1
|
Takahashi Y, Hayakawa A, Sano R, Fukuda H, Kubo R, Tokue H, Okawa T, Kawamura M, Kominato Y. Usefulness of a tissue optical clearing technique for forensic autopsy. J Forensic Sci 2022; 67:1124-1131. [PMID: 35088897 DOI: 10.1111/1556-4029.14995] [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: 11/04/2021] [Revised: 12/23/2021] [Accepted: 01/11/2022] [Indexed: 11/30/2022]
Abstract
Forensic pathologists are required to investigate lethal trauma or disease at autopsy. In addition to massive contusions of various organs, a number of small features with potentially fatal implications also need to be sought. Since such lesions may need microscopic examinations for detailed evaluation, it is important to select suitable anatomic locations for tissue sampling. For practical screening of small lesions, we have developed a tissue optical clearing (TOC) technique for forensic autopsy. The technique involves clearing with a non-toxic organic solvent, ethyl cinnamate, which renders excised organs transparent, while hemorrhages or blood-containing vessels remain opaque. Using this technique, tiny hemorrhages in the spinal cord were able to be identified by gross examination, allowing proper selection of locations for tissue sampling. Subsequent histopathological evaluation was successfully performed with no apparent artifacts related with the TOC procedure. In addition, a combination of TOC and targeted CT angiography allowed feasible examination of the arterial occlusive lesion in the superior mesenteric artery, and when combined with micro-CT scanning it was useful for evaluating the lumen of the coronary artery with stent implantation. The results obtained so far indicated that TOC could complement routine forensic autopsy procedures when detailed evaluation of small lesions is required.
Collapse
Affiliation(s)
- Yoichiro Takahashi
- Department of Legal Medicine, Gunma University, Graduate School of Medicine, Maebashi, Japan
| | - Akira Hayakawa
- Department of Legal Medicine, Gunma University, Graduate School of Medicine, Maebashi, Japan
| | - Rie Sano
- Department of Legal Medicine, Gunma University, Graduate School of Medicine, Maebashi, Japan
| | - Haruki Fukuda
- Department of Legal Medicine, Gunma University, Graduate School of Medicine, Maebashi, Japan
| | - Rieko Kubo
- Department of Legal Medicine, Gunma University, Graduate School of Medicine, Maebashi, Japan
| | - Hiroyuki Tokue
- Department of Diagnostic Radiology & Nuclear Medicine, Graduate School of Medicine, Gunma University, Maebashi, Japan
| | - Takafumi Okawa
- Department of Legal Medicine, Gunma University, Graduate School of Medicine, Maebashi, Japan
| | - Miki Kawamura
- Department of Legal Medicine, Gunma University, Graduate School of Medicine, Maebashi, Japan
| | - Yoshihiko Kominato
- Department of Legal Medicine, Gunma University, Graduate School of Medicine, Maebashi, Japan
| |
Collapse
|
2
|
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
|
3
|
Paratz ED, Costello B, Rowsell L, Morgan N, Smith K, Thompson T, Semsarian C, Pflaumer A, James P, Stub D, La Gerche A, Zentner D, Parsons S. Can post-mortem coronary artery calcium scores aid diagnosis in young sudden death? Forensic Sci Med Pathol 2020; 17:27-35. [PMID: 33190173 DOI: 10.1007/s12024-020-00335-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2020] [Indexed: 12/16/2022]
Abstract
This study sought to explore the feasibility and utility of post-mortem coronary artery calcium (CAC) scoring in identifying patients with ischemic heart disease as cause of sudden death. 100 deceased patients aged 18-50 years underwent post-mortem examination in the setting of sudden death. At post-mortem, fifty cases were determined to have ischemic heart disease, and fifty had death attributed to trauma or unascertained causes. The CAC score was calculated in a blinded manner from post-mortem CTs performed on all cases. CAC scores were assessable in 97 non-decomposed cases (feasibility 97%). The median CAC score was 88 Agatston units [IQR 0-286] in patients deceased from ischemic heart disease vs 0 [IQR 0-0] in patients deceased from other causes (p < 0.0001). Presence of any coronary calcification differed significantly between ischemic heart disease and non-ischemic groups (adjusted odds ratio 10.7, 95% CI 3.2-35.5). All cases with a CAC score > 100 (n = 22) had ischemic heart disease as the cause of death. Fifteen cases had a CAC score of zero but severe coronary disease at post-mortem examination. Post-mortem CAC scoring is highly feasible. An elevated CAC score in cases 18-50 years old with sudden death predicts ischemic heart disease at post-mortem examination. However, a CAC score of zero does not exclude significant coronary artery disease. Post-mortem CAC score may be considered as a further assessment tool to help predict likely cause of death when there is an objection to or unavailability of post-mortem examination.
