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Woon CK, Omar E, Siew SF, Nawawi HM, Kasim NAM, Chainchel Singh MK. The effect of post-mortem computed tomography angiography (PMCTA) on biomarkers of coronary artery disease. J Forensic Leg Med 2024; 102:102654. [PMID: 38310784 DOI: 10.1016/j.jflm.2024.102654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 01/17/2024] [Accepted: 01/30/2024] [Indexed: 02/06/2024]
Abstract
Coronary atherosclerosis is due to build-up of plaque within the coronary arteries. Post-mortem computed tomography (PMCT) allows non or minimally invasive visualization of abnormalities prior to an autopsy, however PMCT-angiography (PMCTA) greatly enhances relevant findings, especially in viewing the cardiovascular system which is important in the diagnosis of coronary atherosclerosis. Contrast media used in PMCTA however has been reported to cause distortion of tissue which may interfere with post-mortem investigation outcomes. A cross sectional study to investigate the effect of PMCTA on tissue biomarkers in coronary arteries was performed involving cases brought in dead to the Institute and Accident and Emergency Unit. Sixty-three autopsy cases were included in this study, whereby 18 cases underwent PMCT while 45 cases underwent PMCTA. The subjects subsequently had a conventional autopsy where coronary artery sections were collected for standard histological examination and immunohistochemistry examination for endothelial inflammatory (CD36), prothrombogenic (TPA) and plaque stability (MMP-9) markers. The subjects consisted of 55 males and 8 females with a mean age ±SD of 49 ± 18.11 years. There were no significant differences in the coronary artery endothelial expression of CD36, MMP-9 and TPA between PMCT and PMCTA subjects. PMCTA does not alter CD36, TPA and MMP-9 markers supporting the safe use of PMCTA in post-mortem examinations.
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Affiliation(s)
- Choy Ker Woon
- Department of Anatomy, Faculty of Medicine, Universiti Teknologi MARA, Jalan Hospital 47000, Sungai Buloh, Selangor, Malaysia; Institute for Pathology, Laboratory and Forensic Medicine (I-PPerForM), Universiti Teknologi MARA, Jalan Hospital, 47000, Sungai Buloh, Selangor, Malaysia
| | - Effat Omar
- Institute for Pathology, Laboratory and Forensic Medicine (I-PPerForM), Universiti Teknologi MARA, Jalan Hospital, 47000, Sungai Buloh, Selangor, Malaysia; Department of Pathology, Faculty of Medicine, Universiti Teknologi MARA, Jalan Hospital, 47000, Sungai Buloh, Selangor, Malaysia
| | - Sheue Feng Siew
- National Institute of Forensic Medicine (IPFN), Hospital Kuala Lumpur, Ministry of Health Malaysia, Jalan Pahang, 50586, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | - Hapizah M Nawawi
- Institute for Pathology, Laboratory and Forensic Medicine (I-PPerForM), Universiti Teknologi MARA, Jalan Hospital, 47000, Sungai Buloh, Selangor, Malaysia; Department of Pathology, Faculty of Medicine, Universiti Teknologi MARA, Jalan Hospital, 47000, Sungai Buloh, Selangor, Malaysia
| | - Noor Alicezah M Kasim
- Institute for Pathology, Laboratory and Forensic Medicine (I-PPerForM), Universiti Teknologi MARA, Jalan Hospital, 47000, Sungai Buloh, Selangor, Malaysia; Department of Pathology, Faculty of Medicine, Universiti Teknologi MARA, Jalan Hospital, 47000, Sungai Buloh, Selangor, Malaysia
| | - Mansharan Kaur Chainchel Singh
- Institute for Pathology, Laboratory and Forensic Medicine (I-PPerForM), Universiti Teknologi MARA, Jalan Hospital, 47000, Sungai Buloh, Selangor, Malaysia; National Institute of Forensic Medicine (IPFN), Hospital Kuala Lumpur, Ministry of Health Malaysia, Jalan Pahang, 50586, Wilayah Persekutuan Kuala Lumpur, Malaysia; Department of Radiology, Hospital Al-Sultan Abdullah, Universiti Teknologi MARA, 42300, Bandar Puncak Alam, Selangor, Malaysia.
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Funayama K, Koyama A, Katsuragi-Go R, Aoyama T, Watanabe H, Takahashi N, Takatsuka H. Bleeding-Source Exploration in Subdural Hematoma: Observational Study on the Usefulness of Postmortem Computed Tomography Angiography. Diagnostics (Basel) 2023; 13:2286. [PMID: 37443680 DOI: 10.3390/diagnostics13132286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 06/29/2023] [Accepted: 07/04/2023] [Indexed: 07/15/2023] Open
Abstract
In a few cases, postmortem computed tomography angiography (PMCTA) is effective in postmortem detection of cortical artery rupture causing subdural hematoma (SDH), which is difficult to detect at autopsy. Here, we explore the usefulness and limitations of PMCTA in detecting the sites of cortical arterial rupture for SDH. In 6 of 10 cases, extravascular leakage of contrast material at nine different places enabled PMCTA to identify cortical arterial rupture. PMCTA did not induce destructive arterial artifacts, which often occur during autopsy. We found that, although not in all cases, PMCTA could show the site of cortical arterial rupture causing subdural hematoma in some cases. This technique is beneficial for cases of SDH autopsy, as it can be performed nondestructively and before destructive artifacts from the autopsy occur.
