University of Leicester Imaging Department, University Hospitals of Leicester, Leicester Royal Infirmary, Leicester, UK
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20
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Michaud K, Genet P, Sabatasso S, Grabherr S. Postmortem imaging as a complementary tool for the investigation of cardiac death. Forensic Sci Res 2019; 4:211-222. [PMID: 31489387 PMCID: PMC6713140 DOI: 10.1080/20961790.2019.1630944] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 06/06/2019] [Accepted: 06/10/2019] [Indexed: 12/26/2022] Open
Abstract
In the past 2 decades, modern radiological methods, such as multiple detector computed tomography (MDCT), MDCT-angiography, and cardiac magnetic resonance imaging (MRI) were introduced into postmortem practice for investigation of sudden death (SD), including cases of sudden cardiac death (SCD). In forensic cases, the underlying cause of SD is most frequently cardiovascular with coronary atherosclerotic disease as the leading cause. There are many controversies about the role of postmortem imaging in establishing the cause of death and especially the value of minimally invasive autopsy techniques. This paper discusses the state of the art for postmortem radiological evaluation of the heart compared to classical postmortem examination, especially in cases of SCD. In SCD cases, postmortem CT is helpful to estimate the heart size and to visualize haemopericardium and calcified plaques and valves, as well as to identify and locate cardiovascular devices. Angiographic methods are useful to provide a detailed view of the coronary arteries and to analyse them, especially regarding the extent and location of stenosis and obstruction. In postsurgical cases, it allows verification and documentation of the patency of stents and bypass grafts before opening the body. Postmortem MRI is used to investigate soft tissues such as the myocardium, but images are susceptible to postmortem changes and further work is necessary to increase the understanding of these radiological aspects, especially of the ischemic myocardium. In postsurgery cases, the value of postmortem imaging of the heart is reportedly for the diagnostic and documentation purposes. The implementation of new imaging methods into routine postmortem practice is challenging, as it requires not only an investment in equipment but, more importantly, investment in the expertise of interpreting the images. Once those requirements are implemented, however, they bring great advantages in investigating cases of SCD, as they allow documentation of the body, orientation of sampling for further analyses and gathering of other information that cannot be obtained by conventional autopsy such as a complete visualization of the vascular system using postmortem angiography.Key pointsThere are no established guidelines for the interpretation of postmortem imaging examination of the heartAt present, postmortem imaging methods are considered as less accurate than the autopsy for cardiac deathsPostmortem imaging is useful as a complementary tool for cardiac deathsThere is still a need to validate postmortem imaging in cardiac deaths by comparing with autopsy findings.
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Affiliation(s)
- Katarzyna Michaud
- Lausanne University Hospital and University of Lausanne, University Center of Legal Medicine Lausanne-Geneva, Lausanne, Switzerland
| | - Pia Genet
- Lausanne University Hospital and University of Lausanne, University Center of Legal Medicine Lausanne-Geneva, Lausanne, Switzerland.,Geneva University Hospital, University Center of Legal Medicine Lausanne-Geneva, Geneva, Switzerland
| | - Sara Sabatasso
- Geneva University Hospital, University Center of Legal Medicine Lausanne-Geneva, Geneva, Switzerland
| | - Silke Grabherr
- Lausanne University Hospital and University of Lausanne, University Center of Legal Medicine Lausanne-Geneva, Lausanne, Switzerland.,Geneva University Hospital, University Center of Legal Medicine Lausanne-Geneva, Geneva, Switzerland
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21
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Robinson C, Deshpande A, Richards C, Rutty G, Mason C, Morgan B. Post-mortem computed tomography in adult non-suspicious death investigation-evaluation of an NHS based service. BJR Open 2019; 1:20190017. [PMID: 33178946 PMCID: PMC7592474 DOI: 10.1259/bjro.20190017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 07/15/2019] [Accepted: 07/16/2019] [Indexed: 11/21/2022] Open
Abstract
Objective: Post-mortem CT (PMCT) can replace autopsy in many cases of non-suspicious death. A purely NHS-based service to replace autopsy with PMCT was launched, with the cost met by the family from 2015 to 2017, and subsequently “free at the point of delivery” after local authority funding was secured. The aim of the service was to improve the experience for the families. This report describes and evaluates the service against local standards of (1) less than four day turn around, (2) cause of death given in >90% and (3) less than 10% require autopsy. Methods: A retrospective review of reports, records and emails was undertaken to collate demographics, times of different stages of the process, the outcome and comments from service users. Results: Between July 2015 and July 2018, 279 patients had PMCT scans, 67 (24.0%) in the family-funded service and 212 (76%) in the current service. 97.1% (n = 271/279) of cases had the radiology report issued by day 3 (96.8% vs 98.6% for the family funded and local authority-funded services respectively). A cause of death was given in 97.2% of scans. 2.8% of patients required autopsy. Feedback from families, coroner’s officers and undertakers has been overwhelmingly positive. Conclusion: The services exceeded local standards and met the needs of the Coroner and the families based on the feedback received. This model could be employed for similar services, but the change to the logistics and financial structures required to initiate such services remains a significant hurdle. Advances in knowledge: This is the first report of a fully NHS-based PMCT service.
