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Grabherr S, Heinemann A, Vogel H, Rutty G, Morgan B, Woźniak K, Dedouit F, Fischer F, Lochner S, Wittig H, Guglielmi G, Eplinius F, Michaud K, Palmiere C, Chevallier C, Mangin P, Grimm JM. Postmortem CT Angiography Compared with Autopsy: A Forensic Multicenter Study. Radiology 2018; 288:270-276. [PMID: 29714682 PMCID: PMC6027995 DOI: 10.1148/radiol.2018170559] [Citation(s) in RCA: 84] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose To determine if postmortem computed tomography (CT) and postmortem CT angiography help to detect more lesions than autopsy in postmortem examinations, to evaluate the strengths and weaknesses of each method, and to define their indications. Materials and Methods Postmortem CT angiography was performed on 500 human corpses and followed by conventional autopsy. Nine centers were involved. All CT images were read by an experienced team including one forensic pathologist and one radiologist, blinded to the autopsy results. All findings were recorded for each method and categorized by anatomic structure (bone, organ parenchyma, soft tissue, and vascular) and relative importance in the forensic case (essential, useful, and unimportant). Results Among 18 654 findings, autopsies helped to identify 61.3% (11 433 of 18 654), postmortem CT helped to identify 76.0% (14 179 of 18 654), and postmortem CT angiography helped to identify 89.9% (16 780 of 18 654; P < .001). Postmortem CT angiography was superior to autopsy, especially at helping to identify essential skeletal lesions (96.1% [625 of 650] vs 65.4% [425 of 650], respectively; P < .001) and vascular lesions (93.5% [938 of 1003] vs 65.3% [655 of 1003], respectively; P < .001). Among the forensically essential findings, 23.4% (1029 of 4393) were not detected at autopsy, while only 9.7% (428 of 4393) were missed at postmortem CT angiography (P < .001). The best results were obtained when postmortem CT angiography was combined with autopsy. Conclusion Postmortem CT and postmortem CT angiography and autopsy each detect important lesions not detected by the other method. More lesions were identified by combining postmortem CT angiography and autopsy, which may increase the quality of postmortem diagnosis. Online supplemental material is available for this article.
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Affiliation(s)
- Silke Grabherr
- From the University Center of Legal Medicine Lausanne-Geneva, Chemin de la Vulliette 4, 1000 Lausanne 25, Switzerland (S.G., F.D., K.M., C.P., C.C., P.M., J.M.G.); Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (A.H., H.V.); East Midlands Forensic Pathology Unit, University of Leicester, Leicester, England (G.R.); University of Leicester Imaging Department, University Hospitals of Leicester, Leicester Royal Infirmary, Leicester, England (B.M.); Department of Forensic Medicine, Jagiellonian University Medical College, Krakow, Poland (K.W.); Departments of Legal Medicine and Radiology, Hôpital Rangueil, Toulouse, France (F.D.); Institute of Legal Medicine, Munich, Germany (F.F., S.L.); Institute of Legal Medicine, Basel, Switzerland (H.W.); University of Foggia, Foggia, Italy (G.G.); Institute of Forensic Medicine, University of Leipzig, Leipzig, Germany (F.E.); and Department of Medical Radiology, University Hospital Center and University of Lausanne, Lausanne, Switzerland (J.M.G.)
| | - Axel Heinemann
- From the University Center of Legal Medicine Lausanne-Geneva, Chemin de la Vulliette 4, 1000 Lausanne 25, Switzerland (S.G., F.D., K.M., C.P., C.C., P.M., J.M.G.); Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (A.H., H.V.); East Midlands Forensic Pathology Unit, University of Leicester, Leicester, England (G.R.); University of Leicester Imaging Department, University Hospitals of Leicester, Leicester Royal Infirmary, Leicester, England (B.M.); Department of Forensic Medicine, Jagiellonian University Medical College, Krakow, Poland (K.W.); Departments of Legal Medicine and Radiology, Hôpital Rangueil, Toulouse, France (F.D.); Institute of Legal Medicine, Munich, Germany (F.F., S.L.); Institute of Legal Medicine, Basel, Switzerland (H.W.); University of Foggia, Foggia, Italy (G.G.); Institute of Forensic Medicine, University of Leipzig, Leipzig, Germany (F.E.); and Department of Medical Radiology, University Hospital Center and University of Lausanne, Lausanne, Switzerland (J.M.G.)
