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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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Colleter R, Bataille CP, Dabernat H, Pichot D, Hamon P, Duchesne S, Labaune-Jean F, Jean S, Le Cloirec G, Milano S, Trost M, Steinbrenner S, Marchal M, Guilbeau-Frugier C, Telmon N, Crubézy É, Jaouen K. The last battle of Anne of Brittany: Solving mass grave through an interdisciplinary approach (paleopathology, biological anthropology, history, multiple isotopes and radiocarbon dating). PLoS One 2021; 16:e0248086. [PMID: 33951047 PMCID: PMC8099129 DOI: 10.1371/journal.pone.0248086] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 04/06/2021] [Indexed: 01/22/2023] Open
Abstract
Mass graves are usually key historical markers with strong incentive for archeological investigations. The identification of individuals buried in mass graves has long benefitted from traditional historical, archaeological, anthropological and paleopathological techniques. The addition of novel methods including genetic, genomic and isotopic geochemistry have renewed interest in solving unidentified mass graves. In this study, we demonstrate that the combined use of these techniques allows the identification of the individuals found in two Breton historical mass graves, where one method alone would not have revealed the importance of this discovery. The skeletons likely belong to soldiers from the two enemy armies who fought during a major event of Breton history: the siege of Rennes in 1491, which ended by the wedding of the Duchess of Brittany with the King of France and signaled the end of the independence of the region. Our study highlights the value of interdisciplinary approaches with a particular emphasis on increasingly accurate isotopic markers. The development of the sulfur isoscape and testing of the triple isotope geographic assignment are detailed in a companion paper [13].
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Affiliation(s)
- Rozenn Colleter
- INRAP (Institut National de Recherches Archéologiques Préventives), Cesson-Sévigné, France
- CNRS, CAGT, UMR 5288, Université Paul Sabatier, 31000, Toulouse, France
| | - Clément P. Bataille
- Department of Earth and Environmental Sciences, University of Ottawa, Ottawa, Canada
- Department of Biology, University of Ottawa, Ottawa, Canada
| | - Henri Dabernat
- CNRS, CAGT, UMR 5288, Université Paul Sabatier, 31000, Toulouse, France
| | | | | | - Sylvie Duchesne
- INRAP (Institut National de Recherches Archéologiques Préventives), Cesson-Sévigné, France
- CNRS, CAGT, UMR 5288, Université Paul Sabatier, 31000, Toulouse, France
| | - Françoise Labaune-Jean
- INRAP (Institut National de Recherches Archéologiques Préventives), Cesson-Sévigné, France
- CNRS, CReAAH, UMR 6566, Rennes, France
| | - Stéphane Jean
- INRAP (Institut National de Recherches Archéologiques Préventives), Cesson-Sévigné, France
| | - Gaétan Le Cloirec
- INRAP (Institut National de Recherches Archéologiques Préventives), Cesson-Sévigné, France
- CNRS, CReAAH, UMR 6566, Rennes, France
| | - Stefania Milano
- Max Planck Institute for Evolutionary Anthropology, Department of Human Evolution, Leipzig, Germany
| | - Manuel Trost
- Max Planck Institute for Evolutionary Anthropology, Department of Human Evolution, Leipzig, Germany
| | - Sven Steinbrenner
- Max Planck Institute for Evolutionary Anthropology, Department of Human Evolution, Leipzig, Germany
| | - Marine Marchal
- CNRS, CAGT, UMR 5288, Université Paul Sabatier, 31000, Toulouse, France
| | - Céline Guilbeau-Frugier
- I2MC, Université de Toulouse, INSERM U1048, 31432, Toulouse, France
- Department of Forensic Medicine, Centre Hospitalier Universitaire de Toulouse, Université de Toulouse, Toulouse, France
- Faculté de Médecine Rangueil, CMEAB, Université de Toulouse, Toulouse, France
| | - Norbert Telmon
- CNRS, CAGT, UMR 5288, Université Paul Sabatier, 31000, Toulouse, France
- Department of Forensic Medicine, Centre Hospitalier Universitaire de Toulouse, Université de Toulouse, Toulouse, France
| | - Éric Crubézy
- CNRS, CAGT, UMR 5288, Université Paul Sabatier, 31000, Toulouse, France
| | - Klervia Jaouen
- Max Planck Institute for Evolutionary Anthropology, Department of Human Evolution, Leipzig, Germany
- CNRS, GET UMR 5563, Observatoire Midi Pyrénées, Toulouse, France
