1
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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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2
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A practical guide to post-mortem selective cervical angiography in a regional institution. Forensic Sci Med Pathol 2023; 19:135-138. [PMID: 36308674 DOI: 10.1007/s12024-022-00550-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2022] [Indexed: 10/31/2022]
Abstract
When a cervicocerebral dissection syndrome (CDS) is amongst the potential causes of death, investigation of the arteries is required. Whilst the proximal common carotid arteries (CCA) are relatively easy to interrogate at post-mortem (PM), assessment of the vertebral arteries (VA) is more challenging. Post-mortem selective cervical angiography (PM-SCA) provides a method to visualise these arteries to replace or guide further dissection. Our institution does not have dedicated radiological facilities; we are reliant on availability in the general hospital of both equipment and staffing. In addition, there is an expectation of the release of the body within 24 h. Therefore, our methods have to be time-efficient, flexible and suitable for available staff. The current paper aims to describe the indications for the procedure, the method as completed in our institution, imaging findings and problem solving.
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3
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Porzionato A, Macchi V, Stecco C, Boscolo-Berto R, Loukas M, Tubbs RS, De Caro R. Clinical Anatomy and Medical Malpractice-A Narrative Review with Methodological Implications. Healthcare (Basel) 2022; 10:1915. [PMID: 36292362 PMCID: PMC9601975 DOI: 10.3390/healthcare10101915] [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: 08/28/2022] [Revised: 09/25/2022] [Accepted: 09/27/2022] [Indexed: 11/04/2022] Open
Abstract
Anatomical issues are intrinsically included in medico-legal methodology, however, higher awareness would be needed about the relevance of anatomy in addressing medico-legal questions in clinical/surgical contexts. Forensic Clinical Anatomy has been defined as "the practical application of Clinical Anatomy to the ascertainment and evaluation of medico-legal problems". The so-called individual anatomy (normal anatomy, anatomical variations, or anatomical modifications due to development, aging, para-physiological conditions, diseases, or surgery) may acquire specific relevance in medico-legal ascertainment and evaluation of cases of supposed medical malpractice. Here, we reviewed the literature on the relationships between anatomy, clinics/surgery, and legal medicine. Some methodological considerations were also proposed concerning the following issues: (1) relevant aspects of individual anatomy may arise from the application of methods of ascertainment, and they may be furtherly ascertained through specific anatomical methodology; (2) data about individual anatomy may help in the objective application of the criteria of evaluation (physio-pathological pathway, identification-evaluation of errors, causal value, damage estimation) and in final judgment about medical responsibility/liability. Awareness of the relevance of individual anatomy (risk of iatrogenic lesions, need for preoperative diagnostic procedures) should be one of the principles guiding the clinician; medico-legal analyses can also take advantage of its contribution in terms of ascertainment/evaluation.
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Affiliation(s)
- Andrea Porzionato
- Section of Anatomy, Department of Neuroscience, University of Padova, Via Gabelli, 65, 35127 Padova, Italy
| | - Veronica Macchi
- Section of Anatomy, Department of Neuroscience, University of Padova, Via Gabelli, 65, 35127 Padova, Italy
| | - Carla Stecco
- Section of Anatomy, Department of Neuroscience, University of Padova, Via Gabelli, 65, 35127 Padova, Italy
| | - Rafael Boscolo-Berto
- Section of Anatomy, Department of Neuroscience, University of Padova, Via Gabelli, 65, 35127 Padova, Italy
| | - Marios Loukas
- Department of Anatomical Sciences, True Blue Campus, St. George’s University, St. George 1473, Grenada
| | - Ronald Shane Tubbs
- Department of Anatomical Sciences, True Blue Campus, St. George’s University, St. George 1473, Grenada
- Department of Neurosurgery, Tulane University, New Orleans, LA 70112, USA
| | - Raffaele De Caro
- Section of Anatomy, Department of Neuroscience, University of Padova, Via Gabelli, 65, 35127 Padova, Italy
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Okumura S, Usui A, Kawasumi Y, Odagiri H, Funayama M, Kaneta T. Diagnostic Accuracy of Liver Damage Based on Postmortem Computed Tomography Findings in High-Energy Trauma. TOHOKU J EXP MED 2022; 257:327-332. [PMID: 35691914 DOI: 10.1620/tjem.2022.j046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Satsuki Okumura
- Department of Diagnostic Image Analysis, Tohoku University Graduate School of Medicine
| | - Akihito Usui
- Department of Diagnostic Image Analysis, Tohoku University Graduate School of Medicine
| | - Yusuke Kawasumi
- Department of Clinical Imaging, Tohoku University Graduate School of Medicine
| | - Hayato Odagiri
- Department of Diagnostic Image Analysis, Tohoku University Graduate School of Medicine
| | - Masato Funayama
- Department of Forensic Medicine, Tohoku University Graduate School of Medicine
| | - Tomohiro Kaneta
- Department of Diagnostic Image Analysis, Tohoku University Graduate School of Medicine
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5
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Blaettler C, Kaessmeyer S, Grabherr S, Koch C, Schweizer D, Van der Vekens E. Post-mortem Computed Tomographic Angiography in Equine Distal Forelimbs: A Feasibility Study. Front Vet Sci 2022; 9:868390. [PMID: 35647108 PMCID: PMC9132589 DOI: 10.3389/fvets.2022.868390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 03/24/2022] [Indexed: 01/11/2023] Open
Abstract
In-depth understanding of pathophysiological processes occurring in the vasculature of the equine distal limb is of great importance to improve both diagnostic and therapeutic approaches to diseases. To gain further insights, a model allowing high-resolution 3D-visualization of the vasculature is necessary. This pilot study evaluated the feasibility of restoring vascular perfusion in frozen-thawed distal equine cadaver limbs without prior preparation using computer tomographic imaging (CT). Five frozen-thawed, radiographically normal forelimbs were perfused with a lipophilic contrast agent through the median artery and radial vein in three phases (arterial, venous, and arterial-venous combined (AVC) dynamic). For comparison, one additional limb was perfused with a hydrosoluble contrast agent. The CT-studies (16-slice MDCT, 140 kV, 200 mA, 2 mm slice thickness, 1 mm increment, pitch 0.688) were evaluated at 11 specified regions for visualization of the vasculature and presence of artifacts or anatomic variations. The protocol used in this study proved to be feasible and provided good visualization (93.1%) of vasculature with low rates of artifacts. During the different phases, vascular visualization was similar, but while filling defects decreased in the later phases, extravasation worsened in the 2 limbs where it was observed. Subjectively, the best quality of angiographic images was achieved during the AVC dynamic phase. Perfusion with hydrosoluble contrast resulted in significantly lower vascular visualization (74.0%) and higher artifact rates. This study shows that reperfusion of frozen-thawed equine distal limbs with a lipophilic contrast agent allows for high-quality 3D-visualization of the vasculature and may serve as a model for in situ vascular evaluation in the future.