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Affiliation(s)
- Claire Robinson
- Department of Imaging, University Hospitals of Leicester NHS Trust, Leicester, England
| | - Aparna Deshpande
- Department of Imaging, University Hospitals of Leicester NHS Trust, Leicester, England
| | - Cathy Richards
- Department of Histopathology, University Hospitals of Leicester NHS Trust, Leicester, England
| | - Guy Rutty
- East Midlands Forensic Pathology Unit, University of Leicester, England
| | - Catherine Mason
- The Coroner's Court, Town Hall, Town Hall Square, Leicester, England
| | - Bruno Morgan
- University of Leicester Imaging Department, University Hospitals of Leicester, Leicester Royal Infirmary, Leicester
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22
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Forensic Radiology: A Primer. Acad Radiol 2019; 26:820-830. [PMID: 31005405 DOI: 10.1016/j.acra.2019.03.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 03/05/2019] [Accepted: 03/08/2019] [Indexed: 11/21/2022]
Abstract
RATIONALE AND OBJECTIVE Forensic radiology is a relatively unknown subspecialty which is becoming increasingly more important. The field incorporates antemortem and postmortem imaging for the detection and documentation of various pathologies for medicolegal purposes. Postmortem imaging is increasingly used in conjunction with the traditional autopsy in a process called a "virtual" autopsy. Radiography has been a staple of forensic investigations for over a century, first used in 1896. Advanced imaging techniques such as postmortem computed tomography and postmortem magnetic resonance imaging have only recently gained acceptance in the forensic science community. Postmortem computed tomography and postmortem magnetic resonance imaging methods are now widely used in some parts of the world, while other countries including the United States have been slower to adopt these methods into their daily practice. Advanced forensic imaging is increasingly used in the courts where juries have responded positively to such presentation of forensic data. For these reasons, advanced postmortem imaging is becoming a regular part of forensic investigations. The increase in the use of forensic imaging presents a unique opportunity for radiologists to collaborate with pathologists and law enforcement officials. This paper provides an overview of forensic radiology and identifies potential challenges and opportunities.
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23
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State of the art in post-mortem computed tomography: a review of current literature. Virchows Arch 2019; 475:139-150. [PMID: 30937612 DOI: 10.1007/s00428-019-02562-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 02/06/2019] [Accepted: 03/12/2019] [Indexed: 12/14/2022]
Abstract
Computed tomography (CT) and other advanced diagnostic imaging techniques are gaining popularity in forensic pathology. This paper aims to define and offer complete and easily accessible "state of the art" for post-mortem computed tomography (PMCT), by reviewing the latest international literature. The proposed format answers the "five Ws" that follows: (1) What: We report the different kinds of CT scan and settings generally used in post-mortem imaging. The machine most employed is a 8/16-slice spiral CT, usually without contrast enhancement. The introduction of some variables, such as CT-guided biopsies, post-mortem ventilation, and PMCT angiography is becoming increasingly useful. (2) Why: Literature highlights the many advantages of PMCT. Limitations can be partly overcome by modern imaging techniques and combined evaluation with traditional autopsy. (3) Who: Most authors agree that collaboration between different specialists, i.e., radiologists and pathologists, is the best scenario, since radiologic, anatomic, and forensic skills are needed simultaneously. The most important human factor is "teamwork". (4) When: Literature provides no absolute limits for performing PMCT. Some authors have tested PMCT as a replacement for conventional autopsy but found some limitations. Others evaluated PMCT as a guide or screening tool for traditional autopsy. (5) Where: Many research groups around the world have performed studies on the use of PMCT. Although few countries adopt PMCT in routine practice, its use is rapidly spreading.
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24
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Wagensveld IM, Blokker BM, Pezzato A, Wielopolski PA, Renken NS, von der Thüsen JH, Krestin GP, Hunink MGM, Oosterhuis JW, Weustink AC. Diagnostic accuracy of postmortem computed tomography, magnetic resonance imaging, and computed tomography-guided biopsies for the detection of ischaemic heart disease in a hospital setting. Eur Heart J Cardiovasc Imaging 2019; 19:739-748. [PMID: 29474537 DOI: 10.1093/ehjci/jey015] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 01/15/2018] [Indexed: 11/12/2022] Open
Abstract
Aims The autopsy rate worldwide is alarmingly low (0-15%). Mortality statistics are important, and it is, therefore, essential to perform autopsies in a sufficient proportion of deaths. The imaging autopsy, non-invasive, or minimally invasive autopsy (MIA) can be used as an alternative to the conventional autopsy in an attempt to improve postmortem diagnostics by increasing the number of postmortem procedures. The aim of this study was to determine the diagnostic accuracy of postmortem magnetic resonance imaging (MRI), computed tomography (CT), and CT-guided biopsy for the detection of acute and chronic myocardial ischaemia. Methods and results We included 100 consecutive adult patients who died in hospital, and for whom next-of-kin gave permission to perform both conventional autopsy and MIA. The MIA consists of unenhanced total-body MRI and CT followed by CT-guided biopsies. Conventional autopsy was used as reference standard. We calculated sensitivity and specificity and receiver operating characteristics curves for CT and MRI as the stand-alone test or combined with biopsy for detection of acute and chronic myocardial infarction (MI). Sensitivity and specificity of MRI with biopsies for acute MI was 0.97 and 0.95, respectively and 0.90 and 0.75, respectively for chronic MI. MRI without biopsies showed a high specificity (acute: 0.92; chronic: 1.00), but low sensitivity (acute: 0.50; chronic: 0.35). CT (total Agatston calcium score) had a good diagnostic value for chronic MI [area under curve (AUC) 0.74, 95% confidence interval (CI) 0.64-0.84], but not for acute MI (AUC 0.60, 95% CI 0.48-0.72). Conclusion We found that the combination of MRI with biopsies had high sensitivity and specificity for the detection of acute and chronic myocardial ischaemia.