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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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Colleter R, Dedouit F, Duchesne S, Gérard P, Dercle L, Poilpré P, Gendrot V, Rousseau H, Crubézy É, Telmon N, Mokrane FZ. Study of a seventeenth-century French artificial mummy: autopsical, native, and contrast-injected CT investigations. Int J Legal Med 2018; 132:1405-1413. [PMID: 29594348 DOI: 10.1007/s00414-018-1830-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 03/21/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND A lead coffin was fortuitously discovered in a church called "Eglise des Toussaints" in Rennes (French Brittany). A collaborative taskforce investigated this extraordinary discovery. A multi-disciplinary team of experts from the National Institute for Preventive Archeological Research (INRAP) and Rangueil University Hospital of Toulouse was created, including anthropologists, archeologists, forensic pathologists, radiologists, and pathologists. The inscription on the lead coffin specified that the body belonged to "Messer Louys de Bruslon, Lord of Plessis," a nobleman who died on November 1, 1661. Multiple holes were visible in the lead coffin, and deterioration threatened the mummy. We opened the lead coffin and discovered an excellently preserved mummy, except for mostly skeletonized upper and lower limbs. The mummy was conserved in several layers of shrouds. Vegetal embalming material covered the head and filled the face, the thorax, and the abdomen. The embalmers had removed all thoracic and abdominal organs and conserved some pelvic organs (e.g., the bladder). METHODS Multi-slice computed tomography (MSCT) scanner evaluated the mummy, at each step of our analysis. The excellent preservation of abdominal vascular axes led us to perform a CT angiography using Angiofil®, an oily contrast agent developed for postmortem imaging, before an autopsy. RESULTS Sub-diaphragmatic arteries, including the abdominal aorta and iliac arteries, were excellently preserved. The vascular contrast agent filled all arteries. The native CT, CT angiography, and autopsy did not detect any vascular lesion. CONCLUSION Our study, based on rare archeological material, allowed a complete examination of an excellently preserved seventeenth-century mummy, using MSCT, angiography, and an autopsy. We did not detect any arterial lesion and proposed a comprehensive description of the embalmment process.
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Affiliation(s)
- Rozenn Colleter
- INRAP National Institute of Preventive Archaeological Research (INRAP, France), 37 rue du Bignon, CS 67737, 35577, Cesson-Sévigné, France
- AMIS Laboratory: University of Toulouse, French National Center for Scientific Research, UMR 5288, 37 allées Jules Guesde, 31073, Toulouse, France
| | - Fabrice Dedouit
- AMIS Laboratory: University of Toulouse, French National Center for Scientific Research, UMR 5288, 37 allées Jules Guesde, 31073, Toulouse, France
- Unit of Forensic and Anthropological Imaging, Centre Universitaire Romand de Médecine Légale (CURML), Chemin de la Vulliette 4, CH-1000, Lausanne 25, Switzerland
| | - Sylvie Duchesne
- INRAP National Institute of Preventive Archaeological Research (INRAP, France), 37 rue du Bignon, CS 67737, 35577, Cesson-Sévigné, France
- AMIS Laboratory: University of Toulouse, French National Center for Scientific Research, UMR 5288, 37 allées Jules Guesde, 31073, Toulouse, France
| | - Patrice Gérard
- AMIS Laboratory: University of Toulouse, French National Center for Scientific Research, UMR 5288, 37 allées Jules Guesde, 31073, Toulouse, France
| | - Laurent Dercle
- Gustave Roussy Institute, Université Paris-Saclay, F-94805, Villejuif, France
- New York Presbyterian Hospital, Columbia University, New York City, NY, USA
| | - Pierre Poilpré
- INRAP National Institute of Preventive Archaeological Research (INRAP, France), 37 rue du Bignon, CS 67737, 35577, Cesson-Sévigné, France
| | - Véronique Gendrot
- French Regional Archaeological Service, Bretagne Avenue Charles Foulon, 35700, Rennes, France
- French National Center for Scientific Research, UMR 6566, Rennes, France
| | - Hervé Rousseau
- Radiology Department, Rangueil University Hospital, 1 Avenue du Professeur Jean Poulhes, 31059 Cedex, Toulouse, France
| | - Éric Crubézy
- AMIS Laboratory: University of Toulouse, French National Center for Scientific Research, UMR 5288, 37 allées Jules Guesde, 31073, Toulouse, France
| | - Norbert Telmon
- AMIS Laboratory: University of Toulouse, French National Center for Scientific Research, UMR 5288, 37 allées Jules Guesde, 31073, Toulouse, France
- Forensic Department, Rangueil University Hospital, 1 avenue du Professeur Jean Poulhes, 31059 Cedex, Toulouse, France
| | - Fatima-Zohra Mokrane
- AMIS Laboratory: University of Toulouse, French National Center for Scientific Research, UMR 5288, 37 allées Jules Guesde, 31073, Toulouse, France.
