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Melvinsdottir I, Solomon N, Wadia R, Muniraj T, Huber S, Sinusas AJ. Massive Air Embolism Following Necrotizing Pancreatitis and COVID-19 Infection-The Role of Postmortem Computed Tomography. Acad Forensic Pathol 2022; 12:31-38. [PMID: 35694008 PMCID: PMC9178998 DOI: 10.1177/19253621211073284] [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: 06/23/2021] [Accepted: 11/02/2021] [Indexed: 02/04/2023]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that caused the COVID-19 pandemic raised important questions about workplace exposures to the virus, including postmortem exposures. The complexity of COVID-19 disease and its numerous unanticipated complications made autopsy even more vital in determining the pathophysiology of the disease. Performing traditional autopsy, however, carries risk of exposure. The following report describes an unusual case in which a patient diagnosed with COVID-19 and necrotizing pancreatitis underwent postmortem computed tomography (PMCT) prior to limited traditional autopsy and was unexpectedly found via PMCT to have large and diffuse venous air emboli and a new peripancreatic hematoma. In this case, not only did PMCT play a crucial role in determining the cause of death but also it allowed for a limited autopsy, thereby reducing the exposure to SARS-CoV-2 and associated risk to the autopsy staff and pathologists.
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Affiliation(s)
| | | | | | | | | | - Albert J. Sinusas
- Albert J. Sinusas, MD, Medicine and Radiology & Biomedical Imaging and Biomedical Engineering; Yale Translational Research Imaging Center (Y-TRIC), Yale University School of Medicine, Section Cardiovascular Medicine, DANA3, P.O. Box 208017, New Haven, CT 06520,
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Alsop K, Norman DG, Baier W, Colclough J, Williams MA. Advantages of micro-CT in the case of a complex dismemberment. J Forensic Sci 2022; 67:1258-1266. [PMID: 35118663 PMCID: PMC9305105 DOI: 10.1111/1556-4029.15007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 01/11/2022] [Accepted: 01/24/2022] [Indexed: 11/27/2022]
Abstract
This case study reports the advantages of micro‐CT to aid the investigative process in a complex dismemberment case. Micro‐CT was successfully implemented to scan all skeletal remains of a dismembered female. The digital models were utilized to (i) screen for any further injuries not related to the dismemberment, (ii) provide measurements from false starts non‐destructively, and (iii) visually represent the evidence in a structured format in court to improve the understanding of the forensic evidence by the jury. Acquiring high‐resolution scans in this manner improved the efficiency of the forensic investigation by screening the remains and provided complementary toolmark evidence to the investigating team and forensic pathologist. A total of 14 false starts were identified along with the directionality of each dismemberment cut. Furthermore, the visual 3D representation of the remains in court provided a powerful tool to communicate this important evidence to the jury and form a prosecution narrative. As a forensic radiological method, micro‐CT provided valuable information both in the investigation and the court presentation.
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Affiliation(s)
- Kirsty Alsop
- Forensic Centre for Digital Scanning and 3D Printing, WMG, University of Warwick, Coventry, UK
| | - Danielle G Norman
- Forensic Centre for Digital Scanning and 3D Printing, WMG, University of Warwick, Coventry, UK
| | - Waltraud Baier
- Forensic Centre for Digital Scanning and 3D Printing, WMG, University of Warwick, Coventry, UK
| | | | - Mark A Williams
- Forensic Centre for Digital Scanning and 3D Printing, WMG, University of Warwick, Coventry, UK
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Femia G, Langlois N, Raleigh J, Gray B, Othman F, Perumal SR, Semsarian C, Puranik R. Comparison of conventional autopsy with post-mortem magnetic resonance, computed tomography in determining the cause of unexplained death. Forensic Sci Med Pathol 2021; 17:10-18. [PMID: 33464532 DOI: 10.1007/s12024-020-00343-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2020] [Indexed: 11/26/2022]
Abstract
Conventional autopsy is the gold standard for identifying unexplained death but due to declines in referrals, there is an emerging role for post-mortem imaging. We evaluated whether post-mortem magnetic resonance (PMMR) and computed tomography (PMCT) are inferior to conventional autopsy. Deceased individuals ≥ 2 years old with unexplained death referred for coronial investigation between October 2014 to December 2016 underwent PMCT and PMMR prior to conventional autopsy. Images were reported separately and then compared to the autopsy findings by independent and blinded investigators. Outcomes included the accuracy of imaging modalities to identify an organ system cause of death and other significant abnormalities. Sixty-nine individuals underwent post-mortem scanning and autopsy (50 males; 73%) with a median age of 61 years (IQR 50-73) and median time from death to imaging of 2 days (IQR 2-3). With autopsy, 48 (70%) had an organ system cause of death and were included in assessing primary outcome while the remaining 21 (30%) were only included in assessing secondary outcome; 12 (17%) had a non-structural cause and 9 (13%) had no identifiable cause. PMMR and PMCT identified the cause of death in 58% (28/48) of cases; 50% (24/48) for PMMR and 35% (17/48) for PMCT. The sensitivity and specificity were 57% and 57% for PMMR and 38% and 73% for PMCT. Both PMMR and PMCT identified 61% (57/94) of other significant abnormalities. Post-mortem imaging is inferior to autopsy but when reported by experienced clinicians, PMMR provides important information for cardiac and neurological deaths while PMCT is beneficial for neurological, traumatic and gastrointestinal deaths.