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Affiliation(s)
- Ivo M Wagensveld
- Department of Radiology, Erasmus University Medical Center, 's Gravendijkwal 230, 3015 CD, Rotterdam, The Netherlands.,Department of Pathology, Erasmus University Medical Center, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands
| | - Britt M Blokker
- Department of Radiology, Erasmus University Medical Center, 's Gravendijkwal 230, 3015 CD, Rotterdam, The Netherlands.,Department of Pathology, Erasmus University Medical Center, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands
| | - Andrea Pezzato
- Department of Radiology, Erasmus University Medical Center, 's Gravendijkwal 230, 3015 CD, Rotterdam, The Netherlands
| | - Piotr A Wielopolski
- Department of Radiology, Erasmus University Medical Center, 's Gravendijkwal 230, 3015 CD, Rotterdam, The Netherlands
| | - Nomdo S Renken
- Department of Radiology, Erasmus University Medical Center, 's Gravendijkwal 230, 3015 CD, Rotterdam, The Netherlands
| | - Jan H von der Thüsen
- Department of Pathology, Erasmus University Medical Center, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands
| | - Gabriel P Krestin
- Department of Radiology, Erasmus University Medical Center, 's Gravendijkwal 230, 3015 CD, Rotterdam, The Netherlands
| | - M G Myriam Hunink
- Department of Radiology, Erasmus University Medical Center, 's Gravendijkwal 230, 3015 CD, Rotterdam, The Netherlands.,Department of Epidemiology, Erasmus University Medical Center, Dr. Molewaterplein 50, 3015 GE, Rotterdam, The Netherlands.,Center for Health Decision Science, Harvard T.H. Chan School of Public Health, 718 Huntington Avenue, Boston, 02115 MA, USA
| | - J Wolter Oosterhuis
- Department of Pathology, Erasmus University Medical Center, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands
| | - Annick C Weustink
- Department of Radiology, Erasmus University Medical Center, 's Gravendijkwal 230, 3015 CD, Rotterdam, The Netherlands.,Department of Pathology, Erasmus University Medical Center, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands
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25
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Post-Mortem Imaging Adjudicated Sudden Death: Causes and Controversies. Heart Lung Circ 2018; 28:15-21. [PMID: 30340963 DOI: 10.1016/j.hlc.2018.09.003] [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: 07/28/2018] [Accepted: 09/09/2018] [Indexed: 12/30/2022]
Abstract
Sudden cardiac death (SCD) is a catastrophic complication of many cardiac conditions often occurring without warning. In these cases, a post-mortem examination is required to elucidate the cause of death and is regarded as the 'gold standard'. However, in circumstances of certain religious/cultural beliefs and advanced body decomposition an alternative non-invasive approach would be preferred. Although a developing field, post-mortem imaging using computed tomography (pmCT) or magnetic resonance imaging (pmMR) provides a non-invasive and accurate alternative to traditional post-mortem in specific circumstances. In particular, pmMR has an important role in younger decedents while pmCT is more suited to examination of adults with SCD. Despite encouraging results from several preliminary studies, more research is needed to determine the most appropriate role for post-mortem imaging in the clinical algorhythm for investigation of SCD.
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26
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27
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Visualization of Myocardial Infarction in Postmortem Multiphase Computed Tomography Angiography: A Feasibility Study. Am J Forensic Med Pathol 2018; 39:106-113. [PMID: 29438137 DOI: 10.1097/paf.0000000000000372] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Recent studies have indicated that multiphase postmortem computed tomography angiography (MPMCTA) allows detection of a pathological enhancement of the myocardium in regions that correlate with the localization of the infarction at histology. The aim of this study was to verify this hypothesis by examining MPMCTA images in cases of myocardial infarction. Therefore, we investigated 10 autopsy cases where death was attributed to myocardial infarction or which showed cardiovascular pathology. As a control group, we selected 10 cases of non-natural (namely, not cardiac) death. The MPMCTA was performed in both groups to ascertain whether a pathological enhancement could be observed. We detected a myocardial enhancement in all cardiac death cases, in the same region that showed infarction at histology. No enhancement was observed in control cases. These results have important implications in the routine management of sudden cardiac death cases. In fact, MPMCTA can not only orient about the cause of death before autopsy, but can especially help to identify affected regions for guiding and improving the sampling for microscopic examination.
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28
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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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Takei H, Sano R, Takahashi Y, Takahashi K, Kominato Y, Tokue H, Shimada T, Awata S, Hirasawa S, Ohta N. Usefulness of coronary postmortem computed tomography angiography to detect lesions in the coronary artery and myocardium in cases of sudden death. Leg Med (Tokyo) 2017; 30:46-51. [PMID: 29175582 DOI: 10.1016/j.legalmed.2017.11.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 11/16/2017] [Accepted: 11/16/2017] [Indexed: 12/17/2022]
Abstract
Coronary postmortem computed tomography angiography (coronary PMCTA) has been introduced as a routine examination procedure for autopsy at our department. Here, we reviewed eight autopsy cases in which apparent histopathological changes including acute myocardial infarction (AMI), anomalous aortic origin of a coronary artery (AAOCA), hypertrophic obstructive cardiomyopathy (HOCM) and acute myocarditis were involved in the cause of death. For investigation of the coronary artery and shape of the heart, coronary PMCTA was valuable in detecting narrowing or obstruction of coronary artery in AMI, indicating an anomalous aortic origin of the left coronary artery in AAOCA, and demonstrating septal hypertrophy and intracavitary obstruction in HOCM. However, it was debatable whether the hypervascularity demonstrated by coronary PMCTA in the case of acute myocarditis was more prominent than the vascular images obtained in other cases without inflammation. Thus, coronary PMCTA appeared to be useful not only for detection of coronary artery stenosis, but also for indicating other distinctive changes involved in AAOCA and HOCM.