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Affiliation(s)
- Chantal Blaettler
- Division of Clinical Radiology, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Sabine Kaessmeyer
- Division of Veterinary Anatomy, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Silke Grabherr
- Centre Universitaire Roman (Lausanne-Geneva), University Centre of Legal Medicine (CURML), Lausanne, Switzerland
| | - Christoph Koch
- Swiss Institute of Equine Medicine, Department of Clinical Veterinary Sciences, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Daniela Schweizer
- Division of Clinical Radiology, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Elke Van der Vekens
- Division of Clinical Radiology, Vetsuisse Faculty, University of Bern, Bern, Switzerland
- *Correspondence: Elke Van der Vekens
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6
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MAHE K, GARETIER M, DUCLOYER M. Advances in Forensic Neuroimaging. J Neuroradiol 2022; 49:235-236. [DOI: 10.1016/j.neurad.2022.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 04/14/2022] [Accepted: 04/14/2022] [Indexed: 10/18/2022]
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7
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Bhurwani MMS, Sommer KN, Ionita CN. Recovery of complete time density curves from incomplete angiographic data using recurrent neural networks. PROCEEDINGS OF SPIE--THE INTERNATIONAL SOCIETY FOR OPTICAL ENGINEERING 2022; 12036:1203617. [PMID: 35983496 PMCID: PMC9385185 DOI: 10.1117/12.2611225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Quantitative angiography is a 2D/3D x-ray imaging modality that summarizes hemodynamic information using time density curve (TDC) based parameters. Estimation of the TDC parameters are susceptible to errors due to various factors including, patient motion, incomplete temporal data, imaging trigger errors etc. In this study, we tested the feasibility of using recurrent neural networks (RNN) to recover complete TDC temporal information from incomplete sequences and evaluate quantitative parameters generated from the corrected TDCs. Digital subtraction angiograms (DSAs) were collected from patients undergoing endovascular treatments and angiographic parametric imaging (API) parameters were calculated from each DSA. Each set of API parameters was used to simulate a TDC resulting in a dataset of 760 TDCs. One-third of each TDC was continuously masked from pseudo-random points past the peak height (PH) point to simulate missing/artifact information. An RNN was developed, trained and tested to generate completed/corrected TDCs. The RNN recovered complete TDC temporal information with an average mean squared error of 0.0086±0.002. Average mean absolute errors were calculated between each API parameter generated from the ground truth TDCs and RNN corrected TDCs, these were 11.02%±0.91 for time to peak, 10.97%±0.69 for mean transit time, 5.65%±0.76 for PH, and 15.08%±0.98 for area under the TDC. The change in API parameters was not clinically significant and the predictive power of the API parameters was retained. This study proved the feasibility of using RNNs to mitigate motion artifacts and incomplete angiographic acquisitions to extract accurate quantitative parameters.
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Affiliation(s)
- Mohammad Mahdi Shiraz Bhurwani
- Department of Biomedical Engineering, University at Buffalo, Buffalo NY 14228
- Canon Stroke and Vascular Research Center, Buffalo, NY 14203
| | - Kelsey N Sommer
- Department of Biomedical Engineering, University at Buffalo, Buffalo NY 14228
- Canon Stroke and Vascular Research Center, Buffalo, NY 14203
- QAS.AI Incorporated, Buffalo NY 14203
| | - Ciprian N Ionita
- Department of Biomedical Engineering, University at Buffalo, Buffalo NY 14228
- Canon Stroke and Vascular Research Center, Buffalo, NY 14203
- University at Buffalo Neurosurgery, University at Buffalo Jacobs School of Medicine, Buffalo NY 14228
- QAS.AI Incorporated, Buffalo NY 14203
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8
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Kader M, Weyer C, Avila A, Stealey S, Sell S, Zustiak SP, Buckner S, McBride-Gagyi S, Jelliss PA. Synthesis and Characterization of BaSO4-CaCO3-Alginate Nanocomposite Materials as Contrast Agents for Fine Vascular Imaging. ACS MATERIALS AU 2022; 2:260-268. [PMID: 36855388 PMCID: PMC9888639 DOI: 10.1021/acsmaterialsau.1c00070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Microcomputed tomography is an important technique for distinguishing the vascular network from tissues with similar X-ray attenuation. Here, we describe a composite of barium sulfate (BaSO4) nanoparticles, calcium carbonate (CaCO3) nanoparticles, and alginate that provides improved performance over microscale BaSO4 particles, which are currently used clinically as X-ray contrast agents. BaSO4 and CaCO3 nanoparticles were synthesized using a polyol method with tetraethylene glycol as solvent and capping agent. The nanoparticles show good colloidal stability in aqueous solutions. A deliverable nanocomposite gel contrast agent was produced by encapsulation of the BaSO4 and CaCO3 nanoparticles in an alginate gel matrix. The gelation time was controlled by addition of d-(+)-gluconic acid δ-lactone, which controls the rate of dissolution of the CaCO3 nanoparticles that produce Ca2+ which cross-links the gel. Rapid cross-linking of the gel by Ba2+ was minimized by producing BaSO4 nanoparticles with an excess of surface sulfate. The resulting BaSO4-CaCO3 nanoparticle alginate gel mechanical properties were characterized, including the gel storage modulus, peak stress and elastic modulus, and radiodensity. The resulting nanocomposite has good viscosity control and good final gel stiffness. The nanocomposite has gelation times between 30 and 35 min, adequate for full body perfusion. This is the first nanoscale composite of a radiopaque metal salt to be developed in combination with an alginate hydrogel and designed for medical perfusion and vascular imaging applications.
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Affiliation(s)
- Mohammad
S. Kader
- Department
of Chemistry, Saint Louis University, 3501 Laclede Avenue, St. Louis, Missouri 63103, United States
| | - Conner Weyer
- Department
of Chemistry, Saint Louis University, 3501 Laclede Avenue, St. Louis, Missouri 63103, United States
| | - Abigail Avila
- Department
of Biomedical Engineering, Parks College of Engineering, Aviation
and Technology, Saint Louis University, St. Louis, Missouri 63103, United States
| | - Samuel Stealey
- Department
of Biomedical Engineering, Parks College of Engineering, Aviation
and Technology, Saint Louis University, St. Louis, Missouri 63103, United States
| | - Scott Sell
- Department
of Biomedical Engineering, Parks College of Engineering, Aviation
and Technology, Saint Louis University, St. Louis, Missouri 63103, United States
| | - Silviya P. Zustiak
- Department
of Biomedical Engineering, Parks College of Engineering, Aviation
and Technology, Saint Louis University, St. Louis, Missouri 63103, United States
| | - Steven Buckner
- Department
of Chemistry, Saint Louis University, 3501 Laclede Avenue, St. Louis, Missouri 63103, United States,
| | - Sara McBride-Gagyi
- Department
of Orthopaedic Surgery, Saint Louis University
School of Medicine, 1402
South Grand, St. Louis, Missouri 63110, United States,
| | - Paul A. Jelliss
- Department
of Chemistry, Saint Louis University, 3501 Laclede Avenue, St. Louis, Missouri 63103, United States,
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9
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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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10
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11
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Okimoto N, Ishida M, Abe H, Ikemura M, Fujimoto K, Kanemaru N, Ushiku T, Abe O, Gonoi W. Delayed cerebral enhancement on post-mortem computed tomography due to residual contrast medium administered shortly before death. Radiol Case Rep 2021; 16:2056-2060. [PMID: 34158893 PMCID: PMC8203565 DOI: 10.1016/j.radcr.2021.04.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 04/20/2021] [Accepted: 04/21/2021] [Indexed: 12/05/2022] Open
Abstract
Postmortem computed tomography (CT) is currently a well-known procedure and helps in postmortem investigations. In this case report, we report a unique postmortem CT finding: delayed cerebral enhancement associated with the antemortem infusion of contrast medium. A 72-year-old female lost consciousness at a restaurant and was taken to a hospital in an ambulance. Despite resuscitation efforts, she died of hypoxic–ischemic encephalopathy caused by cardiac arrest. About 6 h before her death, she underwent enhanced antemortem CT of the head. No abnormal enhancement was observed in the cerebral parenchyma. Then, 11 h after her death, she underwent unenhanced postmortem CT, which showed bilateral hyperdense caudate nucleus and putamina, due to residual iodinated contrast medium, in addition to other characteristic findings of hypoxic–ischemic encephalopathy. The mechanism underlying this phenomenon could be the destruction of the blood–brain barrier, and/or selective vulnerability, due to hypoxic–ischemic changes in the gray matter. Enhancement of basal ganglia on postmortem CT due to antemortem infusion of iodinated contrast medium might suggest hypoxic–ischemic encephalopathy, which should be noted in postmortem CT interpretations.
