1
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Objective evaluation of chest findings in infants by postmortem computed tomography. Leg Med (Tokyo) 2023; 60:102178. [PMID: 36495780 DOI: 10.1016/j.legalmed.2022.102178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 10/31/2022] [Accepted: 11/17/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE The purpose of this study was to review the findings of computed tomography (CT) performed early postmortem on infants and to clarify the postmortem CT lung findings that occur in the absence of abnormal histopathological findings. MATERIALS AND METHODS From July 2016 to March 2022, 72 infants were autopsied with postmortem CT (41 boys 31 girls, aged 0-36 (mean 8.2) months). Autopsy and postmortem CT lung findings were compared with the causes of death identified by the autopsies, namely sudden infant death syndrome (n = 37), acute circulatory system disease (18), drowning (7), asphyxia (5), and dehydration/undernutrition (5). RESULTS The %aerated lung volume (-700 HU or less) ranged from 0 % to 33 % (mean 1.5 %, median 0 %), being <1 % in 61 cases (84.7 %) and >3 % in 3/5 (60 %) of the dehydration/undernutrition group. The dehydration/undernutrition group showed significant preservation of lung field air content compared with the other causes of death groups (p < 0.05). Receiver characteristic curve analysis showed a cut off value of 0.8 % and area under the curve of 0.88806. The drowning group had significantly greater pleural cavity fluid retention than the other causes of death groups (p < 0.05). No correlation was found between postmortem interval and pleural cavity fluid retention. However, resuscitation time and pleural cavity fluid retention were correlated. CONCLUSION Evaluation of CT values on postmortem lung fields of infants usually reveals a marked decrease in air content. When air content exceeds 0.8% on infant postmortem CT, dehydration/undernutrition should be considered in the differential diagnosis.
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2
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Post-mortem computed tomography is a useful tool for determining the pulmonary ventilation status in newborns. Rechtsmedizin (Berl) 2021. [DOI: 10.1007/s00194-021-00536-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Abstract
Introduction
Lung ventilation is a standard sign of life in newborns. Post-mortem computed tomography (PMCT) is highly sensitive to the presence of gas in the body including the lungs. Current standard examinations to determine the pulmonary ventilation status in newborns are the flotation test and histology. The purpose of this study was to compare the accuracy of PMCT with the flotation test for determining the lung ventilation status with histological control as reference standard. A cut-off value as CT number in Hounsfield Units (HU) determining lung ventilation of newborns in PMCT should be established.
Methods
A total of 38 infant lungs were examined of which 21 lungs were from infants deceased shortly after live birth (control group) and 17 lungs belonged to infants where live birth was in question (study group). All lungs were examined using PMCT, flotation test, and histological examination.
Results
The control group showed an overall mean attenuation ± standard deviation of −219 HU ± 135; the study group of 45 ± 15 HU in histologically nonventilated lungs versus −192 ± 207 HU; (p < 0.001) in ventilated lungs. The best cut-off value for optimal discrimination of ventilated and nonventilated lungs in newborns was −35 mean HU.
Conclusion
PMCT is equally well suited to determine lung ventilation as the flotation test. It provides additional information regarding pulmonary infiltration, degree of putrefaction, or signs of trauma (fractures, pneumothorax). Histology remains mandatory in ambiguous cases.
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Gould SW, Harty MP, Givler NE, Christensen TE, Curtin RN, Harcke HT. Pediatric postmortem computed tomography: initial experience at a children's hospital in the United States. Pediatr Radiol 2019; 49:1113-1129. [PMID: 31201439 DOI: 10.1007/s00247-019-04433-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 04/17/2019] [Accepted: 05/16/2019] [Indexed: 12/18/2022]
Abstract
Postmortem CT might provide valuable information in determining the cause of death and understanding disease processes, particularly when combined with traditional autopsy. Pediatric applications of postmortem imaging represent a new and rapidly growing field. We describe our experience in establishing a pediatric postmortem CT program and present a discussion of the distinct challenges in developing this type of program in the United States of America, where forensic practice varies from other countries. We give a brief overview of recent literature along with the common imaging findings on postmortem CT that can simulate antemortem pathology.
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Affiliation(s)
- Sharon W Gould
- Department of Medical Imaging, Nemours/Alfred I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE, 19803, USA.