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Affiliation(s)
- Hiroyuki Takei
- Division of Electronics and Informatics, Gunma University Graduate School of Science and Technology, Kiryu 376-8515, Japan; Department of Radiology, Gunma University Hospital, Maebashi 371-8511, Japan
| | - Rie Sano
- Department of Legal Medicine, Gunma University Graduate School of Medicine, Maebashi 371-8511, Japan
| | - Yoichiro Takahashi
- Department of Legal Medicine, Gunma University Graduate School of Medicine, Maebashi 371-8511, Japan; Lieber Institute for Brain Develoment, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Keiko Takahashi
- Department of Legal Medicine, Gunma University Graduate School of Medicine, Maebashi 371-8511, Japan
| | - Yoshihiko Kominato
- Department of Legal Medicine, Gunma University Graduate School of Medicine, Maebashi 371-8511, Japan.
| | - Hiroyuki Tokue
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University, Graduate School of Medicine, Maebashi 371-8511, Japan
| | - Takehiro Shimada
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University, Graduate School of Medicine, Maebashi 371-8511, Japan
| | - Sachiko Awata
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University, Graduate School of Medicine, Maebashi 371-8511, Japan
| | - Satoshi Hirasawa
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University, Graduate School of Medicine, Maebashi 371-8511, Japan
| | - Naoya Ohta
- Division of Electronics and Informatics, Gunma University Graduate School of Science and Technology, Kiryu 376-8515, Japan
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31
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Troxler R, Minoiu C, Vaucher P, Michaud K, Doenz F, Ducrot K, Grabherr S. The role of angiography in the congruence of cardiovascular measurements between autopsy and postmortem imaging. Int J Legal Med 2017; 132:249-262. [PMID: 28741057 DOI: 10.1007/s00414-017-1652-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 07/12/2017] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Postmortem CT angiography is the method of choice for the postmortem imaging investigations of the cardiovascular (CV) system. However, autopsy still remains the gold standard for CV measurement. Nevertheless, there are not any studies on CV measurements on the multi-phase postmortem angiography (MPMCTA) which includes comparisons with autopsy. Therefore, the aim of this study is to compare CV measurements between the native CT scan and the three phases of the MPMCTA to find out which of these modalities correlate the best with autopsy measurements. METHODS For this study, we selected retrospectively 50 postmortem cases that underwent both MPMCTA and autopsy. A comparison was carried out between the CV measurements obtained with imaging (aorta; heart cavities and cardiac wall thicknesses; maximum cardiac diameter and cardiothoracic ratio) and at the autopsy (aorta; cardiac valves, ventricular thicknesses, and weight). RESULTS Our results show that the dynamic phase displays an advantage for the measurement of the aortas. However, the MPMCTA is not accurate to measure the cardiac wall thicknesses. The measurements of the heart cavities show no correlation with the heart valves. The cardiothoracic ratio measured by the MPMCTA shows no correlation with the heart weight. Nevertheless, the maximum cardiac diameter exhibits a correlation with the latter on the venous and dynamic phase. CONCLUSIONS These results show that only few CV parameters measured with imaging correlate with measurement obtained at the autopsy. These results indicate that in order to better estimate values obtained at the autopsy, we need to define new reference values for the CV measurement on MPMCTA.
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Affiliation(s)
- Renaud Troxler
- University Center of Legal Medicine Lausanne-Geneva, Chemin de la Vulliette 4, 1000, 25, Lausanne, Switzerland
| | - Costin Minoiu
- University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania
| | - Paul Vaucher
- University Center of Legal Medicine Lausanne-Geneva, Chemin de la Vulliette 4, 1000, 25, Lausanne, Switzerland.,School of Health Sciences Fribourg, University of Applied Sciences and Arts Western Switzerland (HES-SO), Rue des Cliniques 15, 1700, Fribourg, Switzerland
| | - Katarzyna Michaud
- University Center of Legal Medicine Lausanne-Geneva, Chemin de la Vulliette 4, 1000, 25, Lausanne, Switzerland
| | - Francesco Doenz
- Department of Diagnostic and Interventional Radiology, University Hospital of Lausanne, Lausanne, Switzerland
| | - Kewin Ducrot
- University Center of Legal Medicine Lausanne-Geneva, Chemin de la Vulliette 4, 1000, 25, Lausanne, Switzerland
| | - Silke Grabherr
- University Center of Legal Medicine Lausanne-Geneva, Chemin de la Vulliette 4, 1000, 25, Lausanne, Switzerland.
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Chen Y. State of the art in post-mortem forensic imaging in China. Forensic Sci Res 2017; 2:75-84. [PMID: 30483623 PMCID: PMC6197115 DOI: 10.1080/20961790.2017.1337501] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 05/30/2017] [Indexed: 10/26/2022] Open
Abstract
The autopsy and histopathologic examination are traditional and classic approaches in forensic pathology. In recent years, with the tremendous progresses of computer technology and medical imaging technology, the developed post-mortem computer tomography, post-mortem magnetic resonance imaging and other new methods provide non-invasive, intuitive, high-precision examining methods and research tools for the forensic pathology. As a result, the reconstruction of the injury as well as the analysis of injury mechanism has been essentially achieved. Such methods have become popular in the research field of forensic science and related work has also been carried out in China. This paper reviews the development and application of abovementioned post-mortem forensic imaging methods in China based on the relevant literature.