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Affiliation(s)
- Naomasa Okimoto
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Masanori Ishida
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Hiroyuki Abe
- Department of Pathology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Masako Ikemura
- Department of Pathology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Kotaro Fujimoto
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Noriko Kanemaru
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Tetsuo Ushiku
- Department of Pathology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Osamu Abe
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Wataru Gonoi
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
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12
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Ferrante B, Baroni C, Muramoto C, Ribas L, Torres L, Catão-Dias J, Pinto A. Histological effect caused by contrast solution injection for post mortem computed tomography angiography in dogs. FORENSIC IMAGING 2021. [DOI: 10.1016/j.fri.2021.200435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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13
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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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14
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Peña-Solórzano CA, Albrecht DW, Bassed RB, Burke MD, Dimmock MR. Findings from machine learning in clinical medical imaging applications - Lessons for translation to the forensic setting. Forensic Sci Int 2020; 316:110538. [PMID: 33120319 PMCID: PMC7568766 DOI: 10.1016/j.forsciint.2020.110538] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 04/28/2020] [Accepted: 10/04/2020] [Indexed: 12/18/2022]
Abstract
Machine learning (ML) techniques are increasingly being used in clinical medical imaging to automate distinct processing tasks. In post-mortem forensic radiology, the use of these algorithms presents significant challenges due to variability in organ position, structural changes from decomposition, inconsistent body placement in the scanner, and the presence of foreign bodies. Existing ML approaches in clinical imaging can likely be transferred to the forensic setting with careful consideration to account for the increased variability and temporal factors that affect the data used to train these algorithms. Additional steps are required to deal with these issues, by incorporating the possible variability into the training data through data augmentation, or by using atlases as a pre-processing step to account for death-related factors. A key application of ML would be then to highlight anatomical and gross pathological features of interest, or present information to help optimally determine the cause of death. In this review, we highlight results and limitations of applications in clinical medical imaging that use ML to determine key implications for their application in the forensic setting.
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Affiliation(s)
- Carlos A Peña-Solórzano
- Department of Medical Imaging and Radiation Sciences, Monash University, Wellington Rd, Clayton, Melbourne, VIC 3800, Australia.
| | - David W Albrecht
- Clayton School of Information Technology, Monash University, Wellington Rd, Clayton, Melbourne, VIC 3800, Australia.
| | - Richard B Bassed
- Victorian Institute of Forensic Medicine, 57-83 Kavanagh St., Southbank, Melbourne, VIC 3006, Australia; Department of Forensic Medicine, Monash University, Wellington Rd, Clayton, Melbourne, VIC 3800, Australia.
| | - Michael D Burke
- Victorian Institute of Forensic Medicine, 57-83 Kavanagh St., Southbank, Melbourne, VIC 3006, Australia; Department of Forensic Medicine, Monash University, Wellington Rd, Clayton, Melbourne, VIC 3800, Australia.
| | - Matthew R Dimmock
- Department of Medical Imaging and Radiation Sciences, Monash University, Wellington Rd, Clayton, Melbourne, VIC 3800, Australia.
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15
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Uthandi D, Sabarudin A, Mohd Z, Rahman MAA, Karim MKA. Effectiveness of Post-Mortem Computed Tomography (PMCT) in Comparison with Conventional Autopsy: A Systematic Review. Curr Med Imaging 2020; 16:669-676. [PMID: 32723237 DOI: 10.2174/1573405615666190821115426] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 05/27/2019] [Accepted: 07/08/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND With the advancement of technology, Computed Tomography (CT) scan imaging can be used to gain deeper insight into the cause of death. AIMS The purpose of this study was to perform a systematic review of the efficacy of Post- Mortem Computed Tomography (PMCT) scan compared with the conventional autopsies gleaned from literature published in English between the year 2009 and 2016. METHODOLOGY A literature search was conducted on three databases, namely PubMed, MEDLINE, and Scopus. A total of 387 articles were retrieved, but only 21 studies were accepted after meeting the review criteria. Data, such as the number of victims, the number of radiologists and forensic pathologists involved, causes of death, and additional and missed diagnoses in PMCT scans were tabulated and analysed by two independent reviewers. RESULTS Compared with the conventional autopsy, the accuracy of PMCT scans in detecting injuries and causes of death was observed to range between 20% and 80%. The analysis also showed that PMCT had more advantages in detecting fractures, fluid in airways, gas in internal organs, major hemorrhages, fatty liver, stones, and bullet fragments. Despite its benefits, PMCT could also miss certain important lesions in a certain region such as cardiovascular injuries and minor vascular injuries. CONCLUSION This systematic review suggests that PMCT can replace most of the conventional autopsies in specific cases and is also a good complementary tool in most cases.
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Affiliation(s)
- Deveshini Uthandi
- Department of Diagnostic Imaging, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
| | - Akmal Sabarudin
- Department of Diagnostic Imaging, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
| | - Zanariah Mohd
- Department of Diagnostic Imaging, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
| | - Mohd Amiruddin Abd Rahman
- Department of Physics, Faculty of Science, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia
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Stumm CJP, Wittig H, Kalberer NM, Scheurer E. Histomorphological assessment of isolated abdominal organs after targeted perfusion with the contrast agent Angiofil® in postmortem computed tomography angiography. Forensic Sci Int 2020; 315:110427. [PMID: 32771885 DOI: 10.1016/j.forsciint.2020.110427] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 07/15/2020] [Accepted: 07/16/2020] [Indexed: 10/23/2022]
Abstract
The current literature about histological alterations and artefacts associated with postmortem computed tomography angiography (PMCTA) is scarce and limited to qualitative research. The aim of this study was to describe and quantify histological alterations and artefacts in histologic specimens of the inner organs. The spleen, the liver, the kidneys and the pancreas were eviscerated in the course of standard forensic autopsy, followed by manual arterial and venous perfusion of the organs with the lipophilic contrast agent Angiofil®. Computed tomography (CT) of the organ packages was executed to evaluate if the perfusion with Angiofil® was sufficient. The CT scans revealed a good delineation of the vessel trees up to the organ periphery, suggesting a sufficient perfusion. Tissue samples were taken before and after perfusion, stained with hematoxylin-eosin (H&E) and examined by using microscopy. Native and perfused specimens were assessed on the basis of a qualitative rating scale in regard to the integrity of the cells, the tissue architecture and induced alterations. Subsequently the observed differences before and after perfusion with Angiofil® were analyzed quantitatively. While the liver, spleen and kidneys could be evaluated, further microscopic examinations of the pancreatic tissue were not possible due to vast autolytic changes. On the cellular level no changes in the liver, spleen and kidneys were observed after administering Angiofil®. While the tissue architecture of these organs remained intact, a significant blood volume displacement occurred. As a consequence, tissue with hypoemic or normal blood state demonstrated congestion. Further, optically empty spaces emerged regularly in the vessels and the parenchyma of each organ as a surrogate for the lipophilic contrast agent. With a few exceptions an adequate perfusion up to the microscopic level was observed. Following the results of this investigation, CT-controlled manual injection of Angiofil® into isolated organs may be an alternative to the generalized in situ application of contrast agents in the course of PMCTA. It is of eminent importance to know the artefacts induced by an Angiofil® injection in order to avoid a misinterpretation or a masking of findings. Thus, a collection of native tissue specimens has to be done before contrast agent application.