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Affiliation(s)
- Kazuhisa Funayama
- Division of Legal Medicine, Department of Community Preventive Medicine, Graduate School of Medicine and Dental Sciences, Niigata University, Niigata 951-8510, Japan
- Center of Cause of Death Investigation, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8510, Japan
| | - Akihide Koyama
- Division of Legal Medicine, Department of Community Preventive Medicine, Graduate School of Medicine and Dental Sciences, Niigata University, Niigata 951-8510, Japan
- Center of Cause of Death Investigation, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8510, Japan
| | - Rieka Katsuragi-Go
- Division of Legal Medicine, Department of Community Preventive Medicine, Graduate School of Medicine and Dental Sciences, Niigata University, Niigata 951-8510, Japan
- Center of Cause of Death Investigation, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8510, Japan
| | - Takashi Aoyama
- Division of Legal Medicine, Department of Community Preventive Medicine, Graduate School of Medicine and Dental Sciences, Niigata University, Niigata 951-8510, Japan
| | - Hiraku Watanabe
- Division of Legal Medicine, Department of Community Preventive Medicine, Graduate School of Medicine and Dental Sciences, Niigata University, Niigata 951-8510, Japan
| | - Naoya Takahashi
- Center of Cause of Death Investigation, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8510, Japan
- Department of Radiological Technology, Graduate School of Health Sciences, Niigata University, Niigata 951-8518, Japan
| | - Hisakazu Takatsuka
- Division of Legal Medicine, Department of Community Preventive Medicine, Graduate School of Medicine and Dental Sciences, Niigata University, Niigata 951-8510, Japan
- Center of Cause of Death Investigation, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8510, Japan
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Franckenberg S, Sieberth T, Ptacek W, Fürst M, Colacicco G, Ebert L. Technical note: Semiautomated targeted postmortem computed tomography angiography of the pulmonary arteries using a robotic system. Forensic Sci Int 2023; 348:111712. [PMID: 37182280 DOI: 10.1016/j.forsciint.2023.111712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 04/20/2023] [Accepted: 04/27/2023] [Indexed: 05/16/2023]
Abstract
INTRODUCTION To better depict vascular lesions on postmortem computed tomography (PMCT), whole-body postmortem computed tomography angiography (PMCTA) can be used in forensic diagnostics. Targeted angiography, in which only a specific vessel is filled with contrast agent, might help in cases of traumatic changes that render whole-body PMCTA impossible. Moreover, in targeted PMCTA, the contrast agent does not affect the haptics of any other organs. In this article, we describe automated, CT-guided targeted angiography of the pulmonary artery (PA) using the Virtobot system. MATERIAL AND METHODS Our study group consisted of 8 deceased persons (3 males, 5 females). We first performed an unenhanced CT scan and used the data obtained to plan the needle trajectories with the Virtobot planning software. Then, the needle was fully automatically placed by the Virtobot system. Subsequently, 50 ml of contrast agent was injected manually, and the CT scan was repeated (targeted PMCTA). RESULTS AND DISCUSSION We tested a new method for performing semiautomated targeted postmortem angiography of the PAs using a robotic needle placement system (Virtobot). In 6 out of our 8 cases, the injection of contrast agent in the PA was successful. In five of the six successful cases, there was reflux of contrast agent to some extent, but the reflux did not affect the readout. In general, the procedure was easy to plan based on a PMCT data set, and the pulmonary trunk was easy to reach with a robotic needle placement system.
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Affiliation(s)
- Sabine Franckenberg
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Switzerland; Department of Diagnostic and Interventional Radiology, University Hospital Zurich, Switzerland.
| | - Till Sieberth
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Switzerland
| | - Wolfgang Ptacek
- Austrian Center for Medical Innovation and Technology (ACMIT GmbH), Wiener Neustadt, Austria
| | - Martin Fürst
- Austrian Center for Medical Innovation and Technology (ACMIT GmbH), Wiener Neustadt, Austria
| | | | - Lars Ebert
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Switzerland
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Whittington B, Tzolos E, Williams MC, Dweck MR, Newby DE. Imaging of intracoronary thrombus. Heart 2023; 109:740-747. [PMID: 36549679 DOI: 10.1136/heartjnl-2022-321361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 11/22/2022] [Indexed: 12/24/2022] Open
Abstract
The identification of intracoronary thrombus and atherothrombosis is central to the diagnosis of acute myocardial infarction, with the differentiation between type 1 and type 2 myocardial infarction being crucial for immediate patient management. Invasive coronary angiography has remained the principal imaging modality used in the investigation of patients with myocardial infarction. More recently developed invasive intravascular imaging approaches, such as angioscopy, intravascular ultrasound and optical coherence tomography, can be used as adjunctive imaging modalities to provide more direct visualisation of coronary atheroma and the causes of myocardial infarction as well as to improve the sensitivity of thrombus detection. However, these invasive approaches have practical and logistic constraints that limit their widespread and routine application. Non-invasive angiographic techniques, such as CT and MRI, have become more widely available and have improved the non-invasive visualisation of coronary artery disease. Although they also have a limited ability to reliably identify intracoronary thrombus, this can be overcome by combining their anatomical and structural characterisation of coronary anatomy with positron emission tomography. Specific radiotracers which bind with high specificity and sensitivity to components of thrombus, such as activated platelets, fibrin and factor XIIIa, hold promise for the non-invasive detection of intracoronary thrombus. The development of these novel non-invasive approaches has the potential to inform clinical decision making and patient management as well as to provide a non-invasive technique to assess the efficacy of novel antithrombotic therapies or interventional strategies. However, these have yet to be realised in routine clinical practice.
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Affiliation(s)
- Beth Whittington
- BHF Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, UK
- Edinburgh Imaging, Queen's Medical Research Institute, Edinburgh, UK
| | - Evangelos Tzolos
- BHF Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, UK
- Edinburgh Imaging, Queen's Medical Research Institute, Edinburgh, UK
| | - Michelle C Williams
- BHF Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, UK
- Edinburgh Imaging, Queen's Medical Research Institute, Edinburgh, UK
| | - Marc R Dweck
- BHF Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, UK
- Edinburgh Imaging, Queen's Medical Research Institute, Edinburgh, UK
| | - David E Newby
- BHF Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, UK
- Edinburgh Imaging, Queen's Medical Research Institute, Edinburgh, UK
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Lee H, Lee S, Baek T, Cha JG, Yang KM. Natural Death. FORENSIC IMAGING 2022. [DOI: 10.1007/978-3-030-83352-7_11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Wang Y, Liu N, Yang M, Tian Z, Dong H, Lu Y, Zou D. Application and Prospect of Postmortem Imaging Technology in Forensic Cardiac Pathology: A Systemic Review. JOURNAL OF FORENSIC SCIENCE AND MEDICINE 2022. [DOI: 10.4103/jfsm.jfsm_129_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
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Jessika C, Anna Laura S, Stefano D, Giuliano GB, Marco B, Riccardo B, Riccardo R, Enrico S. Diagnosing coronary thrombosis using multiphase post-mortem CT angiography (MPMCTA): A case study. MEDICINE, SCIENCE, AND THE LAW 2021; 61:77-81. [PMID: 33591864 DOI: 10.1177/0025802420923175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
While post-mortem angiography (PMA) is gradually establishing its role in Forensic Radiology, the available literature in Italy lacks a solid foundation, particularly regarding its use in criminal court proceedings. An illustrative example of multiphase post-mortem CT angiography (MPMCTA) is presented here to encourage the systematic implementation of PMA methods. To demonstrate concordance between MPMCTA and the reference standard (autopsy and histology) in a case of acute coronary thrombosis, we report a case where MPMCTA, autopsy, histological and toxicological analyses were performed on a previously healthy 51-year-old man. MPMCTA detected a right coronary artery filling defect that could be ascribed to coronary thrombosis, which was later confirmed by autopsy and histological examinations.