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Affiliation(s)
- Yijiu Chen
- Institute of Forensic Science, Ministry of Justice, PRC, Shanghai, China
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33
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Grabherr S, Egger C, Vilarino R, Campana L, Jotterand M, Dedouit F. Modern post-mortem imaging: an update on recent developments. Forensic Sci Res 2017; 2:52-64. [PMID: 30483621 PMCID: PMC6197109 DOI: 10.1080/20961790.2017.1330738] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 05/05/2017] [Indexed: 12/25/2022] Open
Abstract
Modern post-mortem investigations use an increasing number of digital imaging methods, which can be collected under the term "post-mortem imaging". Most methods of forensic imaging are from the radiology field and are therefore techniques that show the interior of the body with technologies such as X-ray or magnetic resonance imaging. To digitally image the surface of the body, other techniques are regularly applied, e.g. three-dimensional (3D) surface scanning (3DSS) or photogrammetry. Today's most frequently used techniques include post-mortem computed tomography (PMCT), post-mortem magnetic resonance imaging (PMMR), post-mortem computed tomographic angiography (PMCTA) and 3DSS or photogrammetry. Each of these methods has specific advantages and limitations. Therefore, the indications for using each method are different. While PMCT gives a rapid overview of the interior of the body and depicts the skeletal system and radiopaque foreign bodies, PMMR allows investigation of soft tissues and parenchymal organs. PMCTA is the method of choice for viewing the vascular system and detecting sources of bleeding. However, none of those radiological methods allow a detailed digital view of the body's surface, which makes 3DSS the best choice for such a purpose. If 3D surface scanners are not available, photogrammetry is an alternative. This review article gives an overview of different imaging techniques and explains their applications, advantages and limitations. We hope it will improve understanding of the methods.
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Affiliation(s)
- Silke Grabherr
- University Centre of Legal Medicine Lausanne-Geneva, Lausanne, Switzerland
| | - Coraline Egger
- University Centre of Legal Medicine Lausanne-Geneva, Lausanne, Switzerland
| | - Raquel Vilarino
- University Centre of Legal Medicine Lausanne-Geneva, Lausanne, Switzerland
- Service of Legal Medicine, Central Institute of Hospitals, Sion, Switzerland
| | - Lorenzo Campana
- University Centre of Legal Medicine Lausanne-Geneva, Lausanne, Switzerland
| | - Melissa Jotterand
- University Centre of Legal Medicine Lausanne-Geneva, Lausanne, Switzerland
| | - Fabrice Dedouit
- University Centre of Legal Medicine Lausanne-Geneva, Lausanne, Switzerland
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Wan L, Shao Y, Zou D, Huang P, Li Z, Wang M, Chen Y. Diagnosis of coronary artery disease using targeted post-mortem computed tomography coronary angiography: a case report. Forensic Sci Res 2017; 2:107-111. [PMID: 30483627 PMCID: PMC6197108 DOI: 10.1080/20961790.2017.1328795] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 05/05/2017] [Indexed: 12/26/2022] Open
Abstract
Targeted post-mortem computed tomography (PMCT) combined with coronary angiography has the potential to play a significant role in the investigation of sudden cardiac death. The authors utilized a targeted PMCT coronary angiography in a case involving a 53-year-old man who died from acute myocardial ischemia and cardiac decompensation which may result from coronary artery disease (CAD). The victim collapsed suddenly at work and died soon after arrival to hospital. The body was examined using PMCT and targeted PMCT coronary angiography. The left anterior descending coronary artery exhibited 75%–100% stenosis in the middle segment; however, the distal segment could not be clearly visualized. In addition, the left circumflex and right coronary artery exhibited calcification, atherosclerosis and an area of 50% stenosis. Signs of cardiogenic pulmonary oedema were also identified. The imaging results suggested that this individual had coronary atherosclerosis and probably died from CAD. The autopsy and histological examination revealed acute myocardial ischemia and myocardial scarring, confirming the cause of death while excluding other probabilities. In summary, targeted post-mortem computed tomography angiography (PMCTA) can visualize the arteries and estimate the degree of principal pathological changes. This method is a simple, reliable and sensitive technique for identifying the presence of coronary atherosclerosis. It is a valuable post-mortem forensic imaging method and should be recommended in the investigation of suspicious cardiac deaths.
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Affiliation(s)
- Lei Wan
- Shanghai Key Laboratory of Forensic Science, Shanghai Forensic Service Platform, Department of Forensic Pathology, Institute of Forensic Science, Ministry of Justice, Shanghai, China
| | - Yu Shao
- Shanghai Key Laboratory of Forensic Science, Shanghai Forensic Service Platform, Department of Forensic Pathology, Institute of Forensic Science, Ministry of Justice, Shanghai, China
| | - Donghua Zou
- Shanghai Key Laboratory of Forensic Science, Shanghai Forensic Service Platform, Department of Forensic Pathology, Institute of Forensic Science, Ministry of Justice, Shanghai, China
| | - Ping Huang
- Shanghai Key Laboratory of Forensic Science, Shanghai Forensic Service Platform, Department of Forensic Pathology, Institute of Forensic Science, Ministry of Justice, Shanghai, China
| | - Zhengdong Li
- Shanghai Key Laboratory of Forensic Science, Shanghai Forensic Service Platform, Department of Forensic Pathology, Institute of Forensic Science, Ministry of Justice, Shanghai, China
| | - Maowen Wang
- Shanghai Key Laboratory of Forensic Science, Shanghai Forensic Service Platform, Department of Forensic Pathology, Institute of Forensic Science, Ministry of Justice, Shanghai, China
| | - Yijiu Chen
- Shanghai Key Laboratory of Forensic Science, Shanghai Forensic Service Platform, Department of Forensic Pathology, Institute of Forensic Science, Ministry of Justice, Shanghai, China
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Ferrara SD, Cecchetto G, Cecchi R, Favretto D, Grabherr S, Ishikawa T, Kondo T, Montisci M, Pfeiffer H, Bonati MR, Shokry D, Vennemann M, Bajanowski T. Back to the Future - Part 2. Post-mortem assessment and evolutionary role of the bio-medicolegal sciences. Int J Legal Med 2017; 131:1085-1101. [PMID: 28444439 DOI: 10.1007/s00414-017-1585-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 03/29/2017] [Indexed: 02/06/2023]
Abstract
Part 2 of the review "Back to the Future" is dedicated to the evolutionary role of the bio-medicolegal sciences, reporting the historical profiles, the state of the art, and prospects for future development of the main related techniques and methods of the ancillary disciplines that have risen to the role of "autonomous" sciences, namely, Genetics and Genomics, Toxicology, Radiology, and Imaging, involved in historic synergy in the "post-mortem assessment," together with the mother discipline Legal Medicine, by way of its primary fundament, universally denominated as Forensic Pathology. The evolution of the scientific research and the increased accuracy of the various disciplines will be oriented towards the elaboration of an "algorithm," able to weigh the value of "evidence" placed at the disposal of the "justice system" as real truth and proof.