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Affiliation(s)
- Christian Jean-Paul Stumm
- Institute of Forensic Medicine, University Basel, Health Department Basel-Stadt, Pestalozzistrasse 22, 4056 Basel, Switzerland.
| | - Holger Wittig
- Institute of Forensic Medicine, University Basel, Health Department Basel-Stadt, Pestalozzistrasse 22, 4056 Basel, Switzerland.
| | - Nicole M Kalberer
- Institute of Forensic Medicine, University Basel, Health Department Basel-Stadt, Pestalozzistrasse 22, 4056 Basel, Switzerland.
| | - Eva Scheurer
- Institute of Forensic Medicine, University Basel, Health Department Basel-Stadt, Pestalozzistrasse 22, 4056 Basel, Switzerland.
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Evaluation of an acetated Ringer-based contrast material mixture for postmortem computed tomography angiography. Diagn Interv Imaging 2020; 101:489-497. [DOI: 10.1016/j.diii.2020.01.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 01/15/2020] [Accepted: 01/15/2020] [Indexed: 11/19/2022]
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18
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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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Wittekind C, Gradistanac T. Post-Mortem Examination as a Quality Improvement Instrument. DEUTSCHES ARZTEBLATT INTERNATIONAL 2019; 115:653-658. [PMID: 30375329 DOI: 10.3238/arztebl.2018.0653] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 11/06/2017] [Accepted: 06/18/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Autopsies are considered an important quality assurance instrument in medicine, yet autopsy rates in many countries have been declining for many years. The proper role of the post-mortem examination in modern medicine is a matter deserving of study. METHODS This review is based on a selective search of the literature for publications on the role of autopsies as a quality assurance instrument. RESULTS Multiple studies have revealed substantial rates of discrepancy between pre- and post-mortem diagnoses, with reported rates lying in the range of 10% to 40%. The frequen- cy of so-called Goldman I erroneous diagnoses, i.e., those that are determined at autopsy and might have influenced the patient's survival, ranges from 2.4% to 10.7%. It can be as- sumed that the rate of serious diagnostic errors revealed by autopsy would fall if autopsy rates were to rise. Independently of the above-mentioned studies, a large-scale study of data from the period 1988-2008 revealed a decline in the rate of Goldman I erroneous diagnoses by more than half. The qualitative effects of autopsies, however, are difficult to measure. At present, imaging studies and minimally invasive or endoscopic diagnostic procedures can be performed post mortem as well, but the available studies show that these methods do not yet suffice to enable a coherent pathogenetic classification of disease processes. CONCLUSION Autopsies should still be performed in the interest of quality assurance in medicine. Uniform standards in the performance and reporting of autopsies could lead to im- provement in the use of the data acquired through them.
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Michaud K, Genet P, Sabatasso S, Grabherr S. Postmortem imaging as a complementary tool for the investigation of cardiac death. Forensic Sci Res 2019; 4:211-222. [PMID: 31489387 PMCID: PMC6713140 DOI: 10.1080/20961790.2019.1630944] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 06/06/2019] [Accepted: 06/10/2019] [Indexed: 12/26/2022] Open
Abstract
In the past 2 decades, modern radiological methods, such as multiple detector computed tomography (MDCT), MDCT-angiography, and cardiac magnetic resonance imaging (MRI) were introduced into postmortem practice for investigation of sudden death (SD), including cases of sudden cardiac death (SCD). In forensic cases, the underlying cause of SD is most frequently cardiovascular with coronary atherosclerotic disease as the leading cause. There are many controversies about the role of postmortem imaging in establishing the cause of death and especially the value of minimally invasive autopsy techniques. This paper discusses the state of the art for postmortem radiological evaluation of the heart compared to classical postmortem examination, especially in cases of SCD. In SCD cases, postmortem CT is helpful to estimate the heart size and to visualize haemopericardium and calcified plaques and valves, as well as to identify and locate cardiovascular devices. Angiographic methods are useful to provide a detailed view of the coronary arteries and to analyse them, especially regarding the extent and location of stenosis and obstruction. In postsurgical cases, it allows verification and documentation of the patency of stents and bypass grafts before opening the body. Postmortem MRI is used to investigate soft tissues such as the myocardium, but images are susceptible to postmortem changes and further work is necessary to increase the understanding of these radiological aspects, especially of the ischemic myocardium. In postsurgery cases, the value of postmortem imaging of the heart is reportedly for the diagnostic and documentation purposes. The implementation of new imaging methods into routine postmortem practice is challenging, as it requires not only an investment in equipment but, more importantly, investment in the expertise of interpreting the images. Once those requirements are implemented, however, they bring great advantages in investigating cases of SCD, as they allow documentation of the body, orientation of sampling for further analyses and gathering of other information that cannot be obtained by conventional autopsy such as a complete visualization of the vascular system using postmortem angiography.Key pointsThere are no established guidelines for the interpretation of postmortem imaging examination of the heartAt present, postmortem imaging methods are considered as less accurate than the autopsy for cardiac deathsPostmortem imaging is useful as a complementary tool for cardiac deathsThere is still a need to validate postmortem imaging in cardiac deaths by comparing with autopsy findings.
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Affiliation(s)
- Katarzyna Michaud
- Lausanne University Hospital and University of Lausanne, University Center of Legal Medicine Lausanne-Geneva, Lausanne, Switzerland
| | - Pia Genet
- Lausanne University Hospital and University of Lausanne, University Center of Legal Medicine Lausanne-Geneva, Lausanne, Switzerland.,Geneva University Hospital, University Center of Legal Medicine Lausanne-Geneva, Geneva, Switzerland
| | - Sara Sabatasso
- Geneva University Hospital, University Center of Legal Medicine Lausanne-Geneva, Geneva, Switzerland
| | - Silke Grabherr
- Lausanne University Hospital and University of Lausanne, University Center of Legal Medicine Lausanne-Geneva, Lausanne, Switzerland.,Geneva University Hospital, University Center of Legal Medicine Lausanne-Geneva, Geneva, Switzerland
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Gould SW, Harty MP, Givler NE, Christensen TE, Curtin RN, Harcke HT. Pediatric postmortem computed tomography: initial experience at a children's hospital in the United States. Pediatr Radiol 2019; 49:1113-1129. [PMID: 31201439 DOI: 10.1007/s00247-019-04433-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 04/17/2019] [Accepted: 05/16/2019] [Indexed: 12/18/2022]
Abstract
Postmortem CT might provide valuable information in determining the cause of death and understanding disease processes, particularly when combined with traditional autopsy. Pediatric applications of postmortem imaging represent a new and rapidly growing field. We describe our experience in establishing a pediatric postmortem CT program and present a discussion of the distinct challenges in developing this type of program in the United States of America, where forensic practice varies from other countries. We give a brief overview of recent literature along with the common imaging findings on postmortem CT that can simulate antemortem pathology.
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Affiliation(s)
- Sharon W Gould
- Department of Medical Imaging, Nemours/Alfred I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE, 19803, USA.
| | - M Patricia Harty
- Department of Medical Imaging, Nemours/Alfred I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE, 19803, USA
| | - Nicole E Givler
- Department of Medical Imaging, Nemours/Alfred I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE, 19803, USA
| | - Theresa E Christensen
- Department of Biomedical Research, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA
| | - Riley N Curtin
- Department of Biomedical Research, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA
| | - Howard T Harcke
- Department of Medical Imaging, Nemours/Alfred I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE, 19803, USA
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State of the art in post-mortem computed tomography: a review of current literature. Virchows Arch 2019; 475:139-150. [PMID: 30937612 DOI: 10.1007/s00428-019-02562-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 02/06/2019] [Accepted: 03/12/2019] [Indexed: 12/14/2022]
Abstract
Computed tomography (CT) and other advanced diagnostic imaging techniques are gaining popularity in forensic pathology. This paper aims to define and offer complete and easily accessible "state of the art" for post-mortem computed tomography (PMCT), by reviewing the latest international literature. The proposed format answers the "five Ws" that follows: (1) What: We report the different kinds of CT scan and settings generally used in post-mortem imaging. The machine most employed is a 8/16-slice spiral CT, usually without contrast enhancement. The introduction of some variables, such as CT-guided biopsies, post-mortem ventilation, and PMCT angiography is becoming increasingly useful. (2) Why: Literature highlights the many advantages of PMCT. Limitations can be partly overcome by modern imaging techniques and combined evaluation with traditional autopsy. (3) Who: Most authors agree that collaboration between different specialists, i.e., radiologists and pathologists, is the best scenario, since radiologic, anatomic, and forensic skills are needed simultaneously. The most important human factor is "teamwork". (4) When: Literature provides no absolute limits for performing PMCT. Some authors have tested PMCT as a replacement for conventional autopsy but found some limitations. Others evaluated PMCT as a guide or screening tool for traditional autopsy. (5) Where: Many research groups around the world have performed studies on the use of PMCT. Although few countries adopt PMCT in routine practice, its use is rapidly spreading.