| | - M Patricia Harty
- Department of Medical Imaging, Nemours/Alfred I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE, 19803, USA
| | - Nicole E Givler
- Department of Medical Imaging, Nemours/Alfred I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE, 19803, USA
| | - Theresa E Christensen
- Department of Biomedical Research, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA
| | - Riley N Curtin
- Department of Biomedical Research, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA
| | - Howard T Harcke
- Department of Medical Imaging, Nemours/Alfred I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE, 19803, USA
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4
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Diagnostic Accuracy of Postmortem CT of Children: A Retrospective Single-Center Study. AJR Am J Roentgenol 2019; 212:1335-1347. [PMID: 30917029 DOI: 10.2214/ajr.18.20534] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE. The objective of our study was to determine the diagnostic accuracy of postmortem CT in children compared with standard autopsy. MATERIALS AND METHODS. This single-center retrospective study reviewed un-enhanced whole-body postmortem CT examinations of children less than 16 years old with corresponding autopsy reports irrespective of the clinical indication for referral for postmortem CT. Perinatal deaths were excluded. Postmortem CT was reported by experienced postmortem radiologists who were blinded to autopsy findings, with the primary outcome being concordance for the main pathologic diagnosis or findings leading to a cause of death. Autopsy performed by pediatric pathologists was the reference standard. RESULTS. One hundred thirty-six patients (74 [54.4%] male and 62 [45.6%] female patients) were included. The mean age of the 136 patients was 2 years 1 month (range, 2 days-14.7 years). A cause of death at autopsy was found for 77 of the 136 (56.6%) patients. Postmortem CT depicted a correct cause of death in 55 of 77 (71.4%) patients; (55/136 overall [40.4%]), with the majority attributable to traumatic brain or body injuries. For major pathologic findings, diagnostic accuracy rates were a sensitivity of 71.4% (95% CI, 60.5-80.3%), specificity of 81.4% (95% CI, 69.6-89.3%), positive predictive value of 83.3% (95% CI, 72.6-90.4%), negative predictive value of 68.6% (95% CI, 57.0-78.2%), and concordance rate of 75.7% (95% CI, 67.9-82.2%). The sensitivity of postmortem CT versus autopsy was highest for intracranial (75.6%; 95% CI, 60.7-86.2%) and musculoskeletal (98.4%; 95% CI, 91.4-99.7%) abnormalities and lowest for cardiac (31.3%; 95% CI, 14.2-55.6%) and abdominal (53.8%; 95% CI, 29.1-78.6%) findings. CONCLUSION. Postmortem CT gives an acceptable diagnostic concordance rate with autopsy of 71.4%, although identification of the cause of death overall was low at 40.4%. The highest accuracy rates were for intracranial and musculoskeletal abnormalities.
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5
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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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Shelmerdine SC, Gerrard CY, Rao P, Lynch M, Kroll J, Martin D, Miller E, Filograna L, Martinez RM, Ukpo O, Daly B, Hyodoh H, Johnson K, Watt A, Taranath A, Brown S, Perry D, Boel LWT, Borowska-Solonynko A, van Rijn R, Klein W, Whitby E, Arthurs OJ. Joint European Society of Paediatric Radiology (ESPR) and International Society for Forensic Radiology and Imaging (ISFRI) guidelines: paediatric postmortem computed tomography imaging protocol. Pediatr Radiol 2019; 49:694-701. [PMID: 30815716 PMCID: PMC6459792 DOI: 10.1007/s00247-018-04340-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 10/29/2018] [Accepted: 12/20/2018] [Indexed: 11/30/2022]
Abstract
Postmortem CT for investigating childhood deaths is increasingly utilised as a noninvasive adjunct or alternative to standard autopsy; however there are no standardised published imaging protocols. This article describes a standardised imaging protocol that has been developed based on current practices of international postmortem imaging practitioners and experts. This recommendation is expected to be useful for postmortem imaging centres wishing to update their existing practices and for those starting paediatric postmortem CT as a new service.
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Affiliation(s)
- Susan C Shelmerdine
- Department of Clinical Radiology, Great Ormond Street Hospital for Children, London, UK
- UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital for Children, London, UK
| | - Chandra Y Gerrard
- Department of Radiology, University of New Mexico, Albuquerque, NM, USA
| | - Padma Rao
- Department of Medical Imaging, Victorian Institute of Forensic Medicine & Royal Children's Hospital, Melbourne, Australia
| | - Matthew Lynch
- Department of Medical Imaging, Victorian Institute of Forensic Medicine & Royal Children's Hospital, Melbourne, Australia
| | - Jeroen Kroll
- Department of Radiology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Dan Martin
- Department of Radiology, Gold Coast University Hospital, Gold Coast, Australia
| | - Elka Miller
- Department of Medical Imaging, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Laura Filograna
- Department of Diagnostic and Interventional Radiology, "Tor Vergata" University of Rome, Rome, Italy
| | - Rosa Maria Martinez
- Institute of Forensic Medicine (Virtopsy), University of Zurich, Zurich, Switzerland
| | - Odey Ukpo
- Los Angeles County Medical Examiner-Coroner Office, Los Angeles, CA, USA
| | - Barry Daly
- Office of the Chief Medical Examiner, University of Maryland, Baltimore, MD, USA
| | - Hideki Hyodoh
- Center for Cause of Death Investigation, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Karl Johnson
- Department of Radiology, Birmingham Children's Hospital, Birmingham, UK
| | - Andrew Watt
- Department of Diagnostic Imaging & Clinical Physics, The Royal Hospital for Children, Glasgow, Scotland, UK
| | - Ajay Taranath
- Department of Medical Imaging, Women's and Children's Hospital, North Adelaide, South Australia, Australia
| | - Scott Brown
- Department of Medical Imaging, Women's and Children's Hospital, North Adelaide, South Australia, Australia
| | - David Perry
- Radiology Department, National Women's Health and Starship Children's Hospital, Auckland City Hospital, Auckland, New Zealand
| | | | | | - Rick van Rijn
- Department of Radiology, Emma Children's Hospital, Academic Medical Center Amsterdam, Amsterdam, the Netherlands
| | - Willemijn Klein
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Elspeth Whitby
- Academic Unit of Radiology, University of Sheffield, Sheffield, UK
| | - Owen J Arthurs
- Department of Clinical Radiology, Great Ormond Street Hospital for Children, London, UK.
- UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital for Children, London, UK.
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7
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Shelmerdine S, Langan D, Sebire NJ, Arthurs O. Diagnostic accuracy of perinatal post-mortem ultrasound (PMUS): a systematic review. BMJ Paediatr Open 2019; 3:e000566. [PMID: 31799452 PMCID: PMC6863669 DOI: 10.1136/bmjpo-2019-000566] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 10/08/2019] [Accepted: 10/14/2019] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE Ultrasound is ubiquitous in live paediatric imaging; however, its usage in post-mortem setting is less established. This systematic review aims to evaluate the diagnostic accuracy of paediatric post-mortem ultrasound (PMUS). DESIGN MEDLINE, Embase and Cochrane Library databases were queried for studies published between 1998 and 2018 assessing PMUS diagnostic accuracy rates in children<18 years old, using autopsy as reference standard. Risk of bias was assessed using Quality Assessment of Diagnostic Accuracy Studies 2. A bivariate random-effects model was used to obtain combined mean estimates of sensitivity and specificity for different body systems. RESULTS Four studies were included, all relating to ultrasound for perinatal deaths. The mean diagnostic sensitivity and specificity for neurological abnormalities were 84.3% (95% CI: 70.8% to 92.2%) and 96.7% (95% CI: 86.5% to 99.3%); for cardiothoracic abnormalities 52.1% (95% CI: 27.6% to 75.5%,) and 96.6% (95% CI: 86.8% to 99.2%); and for abdominal abnormalities 78.4% (95% CI: 61.0% to 89.4%) and 97.3% (95% CI: 88.9% to 99.4%). Combining all body systems, the mean sensitivity and specificity were 73.3% (95% CI: 59.9% to 83.5%) and 96.6% (95% CI: 92.6% to 98.4%). CONCLUSIONS PMUS demonstrates a reasonable diagnostic accuracy, particularly for abdominal and neurological abnormalities, although cardiac anomalies were less readily identified. TRIAL REGISTRATION NUMBER CRD42018106968.
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Affiliation(s)
- Susan Shelmerdine
- Department of Clinical Radiology, Great Ormond Street Hospital for Children, London, UK.,UCL GOSH ICH, London, UK
| | | | - Neil J Sebire
- UCL GOSH ICH, London, UK.,Department of Paediatric Pathology, Great Ormond Street Hospital for Children, London, UK
| | - Owen Arthurs
- Department of Clinical Radiology, Great Ormond Street Hospital for Children, London, UK.,UCL GOSH ICH, London, UK
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8
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Ben Taher M, Pearson J, Cohen M, Offiah AC. Acceptability of post-mortem imaging among Muslim and non-Muslim communities. Br J Radiol 2018; 91:20180295. [PMID: 30059236 DOI: 10.1259/bjr.20180295] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE: People's views regarding autopsy vary according to their cultural and religious beliefs. This paper aims to determine the opinions towards this procedure among Muslims resident in Libya and Muslims and non-Muslims resident in the UK. Our long-term goal is to improve autopsy rates; whether conventional or through the use of post-mortem imaging. METHODS: 400 questionnaires were distributed to the three communities, interrogating belief about post-mortem investigations. Descriptive statistics and non-parametric statistics were used to analyse the data. RESULTS: Of the 400 distributed questionnaires, there was a high return rate of 320 (80%). All groups felt that children should be buried sooner than adults(p < 0.001), but 77% of Libyan Muslims thought that children should be buried within 12 h of death compared to 16% of UK Muslims and only 7% of UK non-Muslims (p < 0.001). More non-Muslims were unconcerned about a negative impact of traditional autopsy on the dignity of the corpse than Muslims (p < 0.001) and more Muslims responded that autopsy has a negative emotional effect on the family (p < 0.001). Type of death altered what sort of investigations were desired. In the case of homicide, Libyan Muslims were less likely to prefer CT (p < 0.001) or MRI (p = 0.001). Sex had no effect on the results of the survey. CONCLUSION: Post-mortem imaging is acceptable to both Muslims and non-Muslims in Libya and the UK, but Muslims have a significant preference for post-mortem imaging compared to autopsy, except in homicidal cases. ADVANCES IN KNOWLEDGE: (1) The ability of post-mortem imaging to preserve the dignity of the corpse is independent of religion, however, significantly more Muslims feel that autopsy has a negative emotional effect on the family of the deceased. (2) A significant majority of Muslims in Libya prefer to bury children within 12 h of death, while a delay of up to a week is acceptable in UK. (3) Muslims resident in UK have an attitude closer to that of the indigenous (non-Muslim) population and therefore, educational programmes may be successful in changing attitudes of Muslims in Libya and other predominantly Muslim countries.