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Affiliation(s)
- Camatti Jessika
- Department of Biomedical, Metabolic and Neural Sciences, Institute of Legal Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Santunione Anna Laura
- Department of Biomedical, Metabolic and Neural Sciences, Institute of Legal Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Draisci Stefano
- Department of Adult and Neonatal-Gynaecological Medical Surgical Sciences, Section of Diagnostic Imaging, University of Modena and Reggio Emilia, Modena, Italy
| | - Gangi Bruno Giuliano
- Department of Biomedical, Metabolic and Neural Sciences, Institute of Legal Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Bisceglia Marco
- Department of Biomedical, Metabolic and Neural Sciences, Institute of Legal Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Bini Riccardo
- Department of Biomedical, Metabolic and Neural Sciences, Institute of Legal Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Renzi Riccardo
- Department of Biomedical, Metabolic and Neural Sciences, Institute of Legal Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Silingardi Enrico
- Department of Biomedical, Metabolic and Neural Sciences, Institute of Legal Medicine, University of Modena and Reggio Emilia, Modena, Italy
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Ferrante B, Baroni C, Torres L, Catão-Dias J, Pinto A. Nankeen ink model for histological distribution of solutions used in post mortem CT-angiography. FORENSIC IMAGING 2020. [DOI: 10.1016/j.fri.2020.200387] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Chainchel Singh MK, Abdul Rashid SN, Abdul Hamid S, Mahmood MS, Feng SS, Mohd Nawawi H, Omar E. Correlation and assessment of coronary artery luminal stenosis: Post-mortem computed tomography angiogram versus histopathology. Forensic Sci Int 2020; 308:110171. [PMID: 32032870 DOI: 10.1016/j.forsciint.2020.110171] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 11/05/2019] [Accepted: 01/24/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND Post-mortem Computed Tomography (PMCT) allows non-invasive or minimally invasive detection of findings that may or may not be visible during conventional autopsy, however, it does not allow the investigator to draw any conclusions regarding patency of the vessel's lumen. To address this deficiency, Post-mortem Computed Tomography Angiography (PMCTA) utilizing different contrast media and techniques have been introduced with various studies looking at the correlation between PMCTA, autopsy (gross) findings and coronary artery histology in diagnosing coronary artery disease. OBJECTIVES The aim of this study is to investigate the sensitivity and specificity of PMCTA in diagnosing coronary artery stenosis using water-based contrast media introduced though the vessels of the neck, compared to the gold standard of diagnosis i.e. gross and histological evaluation of the coronary artery. METHOD This was a cross sectional study of 158 arterial sections involving 37 subjects recruited from the National Institute of Forensic Medicine (IPFN), Hospital Kuala Lumpur (HKL). An unenhanced PMCT was performed followed by PMCTA using water-based contrast media introduced though the vessels of the neck. Coronary artery stenosis was determined using multiplanar reconstructionD while the degree of stenosis was determined by calculating the percentage of luminal diameter divided by the diameter of the vessel internal elastic. RESULTS The analysis of PMCTA and histopathology examinations revealed a sensitivity of 61.5%, specificity of 91.7%; positive predictive value (PPV) of 40.0% and negative predictive value (NPV) of 96.4%. CONCLUSION PMCTA utilizing water-based contrast introduced though the vessels of the neck yielded similar results as other methods and techniques of PMCTA. We would therefore conclude that PMCTA utilizing this technique could be used to assess the degree of calcification and the presence of significant stenosis.
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Affiliation(s)
- Mansharan Kaur Chainchel Singh
- Institute for Pathology, Laboratory and Forensic Medicine (I-PPerForM), Universiti Teknologi MARA (UiTM), Sg Buloh, Selangor, Malaysia; Faculty of Medicine, Universiti Teknologi MARA (UiTM), Sg Buloh, Selangor, Malaysia; National Institute of Forensic Medicine (IPFN), Hospital Kuala Lumpur, Malaysia.
| | - Saiful Nizam Abdul Rashid
- Imaging Department, Desa Park Medical City, Kuala Lumpur, Malaysia; Faculty of Medicine and Health Sciences, Universiti Putra Malaysia (UPM), Serdang, Selangor, Malaysia
| | - Suzana Abdul Hamid
- Faculty of Medicine and Health Sciences, Universiti Putra Malaysia (UPM), Serdang, Selangor, Malaysia
| | - Mohd Shah Mahmood
- National Institute of Forensic Medicine (IPFN), Hospital Kuala Lumpur, Malaysia
| | - Siew Sheue Feng
- National Institute of Forensic Medicine (IPFN), Hospital Kuala Lumpur, Malaysia
| | - Hapizah Mohd Nawawi
- Institute for Pathology, Laboratory and Forensic Medicine (I-PPerForM), Universiti Teknologi MARA (UiTM), Sg Buloh, Selangor, Malaysia; Faculty of Medicine, Universiti Teknologi MARA (UiTM), Sg Buloh, Selangor, Malaysia
| | - Effat Omar
- Institute for Pathology, Laboratory and Forensic Medicine (I-PPerForM), Universiti Teknologi MARA (UiTM), Sg Buloh, Selangor, Malaysia; Faculty of Medicine, Universiti Teknologi MARA (UiTM), Sg Buloh, Selangor, Malaysia
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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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11
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Fais P, Mazzotti MC, Montisci M, Palazzo C, Leone O, Cecchetto G, Viel G, Pelotti S. Post-mortem thermal angiography: a pilot study on swine coronary circulation. Int J Legal Med 2018; 133:571-581. [PMID: 30218174 DOI: 10.1007/s00414-018-1935-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 09/07/2018] [Indexed: 10/28/2022]
Abstract
Thermal imaging (TI) allows the detection of thermal patterns emitted from objects as a function of their temperature in the long-infrared spectrum and produces visible images displaying temperature differences. The aim of this pilot study was to test TI to visualize the coronary circulation of swine hearts. Thirty swine hearts were prepared for ex situ coronarography, and thermal images were acquired through a FlirOne thermal camera (FLIR Systems®) paired with a Google Android Smartphone. Coronary arteries were cannulated, namely the anterior interventricular artery, the circumflex branch of the left coronary artery, and the right coronary artery. The heart was cooled, and contrast medium (CM) consisting of distilled water heated to 40 °C was injected in a coronary vessel, while thermal images were captured. These steps were repeated for each coronary vessel and under experimentally simulated coronary heart disease. Thermal imaging coronarography (TIC) allowed a clear representation of the morphology and course of the coronary vessels and of experimentally simulated coronary heart disease, moreover, demonstrated to be easy to perform during or after autopsies on ex situ hearts, non-destructive, reproducible, and cheap. On the basis of these preliminary results, TIC might allow a subsequent more focused and comprehensive cardiopathological examination of the heart, which remains mandatory for the definitive diagnosis of coronary heart disease. Although these preliminary results seem encouraging, further systematic studies on human hearts, both normal and pathological, are necessary for estimating the sensitivity and specificity of the proposed method and to draw any definitive conclusion.