Collapse
Affiliation(s)
- Elizabeth D Paratz
- Baker Heart and Diabetes Institute, 75 Commercial Rd, Prahran, VIC, 3181, Australia. .,Alfred Hospital, 55 Commercial Rd, Prahran, VIC, 3181, Australia. .,St Vincent's Hospital Melbourne, 41 Victoria Pde, Fitzroy, VIC, 3065, Australia.
| | - Ben Costello
- Baker Heart and Diabetes Institute, 75 Commercial Rd, Prahran, VIC, 3181, Australia.,St Vincent's Hospital Melbourne, 41 Victoria Pde, Fitzroy, VIC, 3065, Australia
| | - Luke Rowsell
- Baker Heart and Diabetes Institute, 75 Commercial Rd, Prahran, VIC, 3181, Australia
| | - Natalie Morgan
- Victorian Institute of Forensic Medicine, 65 Kavanagh St, Southbank, VIC, 3006, Australia
| | - Karen Smith
- , Ambulance Victoria, 375 Manningham Rd, Doncaster, VIC, 3108, Australia.,Department of Community Emergency Health and Paramedic Practice, Monash University, Melbourne, VIC, Australia.,Murdoch Children's Research Institute, Royal Children's Hospital, Flemington Rd, Parkville, VIC, 3052, Australia
| | - Tina Thompson
- Royal Melbourne Hospital, 300 Grattan St, Parkville, VIC, 3050, Australia
| | - Chris Semsarian
- Centenary Institute and The University of Sydney, Missenden Rd, Sydney, NSW, 2050, Australia
| | - Andreas Pflaumer
- Royal Children's Hospital, 50 Flemington Rd, Parkville Melbourne, VIC, 3052, Australia.,Department of Paediatrics, Melbourne University, Parkville, VIC, 3010, Australia.,Murdoch Children's Research Institute, Royal Children's Hospital, Flemington Rd, Parkville, VIC, 3052, Australia
| | - Paul James
- Peter MacCallum Cancer Centre, 305 Grattan St, Parkville, VIC, 3050, Australia
| | - Dion Stub
- Baker Heart and Diabetes Institute, 75 Commercial Rd, Prahran, VIC, 3181, Australia.,Alfred Hospital, 55 Commercial Rd, Prahran, VIC, 3181, Australia.,Department of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, 3004, Australia
| | - André La Gerche
- Baker Heart and Diabetes Institute, 75 Commercial Rd, Prahran, VIC, 3181, Australia.,Alfred Hospital, 55 Commercial Rd, Prahran, VIC, 3181, Australia.,St Vincent's Hospital Melbourne, 41 Victoria Pde, Fitzroy, VIC, 3065, Australia
| | - Dominica Zentner
- Royal Melbourne Hospital, 300 Grattan St, Parkville, VIC, 3050, Australia.,Royal Melbourne Hospital Clinical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, 3000, Australia
| | - Sarah Parsons
- Victorian Institute of Forensic Medicine, 65 Kavanagh St, Southbank, VIC, 3006, Australia.,Department of Forensic Medicine, Monash University, 65 Kavanagh St, Southbank, VIC, 3006, Australia
| |
Collapse
|
4
|
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.
Collapse
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
| |
Collapse
|
5
|
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.
Collapse
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
| |
Collapse
|
6
|
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.
Collapse
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
| |
Collapse
|