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Palmiere C, Tettamanti C, Scarpelli MP, Tse R. The forensic spleen: Morphological, radiological, and toxicological investigations. Forensic Sci Int 2019; 297:384-387. [PMID: 30803735 DOI: 10.1016/j.forsciint.2019.01.042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The spleen is only uncommonly investigated in the forensic setting. Thorough examinations are performed in some specific situations such as splenic trauma (including iatrogenic trauma from cardiopulmonary resuscitation attempts), anaphylaxis, drowning, and sepsis-related deaths. The aim of this review is to present the available literature focusing on a few selected splenic diseases as well as forensic investigations performed on the spleen in order to summarize the most frequent situations in which this routinely unexplored organ may merit more extensive examination.
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Affiliation(s)
- Cristian Palmiere
- CURML, University Center of Legal Medicine, Chemin de la Vulliette 4, 1000 Lausanne 25, Switzerland.
| | | | - Maria Pia Scarpelli
- CURML, University Center of Legal Medicine, Chemin de la Vulliette 4, 1000 Lausanne 25, Switzerland
| | - Rexson Tse
- Department of Forensic Pathology, LabPLUS, Auckland City Hospital, Auckland 1148, New Zealand
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25
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Filograna L, Pugliese L, Muto M, Tatulli D, Guglielmi G, Thali MJ, Floris R. A Practical Guide to Virtual Autopsy: Why, When and How. Semin Ultrasound CT MR 2018; 40:56-66. [PMID: 30686369 DOI: 10.1053/j.sult.2018.10.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Postmortem imaging is considered a routine investigative modality in many forensic institutions worldwide. Because of its ability to provide a quick and complete documentation of skeletal system and major parenchymal alterations, postmortem computed tomography (PMCT) is the imaging technique most frequently applied in postmortem forensic investigations. Also postmortem magnetic resonance has been implemented in postmortem setting, but its use is mostly limited to focused analysis (eg, study of the heart and brain). PMCT presents some limits in investigating "natural" deaths, particularly related to its poor ability in differentiating soft tissue interfaces and in depicting vascular lesions. For this reason, PMCT angiography has been introduced. A major limitation of these postmortem imaging techniques is the absence of body samples for histopathologic, toxicologic, or microbiological analysis. This limit has been overcome by the introduction of postmortem percutaneous biopsies. The aim of this review is to provide a practical guide for virtual autopsy, with the intent of facilitating standardization and augmenting its quality. In particular, the indications of virtual autopsy as well protocols in PMCT examinations and its ancillary techniques will be discussed. Finally, the workflow of a typical virtual autopsy and its main steps will be described.
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Affiliation(s)
- Laura Filograna
- Department of Diagnostic and Interventional Radiology, Molecular Imaging and Radiotherapy, PTV Foundation, "Tor Vergata" University of Rome, Rome, Italy.
| | - Luca Pugliese
- Department of Diagnostic and Interventional Radiology, Molecular Imaging and Radiotherapy, PTV Foundation, "Tor Vergata" University of Rome, Rome, Italy
| | - Massimo Muto
- Department of Diagnostic and Interventional Radiology, Molecular Imaging and Radiotherapy, PTV Foundation, "Tor Vergata" University of Rome, Rome, Italy
| | - Doriana Tatulli
- Department of Diagnostic and Interventional Radiology, Molecular Imaging and Radiotherapy, PTV Foundation, "Tor Vergata" University of Rome, Rome, Italy
| | | | - Michael John Thali
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Zurich, Switzerland
| | - Roberto Floris
- Department of Diagnostic and Interventional Radiology, Molecular Imaging and Radiotherapy, PTV Foundation, "Tor Vergata" University of Rome, Rome, Italy
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Krombach GA. Can Postmortem Imaging Replace Autopsy and Reverse the Trend of Dwindling Postmortem Examinations? Radiology 2018; 289:668-669. [PMID: 30251927 DOI: 10.1148/radiol.2018181982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Gabriele A Krombach
- From the Department of Radiology, University Hospital Giessen, Justus Liebig University, Klinikstrasse 33, 35385 Giessen, Germany
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27
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Steenburg SD, Spitzer T, Rhodes A. Post-mortem computed tomography improves completeness of the trauma registry: a single institution experience. Emerg Radiol 2018; 26:5-13. [PMID: 30159814 DOI: 10.1007/s10140-018-1637-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 08/20/2018] [Indexed: 12/13/2022]
Abstract
PURPOSE To describe our institutional experience with post-mortem computed tomography (PMCT) and its impact on decedent injury severity score (ISS) and to assess the adequacy of emergently placed support medical devices. METHODS Over a 5-year period, patients who died at or soon after arrival and have physical exam findings inconsistent with death were candidates for inclusion. Whole body CT was performed without contrast with support medical devices left in place. ISS was calculated with and without the PMCT findings. PMCT results were compared to autopsy findings, if performed. The location of support medical devices was documented. RESULTS A total of 38 decedents underwent PMCT, including 53.1% males and a mean age of 42.0 years. Pre-PMCT ISS based on physical exam findings alone was 5.2 (range 0-25), including 16 with ISS = 0. Post-PMCT ISS using the additional imaging data was 50.3 (range 21-75), including 15 with ISS = 50 or greater. Nearly half (47.4%) had at least one support medical device that was either malpositioned or suboptimally positioned, including 26.3% with malpositioned airway devices, 10.3% with malpositioned intra-osseous catheters, and 100% with malpositioned decompressive needle thoracotomies. CONCLUSIONS PMCT adds value in identifying injuries that otherwise may have gone undetected in lieu of a formal autopsy, thus creating a more complete trauma registry. The identification of malpositioned support lines and tubes allows for educational feedback to the first responders and trainees. Institutions with a low formal autopsy rate for trauma victims may benefit from developing a PMCT program.
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Affiliation(s)
- Scott D Steenburg
- Department of Radiology and Imaging Sciences, Division of Emergency Radiology, Indiana University School of Medicine and Indiana University Health Methodist Hospital, 1701 N. Senate Blvd, Room AG-176, Indianapolis, IN, 46202, USA.
| | - Tracy Spitzer
- Department of Trauma and Critical Care Surgery, Indiana University School of Medicine and Indiana University Health Methodist Hospital, Indianapolis, IN, USA
| | - Amy Rhodes
- Department of Radiology and Imaging Sciences, Division of Emergency Radiology, Indiana University School of Medicine and Indiana University Health Methodist Hospital, 1701 N. Senate Blvd, Room AG-176, Indianapolis, IN, 46202, USA
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Palmiere C, Tettamanti C, Scarpelli MP, Tse R. The forensic spleen: Morphological, radiological, and toxicological investigations. Forensic Sci Int 2018; 291:94-99. [PMID: 30173072 DOI: 10.1016/j.forsciint.2018.08.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 08/07/2018] [Accepted: 08/09/2018] [Indexed: 01/01/2023]
Abstract
The spleen is infrequently investigated in forensic pathology routine. Thorough examinations are performed in very specific situations such as splenic trauma (including iatrogenic trauma from cardiopulmonary resuscitation attempts), anaphylaxis-related deaths, drowning and sepsis. The purpose of this review article is to provide a general overview of available literature focusing on a few selected splenic diseases as well as available forensic investigation techniques performed on the spleen in order to summarize the most frequent situations of forensic interest in which this routinely unexplored organ may merit more extensive examination.