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Affiliation(s)
- Paolo Fais
- DIMEC, Department of Medical and Surgical Sciences, University of Bologna, 40126, Bologna, Italy
| | - Maria Carla Mazzotti
- DIMEC, Department of Medical and Surgical Sciences, University of Bologna, 40126, Bologna, Italy
| | - Massimo Montisci
- Legal Medicine and Toxicology, University Hospital of Padova, Via Falloppio, 50, 35121, Padova, Italy
| | - Chiara Palazzo
- DIMEC, Department of Medical and Surgical Sciences, University of Bologna, 40126, Bologna, Italy
| | - Ornella Leone
- Department of Pathology, Sant'Orsola-Malpighi University Hospital, Bologna, Italy
| | - Giovanni Cecchetto
- Legal Medicine and Toxicology, University Hospital of Padova, Via Falloppio, 50, 35121, Padova, Italy
| | - Guido Viel
- Legal Medicine and Toxicology, University Hospital of Padova, Via Falloppio, 50, 35121, Padova, Italy.
| | - Susi Pelotti
- DIMEC, Department of Medical and Surgical Sciences, University of Bologna, 40126, Bologna, Italy
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Shokry DA, Hussein MN, Hassan FM, Heinemann A, Vogel H, Pueschel K. Diagnostic value of multiphase postmortem computed tomography angiography in selected cases of blunt traumatic deaths. Leg Med (Tokyo) 2018; 34:1-6. [DOI: 10.1016/j.legalmed.2018.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 06/05/2018] [Accepted: 07/10/2018] [Indexed: 12/01/2022]
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Visualization of Myocardial Infarction in Postmortem Multiphase Computed Tomography Angiography: A Feasibility Study. Am J Forensic Med Pathol 2018; 39:106-113. [PMID: 29438137 DOI: 10.1097/paf.0000000000000372] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Recent studies have indicated that multiphase postmortem computed tomography angiography (MPMCTA) allows detection of a pathological enhancement of the myocardium in regions that correlate with the localization of the infarction at histology. The aim of this study was to verify this hypothesis by examining MPMCTA images in cases of myocardial infarction. Therefore, we investigated 10 autopsy cases where death was attributed to myocardial infarction or which showed cardiovascular pathology. As a control group, we selected 10 cases of non-natural (namely, not cardiac) death. The MPMCTA was performed in both groups to ascertain whether a pathological enhancement could be observed. We detected a myocardial enhancement in all cardiac death cases, in the same region that showed infarction at histology. No enhancement was observed in control cases. These results have important implications in the routine management of sudden cardiac death cases. In fact, MPMCTA can not only orient about the cause of death before autopsy, but can especially help to identify affected regions for guiding and improving the sampling for microscopic examination.
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De Marco E, Vacchiano G, Frati P, La Russa R, Santurro A, Scopetti M, Guglielmi G, Fineschi V. Evolution of post-mortem coronary imaging: from selective coronary arteriography to post-mortem CT-angiography and beyond. Radiol Med 2018; 123:351-358. [PMID: 29357039 DOI: 10.1007/s11547-018-0855-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 01/08/2018] [Indexed: 12/17/2022]
Abstract
Since the 1970s, remarkable efforts have been made in the post-mortem coronary study, especially by angiography, as an added tool to diagnose heart-related deaths. In more recent times, post-mortem CT (PMCT) and post-mortem CT-angiography (PMCTA) have become an established practice in numerous forensic units, because of the undeniable advantages these diagnostic instruments can offer: data acquisition times are increasingly fast, costs have become lower and, once acquired, data can be re-utilized and re-evaluated at any given time. This review aims to chart the history of post-mortem cardiac imaging, highlighting its evolution both in terms of methodology and technology as well as the contribution that forensic radiology has been able to offer to forensic pathology, not as an alternative to autopsy but as a guide and aid when performing one. Finally, the latest advances in the study of cardiac deaths are explored, namely by cardiac post-mortem MRI (PMMR), able to visualize all the various stages of a myocardial infarction, post-mortem MRI-angiography (PMMRA), useful in investigating coronary artery pathology and post-mortem cardiac micro-CT, able to provide near-histological levels of myocardial, coronary and valvular detail.
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Affiliation(s)
- Emidio De Marco
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy
| | - Giuseppe Vacchiano
- Department of Law, Economics, Management and Quantitative Methods, University of Sannio, Benevento, Italy
| | - Paola Frati
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy
- Department of Law, Economics, Management and Quantitative Methods, University of Sannio, Benevento, Italy
- Malzoni Clinical-Scientific Institute, Avellino, Italy
| | - Raffaele La Russa
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy
- Department of Law, Economics, Management and Quantitative Methods, University of Sannio, Benevento, Italy
- Malzoni Clinical-Scientific Institute, Avellino, Italy
- IRCCS Neuromed, Pozzilli, Italy
| | - Alessandro Santurro
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy
| | - Matteo Scopetti
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy
| | - Giuseppe Guglielmi
- Department of Radiology, University of Foggia, Viale Luigi Pinto 1, 71100, Foggia, Italy.
| | - Vittorio Fineschi
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy
- Department of Law, Economics, Management and Quantitative Methods, University of Sannio, Benevento, Italy
- Malzoni Clinical-Scientific Institute, Avellino, Italy
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Takei H, Sano R, Takahashi Y, Takahashi K, Kominato Y, Tokue H, Shimada T, Awata S, Hirasawa S, Ohta N. Usefulness of coronary postmortem computed tomography angiography to detect lesions in the coronary artery and myocardium in cases of sudden death. Leg Med (Tokyo) 2017; 30:46-51. [PMID: 29175582 DOI: 10.1016/j.legalmed.2017.11.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 11/16/2017] [Accepted: 11/16/2017] [Indexed: 12/17/2022]
Abstract
Coronary postmortem computed tomography angiography (coronary PMCTA) has been introduced as a routine examination procedure for autopsy at our department. Here, we reviewed eight autopsy cases in which apparent histopathological changes including acute myocardial infarction (AMI), anomalous aortic origin of a coronary artery (AAOCA), hypertrophic obstructive cardiomyopathy (HOCM) and acute myocarditis were involved in the cause of death. For investigation of the coronary artery and shape of the heart, coronary PMCTA was valuable in detecting narrowing or obstruction of coronary artery in AMI, indicating an anomalous aortic origin of the left coronary artery in AAOCA, and demonstrating septal hypertrophy and intracavitary obstruction in HOCM. However, it was debatable whether the hypervascularity demonstrated by coronary PMCTA in the case of acute myocarditis was more prominent than the vascular images obtained in other cases without inflammation. Thus, coronary PMCTA appeared to be useful not only for detection of coronary artery stenosis, but also for indicating other distinctive changes involved in AAOCA and HOCM.