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Affiliation(s)
- Giuseppe Femia
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, NSW, 2050, Camperdown, Australia.
- Department of Cardiology, Royal Prince Alfred Hospital, NSW, Camperdown, Australia.
| | - Neil Langlois
- Forensic Science South Australia, SA, Adelaide, Australia
- School of Medical and Health Sciences, University of Adelaide, SA, Adelaide, Australia
| | - Jim Raleigh
- Department of Radiology, Royal Prince Alfred Hospital, NSW, Camperdown, Australia
| | - Belinda Gray
- Department of Cardiology, Royal Prince Alfred Hospital, NSW, Camperdown, Australia
| | - Farrah Othman
- Department of Cardiology, Royal Prince Alfred Hospital, NSW, Camperdown, Australia
| | - Sunthara Rajan Perumal
- South Australia Health & Medical Research Institute, Preclinical, Imaging & Research Laboratories, Adelaide, Australia
| | - Christopher Semsarian
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, NSW, 2050, Camperdown, Australia
- Department of Cardiology, Royal Prince Alfred Hospital, NSW, Camperdown, Australia
- Agnes Ginges Centre for Molecular Cardiology Centenary Institute, The University of Sydney, Sydney, Australia
| | - Rajesh Puranik
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, NSW, 2050, Camperdown, Australia
- Department of Cardiology, Royal Prince Alfred Hospital, NSW, Camperdown, Australia
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Ampanozi G, Halbheer D, Ebert LC, Thali MJ, Held U. Postmortem imaging findings and cause of death determination compared with autopsy: a systematic review of diagnostic test accuracy and meta-analysis. Int J Legal Med 2019; 134:321-337. [PMID: 31455980 DOI: 10.1007/s00414-019-02140-y] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 08/06/2019] [Indexed: 01/06/2023]
Abstract
BACKGROUND The aim of this study was to evaluate the sensitivity of postmortem computed tomography (PMCT), postmortem magnetic resonance imaging (PMMR) and PMCT angiography (PMCTA) compared with autopsy in cases of adult death investigations. METHODS For this systematic review and meta-analysis, Embase, PubMed, Scopus, Web of Science and Medline were searched for eligible studies in October 2016; a follow-up literature search was conducted in March 2018. Studies referring to PMCT, PMCTA and/or PMMR of more than 3 cases with subsequent autopsy were included. Data were extracted from published texts in duplicate. The extracted outcomes were categorized as follows: soft tissue and organ findings, skeletal injuries, haemorrhages, abnormal gas accumulations and causes of death. The summary measure was sensitivity, if 3 or more studies were available. To combine studies, a random effects model was used. Variability and heterogeneity within the meta-analysis was assessed. RESULTS Of 1053 studies, 66 were eligible, encompassing a total of 4213 individuals. For soft tissue and organ findings, there was a high pooled sensitivity with PMCTA (0.91, 95% CI 0.81-0.96), without evidence for between-study variability (Cochrane's Q test p = 0.331, I2 = 24.5%). The pooled sensitivity of PMCT+PMMR was very high in skeletal injuries (0.97, CI 0.87-0.99), without evidence for variability (p = 0.857, I2 = 0.0%). In detecting haemorrhages, the pooled sensitivity for PMCT+PMMR was the highest (0.88, 95% CI 0.35-0.99), with strong evidence of heterogeneity (p < 0.05, I2 > 50%). Pooled sensitivity for the correct cause of death was the highest for PMCTA with 0.79 (95% CI 0.52-0.93), again with evidence of heterogeneity (p = 0.062, I2 > 50%). CONCLUSION Distinct postmortem imaging modalities can achieve high sensitivities for detecting various findings and causes of death. This knowledge should lead to a reasoned use of each modality. Both forensic evidence and in-hospital medical quality would be enhanced.