| | - Hermann Vogel
- From the University Center of Legal Medicine Lausanne-Geneva, Chemin de la Vulliette 4, 1000 Lausanne 25, Switzerland (S.G., F.D., K.M., C.P., C.C., P.M., J.M.G.); Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (A.H., H.V.); East Midlands Forensic Pathology Unit, University of Leicester, Leicester, England (G.R.); University of Leicester Imaging Department, University Hospitals of Leicester, Leicester Royal Infirmary, Leicester, England (B.M.); Department of Forensic Medicine, Jagiellonian University Medical College, Krakow, Poland (K.W.); Departments of Legal Medicine and Radiology, Hôpital Rangueil, Toulouse, France (F.D.); Institute of Legal Medicine, Munich, Germany (F.F., S.L.); Institute of Legal Medicine, Basel, Switzerland (H.W.); University of Foggia, Foggia, Italy (G.G.); Institute of Forensic Medicine, University of Leipzig, Leipzig, Germany (F.E.); and Department of Medical Radiology, University Hospital Center and University of Lausanne, Lausanne, Switzerland (J.M.G.)
| | - Guy Rutty
- From the University Center of Legal Medicine Lausanne-Geneva, Chemin de la Vulliette 4, 1000 Lausanne 25, Switzerland (S.G., F.D., K.M., C.P., C.C., P.M., J.M.G.); Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (A.H., H.V.); East Midlands Forensic Pathology Unit, University of Leicester, Leicester, England (G.R.); University of Leicester Imaging Department, University Hospitals of Leicester, Leicester Royal Infirmary, Leicester, England (B.M.); Department of Forensic Medicine, Jagiellonian University Medical College, Krakow, Poland (K.W.); Departments of Legal Medicine and Radiology, Hôpital Rangueil, Toulouse, France (F.D.); Institute of Legal Medicine, Munich, Germany (F.F., S.L.); Institute of Legal Medicine, Basel, Switzerland (H.W.); University of Foggia, Foggia, Italy (G.G.); Institute of Forensic Medicine, University of Leipzig, Leipzig, Germany (F.E.); and Department of Medical Radiology, University Hospital Center and University of Lausanne, Lausanne, Switzerland (J.M.G.)
| | - Bruno Morgan
- From the University Center of Legal Medicine Lausanne-Geneva, Chemin de la Vulliette 4, 1000 Lausanne 25, Switzerland (S.G., F.D., K.M., C.P., C.C., P.M., J.M.G.); Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (A.H., H.V.); East Midlands Forensic Pathology Unit, University of Leicester, Leicester, England (G.R.); University of Leicester Imaging Department, University Hospitals of Leicester, Leicester Royal Infirmary, Leicester, England (B.M.); Department of Forensic Medicine, Jagiellonian University Medical College, Krakow, Poland (K.W.); Departments of Legal Medicine and Radiology, Hôpital Rangueil, Toulouse, France (F.D.); Institute of Legal Medicine, Munich, Germany (F.F., S.L.); Institute of Legal Medicine, Basel, Switzerland (H.W.); University of Foggia, Foggia, Italy (G.G.); Institute of Forensic Medicine, University of Leipzig, Leipzig, Germany (F.E.); and Department of Medical Radiology, University Hospital Center and University of Lausanne, Lausanne, Switzerland (J.M.G.)
| | - Krzysztof Woźniak
- From the University Center of Legal Medicine Lausanne-Geneva, Chemin de la Vulliette 4, 1000 Lausanne 25, Switzerland (S.G., F.D., K.M., C.P., C.C., P.M., J.M.G.); Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (A.H., H.V.); East Midlands Forensic Pathology Unit, University of Leicester, Leicester, England (G.R.); University of Leicester Imaging Department, University Hospitals of Leicester, Leicester Royal Infirmary, Leicester, England (B.M.); Department of Forensic Medicine, Jagiellonian University Medical College, Krakow, Poland (K.W.); Departments of Legal Medicine and Radiology, Hôpital Rangueil, Toulouse, France (F.D.); Institute of Legal Medicine, Munich, Germany (F.F., S.L.); Institute of Legal Medicine, Basel, Switzerland (H.W.); University of Foggia, Foggia, Italy (G.G.); Institute of Forensic Medicine, University of Leipzig, Leipzig, Germany (F.E.); and Department of Medical Radiology, University Hospital Center and University of Lausanne, Lausanne, Switzerland (J.M.G.)