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Affiliation(s)
- Mohamed Ben Taher
- 1 Department of Oncology and Metabolism, University of Sheffield , Sheffield , UK
| | - Jean Pearson
- 2 Corporate Information and Computing Services, University of Sheffield , Sheffield , UK
| | - Marta Cohen
- 3 Department of Pathology, Sheffield Children's NHS Foundation Trust, Western Bank , Sheffield , UK
| | - Amaka C Offiah
- 1 Department of Oncology and Metabolism, University of Sheffield , Sheffield , UK.,4 Department of Radiology, Sheffield Children's NHS Foundation Trust, Western Bank , Sheffield , UK
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9
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Gulino SP, Burns K, Gunther WM, MacLeod H. Improving Forensic Pathologic Investigation of Sudden Death in the Young: Tools, Guidance, and Methods of Cardiovascular Dissection from the Sudden Death in the Young Case Registry. Acad Forensic Pathol 2018; 8:347-391. [PMID: 31240048 DOI: 10.1177/1925362118782077] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 04/18/2018] [Indexed: 11/16/2022]
Abstract
The Sudden Death in the Young (SDY) Case Registry, a prospective, population-based registry active in ten states, has developed tools to aid pathologists and death investigators in the evaluation and autopsy of unexplained, natural sudden deaths in the pediatric population. The tools were developed by a team of experts representing forensic pathology; pediatric-, cardiac-, and neuropathology; cardiology; neurology/epileptology; pediatrics; genetic counseling; and public health. These tools focus on collecting data relevant to determination of cause of death with a focus on dissection of the cardiovascular system. The tools provide an objective checklist format for ease of use and data extraction. By sharing the tools here and highlighting the examination of the cardiovascular system, the SDY Case Registry encourages a standardized approach to death investigation, autopsy, and data collection for sudden, unexpected deaths in the young towards a goal of informing prevention efforts. Acad Forensic Pathol. 2018 8(2): 347-391.
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10
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Arthurs OJ, van Rijn RR, Whitby EH, Johnson K, Miller E, Stenzel M, Watt A, Taranath A, Perry DH. ESPR postmortem imaging task force: where we begin. Pediatr Radiol 2016; 46:1363-9. [PMID: 27412272 DOI: 10.1007/s00247-016-3639-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 05/04/2016] [Indexed: 11/24/2022]
Abstract
A new task force on postmortem imaging was established at the annual meeting of the European Society of Paediatric Radiology (ESPR) in Graz, Austria, in 2015. The postmortem task force is separate from the child abuse task force as it covers all aspects of fetal, neonatal and non-forensic postmortem imaging. The main focus of the task force is the guidance and standardization of non-radiographic postmortem imaging, particularly postmortem CT and postmortem MRI. This manuscript outlines the starting point of the task force, with a mission statement, outline of current experience, and short- and long-term goals.
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Affiliation(s)
- Owen J Arthurs
- Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH, UK. .,Institute of Child Health, UCL, London, UK.
| | - Rick R van Rijn
- Department of Radiology, Emma Children's Hospital - Academic Medical Center Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Elspeth H Whitby
- Academic unit of Reproductive and Developmental Medicine, University of Sheffield, Sheffield, S10 1SF, UK
| | - Karl Johnson
- Radiology Department, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, UK
| | - Elka Miller
- Department of Medical Imaging, Children's Hospital of Eastern Ontario, University of Ottawa, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada
| | - Martin Stenzel
- Department of Radiology, University Hospital Freiburg, Hugstetter Str. 55, D-79106, Freiburg, Germany
| | - Andrew Watt
- Department of Diagnostic Imaging & Clinical Physics, The Royal Hospital for Children, 1345 Govan Road, Glasgow, G51 4TF, UK
| | - Ajay Taranath
- Department of Medical Imaging, Women's and Children's Hospital, 72 King William St., North Adelaide, South Australia, Australia
| | - David H Perry
- Radiology Department, National Women's Health and Starship Children's Hospital, Auckland City Hospital, Park Road, Grafton, Auckland, New Zealand
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11
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Comparison of diagnostic performance for perinatal and paediatric post-mortem imaging: CT versus MRI. Eur Radiol 2015; 26:2327-36. [PMID: 26489748 DOI: 10.1007/s00330-015-4057-9] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 09/10/2015] [Accepted: 10/06/2015] [Indexed: 01/10/2023]
Abstract
OBJECTIVES To compare the diagnostic yield of whole-body post-mortem computed tomography (PMCT) imaging to post-mortem magnetic resonance (PMMR) imaging in a prospective study of fetuses and children. METHODS We compared PMCT and PMMR to conventional autopsy as the gold standard for the detection of (a) major pathological abnormalities related to the cause of death and (b) all diagnostic findings in five different body organ systems. RESULTS Eighty two cases (53 fetuses and 29 children) underwent PMCT and PMMR prior to autopsy, at which 55 major abnormalities were identified. Significantly more PMCT than PMMR examinations were non-diagnostic (18/82 vs. 4/82; 21.9 % vs. 4.9 %, diff 17.1 % (95 % CI 6.7, 27.6; p < 0.05)). PMMR gave an accurate diagnosis in 24/55 (43.64 %; 95 % CI 31.37, 56.73 %) compared to 18/55 PMCT (32.73 %; 95 % CI 21.81, 45.90). PMCT was particularly poor in fetuses <24 weeks, with 28.6 % (8.1, 46.4 %) more non-diagnostic scans. Where both PMCT and PMMR were diagnostic, PMMR gave slightly higher diagnostic accuracy than PMCT (62.8 % vs. 59.4 %). CONCLUSION Unenhanced PMCT has limited value in detection of major pathology primarily because of poor-quality, non-diagnostic fetal images. On this basis, PMMR should be the modality of choice for non-invasive PM imaging in fetuses and children. KEY POINTS • Overall 17.1 % more PMCT examinations than PMMR were non-diagnostic • 28.6 % more PMCT were non-diagnostic than PMMR in fetuses <24 weeks • PMMR detected almost a third more pathological abnormalities than PMCT • PMMR gave slightly higher diagnostic accuracy when both were diagnostic.