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Affiliation(s)
- Hiroyuki Takei
- Division of Electronics and Informatics, Gunma University Graduate School of Science and Technology, Kiryu 376-8515, Japan; Department of Radiology, Gunma University Hospital, Maebashi 371-8511, Japan
| | - Rie Sano
- Department of Legal Medicine, Gunma University Graduate School of Medicine, Maebashi 371-8511, Japan
| | - Yoichiro Takahashi
- Department of Legal Medicine, Gunma University Graduate School of Medicine, Maebashi 371-8511, Japan; Lieber Institute for Brain Develoment, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Keiko Takahashi
- Department of Legal Medicine, Gunma University Graduate School of Medicine, Maebashi 371-8511, Japan
| | - Yoshihiko Kominato
- Department of Legal Medicine, Gunma University Graduate School of Medicine, Maebashi 371-8511, Japan.
| | - Hiroyuki Tokue
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University, Graduate School of Medicine, Maebashi 371-8511, Japan
| | - Takehiro Shimada
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University, Graduate School of Medicine, Maebashi 371-8511, Japan
| | - Sachiko Awata
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University, Graduate School of Medicine, Maebashi 371-8511, Japan
| | - Satoshi Hirasawa
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University, Graduate School of Medicine, Maebashi 371-8511, Japan
| | - Naoya Ohta
- Division of Electronics and Informatics, Gunma University Graduate School of Science and Technology, Kiryu 376-8515, Japan
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17
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Grabherr S, Egger C, Vilarino R, Campana L, Jotterand M, Dedouit F. Modern post-mortem imaging: an update on recent developments. Forensic Sci Res 2017; 2:52-64. [PMID: 30483621 PMCID: PMC6197109 DOI: 10.1080/20961790.2017.1330738] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 05/05/2017] [Indexed: 12/25/2022] Open
Abstract
Modern post-mortem investigations use an increasing number of digital imaging methods, which can be collected under the term "post-mortem imaging". Most methods of forensic imaging are from the radiology field and are therefore techniques that show the interior of the body with technologies such as X-ray or magnetic resonance imaging. To digitally image the surface of the body, other techniques are regularly applied, e.g. three-dimensional (3D) surface scanning (3DSS) or photogrammetry. Today's most frequently used techniques include post-mortem computed tomography (PMCT), post-mortem magnetic resonance imaging (PMMR), post-mortem computed tomographic angiography (PMCTA) and 3DSS or photogrammetry. Each of these methods has specific advantages and limitations. Therefore, the indications for using each method are different. While PMCT gives a rapid overview of the interior of the body and depicts the skeletal system and radiopaque foreign bodies, PMMR allows investigation of soft tissues and parenchymal organs. PMCTA is the method of choice for viewing the vascular system and detecting sources of bleeding. However, none of those radiological methods allow a detailed digital view of the body's surface, which makes 3DSS the best choice for such a purpose. If 3D surface scanners are not available, photogrammetry is an alternative. This review article gives an overview of different imaging techniques and explains their applications, advantages and limitations. We hope it will improve understanding of the methods.
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Affiliation(s)
- Silke Grabherr
- University Centre of Legal Medicine Lausanne-Geneva, Lausanne, Switzerland
| | - Coraline Egger
- University Centre of Legal Medicine Lausanne-Geneva, Lausanne, Switzerland
| | - Raquel Vilarino
- University Centre of Legal Medicine Lausanne-Geneva, Lausanne, Switzerland
- Service of Legal Medicine, Central Institute of Hospitals, Sion, Switzerland
| | - Lorenzo Campana
- University Centre of Legal Medicine Lausanne-Geneva, Lausanne, Switzerland
| | - Melissa Jotterand
- University Centre of Legal Medicine Lausanne-Geneva, Lausanne, Switzerland
| | - Fabrice Dedouit
- University Centre of Legal Medicine Lausanne-Geneva, Lausanne, Switzerland
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Diagnostic accuracy of postmortem imaging vs autopsy-A systematic review. Eur J Radiol 2016; 89:249-269. [PMID: 28089245 DOI: 10.1016/j.ejrad.2016.08.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Revised: 07/11/2016] [Accepted: 08/02/2016] [Indexed: 11/23/2022]
Abstract
Background Postmortem imaging has been used for more than a century as a complement to medico-legal autopsies. The technique has also emerged as a possible alternative to compensate for the continuous decline in the number of clinical autopsies. To evaluate the diagnostic accuracy of postmortem imaging for various types of findings, we performed this systematic literature review. Data sources The literature search was performed in the databases PubMed, Embase and Cochrane Library through January 7, 2015. Relevant publications were assessed for risk of bias using the QUADAS tool and were classified as low, moderate or high risk of bias according to pre-defined criteria. Autopsy and/or histopathology were used as reference standard. Findings The search generated 2600 abstracts, of which 340 were assessed as possibly relevant and read in full-text. After further evaluation 71 studies were finally included, of which 49 were assessed as having high risk of bias and 22 as moderate risk of bias. Due to considerable heterogeneity - in populations, techniques, analyses and reporting - of included studies it was impossible to combine data to get a summary estimate of the diagnostic accuracy of the various findings. Individual studies indicate, however, that imaging techniques might be useful for determining organ weights, and that the techniques seem superior to autopsy for detecting gas Conclusions and Implications In general, based on the current scientific literature, it was not possible to determine the diagnostic accuracy of postmortem imaging and its usefulness in conjunction with, or as an alternative to autopsy. To correctly determine the usefulness of postmortem imaging, future studies need improved planning, improved methodological quality and larger materials, preferentially obtained from multi-center studies.
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Vanhaebost J, Ducrot K, de Froidmont S, Scarpelli MP, Egger C, Baumann P, Schmit G, Grabherr S, Palmiere C. Diagnosis of myocardial ischemia combining multiphase postmortem CT-angiography, histology, and postmortem biochemistry. Radiol Med 2016; 122:95-105. [DOI: 10.1007/s11547-016-0698-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 10/06/2016] [Indexed: 01/18/2023]
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20
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Kuninaka H, Takahashi Y, Sano R, Takahashi K, Kubo R, Kominato Y, Takei H, Kobayashi S, Shimada T, Tokue H, Awata S, Hirasawa S. Use of postmortem computed tomography angiography to detect vascular injuries accompanying skull base fracture. Leg Med (Tokyo) 2016; 23:55-58. [PMID: 27890105 DOI: 10.1016/j.legalmed.2016.09.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 08/30/2016] [Accepted: 09/28/2016] [Indexed: 11/15/2022]
Abstract
A 58-year-old woman who had presented for upper gastrointestinal barium examination accidently slipped from the movable bed, and her head became compressed between the end of the bed and the side wall. She suffered massive bleeding from her nose and ear followed by cardiac arrest, and subsequent attempts at cardiopulmonary resuscitation failed. A medicolegal autopsy was performed to reveal the cause of death, as part of the investigation of the accident. During the autopsy, postmortem cerebral CT angiography was carried out by injection of 5% gelatin-barium emulsion as a radiopaque contrast medium into the bilateral common carotid arteries, demonstrating transudation of the contrast medium into the right acoustic meatus and the sphenoidal sinus cavity. Considering that the body appeared anemic and that PMCTA suggested vascular injuries, the cause of death was definitively determined to be hemorrhagic shock due to injuries to the right internal carotid artery, accompanied by skull base fracture. Postmortem CT angiography played an important role in confirming that the vascular injuries had been responsible for the bleeding, as the lesions could not be fully confirmed by native CT or macroscopic examination.