| | - Fabrice Dedouit
- From the University Center of Legal Medicine Lausanne-Geneva, Chemin de la Vulliette 4, 1000 Lausanne 25, Switzerland (S.G., F.D., K.M., C.P., C.C., P.M., J.M.G.); Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (A.H., H.V.); East Midlands Forensic Pathology Unit, University of Leicester, Leicester, England (G.R.); University of Leicester Imaging Department, University Hospitals of Leicester, Leicester Royal Infirmary, Leicester, England (B.M.); Department of Forensic Medicine, Jagiellonian University Medical College, Krakow, Poland (K.W.); Departments of Legal Medicine and Radiology, Hôpital Rangueil, Toulouse, France (F.D.); Institute of Legal Medicine, Munich, Germany (F.F., S.L.); Institute of Legal Medicine, Basel, Switzerland (H.W.); University of Foggia, Foggia, Italy (G.G.); Institute of Forensic Medicine, University of Leipzig, Leipzig, Germany (F.E.); and Department of Medical Radiology, University Hospital Center and University of Lausanne, Lausanne, Switzerland (J.M.G.)
| | - Florian Fischer
- From the University Center of Legal Medicine Lausanne-Geneva, Chemin de la Vulliette 4, 1000 Lausanne 25, Switzerland (S.G., F.D., K.M., C.P., C.C., P.M., J.M.G.); Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (A.H., H.V.); East Midlands Forensic Pathology Unit, University of Leicester, Leicester, England (G.R.); University of Leicester Imaging Department, University Hospitals of Leicester, Leicester Royal Infirmary, Leicester, England (B.M.); Department of Forensic Medicine, Jagiellonian University Medical College, Krakow, Poland (K.W.); Departments of Legal Medicine and Radiology, Hôpital Rangueil, Toulouse, France (F.D.); Institute of Legal Medicine, Munich, Germany (F.F., S.L.); Institute of Legal Medicine, Basel, Switzerland (H.W.); University of Foggia, Foggia, Italy (G.G.); Institute of Forensic Medicine, University of Leipzig, Leipzig, Germany (F.E.); and Department of Medical Radiology, University Hospital Center and University of Lausanne, Lausanne, Switzerland (J.M.G.)
| | - Stefanie Lochner
- From the University Center of Legal Medicine Lausanne-Geneva, Chemin de la Vulliette 4, 1000 Lausanne 25, Switzerland (S.G., F.D., K.M., C.P., C.C., P.M., J.M.G.); Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (A.H., H.V.); East Midlands Forensic Pathology Unit, University of Leicester, Leicester, England (G.R.); University of Leicester Imaging Department, University Hospitals of Leicester, Leicester Royal Infirmary, Leicester, England (B.M.); Department of Forensic Medicine, Jagiellonian University Medical College, Krakow, Poland (K.W.); Departments of Legal Medicine and Radiology, Hôpital Rangueil, Toulouse, France (F.D.); Institute of Legal Medicine, Munich, Germany (F.F., S.L.); Institute of Legal Medicine, Basel, Switzerland (H.W.); University of Foggia, Foggia, Italy (G.G.); Institute of Forensic Medicine, University of Leipzig, Leipzig, Germany (F.E.); and Department of Medical Radiology, University Hospital Center and University of Lausanne, Lausanne, Switzerland (J.M.G.)