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12
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Kawasumi Y, Usui A, Hosokai Y, Igari Y, Hosoya T, Hayashizaki Y, Saito H, Ishibashi T, Funayama M. Post-mortem computed tomography findings of the lungs: Retrospective review and comparison with autopsy results of 30 infant cases. Eur J Radiol 2015; 84:721-5. [PMID: 25600678 DOI: 10.1016/j.ejrad.2014.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Revised: 10/21/2014] [Accepted: 12/03/2014] [Indexed: 10/24/2022]
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13
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Normal pediatric postmortem CT appearances. Pediatr Radiol 2015; 45:517-26. [PMID: 25828355 DOI: 10.1007/s00247-014-3258-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 11/03/2014] [Accepted: 11/26/2014] [Indexed: 10/23/2022]
Abstract
Postmortem radiology is a rapidly developing specialty that is increasingly used as an adjunct to or substitute for conventional autopsy. The goal is to find patterns of disease and possibly the cause of death. Postmortem CT images bring to light processes of decomposition most radiologists are unfamiliar with. These postmortem changes, such as the formation of gas and edema, should not be mistaken for pathological processes that occur in living persons. In this review we discuss the normal postmortem thoraco-abdominal changes and how these appear on CT images, as well as how to differentiate these findings from those of pathological processes.
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14
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The future of pediatric and perinatal postmortem imaging. Pediatr Radiol 2015; 45:509-16. [PMID: 25828354 DOI: 10.1007/s00247-014-3266-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Revised: 10/23/2014] [Accepted: 12/19/2014] [Indexed: 12/21/2022]
Abstract
The field and applications of postmortem imaging are exponentially growing. Its potential to identify the cause of death in trauma and ballistic cases is now properly documented, as well as its use in drug mule identification. In pediatric and perinatal practice, large significant series are less available, except for MRI and central nervous system analysis where scientific evidence is now robust. In this review, after a short historical review and analysis of current problems and challenges, we will try to depict the way we see the future of this subspecialty of postmortem cross-sectional imaging, including all specific situations: terminations of pregnancy, intrauterine death, sudden unexpected infant death and identification issues.
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15
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Non-specific post-mortem modifications on whole-body post-mortem computed tomography in sudden unexpected death in infancy. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.jofri.2015.02.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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16
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Arthurs OJ, Taylor AM, Sebire NJ. Indications, advantages and limitations of perinatal postmortem imaging in clinical practice. Pediatr Radiol 2015; 45:491-500. [PMID: 25274468 PMCID: PMC4381094 DOI: 10.1007/s00247-014-3165-z] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Revised: 07/01/2014] [Accepted: 08/20/2014] [Indexed: 11/29/2022]
Abstract
Just as there is a range of paediatric imaging techniques available during life, a similar repertoire is available as part of the foetal and perinatal postmortem examination. In this article, we review the literature regarding the diagnostic utility of postmortem radiography, US, CT and MRI in this clinical setting. There is limited direct evidence on the diagnostic utility of any of these techniques, apart from postmortem MRI, which when combined with other noninvasive investigations, has been shown to be highly sensitive and specific for many foetal postmortem diagnoses. The main disadvantages of postmortem MRI include the longer duration of imaging, the need for appropriate training in the interpretation of normal postmortem changes, and possible non-diagnostic imaging examinations in early gestation foetuses. As less-invasive autopsy becomes increasingly available, the true utility of these techniques will evolve, and clinical guidelines for maximal diagnostic yield can be developed.
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Affiliation(s)
- Owen J. Arthurs
- Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH UK ,Institute of Child Health, University College London, London, UK
| | - Andrew M. Taylor
- Cardiorespiratory Division, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK ,Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, London, UK
| | - Neil J. Sebire
- Institute of Child Health, University College London, London, UK ,Department of Histopathology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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17
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Beck JJ. Can cross sectional imaging contribute to the investigation of unexplained child deaths? A literature review. Radiography (Lond) 2014. [DOI: 10.1016/j.radi.2013.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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18
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High-resolution 3D-MRI of postmortem brain specimens fixed by formalin and gadoteridol. Leg Med (Tokyo) 2014; 16:218-21. [DOI: 10.1016/j.legalmed.2014.03.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2014] [Revised: 03/13/2014] [Accepted: 03/15/2014] [Indexed: 11/24/2022]
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19
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Postmortem computed tomography imaging in the investigation of nontraumatic death in infants and children. BIOMED RESEARCH INTERNATIONAL 2013; 2013:327903. [PMID: 24093093 PMCID: PMC3777181 DOI: 10.1155/2013/327903] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Accepted: 08/03/2013] [Indexed: 11/23/2022]
Abstract
Objective. To determine the accuracy of postmortem computed tomography (PMCT) for the assessment of causes in nontraumatic deaths in children. Study Design. We enrolled cases of nontraumatic deaths of infants and children who underwent PMCT at a single center. The presumed cause of death determined by PMCT was prospectively compared with the clinical and pathological diagnoses of deaths. Results. Thirty-eight cases were enrolled for analysis. Among them, seven cases also underwent conventional medical autopsy. PMCT revealed an identifiable cause of death in accordance with the clinical diagnosis of death in 16 cases of the 38 cases (the concordance rate was 42%) and in accordance with the autopsy cause of death in four of the seven autopsy cases (the concordance rate was 57%). Among eight cases with unknown cause of death by clinical diagnosis, four cases (50%) were identified with cardiac tamponade as a cause of death (one case) and intracranial hemorrhage suggesting abuse (3 cases). Conclusions. PMCT seems to be a promising technique that might serve as a substitute for conventional medical autopsy and give us the complementary information to clinical diagnoses particularly in cases of child abuse. Larger multicenter trials are worthwhile to validate the general feasibility of PMCT.