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Affiliation(s)
- Cristian Palmiere
- CURML, University Center of Legal Medicine, Chemin de la Vulliette 4, 1000 Lausanne 25, Switzerland.
| | | | - Maria Pia Scarpelli
- CURML, University Center of Legal Medicine, Chemin de la Vulliette 4, 1000 Lausanne 25, Switzerland
| | - Rexson Tse
- Department of Forensic Pathology, LabPLUS, Auckland City Hospital, Auckland 1148, New Zealand
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Willaert W, Tozzi F, Van Herzeele I, D’Herde K, Pattyn P. Systematic review of surgical training on reperfused human cadavers. Acta Chir Belg 2018; 118:141-151. [PMID: 29653497 DOI: 10.1080/00015458.2017.1407099] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND The role of reperfused human cadavers in surgical training has not been established. METHODS Reports describing reperfused human cadaver models in terms of simulated surgeries, the use of tools to assess technical competency and skills transfer to patients, cadaver status and reperfusion techniques were included. RESULTS Thirty-five reports were included. Most participants practised vascular (n = 27), flap (n = 6) and trauma (n = 4) procedures. Training progression was evaluated objectively in only two studies. In two publications, flap techniques were practised on cadavers and repeated successfully in patients. Eighteen studies employed whole bodies. Fresh and embalmed cadavers were both used in 17 publications. Most embalmed cadavers were formalin-fixed (n = 10), resulting in stiffness. Few trainings were offered on soft Thiel-embalmed cadavers (n = 5). Only arteries were reperfused in 20 studies, while in 13 publications, the arteries and veins were filled. Arteries and/or veins were mostly pressurized (n = 21) and arterial flow was generated in 14 studies. CONCLUSIONS Various reperfused human cadaver models exist, enabling practise of mainly vascular procedures. Preservation method determines the level of simulation fidelity. Thorough evaluation of these models as surgical training tools and transfer effectiveness is still lacking.
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Affiliation(s)
- Wouter Willaert
- Department of Gastrointestinal Surgery, Ghent University Hospital, Ghent, Belgium
| | - Francesca Tozzi
- Department of Gastrointestinal Surgery, Ghent University Hospital, Ghent, Belgium
| | - Isabelle Van Herzeele
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium
| | - Katharina D’Herde
- Department of Basic Medical Sciences, Ghent University Hospital, Ghent, Belgium
| | - Piet Pattyn
- Department of Gastrointestinal Surgery, Ghent University Hospital, Ghent, Belgium
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Willaume T, Farrugia A, Kieffer EM, Charton J, Geraut A, Berthelon L, Bierry G, Raul JS. The benefits and pitfalls of post-mortem computed tomography in forensic external examination: A retrospective study of 145 cases. Forensic Sci Int 2018; 286:70-80. [DOI: 10.1016/j.forsciint.2018.02.030] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 02/26/2018] [Accepted: 02/28/2018] [Indexed: 01/11/2023]
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Sonnemans LJP, Kubat B, Prokop M, Klein WM. Can virtual autopsy with postmortem CT improve clinical diagnosis of cause of death? A retrospective observational cohort study in a Dutch tertiary referral centre. BMJ Open 2018; 8:e018834. [PMID: 29549202 PMCID: PMC5857682 DOI: 10.1136/bmjopen-2017-018834] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE To investigate whether virtual autopsy with postmortem CT (PMCT) improves clinical diagnosis of the immediate cause of death. DESIGN Retrospective observational cohort study. INCLUSION CRITERIA inhospital and out-of-hospital deaths over the age of 1 year in whom virtual autopsy with PMCT and conventional autopsy were performed. EXCLUSION CRITERIA forensic cases, postmortal organ donors and cases with incomplete scanning procedures. Cadavers were examined by virtual autopsy with PMCT prior to conventional autopsy. The clinically determined cause of death was recorded before virtual autopsy and was then adjusted with the findings of virtual autopsy. Using conventional autopsy as reference standard, we investigated the increase in sensitivity for immediate cause of death, type of pathology and anatomical system involved before and after virtual autopsy. SETTING Tertiary referral centre. PARTICIPANTS 86 cadavers that underwent conventional and virtual autopsy between July 2012 and June 2016. INTERVENTION PMCT consisted of brain, cervical spine and chest-abdomen-pelvis imaging. Conventional autopsy consisted of thoracoabdominal examination with/without brain autopsy. PRIMARY AND SECONDARY OUTCOME MEASURES Increase in sensitivity for the immediate cause of death, type of pathology (infection, haemorrhage, perfusion disorder, other or not assigned) and anatomical system (pulmonary, cardiovascular, gastrointestinal, other or not assigned) involved, before and after virtual autopsy. RESULTS Using PMCT, the sensitivity for immediate cause of death increased with 12% (95% CI 2% to 22%) from 53% (41% to 64%) to 64% (53% to 75%), with 18% (9% to 27%) from 65% (54% to 76%) to 83% (73% to 91%) for type of pathology and with 19% (9% to 30%) from 65% (54% to 76%) to 85% (75% to 92%) for anatomical system. CONCLUSION While unenhanced PMCT is an insufficient substitute for conventional autopsy, it can improve diagnosis of cause of death over clinical diagnosis alone and should therefore be considered whenever autopsy is not performed.
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Affiliation(s)
- Lianne J P Sonnemans
- Department of Radiology and Nuclear Medicine, Radboudumc, Nijmegen, The Netherlands
| | - Bela Kubat
- Department of Pathology, Netherlands Forensic Institute, Hague, The Netherlands
- Department of Pathology, Maastricht UMC+, Maastricht, The Netherlands
| | - Mathias Prokop
- Department of Radiology and Nuclear Medicine, Radboudumc, Nijmegen, The Netherlands
| | - Willemijn M Klein
- Department of Radiology and Nuclear Medicine, Radboudumc, Nijmegen, The Netherlands
- Department of Radiology and Nuclear Medicine, Maastricht UMC+, Maastricht, The Netherlands
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Carballeira Álvarez A, Mancini J, Tuchtan-Torrents L, Gach P, Bartoli C, Desfeux J, Piercecchi MD, Gorincour G. Diagnostic value of unenhanced postmortem computed tomography in the detection of traumatic abdominal injuries. Diagn Interv Imaging 2018; 99:397-402. [PMID: 29475777 DOI: 10.1016/j.diii.2017.12.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 12/26/2017] [Accepted: 12/30/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To determine the diagnostic capabilities of unenhanced postmortem computed tomography (UPMCT) in detecting traumatic abdominal injuries. MATERIAL AND METHODS Cases of traumatic death with both UPMCT and classical autopsy were collected retrospectively from our institution "virtopsy" database in a period of 5 years. Cadavers with gunshot injuries were excluded. Sensitivity, specificity, accuracy, negative (NPV) and positive (PPV) predictive values of PMCT globally and for hemoperitoneum, liver, spleen, pancreas and kidney injuries individually were estimated using the autopsy report as gold standard. RESULTS Seventy-one cadavers were included. UPMCT had a sensitivity of 80% and a specificity 94%, with an accuracy of 83%, a PPV of 98% and a NPV of 59% for the diagnosis of traumatic abdominal injuries. The highest sensitivity was obtained for the detection of hepatic injuries (71%) and the lowest for pancreatic injuries (12%). UPMCT had a specificity of 100% for the detection of hemoperitoneum. A NPV of 98% was found for the detection of perihepatic hematomas. CONCLUSION The low sensitivity and low NPV do not support the use of UPMCT as an alternative to conventional autopsy to diagnose and/or rule out traumatic abdominal injuries. Nevertheless, UPMCT remains a helpful tool as it helps detect hemoperitoneum and virtually exclude presence of perihepatic hematomas.