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Affiliation(s)
- Garyfalia Ampanozi
- Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, 8057, Zurich, Switzerland.
| | - Delaja Halbheer
- Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, 8057, Zurich, Switzerland
| | - Lars C Ebert
- Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, 8057, Zurich, Switzerland
| | - Michael J Thali
- Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, 8057, Zurich, Switzerland
| | - Ulrike Held
- Horten Centre, University of Zurich, Pestalozzistrasse 24, 8091, Zurich, Switzerland.,Epidemiology, Biostatistics and Prevention Institute, Department of Biostatistics, University of Zurich, Hirschengraben 84, 8001, Zurich, Switzerland
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Nioi M, Napoli PE, Mayerson SM, Fossarello M, d’Aloja E. Optical coherence tomography in forensic sciences: a review of the literature. Forensic Sci Med Pathol 2019; 15:445-452. [DOI: 10.1007/s12024-019-00136-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2019] [Indexed: 12/20/2022]
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Baier W, Mangham C, Warnett JM, Payne M, Painter M, Williams MA. Using histology to evaluate micro-CT findings of trauma in three post-mortem samples — First steps towards method validation. Forensic Sci Int 2019; 297:27-34. [DOI: 10.1016/j.forsciint.2019.01.027] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 01/21/2019] [Accepted: 01/24/2019] [Indexed: 10/27/2022]
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Ponirakis G, Al Hamad H, Sankaranarayanan A, Khan A, Chandran M, Ramadan M, Tosino R, Gawhale PV, Alobaidi M, AlSulaiti E, Elsotouhy A, Elorrabi M, Khan S, Nadukkandiyil N, Osman S, Thodi N, Almuhannadi H, Gad H, Mahfoud ZR, Al‐Shibani F, Petropoulos IN, Own A, Al Kuwari M, Shuaib A, Malik RA. Association of corneal nerve fiber measures with cognitive function in dementia. Ann Clin Transl Neurol 2019; 6:689-697. [PMID: 31019993 PMCID: PMC6469344 DOI: 10.1002/acn3.746] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 02/05/2019] [Accepted: 02/06/2019] [Indexed: 12/13/2022] Open
Abstract
Objectives Corneal confocal microscopy (CCM) is a noninvasive ophthalmic technique that identifies corneal nerve degeneration in a range of peripheral neuropathies and in patients with multiple sclerosis, Parkinson's disease, and amyotrophic lateral sclerosis. We sought to determine whether there is any association of corneal nerve fiber measures with cognitive function and functional independence in patients with MCI and dementia. Methods In this study, 76 nondiabetic participants with MCI (n = 30), dementia (n = 26), and healthy age‐matched controls (n = 20) underwent assessment of cognitive and physical function and CCM. Results There was a progressive reduction in corneal nerve fiber density (CNFD), branch density (CNBD), and fiber length (CNFL) (P < 0.0001) in patients with MCI and dementia compared to healthy controls. Adjusted for confounders, all three corneal nerve fiber measures were significantly associated with cognitive function (P < 0.05) and functional independence (P < 0.01) in MCI and dementia. The area under the ROC curve to distinguish MCI with CNFD, CNBD, and CNFL was 69.1%, 73.2%, and 73.0% and for dementia it was 84.8%, 84.2%, and 86.2%, respectively. Interpretation CCM demonstrates corneal nerve fiber loss, which is associated with a decline in cognitive function and functional independence in patients with MCI and dementia.