| | - Holger Wittig
- From the University Center of Legal Medicine Lausanne-Geneva, Chemin de la Vulliette 4, 1000 Lausanne 25, Switzerland (S.G., F.D., K.M., C.P., C.C., P.M., J.M.G.); Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (A.H., H.V.); East Midlands Forensic Pathology Unit, University of Leicester, Leicester, England (G.R.); University of Leicester Imaging Department, University Hospitals of Leicester, Leicester Royal Infirmary, Leicester, England (B.M.); Department of Forensic Medicine, Jagiellonian University Medical College, Krakow, Poland (K.W.); Departments of Legal Medicine and Radiology, Hôpital Rangueil, Toulouse, France (F.D.); Institute of Legal Medicine, Munich, Germany (F.F., S.L.); Institute of Legal Medicine, Basel, Switzerland (H.W.); University of Foggia, Foggia, Italy (G.G.); Institute of Forensic Medicine, University of Leipzig, Leipzig, Germany (F.E.); and Department of Medical Radiology, University Hospital Center and University of Lausanne, Lausanne, Switzerland (J.M.G.)
| | - Giuseppe Guglielmi
- From the University Center of Legal Medicine Lausanne-Geneva, Chemin de la Vulliette 4, 1000 Lausanne 25, Switzerland (S.G., F.D., K.M., C.P., C.C., P.M., J.M.G.); Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (A.H., H.V.); East Midlands Forensic Pathology Unit, University of Leicester, Leicester, England (G.R.); University of Leicester Imaging Department, University Hospitals of Leicester, Leicester Royal Infirmary, Leicester, England (B.M.); Department of Forensic Medicine, Jagiellonian University Medical College, Krakow, Poland (K.W.); Departments of Legal Medicine and Radiology, Hôpital Rangueil, Toulouse, France (F.D.); Institute of Legal Medicine, Munich, Germany (F.F., S.L.); Institute of Legal Medicine, Basel, Switzerland (H.W.); University of Foggia, Foggia, Italy (G.G.); Institute of Forensic Medicine, University of Leipzig, Leipzig, Germany (F.E.); and Department of Medical Radiology, University Hospital Center and University of Lausanne, Lausanne, Switzerland (J.M.G.)
| | - Franziska Eplinius
- From the University Center of Legal Medicine Lausanne-Geneva, Chemin de la Vulliette 4, 1000 Lausanne 25, Switzerland (S.G., F.D., K.M., C.P., C.C., P.M., J.M.G.); Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (A.H., H.V.); East Midlands Forensic Pathology Unit, University of Leicester, Leicester, England (G.R.); University of Leicester Imaging Department, University Hospitals of Leicester, Leicester Royal Infirmary, Leicester, England (B.M.); Department of Forensic Medicine, Jagiellonian University Medical College, Krakow, Poland (K.W.); Departments of Legal Medicine and Radiology, Hôpital Rangueil, Toulouse, France (F.D.); Institute of Legal Medicine, Munich, Germany (F.F., S.L.); Institute of Legal Medicine, Basel, Switzerland (H.W.); University of Foggia, Foggia, Italy (G.G.); Institute of Forensic Medicine, University of Leipzig, Leipzig, Germany (F.E.); and Department of Medical Radiology, University Hospital Center and University of Lausanne, Lausanne, Switzerland (J.M.G.)
| | - Katarzyna Michaud
- From the University Center of Legal Medicine Lausanne-Geneva, Chemin de la Vulliette 4, 1000 Lausanne 25, Switzerland (S.G., F.D., K.M., C.P., C.C., P.M., J.M.G.); Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (A.H., H.V.); East Midlands Forensic Pathology Unit, University of Leicester, Leicester, England (G.R.); University of Leicester Imaging Department, University Hospitals of Leicester, Leicester Royal Infirmary, Leicester, England (B.M.); Department of Forensic Medicine, Jagiellonian University Medical College, Krakow, Poland (K.W.); Departments of Legal Medicine and Radiology, Hôpital Rangueil, Toulouse, France (F.D.); Institute of Legal Medicine, Munich, Germany (F.F., S.L.); Institute of Legal Medicine, Basel, Switzerland (H.W.); University of Foggia, Foggia, Italy (G.G.); Institute of Forensic Medicine, University of Leipzig, Leipzig, Germany (F.E.); and Department of Medical Radiology, University Hospital Center and University of Lausanne, Lausanne, Switzerland (J.M.G.)