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Affiliation(s)
- A Carballeira Álvarez
- Department of Radiology, Donostia Hospital (Osakidetza), P° Doctor Beguiristain, s/n, 20014 San Sebastián, Spain.
| | - J Mancini
- Inserm, IRD, UMR912 SESSTIM, Aix-Marseille université, 105, 27, boulevard Leï Roure, CS 30059, 13273 Marseille cedex 09, France; Public Health Department (BIOSTIC), Timone hospital (APHM), 264, rue Saint-Pierre, 13385 Marseille cedex 05, France
| | - L Tuchtan-Torrents
- Department of Forensic Medicine, Timone hospital (APHM), 264, rue Saint-Pierre, 13385 Marseille cedex 05, France
| | - P Gach
- Department of Medical Imaging, Timone hospital (APHM), 264, rue Saint-Pierre, 13385 Marseille cedex 05, France
| | - C Bartoli
- Department of Forensic Medicine, Timone hospital (APHM), 264, rue Saint-Pierre, 13385 Marseille cedex 05, France
| | - J Desfeux
- Department of Forensic Medicine, Timone hospital (APHM), 264, rue Saint-Pierre, 13385 Marseille cedex 05, France
| | - M D Piercecchi
- Department of Forensic Medicine, Timone hospital (APHM), 264, rue Saint-Pierre, 13385 Marseille cedex 05, France
| | - G Gorincour
- Department of Medical Imaging, Timone hospital (APHM), 264, rue Saint-Pierre, 13385 Marseille cedex 05, France
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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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Simonds E, Wilson C, Iwanaga J, Laws T, Holley G, Oskouian RJ, Tubbs RS. A Comprehensive Review of Medical Imaging Equipment Used in Cadaveric Studies. Cureus 2018. [PMID: 29535907 PMCID: PMC5841925 DOI: 10.7759/cureus.2035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Medical imaging techniques have led to great advances in clinical anatomy and forensic pathology. New and emerging technologies allow healthcare professionals to view and understand the human body from different perspectives. This gives way to new and improved interventions, treatment plans, and an overall understanding of the human body. Herein, we present a comprehensive review of the various medical imaging equipment used in cadaveric studies along with their individual strengths and limitations.
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Abstract
Forensic radiology is a specialized area of medical imaging using radiological techniques to assist physicians and pathologists in matters related to the law. The forensic application of diagnostic medical radiology can be applied in many fields; the prime target of evaluation is the osseous skeleton, but soft tissues and abdominal and thoracic viscera may offer key findings. The technological progress in clinical radiology provides a lot of potential tools to forensic radiology, allowing wider fields of applications in this matter.
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Ranson DL, Bugeja L. Medicolegal Death Investigation: Coroner and Forensic Pathology Functions and Processes in Victoria, Australia. Acad Forensic Pathol 2017; 7:567-581. [PMID: 31240007 DOI: 10.23907/2017.048] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 11/03/2017] [Indexed: 11/12/2022]
Abstract
The medicolegal death investigation in Victoria, Australia is a traditional coroner system based on the model in England and Wales in the early 20th Century. In 1985, the first of a series of legislative amendments were made that proved the vanguard of reform of the coroners' jurisdictions in Australia. The Victorian Institute of Forensic Medicine (the Institute) was established by the Coroners Act 1985 (Vic.), now the Victorian Institute of Forensic Medicine Act 1985 (Vic.), to provide forensic pathology, medical, and related scientific services needed by the justice system. In addition to death investigation, other forensic and scientific services are performed by the Institute including: clinical medical examinations and support services for assault victims and perpetrators, forensic toxicology services and molecular biology, and anthropology and odontology services in relation to human identification. Medical and nursing staff provide medical information and support to families in a therapeutic setting, as well as direct referral to clinical medical specialists. This takes place where a medical death investigation procedure uncovers genetic or familial disease that may place other family members at risk of future illness. A donor tissue bank ensures that a death also provides the opportunity for families to donate organs and tissues from the deceased for transplantation. Today, the traditional autopsy is one of several modalities of death investigation with postmortem radiology and imaging playing a significant role. This paper describes the principles and new processes at the Institute that support the coroner in death investigation and prevention as well as the therapeutic services designed to relieve the burden of disease on the community.
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Affiliation(s)
| | - Lyndal Bugeja
- Department of Forensic Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University
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Gould SW, Harty MP, Givler N, Christensen T, Harcke HT. Pediatric Postmortem CT: Initial Experience at a Tertiary Care Children’s Hospital. CURRENT RADIOLOGY REPORTS 2017. [DOI: 10.1007/s40134-017-0250-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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The effect of post-mortem computed tomography angiography (PMCTA) using water-soluble, iodine-based radiographic contrast on histological analysis of the liver, kidneys and left ventricle of the heart. Forensic Sci Med Pathol 2017; 13:317-327. [PMID: 28526950 DOI: 10.1007/s12024-017-9871-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2017] [Indexed: 10/19/2022]
Abstract
The purpose of this study was to investigate the impact of post-mortem computed-tomography angiography (PMCTA) on the histology of the liver, kidneys and heart. Multiple tissue cores were collected from the liver, left and right kidneys and left ventricle utilizing CT-guided biopsy. Subsequent whole body PMCTA was performed using a solution of polyethylene glycol and iodinated radiographic contrast, and an embalming pump. Corresponding biopsy cores were collected at autopsy, and blinded histology analysis assessing for PMCTA-induced histology artefact was performed. The blinded analysis of pre-PMCTA and post-PMCTA biopsy samples demonstrated that whole body PMCTA had no effect on the histological analyses of the liver (0%, CI = 0-13.7%), left ventricle of the heart (0%, CI = 0-36.9%) and right kidney (0%, CI = 13.2%), however likely caused increased Bowman's capsule spaces in the left kidney of one case (4%, CI = 0.01-20.4%). Other artefactual histological changes identified included eosinophilic material in the liver, whiter interstitium and dilated tubules in kidney samples, and autolysis-related changes, however these could not be categorically attributed to the PMCTA procedure. PMCTA causes zero or minimal effect to the histological examination of the liver, left kidney, right kidney and left ventricle, and as such performing PMCTA prior to autopsy is unlikely to impact autopsy histological results in these organs.
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Fonseca Pinto ACBDC, Massad MRR, Ribas LM, Baroni CO, Tremori TM, Reis STJ, Rocha NS. Complete cardiac and bronchial avulsion in a dog: Post-mortem computed tomography and forensic necropsy analysis. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.jofri.2016.11.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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41
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Post-mortem computed tomography angiography and forensic necropsy of a brown howler monkey: A case report. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.jofri.2017.03.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Garetier M, Deloire L, Dédouit F, Dumousset E, Saccardy C, Ben Salem D. Postmortem computed tomography findings in suicide victims. Diagn Interv Imaging 2017; 98:101-112. [DOI: 10.1016/j.diii.2016.06.023] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 06/15/2016] [Accepted: 06/18/2016] [Indexed: 01/05/2023]
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Harcke HT, Warren WS, Gordon CJ, Mazuchowski EL. Computed Tomographic Findings in Unsuspected Aortic Dissection and Adult Polycystic Kidney Disease. Acad Forensic Pathol 2016; 6:673-678. [PMID: 31239939 DOI: 10.23907/2016.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 08/02/2016] [Accepted: 08/23/2016] [Indexed: 11/12/2022]
Abstract
The coexistence of adult polycystic kidney disease and aortic dissection should be recognized by forensic pathologists and radiologists. Two cases with postmortem computed tomography prior to autopsy illustrate the appearance of polycystic kidneys and the hemorrhage patterns that provide clues to the presence and approximate location of the aortic dissections. Optimal imaging technique is discussed.