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Postmortem CT investigation of air/gas distribution in the lungs and gastrointestinal tracts of newborn infants: A serial case study with regard to still- and live birth. Forensic Sci Int 2013; 226:74-80. [DOI: 10.1016/j.forsciint.2012.12.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2012] [Revised: 10/12/2012] [Accepted: 12/02/2012] [Indexed: 11/22/2022]
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21
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Persson A, Falk J, Berge J, Jackowski C. Atlanto-axial rotatory subluxations in postmortem CT: Radiologists be aware of a common pitfall. Forensic Sci Int 2013; 225:9-14. [DOI: 10.1016/j.forsciint.2013.01.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2012] [Revised: 10/04/2012] [Accepted: 01/04/2013] [Indexed: 11/30/2022]
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22
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Whole-body post-mortem computed tomography compared with autopsy in the investigation of unexpected death in infants and children. Eur Radiol 2012; 23:1711-9. [PMID: 23242003 DOI: 10.1007/s00330-012-2738-1] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Revised: 11/04/2012] [Accepted: 11/17/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVES To investigate the contribution of whole-body post-mortem computed tomography (PMCT) in sudden unexpected death in infants and children. METHODS Forty-seven cases of sudden unexpected death in children investigated with radiographic skeletal survey, whole-body PMCT and autopsy were enrolled. For imaging interpretation, non-specific post-mortem modifications and abnormal findings related to the presumed cause of death were considered separately. All findings were correlated with autopsy findings. RESULTS There were 31 boys and 16 girls. Of these, 44 children (93.6 %) were younger than 2 years. The cause of death was found at autopsy in 18 cases (38.3 %), with 4 confirmed as child abuse, 12 as infectious diseases, 1 as metabolic disease and 1 as bowel volvulus. PMCT results were in accordance with autopsy in all but three of these 18 cases. Death remains unexplained in 29 cases (61.7 %) and was correlated with no abnormal findings on PMCT in 27 cases. Major discrepancies between PMCT and autopsy findings concerned pulmonary analysis. CONCLUSIONS Whole-body PMCT may detect relevant findings that can help to explain sudden unexpected death and is essential for detecting non-accidental injuries. We found broad concordance between autopsy and PMCT, except in a few cases of pneumonia. It is a non-invasive technique acceptable to relatives. KEY POINTS • Whole-body post-mortem computed tomography (PMCT) is an effective non-invasive method. • Whole-body PMCT is essential for detecting child abuse in unexpected death. • There is concordance on cause of death between PMCT and autopsy. • Whole-body PMCT could improve autopsy through dissection and sampling guidance. • PMCT shows findings that may be relevant when parents reject autopsy.
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23
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Michiue T, Sakurai T, Ishikawa T, Oritani S, Maeda H. Quantitative analysis of pulmonary pathophysiology using postmortem computed tomography with regard to the cause of death. Forensic Sci Int 2012; 220:232-8. [DOI: 10.1016/j.forsciint.2012.03.007] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2011] [Revised: 12/27/2011] [Accepted: 03/09/2012] [Indexed: 11/28/2022]
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24
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Effectiveness of a worksheet for diagnosing postmortem computed tomography in emergency departments. Jpn J Radiol 2011; 29:701-6. [DOI: 10.1007/s11604-011-0618-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2011] [Accepted: 06/09/2011] [Indexed: 10/16/2022]
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25
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The effectiveness of postmortem multidetector computed tomography in the detection of fatal findings related to cause of non-traumatic death in the emergency department. Eur Radiol 2011; 22:152-60. [PMID: 21861187 DOI: 10.1007/s00330-011-2248-6] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2011] [Revised: 08/04/2011] [Accepted: 08/10/2011] [Indexed: 10/17/2022]
Abstract
OBJECTIVES To investigate the diagnostic performance of postmortem multidetector computed tomography (PMMDCT) for the detection of fatal findings related to causes of non-traumatic death in the emergency department (ED). METHODS 494 consecutive cases of clinically diagnosed non-traumatic death in ED involving PMMDCT were enrolled. The fatal findings were detected on PMMDCT and classified as definite or possible findings. These findings were confirmed by autopsy in 20 cases. RESULTS The fatal findings were detected in 188 subjects (38.1%) including 122 with definite (24.7%) and 66 with possible finding (13.4%). Definite findings included 21 cases of intracranial vascular lesions, 84 with intra-thoracic haemorrhage, 13 with retroperitoneal haemorrhage and one with oesophagogastric haemorrhage. In three patients who had initially been diagnosed with non-traumatic death, PMMDCT revealed fatal traumatic findings. Two definite findings (two haemopericardiums) and seven possible findings (two intestinal obstructions, one each of multiple liver tumours central pulmonary artery dilatation, pulmonary congestion, peritoneal haematoma, and brain oedema) were confirmed by autopsy. The causes of death were not determined in cases with possible findings without autopsy. CONCLUSIONS PMMDCT is a feasible tool for detecting morphological fatal findings in non-traumatic death in ED. It is important to know the ability and limitation of PMMDCT.