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Affiliation(s)
- Hikaru Kuninaka
- Department of Legal Medicine, Gunma University Graduate School of Medicine, Maebashi 371-8511, Japan
| | - Yoichiro Takahashi
- Department of Legal Medicine, Gunma University Graduate School of Medicine, Maebashi 371-8511, Japan.
| | - Rie Sano
- Department of Legal Medicine, Gunma University Graduate School of Medicine, Maebashi 371-8511, Japan
| | - Keiko Takahashi
- Department of Legal Medicine, Gunma University Graduate School of Medicine, Maebashi 371-8511, Japan
| | - Rieko Kubo
- Department of Legal Medicine, Gunma University Graduate School of Medicine, Maebashi 371-8511, Japan
| | - Yoshihiko Kominato
- Department of Legal Medicine, Gunma University Graduate School of Medicine, Maebashi 371-8511, Japan
| | - Hiroyuki Takei
- Department of Radiology, Gunma University Hospital, Maebashi 371-8511, Japan
| | - Susumu Kobayashi
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, Maebashi 371-8511, Japan
| | - Takehiro Shimada
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, Maebashi 371-8511, Japan
| | - Hiroyuki Tokue
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, Maebashi 371-8511, Japan
| | - Sachiko Awata
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, Maebashi 371-8511, Japan
| | - Satoshi Hirasawa
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, Maebashi 371-8511, Japan
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Use of postmortem coronary computed tomography angiography with water-insoluble contrast medium to detect stenosis of the left anterior descending artery in a case of sudden death. Leg Med (Tokyo) 2016; 19:47-51. [DOI: 10.1016/j.legalmed.2016.02.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 01/17/2016] [Accepted: 02/01/2016] [Indexed: 11/22/2022]
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22
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Grabherr S, Baumann P, Fahrni S, Mangin P, Grimm J. Virtuelle vs. reale forensische bildgebende Verfahren. Rechtsmedizin (Berl) 2015. [DOI: 10.1007/s00194-015-0047-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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23
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Postmortem-computed tomography and postmortem-computed tomography-angiography: a focused update. Radiol Med 2015; 120:810-23. [PMID: 26088469 DOI: 10.1007/s11547-015-0559-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 06/08/2015] [Indexed: 01/20/2023]
Abstract
The use of multidetector CT (MDCT) represents a reality routinely used in several forensic institutes, for the numerous advantages that this diagnostic tool can provide; costs are becoming increasingly lower; data acquisition is always faster and once acquired may be revalued at any time. However, there are also some diagnostic limitations, for example, the visualization of the vascular system or a limited soft tissue contrast. In order to overcome these limitations, in recent years, contrast medium has been introduced in postmortem cases, with the development of several techniques of PMCT angiography (PMCTA) and standardized protocols to make them easily reproducible. The aim of this review is to highlight the advantages and pitfalls of PMCT and PMCTA in forensic investigation, taking into consideration the broad spectrum of applications both for natural and unnatural deaths and the numerous methods currently used. Secondly, in the light of the considerable progress in this field and the attempt to develop standardized protocols of PMCTA, the authors aim to evaluate the diagnostic value of PMCTA in comparison both to PMCT and conventional autopsy.
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Makino Y, Inokuchi G, Yokota H, Hayakawa M, Yajima D, Motomura A, Chiba F, Torimitsu S, Nakatani Y, Iwase H. Sudden death due to coronary artery dissection associated with fibromuscular dysplasia revealed by postmortem selective computed tomography coronary angiography: A case report. Forensic Sci Int 2015; 253:e10-5. [PMID: 26048864 DOI: 10.1016/j.forsciint.2015.05.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Revised: 05/13/2015] [Accepted: 05/14/2015] [Indexed: 11/29/2022]
Abstract
We present an autopsy case of sudden death due to coronary artery dissection associated with fibromuscular dysplasia (FMD) in a young female patient. Postmortem selective coronary artery computed tomography (CT) angiography revealed dissections of the left anterior descending and left circumflex arteries. These findings were confirmed by subsequent autopsy. Histopathological examination revealed coronary artery FMD, which is considered a risk factor for dissection. To the best of our knowledge, this is the first postmortem radiology-pathology correlation of coronary artery dissection associated with FMD.
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Affiliation(s)
- Yohsuke Makino
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku 113-0033, Tokyo, Japan; Department of Legal Medicine, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chuo-ku 260-8670, Chiba, Japan.
| | - Go Inokuchi
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chuo-ku 260-8670, Chiba, Japan.
| | - Hajime Yokota
- Department of Radiology, Chiba University Hospital, Inohana 1-8-1, Chuo-ku 260-8677, Chiba, Japan.
| | - Mutsumi Hayakawa
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chuo-ku 260-8670, Chiba, Japan.
| | - Daisuke Yajima
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chuo-ku 260-8670, Chiba, Japan.
| | - Ayumi Motomura
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chuo-ku 260-8670, Chiba, Japan.
| | - Fumiko Chiba
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku 113-0033, Tokyo, Japan; Department of Legal Medicine, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chuo-ku 260-8670, Chiba, Japan.
| | - Suguru Torimitsu
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chuo-ku 260-8670, Chiba, Japan.
| | - Yukio Nakatani
- Department of Diagnostic Pathology, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chuo-ku 260-8670, Chiba, Japan.
| | - Hirotaro Iwase
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku 113-0033, Tokyo, Japan; Department of Legal Medicine, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chuo-ku 260-8670, Chiba, Japan.