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Affiliation(s)
- Santo Davide Ferrara
- Department of Legal and Occupational Medicine, Toxicology and Public Health, University-Hospital of Padova, Padua, Italy.
| | - Giovanni Cecchetto
- Department of Legal and Occupational Medicine, Toxicology and Public Health, University-Hospital of Padova, Padua, Italy
| | - Rossana Cecchi
- Department of Biomedical, Biotechnological and Translational Medicine, University of Parma, Parma, Italy
| | - Donata Favretto
- Department of Legal and Occupational Medicine, Toxicology and Public Health, University-Hospital of Padova, Padua, Italy
| | - Silke Grabherr
- University Center of Legal Medicine Lausanne-Geneva, University of Lausanne, Lausanne, Switzerland
| | - Takaki Ishikawa
- Department of Legal Medicine, Osaka City University Medical School, Osaka, Japan
| | - Toshikazu Kondo
- Department of Forensic Medicine, Wakayama Medical University, Wakayama, Japan
| | - Massimo Montisci
- Department of Legal and Occupational Medicine, Toxicology and Public Health, University-Hospital of Padova, Padua, Italy
| | - Heidi Pfeiffer
- Institute of Legal Medicine, University-Hospital Münster, Münster, Germany
| | - Maurizio Rippa Bonati
- Department of Cardiac, Thoracic and Vascular Sciences, Section of Medical Humanities, University of Padova, Padua, Italy
| | - Dina Shokry
- Department of Forensic Medicine and Clinical Toxicology, University of Cairo, Cairo, Egypt
| | - Marielle Vennemann
- Institute of Legal Medicine, University-Hospital Münster, Münster, Germany
| | - Thomas Bajanowski
- Institute of Legal Medicine, University-Hospital Essen, Essen, Germany
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36
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Heinemann A, Grabherr S, Dedouit F, Woźniak K, Fischer F, Wittig H, Grimm J, Vogel H. The impact of multiphase post-mortem CT- angiography (MPMCTA) for investigating fatal outcomes of medical interventions. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.jofri.2017.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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37
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Kuninaka H, Takahashi Y, Sano R, Takahashi K, Kubo R, Kominato Y, Takei H, Kobayashi S, Shimada T, Tokue H, Awata S, Hirasawa S. Use of postmortem computed tomography angiography to detect vascular injuries accompanying skull base fracture. Leg Med (Tokyo) 2016; 23:55-58. [PMID: 27890105 DOI: 10.1016/j.legalmed.2016.09.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 08/30/2016] [Accepted: 09/28/2016] [Indexed: 11/15/2022]
Abstract
A 58-year-old woman who had presented for upper gastrointestinal barium examination accidently slipped from the movable bed, and her head became compressed between the end of the bed and the side wall. She suffered massive bleeding from her nose and ear followed by cardiac arrest, and subsequent attempts at cardiopulmonary resuscitation failed. A medicolegal autopsy was performed to reveal the cause of death, as part of the investigation of the accident. During the autopsy, postmortem cerebral CT angiography was carried out by injection of 5% gelatin-barium emulsion as a radiopaque contrast medium into the bilateral common carotid arteries, demonstrating transudation of the contrast medium into the right acoustic meatus and the sphenoidal sinus cavity. Considering that the body appeared anemic and that PMCTA suggested vascular injuries, the cause of death was definitively determined to be hemorrhagic shock due to injuries to the right internal carotid artery, accompanied by skull base fracture. Postmortem CT angiography played an important role in confirming that the vascular injuries had been responsible for the bleeding, as the lesions could not be fully confirmed by native CT or macroscopic examination.