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Nolte KB, Mlady G, Zumwalt RE, Cushnyr B, Paul ID, Wiest PW. Postmortem X-ray Computed Tomography (CT) and Forensic Autopsy: A Review of the Utility, the Challenges and the Future implications. Acad Forensic Pathol 2011. [DOI: 10.23907/2011.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The utility of computed tomography (CT) for forensic autopsy is being defined. Small studies have indicated potential areas of use. Systematic studies are few. Evidence of the utility of CT as an autopsy substitute in fatal trauma cases has been inconsistent. Some studies show that there are injuries seen by CT that aren't detected by autopsy indicating that CT, at least, is likely useful as an autopsy adjunct. Research has been limited by small study populations, variation in postmortem interval, differences in protocols including CT slice thickness, who interpreted the scans (radiologists vs. pathologists), and how injuries were scored. Challenges exist to implement and use advanced imaging technology for the forensic autopsy. It is important to determine how to arrange these technologies into a coherent approach to postmortem diagnosis while not encumbering forensic pathologists. Forensic pathologists and radiologists require training in interpreting the unique aspects of postmortem CT scans. Some forensic pathologists might perceive imaging technology as a threat and express concern that it will make the autopsy obsolete. If CT is found to supplant or supplement autopsy in valuable ways, more comprehensive diagnostic information can be provided. If CT can supplant the use of autopsy in certain situations and significantly decrease autopsy numbers it will allow offices to achieve an annual cost savings and divert these resources to other needs. If CT becomes widely available and can supplant autopsy, it could make up some of the gap between the numbers of forensic pathologists available and the numbers needed nationally.
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Affiliation(s)
- Kurt B. Nolte
- Mexico Office of the Medical Investigator and Professor of Pathology at the University of New Mexico School of Medicine
- University of New Mexico - Department of Radiology, Albuquerque, NM (GM, BC, PW), Office of the Medical Investigator - Department of Pathology, Albuquerque, NM (RZ, IP)
| | - Gary Mlady
- University of New Mexico - Department of Radiology, Albuquerque, NM (GM, BC, PW), Office of the Medical Investigator - Department of Pathology, Albuquerque, NM (RZ, IP)
| | - Ross E. Zumwalt
- University of New Mexico - Department of Radiology, Albuquerque, NM (GM, BC, PW), Office of the Medical Investigator - Department of Pathology, Albuquerque, NM (RZ, IP)
| | - Brad Cushnyr
- University of New Mexico - Department of Radiology, Albuquerque, NM (GM, BC, PW), Office of the Medical Investigator - Department of Pathology, Albuquerque, NM (RZ, IP)
| | - Ian D. Paul
- University of New Mexico - Department of Radiology, Albuquerque, NM (GM, BC, PW), Office of the Medical Investigator - Department of Pathology, Albuquerque, NM (RZ, IP)
| | - Philip W. Wiest
- University of New Mexico - Department of Radiology, Albuquerque, NM (GM, BC, PW), Office of the Medical Investigator - Department of Pathology, Albuquerque, NM (RZ, IP)
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Lethal visceral traumatic injuries secondary to child abuse: A case of practical application of autopsy, radiological and microscopic studies. Forensic Sci Int 2011; 206:e62-6. [DOI: 10.1016/j.forsciint.2010.08.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2010] [Revised: 07/18/2010] [Accepted: 08/31/2010] [Indexed: 12/26/2022]
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Kobayashi T, Shiotani S, Kaga K, Saito H, Saotome K, Miyamoto K, Kohno M, Kikuchi K, Hayakawa H, Homma K. Characteristic signal intensity changes on postmortem magnetic resonance imaging of the brain. Jpn J Radiol 2010; 28:8-14. [DOI: 10.1007/s11604-009-0373-9] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2009] [Accepted: 08/26/2009] [Indexed: 10/19/2022]
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Shiotani S, Ueno Y, Atake S, Kohno M, Suzuki M, Kikuchi K, Hayakawa H. Nontraumatic postmortem computed tomographic demonstration of cerebral gas embolism following cardiopulmonary resuscitation. Jpn J Radiol 2010; 28:1-7. [DOI: 10.1007/s11604-009-0372-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2009] [Accepted: 08/26/2009] [Indexed: 11/24/2022]
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30
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KIKUCHI KIYOSHI, KAWAHARA KOICHI, TSUJI CHIYOKO, TAJIMA YUTAKA, KURAMOTO TERUKAZU, SHIHARA MIWAKO, KOGA YUKARI, SHIOMI NAOTO, UCHIKADO HISAAKI, MORIMOTO YOKO, MIURA NAOKI, MERA KENTARO, OHNO YOSHIKO, MIYAGI NAOHISA, HASHIGUCHI TERUTO, MARUYAMA IKURO, HAYABUCHI NAOHUMI, NAKAYAMA KENJI, SHIGEMORI MINORU. Post mortem contrast-enhanced computed tomography in a case of sudden death from acute pulmonary thromboembolism. Exp Ther Med 2010. [DOI: 10.3892/etm_00000079] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