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25
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Grabherr S, Wittig H, Dedouit F, Wozniak K, Vogel H, Heinemann A, Fischer F, Moskala A, Guglielmi G, Mangin P, Grimm J. Pitfalls in post-mortem CT-angiography – Intravascular contrast induces post-mortem pericardial effusion. Leg Med (Tokyo) 2015; 17:218-9. [DOI: 10.1016/j.legalmed.2014.12.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 12/04/2014] [Indexed: 11/29/2022]
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Application of contrast media in post-mortem imaging (CT and MRI). Radiol Med 2015; 120:824-34. [PMID: 25841652 DOI: 10.1007/s11547-015-0532-2] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 03/12/2015] [Indexed: 01/17/2023]
Abstract
The application of contrast media in post-mortem radiology differs from clinical approaches in living patients. Post-mortem changes in the vascular system and the absence of blood flow lead to specific problems that have to be considered for the performance of post-mortem angiography. In addition, interpreting the images is challenging due to technique-related and post-mortem artefacts that have to be known and that are specific for each applied technique. Although the idea of injecting contrast media is old, classic methods are not simply transferable to modern radiological techniques in forensic medicine, as they are mostly dedicated to single-organ studies or applicable only shortly after death. With the introduction of modern imaging techniques, such as post-mortem computed tomography (PMCT) and post-mortem magnetic resonance (PMMR), to forensic death investigations, intensive research started to explore their advantages and limitations compared to conventional autopsy. PMCT has already become a routine investigation in several centres, and different techniques have been developed to better visualise the vascular system and organ parenchyma in PMCT. In contrast, the use of PMMR is still limited due to practical issues, and research is now starting in the field of PMMR angiography. This article gives an overview of the problems in post-mortem contrast media application, the various classic and modern techniques, and the issues to consider by using different media.
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27
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Püschel K, Bajanowski T, Vennemann M, Kernbach-Wighton G, Madea B. Plötzliche und unerwartete Todesfälle aus innerer Ursache. Rechtsmedizin (Berl) 2015. [DOI: 10.1007/978-3-662-43500-7_5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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28
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Postmortem computed tomography angiography, contrast medium administration and toxicological analyses in urine. Leg Med (Tokyo) 2014; 17:157-62. [PMID: 25537625 DOI: 10.1016/j.legalmed.2014.12.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Revised: 11/28/2014] [Accepted: 12/03/2014] [Indexed: 11/24/2022]
Abstract
Postmortem angiography methods that use water soluble or lipid soluble liquid contrast compounds may potentially modify the composition of fluid-based biological samples and thus influence toxicological findings. In this study, we investigated whether toxicological investigations performed in urine collected prior to and post angiography using Angiofil™ mixed with paraffin oil are characterized by different qualitative or quantitative results. In addition, we studied whether diluting samples with 1% and 3% contrast medium solution may modify molecule concentration. A postmortem angiography group consisting of 50 cases and a postmortem group without angiography consisting of 50 cases were formed. In the first group, toxicological investigations were performed in urine samples collected prior to and post angiography as well as in undiluted and diluted samples. In the second group, analyses were performed in undiluted and diluted urine, bile, gastric content, cerebrospinal and pericardial fluids collected during autopsy. The preliminary results indicate that differences may be observed between urine samples collected prior to and post angiography in the number of identified molecules in relation to specific cases. Analyses performed in diluted samples failed to reveal differences that might potentially alter the interpretation of toxicological results in all analyzed specimens for nearly all molecules, except for tetrahydrocannabinol and its metabolites. Though these findings suggest that toxicology might be effectively performed, in very special cases and for a large number of molecules, in biological samples collected after angiography, it remains recommendable to collect biological fluids for toxicology prior to contrast medium injection.
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29
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Ruder TD, Thali MJ, Hatch GM. Essentials of forensic post-mortem MR imaging in adults. Br J Radiol 2014; 87:20130567. [PMID: 24191122 DOI: 10.1259/bjr.20130567] [Citation(s) in RCA: 92] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Post-mortem MR (PMMR) imaging is a powerful diagnostic tool with a wide scope in forensic radiology. In the past 20 years, PMMR has been used as both an adjunct and an alternative to autopsy. The role of PMMR in forensic death investigations largely depends on the rules and habits of local jurisdictions, availability of experts, financial resources, and individual case circumstances. PMMR images are affected by post-mortem changes, including position-dependent sedimentation, variable body temperature and decomposition. Investigators must be familiar with the appearance of normal findings on PMMR to distinguish them from disease or injury. Coronal whole-body images provide a comprehensive overview. Notably, short tau inversion-recovery (STIR) images enable investigators to screen for pathological fluid accumulation, to which we refer as "forensic sentinel sign". If scan time is short, subsequent PMMR imaging may be focussed on regions with a positive forensic sentinel sign. PMMR offers excellent anatomical detail and is especially useful to visualize pathologies of the brain, heart, subcutaneous fat tissue and abdominal organs. PMMR may also be used to document skeletal injury. Cardiovascular imaging is a core area of PMMR imaging and growing evidence indicates that PMMR is able to detect ischaemic injury at an earlier stage than traditional autopsy and routine histology. The aim of this review is to present an overview of normal findings on forensic PMMR, provide general advice on the application of PMMR and summarise the current literature on PMMR imaging of the head and neck, cardiovascular system, abdomen and musculoskeletal system.
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Affiliation(s)
- T D Ruder
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Zurich, Switzerland
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30
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Törő K, Matlakovics B, Dudás I, Karlinger K, Kiss M, Molnár A, Nemeskéri A. The utility of the combination of the corrosion cast method and post mortem MSCT scans. Leg Med (Tokyo) 2014; 16:283-9. [PMID: 25034501 DOI: 10.1016/j.legalmed.2014.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 06/10/2014] [Accepted: 06/11/2014] [Indexed: 10/25/2022]
Abstract
A careful post-mortem investigation is needed to determine the cause of death of patients bearing coronary stents and to describe complications of stent implantation. The main purpose of this study was to combine post mortem methods of CT angiography and corrosion cast preparation for the visualization of coronary stenoses, coronary stents, instent restenosis, and stent occlusion. Injection-corrosion method was combined with post-mortem MSCT angiography to characterize the pathomorphological changes after stent implantation in 6 male cadaver hearts. Multi-slice computed tomography was employed to visualize the coronary artery system. For image post processing, multiplanar reconstructions, maximal intensity projections and three dimensional reconstructions were used. This study was assessing the feasibility of post mortem MSCT for intracoronary stent evaluation. We described a method for characterization of the coronary side branch stenosis caused by stent implantation. Post mortem CT imaging proved to be a feasible and highly reproducible technique for the characterization of pathological changes in the coronary system.