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Affiliation(s)
- Hikaru Kuninaka
- Department of Legal Medicine, Gunma University Graduate School of Medicine, Maebashi 371-8511, Japan
| | - Yoichiro Takahashi
- Department of Legal Medicine, Gunma University Graduate School of Medicine, Maebashi 371-8511, Japan.
| | - Rie Sano
- Department of Legal Medicine, Gunma University Graduate School of Medicine, Maebashi 371-8511, Japan
| | - Keiko Takahashi
- Department of Legal Medicine, Gunma University Graduate School of Medicine, Maebashi 371-8511, Japan
| | - Rieko Kubo
- Department of Legal Medicine, Gunma University Graduate School of Medicine, Maebashi 371-8511, Japan
| | - Yoshihiko Kominato
- Department of Legal Medicine, Gunma University Graduate School of Medicine, Maebashi 371-8511, Japan
| | - Hiroyuki Takei
- Department of Radiology, Gunma University Hospital, Maebashi 371-8511, Japan
| | - Susumu Kobayashi
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, Maebashi 371-8511, Japan
| | - Takehiro Shimada
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, Maebashi 371-8511, Japan
| | - Hiroyuki Tokue
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, Maebashi 371-8511, Japan
| | - Sachiko Awata
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, Maebashi 371-8511, Japan
| | - Satoshi Hirasawa
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, Maebashi 371-8511, Japan
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Multiphase Postmortem Computed Tomography Angiography in Pediatrics: A Case Report. Am J Forensic Med Pathol 2016; 36:239-44. [PMID: 26280883 DOI: 10.1097/paf.0000000000000189] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Postmortem imaging techniques, especially postmortem computed tomography, have become integral tools in forensic investigations. Multiphase postmortem computed tomography angiography (MPMCTA) visualizes the vascular system in detail and makes it possible to evaluate the perfusion of even the smallest vessels. Although the technique has been well described for adults, no pediatric cases have been reported and no pediatric protocol has been established for this type of investigation. We present the case a 7-year-old child for which we used a previously described MPMCTA protocol and adapted values of perfusion, with the same technical equipment as for adult cases. Our main objective was to propose a perfusion protocol adapted for the investigation of infants and children. Moreover, we discuss both the difficulties that we encountered and possible ways to further improve the investigation of pediatric cases by MPMCTA.
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Schweitzer W, Flach PM, Thali M, Laberke P, Gascho D. Very economical immersion pump feasibility for postmortem CT angiography. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.jofri.2015.11.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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40
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Borowska-Solonynko A, Solonynko B, Fudalej M, Żyłkowski J. Postmortem computed tomography with the use of air for blood vessel enhancement—Early experience. Forensic Sci Int 2016; 261:116-22. [DOI: 10.1016/j.forsciint.2016.02.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Revised: 02/06/2016] [Accepted: 02/08/2016] [Indexed: 12/14/2022]
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42
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Use of postmortem coronary computed tomography angiography with water-insoluble contrast medium to detect stenosis of the left anterior descending artery in a case of sudden death. Leg Med (Tokyo) 2016; 19:47-51. [DOI: 10.1016/j.legalmed.2016.02.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 01/17/2016] [Accepted: 02/01/2016] [Indexed: 11/22/2022]
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43
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Grabherr S, Baumann P, Fahrni S, Mangin P, Grimm J. Virtuelle vs. reale forensische bildgebende Verfahren. Rechtsmedizin (Berl) 2015. [DOI: 10.1007/s00194-015-0047-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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44
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Lee H, Park H, Cha JG, Lee S, Yang K. Myocardial Contrast Defect Associated with Thrombotic Coronary Occlusion: Pre-Autopsy Diagnosis of a Cardiac Death with Post-Mortem CT Angiography. Korean J Radiol 2015; 16:1024-8. [PMID: 26357496 PMCID: PMC4559773 DOI: 10.3348/kjr.2015.16.5.1024] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 06/10/2015] [Indexed: 11/23/2022] Open
Abstract
We report the case of a female who died of suspected acute myocardial infarction. Post-mortem CT angiography (PMCTA) was performed with intravascular contrast infusion before the standard autopsy, and it successfully demonstrated the complete thrombotic occlusion of a coronary artery and also a corresponding perfusion defect on myocardium. We herein describe the PMCTA findings of a cardiac death with special emphasis on the potential benefits of this novel CT technique in forensic practice.
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Affiliation(s)
- Heon Lee
- Department of Radiology, Soonchunhyang University Hospital, Bucheon 14584, Korea
| | - Hyejin Park
- Department of Forensic Medicine, National Forensic Service, Wonju 26460, Korea
| | - Jang Gyu Cha
- Department of Radiology, Soonchunhyang University Hospital, Bucheon 14584, Korea
| | - Sookyoung Lee
- Department of Forensic Medicine, National Forensic Service, Wonju 26460, Korea
| | - Kyungmoo Yang
- Department of Forensic Medicine, National Forensic Service, Wonju 26460, Korea
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45
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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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Postmortem-computed tomography and postmortem-computed tomography-angiography: a focused update. Radiol Med 2015; 120:810-23. [PMID: 26088469 DOI: 10.1007/s11547-015-0559-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 06/08/2015] [Indexed: 01/20/2023]
Abstract
The use of multidetector CT (MDCT) represents a reality routinely used in several forensic institutes, for the numerous advantages that this diagnostic tool can provide; costs are becoming increasingly lower; data acquisition is always faster and once acquired may be revalued at any time. However, there are also some diagnostic limitations, for example, the visualization of the vascular system or a limited soft tissue contrast. In order to overcome these limitations, in recent years, contrast medium has been introduced in postmortem cases, with the development of several techniques of PMCT angiography (PMCTA) and standardized protocols to make them easily reproducible. The aim of this review is to highlight the advantages and pitfalls of PMCT and PMCTA in forensic investigation, taking into consideration the broad spectrum of applications both for natural and unnatural deaths and the numerous methods currently used. Secondly, in the light of the considerable progress in this field and the attempt to develop standardized protocols of PMCTA, the authors aim to evaluate the diagnostic value of PMCTA in comparison both to PMCT and conventional autopsy.