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31
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Weustink AC, Hunink MGM, van Dijke CF, Renken NS, Krestin GP, Oosterhuis JW. Minimally invasive autopsy: an alternative to conventional autopsy? Radiology 2009; 250:897-904. [PMID: 19244053 DOI: 10.1148/radiol.2503080421] [Citation(s) in RCA: 146] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE To determine the diagnostic performance of minimally invasive autopsy (MIA) for detection of causes of death and to investigate the feasibility of MIA as an alternative to conventional autopsy (CA) in the clinical setting. MATERIALS AND METHODS The institutional review board approved the MIA procedure and study, and informed consent was obtained for all deceased patients from relatives. Thirty deceased patients (19 men, 11 women; age range, 46-79 years), for whom family permission for CA on medical grounds had already been obtained, underwent additional evaluation with MIA prior to CA. MIA consisted of whole-body 16-section computed tomography (CT) and 1.5-T magnetic resonance (MR) imaging, followed by ultrasonography-guided 12-gauge needle biopsy of heart, both lungs, liver, both kidneys, and spleen. Percentage agreement between MIA and CA on cause of death was evaluated. Sensitivity and corresponding 95% confidence intervals (CIs) of MIA for detection of overall (major plus minor) findings, with CA as the reference standard, were calculated. Specificity was calculated for overall findings. Sensitivity analysis was performed to explore the effect of the clustered nature of the data. RESULTS In 23 patients (77%), MIA and CA were in agreement on the cause of death. Sensitivity of MIA for detection of overall findings and detection of major findings was 93% (95% CI: 90%, 96%) and 94% (95% CI: 87%, 97%), respectively. Specificity was 99% (95% CI: 98%, 99%) for detection of overall findings. MIA failed to demonstrate acute myocardial infarction as the cause of death in four patients. Sensitivity analysis indicated a negligible correlation between observations within each patient. CT was superior to MR for detection of pneumothorax and calcifications. MR was superior to CT for detection of brain abnormalities and pulmonary embolus. With biopsy only, detection of disease in 55 organs was possible, which included 27 major findings. CONCLUSION MIA is a feasible procedure with high diagnostic performance for detection of common causes of death such as pneumonia and sepsis; MIA failed to demonstrate cardiac diseases, such as acute myocardial infarction and endocarditis, as underlying cause of death. SUPPLEMENTAL MATERIAL http://radiology.rsnajnls.org/cgi/content/full/250/3/897//DC1.
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Affiliation(s)
- Annick C Weustink
- Department of Radiology, Erasmus University Medical Center Rotterdam, Dr Molewaterplein 40, 3000 CA Rotterdam, The Netherlands.
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Dedouit F, Guilbeau-Frugier C, Capuani C, Sévely A, Joffre F, Rougé D, Rousseau H, Telmon N. Child abuse: practical application of autopsy, radiological, and microscopic studies. J Forensic Sci 2008; 53:1424-9. [PMID: 18752552 DOI: 10.1111/j.1556-4029.2008.00864.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A 17-month-old male infant died at home. The infant's right arm was immobilized because of a humeral fracture 1 month earlier. The circumstances of death appeared unclear to the police investigators and a medicolegal autopsy was carried out. External examination revealed diffuse ecchymoses of varying color. Postmortem imaging was performed prior to autopsy (X-rays, multislice computed tomography [MSCT], and focused brain magnetic resonance imaging [MRI]). These investigations revealed four rib fractures of varying ages, one of which was posterior. Cerebral and pericerebral traumatic lesions were also diagnosed: bilateral subdural hematomas, intraventricular, meningeal, and interpedoncular hemorrhages. In the abdomen, fresh blood was visible within the anterior abdominal wall and the mesenteric root. Autopsy and microscopic study confirmed these lesions. This case report illustrates the valuable assistance rendered by MSCT and MRI to diagnose abuse when a child has died in unclear circumstances.
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Affiliation(s)
- Fabrice Dedouit
- Service de Médecine Légale, Centre Hospitalier Universitaire Rangueil, Avenue du Professeur Jean Poulhès, 31403 Toulouse Cedex 4, France.
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Clarot F, Proust B, Eurin D, Vaz E, Le Dosseur P. [Sudden infant death syndrome and virtual autopsy: scalpel or mouse?]. Arch Pediatr 2007; 14:636-9. [PMID: 17442554 DOI: 10.1016/j.arcped.2007.02.060] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2007] [Accepted: 02/27/2007] [Indexed: 11/25/2022]
Affiliation(s)
- F Clarot
- Service de médecine légale, CHU de Rouen, 1, rue Germont, 76031 Rouen cedex, France
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