- New York Presbyterian Hospital, Columbia University, New York City, NY, USA.
- Radiology Department, Rangueil University Hospital, 1 Avenue du Professeur Jean Poulhes, 31059 Cedex, Toulouse, France.
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Postmortale Magnetresonanztomographie-Angiographie nach Multiphasen-Computertomographie-Angiographie. Rechtsmedizin (Berl) 2017. [DOI: 10.1007/s00194-017-0188-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Colleter R, Dedouit F, Duchesne S, Mokrane FZ, Gendrot V, Gérard P, Dabernat H, Crubézy É, Telmon N. Procedures and Frequencies of Embalming and Heart Extractions in Modern Period in Brittany. Contribution to the Evolution of Ritual Funerary in Europe. PLoS One 2016; 11:e0167988. [PMID: 28030554 PMCID: PMC5193353 DOI: 10.1371/journal.pone.0167988] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 11/23/2016] [Indexed: 11/24/2022] Open
Abstract
The evolution of funeral practices from the Middle Ages through the Modern era in Europe is generally seen as a process of secularization. The study, through imaging and autopsy, of two mummies, five lead urns containing hearts, and more than six hundred skeletons of nobles and clergymen from a Renaissance convent in Brittany has led us to reject this view. In addition to exceptional embalming, we observed instances in which hearts alone had been extracted, a phenomenon that had never before been described, and brains alone as well, and instances in which each spouse's heart had been placed on the other's coffin. In some identified cases we were able to establish links between the religious attitudes of given individuals and either ancient Medieval practices or more modern ones generated by the Council of Trent. All of these practices, which were a function of social status, were rooted in religion. They offer no evidence of secularization whatsoever.
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Affiliation(s)
- Rozenn Colleter
- National Institute of Preventive Archaeological Research (INRAP), Cesson-Sévigné, France
- University of Toulouse, French National Center for Scientific Research, UMR 5288, Toulouse, France
- * E-mail: (RC); (EC)
| | - Fabrice Dedouit
- University of Toulouse, French National Center for Scientific Research, UMR 5288, Toulouse, France
- Unit of Forensic and Anthropological Imaging, Centre Universitaire Romand de Médecine Légale (CURML), Lausanne, Switzerland
| | - Sylvie Duchesne
- National Institute of Preventive Archaeological Research (INRAP), Cesson-Sévigné, France
- University of Toulouse, French National Center for Scientific Research, UMR 5288, Toulouse, France
| | - Fatima-Zohra Mokrane
- University of Toulouse, French National Center for Scientific Research, UMR 5288, Toulouse, France
- Radiology department, CHU Toulouse-Rangueil, Toulouse, France
| | - Véronique Gendrot
- French Regional Archaeological Service, Rennes, Bretagne, France and French National Center for Scientific Research, UMR 6566, Rennes, France
| | - Patrice Gérard
- University of Toulouse, French National Center for Scientific Research, UMR 5288, Toulouse, France
| | - Henri Dabernat
- University of Toulouse, French National Center for Scientific Research, UMR 5288, Toulouse, France
| | - Éric Crubézy
- University of Toulouse, French National Center for Scientific Research, UMR 5288, Toulouse, France
- * E-mail: (RC); (EC)
| | - Norbert Telmon
- University of Toulouse, French National Center for Scientific Research, UMR 5288, Toulouse, France
- Medico-Legal department, CHU Toulouse-Rangueil, Toulouse, France
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