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Makino Y, Inokuchi G, Yokota H, Hayakawa M, Yajima D, Motomura A, Chiba F, Torimitsu S, Nakatani Y, Iwase H. Sudden death due to coronary artery dissection associated with fibromuscular dysplasia revealed by postmortem selective computed tomography coronary angiography: A case report. Forensic Sci Int 2015; 253:e10-5. [PMID: 26048864 DOI: 10.1016/j.forsciint.2015.05.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Revised: 05/13/2015] [Accepted: 05/14/2015] [Indexed: 11/29/2022]
Abstract
We present an autopsy case of sudden death due to coronary artery dissection associated with fibromuscular dysplasia (FMD) in a young female patient. Postmortem selective coronary artery computed tomography (CT) angiography revealed dissections of the left anterior descending and left circumflex arteries. These findings were confirmed by subsequent autopsy. Histopathological examination revealed coronary artery FMD, which is considered a risk factor for dissection. To the best of our knowledge, this is the first postmortem radiology-pathology correlation of coronary artery dissection associated with FMD.
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Affiliation(s)
- Yohsuke Makino
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku 113-0033, Tokyo, Japan; Department of Legal Medicine, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chuo-ku 260-8670, Chiba, Japan.
| | - Go Inokuchi
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chuo-ku 260-8670, Chiba, Japan.
| | - Hajime Yokota
- Department of Radiology, Chiba University Hospital, Inohana 1-8-1, Chuo-ku 260-8677, Chiba, Japan.
| | - Mutsumi Hayakawa
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chuo-ku 260-8670, Chiba, Japan.
| | - Daisuke Yajima
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chuo-ku 260-8670, Chiba, Japan.
| | - Ayumi Motomura
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chuo-ku 260-8670, Chiba, Japan.
| | - Fumiko Chiba
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku 113-0033, Tokyo, Japan; Department of Legal Medicine, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chuo-ku 260-8670, Chiba, Japan.
| | - Suguru Torimitsu
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chuo-ku 260-8670, Chiba, Japan.
| | - Yukio Nakatani
- Department of Diagnostic Pathology, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chuo-ku 260-8670, Chiba, Japan.
| | - Hirotaro Iwase
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku 113-0033, Tokyo, Japan; Department of Legal Medicine, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chuo-ku 260-8670, Chiba, Japan.
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Acute aortic dissection with carotid and coronary malperfusion: from imaging to pathology. Am J Forensic Med Pathol 2015; 35:157-62. [PMID: 24918952 DOI: 10.1097/paf.0000000000000098] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Postmortem imaging, including postmortem computed tomography angiography, has become an integral tool in forensic investigation in recent years. A relatively new technique, multiphase postmortem computed tomography angiography, allows detailed visualization of the vascular system and makes it possible to evaluate the dynamic perfusion of aortic branches, including the coronary arteries. Here, we report a case of aortic dissection involving the ascending aorta (type A) with coronary and carotid malperfusion. This case illustrates the complementary use of many of the diagnostic tools that are now available in forensic practice, from imaging to conventional autopsy to pathologic techniques such as immunohistochemistry.
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Application of contrast media in post-mortem imaging (CT and MRI). Radiol Med 2015; 120:824-34. [PMID: 25841652 DOI: 10.1007/s11547-015-0532-2] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 03/12/2015] [Indexed: 01/17/2023]
Abstract
The application of contrast media in post-mortem radiology differs from clinical approaches in living patients. Post-mortem changes in the vascular system and the absence of blood flow lead to specific problems that have to be considered for the performance of post-mortem angiography. In addition, interpreting the images is challenging due to technique-related and post-mortem artefacts that have to be known and that are specific for each applied technique. Although the idea of injecting contrast media is old, classic methods are not simply transferable to modern radiological techniques in forensic medicine, as they are mostly dedicated to single-organ studies or applicable only shortly after death. With the introduction of modern imaging techniques, such as post-mortem computed tomography (PMCT) and post-mortem magnetic resonance (PMMR), to forensic death investigations, intensive research started to explore their advantages and limitations compared to conventional autopsy. PMCT has already become a routine investigation in several centres, and different techniques have been developed to better visualise the vascular system and organ parenchyma in PMCT. In contrast, the use of PMMR is still limited due to practical issues, and research is now starting in the field of PMMR angiography. This article gives an overview of the problems in post-mortem contrast media application, the various classic and modern techniques, and the issues to consider by using different media.
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Morgan B, Adlam D, Robinson C, Pakkal M, Rutty GN. Adult post-mortem imaging in traumatic and cardiorespiratory death and its relation to clinical radiological imaging. Br J Radiol 2014; 87:20130662. [PMID: 24338941 DOI: 10.1259/bjr.20130662] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
The use of post-mortem imaging is expanding throughout the world with increasing use of advanced imaging techniques, such as contrast-enhanced CT and MRI. The questions asked of post-mortem imaging are complex and can be very different, for example for natural sudden death investigation will focus on the cause, whereas for trauma the cause of death is often clear, but injury patterns may be very revealing in investigating the background to the incident. Post-mortem imaging is different to clinical imaging regarding both the appearance of pathology and the information required, but there is much to learn from many years of clinical research in the use of these techniques. Furthermore, it is possible that post-mortem imaging research could be used not only for investigating the cause of death but also as a model to conduct clinically relevant research. This article reviews challenges to the development of post-mortem imaging for trauma, identification and cardiorespiratory death, and how they may be influenced by current clinical thinking and practice.
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Affiliation(s)
- B Morgan
- Imaging Department, University Hospitals of Leicester, Leicester Royal Infirmary, Leicester, UK
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