| | - Cristian Palmiere
- From the University Center of Legal Medicine Lausanne-Geneva, Chemin de la Vulliette 4, 1000 Lausanne 25, Switzerland (S.G., F.D., K.M., C.P., C.C., P.M., J.M.G.); Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (A.H., H.V.); East Midlands Forensic Pathology Unit, University of Leicester, Leicester, England (G.R.); University of Leicester Imaging Department, University Hospitals of Leicester, Leicester Royal Infirmary, Leicester, England (B.M.); Department of Forensic Medicine, Jagiellonian University Medical College, Krakow, Poland (K.W.); Departments of Legal Medicine and Radiology, Hôpital Rangueil, Toulouse, France (F.D.); Institute of Legal Medicine, Munich, Germany (F.F., S.L.); Institute of Legal Medicine, Basel, Switzerland (H.W.); University of Foggia, Foggia, Italy (G.G.); Institute of Forensic Medicine, University of Leipzig, Leipzig, Germany (F.E.); and Department of Medical Radiology, University Hospital Center and University of Lausanne, Lausanne, Switzerland (J.M.G.)
| | - Christine Chevallier
- From the University Center of Legal Medicine Lausanne-Geneva, Chemin de la Vulliette 4, 1000 Lausanne 25, Switzerland (S.G., F.D., K.M., C.P., C.C., P.M., J.M.G.); Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (A.H., H.V.); East Midlands Forensic Pathology Unit, University of Leicester, Leicester, England (G.R.); University of Leicester Imaging Department, University Hospitals of Leicester, Leicester Royal Infirmary, Leicester, England (B.M.); Department of Forensic Medicine, Jagiellonian University Medical College, Krakow, Poland (K.W.); Departments of Legal Medicine and Radiology, Hôpital Rangueil, Toulouse, France (F.D.); Institute of Legal Medicine, Munich, Germany (F.F., S.L.); Institute of Legal Medicine, Basel, Switzerland (H.W.); University of Foggia, Foggia, Italy (G.G.); Institute of Forensic Medicine, University of Leipzig, Leipzig, Germany (F.E.); and Department of Medical Radiology, University Hospital Center and University of Lausanne, Lausanne, Switzerland (J.M.G.)
| | - Patrice Mangin
- From the University Center of Legal Medicine Lausanne-Geneva, Chemin de la Vulliette 4, 1000 Lausanne 25, Switzerland (S.G., F.D., K.M., C.P., C.C., P.M., J.M.G.); Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (A.H., H.V.); East Midlands Forensic Pathology Unit, University of Leicester, Leicester, England (G.R.); University of Leicester Imaging Department, University Hospitals of Leicester, Leicester Royal Infirmary, Leicester, England (B.M.); Department of Forensic Medicine, Jagiellonian University Medical College, Krakow, Poland (K.W.); Departments of Legal Medicine and Radiology, Hôpital Rangueil, Toulouse, France (F.D.); Institute of Legal Medicine, Munich, Germany (F.F., S.L.); Institute of Legal Medicine, Basel, Switzerland (H.W.); University of Foggia, Foggia, Italy (G.G.); Institute of Forensic Medicine, University of Leipzig, Leipzig, Germany (F.E.); and Department of Medical Radiology, University Hospital Center and University of Lausanne, Lausanne, Switzerland (J.M.G.)
| | - Jochen M Grimm
- From the University Center of Legal Medicine Lausanne-Geneva, Chemin de la Vulliette 4, 1000 Lausanne 25, Switzerland (S.G., F.D., K.M., C.P., C.C., P.M., J.M.G.); Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (A.H., H.V.); East Midlands Forensic Pathology Unit, University of Leicester, Leicester, England (G.R.); University of Leicester Imaging Department, University Hospitals of Leicester, Leicester Royal Infirmary, Leicester, England (B.M.); Department of Forensic Medicine, Jagiellonian University Medical College, Krakow, Poland (K.W.); Departments of Legal Medicine and Radiology, Hôpital Rangueil, Toulouse, France (F.D.); Institute of Legal Medicine, Munich, Germany (F.F., S.L.); Institute of Legal Medicine, Basel, Switzerland (H.W.); University of Foggia, Foggia, Italy (G.G.); Institute of Forensic Medicine, University of Leipzig, Leipzig, Germany (F.E.); and Department of Medical Radiology, University Hospital Center and University of Lausanne, Lausanne, Switzerland (J.M.G.)
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