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Affiliation(s)
- Klára Törő
- Semmelweis University Department of Forensic and Insurance Medicine, Hungary.
| | - Balázs Matlakovics
- Semmelweis University Department of Human Morphology and Developmental Biology, Hungary
| | - Ibolyka Dudás
- Semmelweis University Department of Diagnostic Radiology and Oncotherapy, Hungary
| | - Kinga Karlinger
- Semmelweis University Department of Diagnostic Radiology and Oncotherapy, Hungary
| | - Mátyás Kiss
- Semmelweis University Department of Human Morphology and Developmental Biology, Hungary
| | - Agnes Molnár
- Semmelweis University Department of Human Morphology and Developmental Biology, Hungary
| | - Agnes Nemeskéri
- Semmelweis University Department of Human Morphology and Developmental Biology, Hungary
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Capuani C, Guilbeau-Frugier C, Mokrane FZ, Delisle MB, Marcheix B, Rousseau H, Telmon N, Rougé D, Dedouit F. Tissue microscopic changes and artifacts in multi-phase post-mortem computed tomography angiography in a hospital setting: a fatal case of systemic vasculitis. Forensic Sci Int 2014; 242:e12-e17. [PMID: 25085763 DOI: 10.1016/j.forsciint.2014.06.039] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Revised: 06/27/2014] [Accepted: 06/30/2014] [Indexed: 12/19/2022]
Abstract
A 27-year-old man suddenly died in hospital of acute respiratory distress syndrome secondary to severe systemic vasculitis. Multi-phase post-mortem computed tomography angiography followed by scientific autopsy of the thoracic and abdominal cavity and histology was performed, illustrating the advantages and drawbacks of such techniques. Imaging enabled us to examine the cranium, as the family refused cerebral dissection. MPMCTA revealed absence of opacification of the left middle cerebral artery. But parenchymal findings of thoracic and abdominal organs were still difficult to interpret after both imaging and macroscopic examination during the autopsy. Microscopic examination provided the definitive diagnosis of cause of death. Analysis revealed systemic vasculitis of the lung complicated by diffuse alveolar, mediastinal, splenic and retroperitoneal lesions. We were unable to determine the type of vasculitis, whether polyarteritis nodosa or microscopic polyangiitis, because of artifactual glomerular collapse. We observed some structural changes in tissue secondary to contrast agent injection, affecting the vascular system and renal parenchyma in particular. Such artifacts must be known in order to avoid misinterpreting them as pathological findings. MPMCTA and conventional autopsy are two complementary techniques showing both their specific advantages and limits which have to be known in order to choose the appropriate technique. One limit of both techniques is the detection of microscopic findings which can only be obtained by additional histological examination. This case report underlines this fact and demonstrates that caution is required in some cases if microscopic analyses are carried out after contrast agent injection.
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Affiliation(s)
- Caroline Capuani
- Service d'Anatomie Pathologique et Histologie-Cytologie, Centre Hospitalier Universitaire Rangueil-Larrey, 1 avenue Professeur Jean Poulhès, 31059 Toulouse Cedex 9, France.
| | - Céline Guilbeau-Frugier
- Service d'Anatomie Pathologique et Histologie-Cytologie, Centre Hospitalier Universitaire Rangueil-Larrey, 1 avenue Professeur Jean Poulhès, 31059 Toulouse Cedex 9, France.
| | - Fatima-Zohra Mokrane
- Service de Radiologie Centrale, Centre Hospitalier Universitaire Rangueil-Larrey, 1 avenue Professeur Jean Poulhès, 31059 Toulouse Cedex 9, France.
| | - Marie-Bernadette Delisle
- Service d'Anatomie Pathologique et Histologie-Cytologie, Centre Hospitalier Universitaire Rangueil-Larrey, 1 avenue Professeur Jean Poulhès, 31059 Toulouse Cedex 9, France.
| | - Bertrand Marcheix
- Service de Chirurgie Cardio-Vasculaire, Centre Hospitalier Universitaire Rangueil-Larrey, 1 avenue Professeur Jean Poulhès, 31059 Toulouse Cedex 9, France.
| | - Hervé Rousseau
- Service de Radiologie Centrale, Centre Hospitalier Universitaire Rangueil-Larrey, 1 avenue Professeur Jean Poulhès, 31059 Toulouse Cedex 9, France.
| | - Norbert Telmon
- Unité Médico-Judiciaire, Centre Hospitalier Universitaire Rangueil, 1 avenue Professeur Jean Poulhès, 31059 Toulouse Cedex 9, France.
| | - Daniel Rougé
- Unité Médico-Judiciaire, Centre Hospitalier Universitaire Rangueil, 1 avenue Professeur Jean Poulhès, 31059 Toulouse Cedex 9, France.
| | - Fabrice Dedouit
- Service de Radiologie Centrale, Centre Hospitalier Universitaire Rangueil-Larrey, 1 avenue Professeur Jean Poulhès, 31059 Toulouse Cedex 9, France; Unité Médico-Judiciaire, Centre Hospitalier Universitaire Rangueil, 1 avenue Professeur Jean Poulhès, 31059 Toulouse Cedex 9, France.
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Can Forensic Pathologists Diagnose Pulmonary Thromboembolism on Postmortem Computed Tomography Pulmonary Angiography? Am J Forensic Med Pathol 2014; 35:124-31. [DOI: 10.1097/paf.0000000000000086] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Grabherr S, Grimm J, Dominguez A, Vanhaebost J, Mangin P. Advances in post-mortem CT-angiography. Br J Radiol 2014; 87:20130488. [PMID: 24234582 PMCID: PMC4067028 DOI: 10.1259/bjr.20130488] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Revised: 11/04/2013] [Accepted: 11/05/2013] [Indexed: 12/31/2022] Open
Abstract
Performing a post-mortem multidetector CT (MDCT) scan has already become routine in some institutes of forensic medicine. To better visualize the vascular system, different techniques of post-mortem CT-angiography have been explored, which can essentially be divided into partial- and whole-body angiography techniques. Probably the most frequently applied technique today is the so-called multiphase post-mortem CT-angiography (MPMCTA) a standardized method for investigating the vessels of the head, thorax and abdomen. Different studies exist, describing its use for medicolegal investigations, and its advantages as well as its artefacts and pitfalls. With the aim to investigate the performance of PMCTA and to develop and validate techniques, an international working group was created in 2012 called the "Technical Working Group Post-mortem Angiography Methods" (TWGPAM). Beyond its primary perspective, the goals of this group include creating recommendations for the indication of the investigation and for the interpretation of the images and to distribute knowledge about PMCTA. This article provides an overview about the different approaches that have been developed and tested in recent years and an update about ongoing research in this field. It will explain the technique of MPMCTA in detail and give an outline of its indications, application, advantages and limitations.
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Affiliation(s)
- S Grabherr
- University Center of Legal Medicine Lausanne-Geneva, University Hospital of Lausanne, Lausanne, Switzerland
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Postmortale Darstellung der Koronararterien durch multiphasische Ganzkörper-CT-Angiographie. Rechtsmedizin (Berl) 2014. [DOI: 10.1007/s00194-014-0947-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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