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Affiliation(s)
| | - Hanadi Al Hamad
- Geriatric & Memory ClinicRumailah HospitalHamad Medical CorporationDohaQatar
| | | | - Adnan Khan
- Weill Cornell Medicine‐QatarQatar FoundationEducation CityDohaQatar
| | - Mani Chandran
- Geriatric & Memory ClinicRumailah HospitalHamad Medical CorporationDohaQatar
| | - Marwan Ramadan
- Geriatric & Memory ClinicRumailah HospitalHamad Medical CorporationDohaQatar
| | - Rhia Tosino
- Geriatric & Memory ClinicRumailah HospitalHamad Medical CorporationDohaQatar
| | | | - Maryam Alobaidi
- Geriatric & Memory ClinicRumailah HospitalHamad Medical CorporationDohaQatar
| | - Essa AlSulaiti
- Geriatric & Memory ClinicRumailah HospitalHamad Medical CorporationDohaQatar
| | - Ahmed Elsotouhy
- NeuroradiologyHamad General HospitalHamad Medical CorporationDohaQatar
| | - Marwa Elorrabi
- Geriatric & Memory ClinicRumailah HospitalHamad Medical CorporationDohaQatar
| | - Shafi Khan
- Geriatric & Memory ClinicRumailah HospitalHamad Medical CorporationDohaQatar
| | - Navas Nadukkandiyil
- Geriatric & Memory ClinicRumailah HospitalHamad Medical CorporationDohaQatar
| | - Susan Osman
- Geriatric & Memory ClinicRumailah HospitalHamad Medical CorporationDohaQatar
| | - Noushad Thodi
- MRI UnitRumailah HospitalHamad Medical CorporationDohaQatar
| | | | - Hoda Gad
- Weill Cornell Medicine‐QatarQatar FoundationEducation CityDohaQatar
| | - Ziyad R. Mahfoud
- Weill Cornell Medicine‐QatarQatar FoundationEducation CityDohaQatar
| | | | | | - Ahmed Own
- NeuroradiologyHamad General HospitalHamad Medical CorporationDohaQatar
| | - Maryam Al Kuwari
- Geriatric & Memory ClinicRumailah HospitalHamad Medical CorporationDohaQatar
| | - Ashfaq Shuaib
- Neuroscience InstituteHamad General HospitalHamad Medical CorporationDohaQatar
- Department of MedicineUniversity of AlbertaEdmontonCanada
| | - Rayaz A. Malik
- Weill Cornell Medicine‐QatarQatar FoundationEducation CityDohaQatar
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Graziani G, Tal S, Adelman A, Kugel C, Bdolah-Abram T, Krispin A. Usefulness of unenhanced post mortem computed tomography - Findings in postmortem non-contrast computed tomography of the head, neck and spine compared to traditional medicolegal autopsy. J Forensic Leg Med 2018; 55:105-111. [PMID: 29494949 DOI: 10.1016/j.jflm.2018.02.022] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 01/25/2018] [Accepted: 02/19/2018] [Indexed: 11/16/2022]
Abstract
INTRODUCTION/BACKGROUND Post-mortem CT (PMCT) is becoming an essential tool available to forensic pathologists worldwide, but its validity with respect to evidence for legal purposes still requires more comprehensive large-scale studies, comparing PMCT to autopsy. This article compares PMCT and autopsy findings of the head, neck, and spine during a period of five years. MATERIALS AND METHODS The study included 203 cases for which both autopsy and PMCT were performed. All relevant findings were extracted from the reports and divided into 30 categories based on anatomical location and tissue characteristics. Data were evaluated quantitatively in a binary fashion. RESULTS/FINDINGS A high level of agreement was noted for skull fractures, intraventricular- and subarachnoid hemorrhages, bullet trajectories, and intracranial shrapnel. A fair correlation was demonstrated for brain atrophy or herniation, and findings in the facial soft tissues. PMCT had higher sensitivity to brain edema, presence of gas in tissues or cavities, and findings in the spinal column and spinal canal, whereas autopsy better demonstrated pathologies in the brain tissue, hemorrhages in the neck and fractures of the larynx and hyoid bone. A relatively low correlation was noted for subdural and epidural hematomata. CONCLUSIONS/INTERPRETATION For several locations, structures, and specific findings in the head, neck and spine, autopsy remains indispensable. However, PMCT better demonstrated some findings in locations that are difficult to access by autopsy, or structures that might be damaged due to autopsy procedure. For the examinations of these, PMCT may in specific cases serve as an alternative to autopsy. Generally, however, due to the vast and fundamental differences that distinguish each case from the next, and the different purposes that autopsy may serve, we propose that the decision as to which method (or a combination of both) should be used, be made according to the circumstances and expected findings of each case.
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Affiliation(s)
- Gil Graziani
- Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - Sigal Tal
- Radiology Department, Assaf Harofeh Medical Center, Zerifin 70300, Israel; The Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Adi Adelman
- Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - Chen Kugel
- The National Institute of Forensic Medicine, 67 Ben Zvi Rd., Tel-Aviv, Israel; The Sackler Faculty of Medicine, Tel Aviv University, Israel
| | | | - Alon Krispin
- The National Institute of Forensic Medicine, 67 Ben Zvi Rd., Tel-Aviv, Israel; The Sackler Faculty of Medicine, Tel Aviv University, Israel.
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