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Forensic 3D Visualization of CT Data Using Cinematic Volume Rendering: A Preliminary Study. AJR Am J Roentgenol 2016; 208:233-240. [PMID: 27824494 DOI: 10.2214/ajr.16.16499] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The 3D volume-rendering technique (VRT) is commonly used in forensic radiology. Its main function is to explain medical findings to state attorneys, judges, or police representatives. New visualization algorithms permit the generation of almost photorealistic volume renderings of CT datasets. The objective of this study is to present and compare a variety of radiologic findings to illustrate the differences between and the advantages and limitations of the current VRT and the physically based cinematic rendering technique (CRT). MATERIALS AND METHODS Seventy volunteers were shown VRT and CRT reconstructions of 10 different cases. They were asked to mark the findings on the images and rate them in terms of realism and understandability. RESULTS A total of 48 of the 70 questionnaires were returned and included in the analysis. On the basis of most of the findings presented, CRT appears to be equal or superior to VRT with respect to the realism and understandability of the visualized findings. Overall, in terms of realism, the difference between the techniques was statistically significant (p < 0.05). Most participants perceived the CRT findings to be more understandable than the VRT findings, but that difference was not statistically significant (p > 0.05). CONCLUSION CRT, which is similar to conventional VRT, is not primarily intended for diagnostic radiologic image analysis, and therefore it should be used primarily as a tool to deliver visual information in the form of radiologic image reports. Using CRT for forensic visualization might have advantages over using VRT if conveying a high degree of visual realism is of importance. Most of the shortcomings of CRT have to do with the software being an early prototype.
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Schweitzer W, Flach PM, Thali M, Laberke P, Gascho D. Very economical immersion pump feasibility for postmortem CT angiography. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.jofri.2015.11.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Hyperdensity of the Basilar Artery on Postmortem CT: A Potential Indicator for Basilar Artery Thrombosis. Am J Forensic Med Pathol 2016; 37:64-6. [PMID: 27049662 DOI: 10.1097/paf.0000000000000227] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Basilar artery thrombosis constitutes 1% of all types of stroke, carries a mortality rate of up to 90%, and is one of the rarer causes of sudden death. It leads to brain stem ischemia and commonly presents with impaired consciousness, cranial nerve palsy, hemiplegia or quadriplegia, and sudden collapse. Clinically, the diagnosis of basilar artery thrombosis is made on clinical symptoms, along with a hyperdense basilar artery in antemortem computed tomography (CT) scan. To our knowledge, whether a hyperdense basilar artery indicates basilar artery thrombosis on postmortem CT scan is not documented in the literature. We present a case report of a 55-year-old man who on postmortem CT scan showed a hyperdense basilar artery and was subsequently confirmed to be a fatal basilar artery thrombosis. We suggest that a hyperdense basilar artery on postmortem CT should prompt the pathologist to consider basilar artery thrombosis.
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Bolliger SA, Thali MJ. Imaging and virtual autopsy: looking back and forward. Philos Trans R Soc Lond B Biol Sci 2016; 370:rstb.2014.0253. [PMID: 26101279 DOI: 10.1098/rstb.2014.0253] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
In order to create a three-dimensional (3D) documentation of findings which can be reassessed if necessary by other experts, the research project 'Virtopsy®' was launched in the late 1990s. This project combined autopsy results with forensic imaging in the form of computed tomography, magnetic resonance tomography and 3D surface scanning. The success of this project eventually succeeded in convincing the courts in Switzerland to accept these novel methods as evidence. As opposition towards autopsies has grown over the last decades, Virtopsy also strives to find and elaborate additional methods which can answer the main forensic questions without autopsy. These methods comprise post-mortem angiography for illustration of the vascular bed and image-guided tissue and fluid sampling for histological, toxicological and microbiological examinations. Based on the promising results, post-mortem imaging, especially with 3D surface scanning, has meanwhile also been applied to living victims of assault, who have suffered patterned injuries due to bites, blows with objects, etc. In our opinion, forensic imaging is an objective method which offers the possibility for a reassessment of the findings by other experts, even after burial or cremation of the corpse, or healing of the injuries in living victims, thus leading to a greater security in court.
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Affiliation(s)
- Stephan A Bolliger
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Wintherthurerstrasse 190/52, Zurich 8057, Switzerland
| | - Michael J Thali
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Wintherthurerstrasse 190/52, Zurich 8057, Switzerland
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Norman W, Jawad N, Jones R, Taylor AM, Arthurs OJ. Perinatal and paediatric post-mortem magnetic resonance imaging (PMMR): sequences and technique. Br J Radiol 2016; 89:20151028. [PMID: 26916282 DOI: 10.1259/bjr.20151028] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
As post-mortem MRI (PMMR) becomes more widely used for investigation following perinatal and paediatric deaths, the best possible images should be acquired. In this article, we review the most widely used published PMMR sequences, together with outlining our acquisition protocol and sequence parameters for foetal, perinatal and paediatric PMMR. We give examples of both normal and abnormal appearances, so that the reader can understand the logic behind each acquisition step before interpretation, as a useful day-to-day reference guide to performing PMMR.
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Affiliation(s)
- Wendy Norman
- 1 Cardiorespiratory Division, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,2 Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, London, UK
| | - Noorulhuda Jawad
- 3 Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Rod Jones
- 1 Cardiorespiratory Division, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,2 Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, London, UK
| | - Andrew M Taylor
- 1 Cardiorespiratory Division, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,2 Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, London, UK
| | - Owen J Arthurs
- 3 Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,4 Institute of Child Health, UCL, London, UK
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Inokuchi G, Makino Y, Yajima D, Motomura A, Chiba F, Torimitsu S, Hoshioka Y, Iwase H. A case of acute subdural hematoma due to ruptured aneurysm detected by postmortem angiography. Int J Legal Med 2015; 130:441-6. [PMID: 26362305 DOI: 10.1007/s00414-015-1262-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 09/03/2015] [Indexed: 11/30/2022]
Abstract
Acute subdural hematoma (ASDH) is mostly caused by head trauma, but intrinsic causes also exist such as aneurysm rupture. We describe here a case involving a man in his 70s who was found lying on the bedroom floor by his family. CT performed at the hospital showed ASDH and a forensic autopsy was requested. Postmortem cerebral angiography showed dilatation of the bifurcation of the middle cerebral artery, which coincided with the dilated part of the Sylvian fissure. Extravasation of contrast medium into the subdural hematoma from this site was suggestive of a ruptured aneurysm. Autopsy revealed a fleshy hematoma (total weight 110 g) in the right subdural space and findings of brain herniation. As indicated on angiography, a ruptured saccular aneurysm was confirmed at the bifurcation of the middle cerebral artery. Obvious injuries to the head or face could not be detected on either external or internal examination, and intrinsic ASDH due to a ruptured middle cerebral artery aneurysm was determined as the cause of death. One of the key points of forensic diagnosis is the strict differentiation between intrinsic and extrinsic onset for conditions leading to death. Although most subdural hematomas (SDH) are caused by extrinsic factors, forensic pathologists should consider the possibility of intrinsic SDH. In addition, postmortem angiography can be useful for identifying vascular lesions in such cases.
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Affiliation(s)
- Go Inokuchi
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan.
| | - Yohsuke Makino
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan.,Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Daisuke Yajima
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Ayumi Motomura
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Fumiko Chiba
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan.,Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Suguru Torimitsu
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan.,Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Yumi Hoshioka
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Hirotaro Iwase
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan.,Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
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