1
|
Hansen PL, Leth PM, Nielsen PA, Bech DM, Nielsen JB, Mørup SD, Holst AK, Bak L, Poulsen MR, Greisen PW, Hansen DL, Precht H. Optimization of Postprocessing parameters for abdominal Forensic CT scans. Forensic Sci Int Synerg 2024; 8:100478. [PMID: 38779309 PMCID: PMC11109732 DOI: 10.1016/j.fsisyn.2024.100478] [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: 01/11/2024] [Revised: 05/02/2024] [Accepted: 05/03/2024] [Indexed: 05/25/2024]
Abstract
Aim Postmortem Computed Tomography (PMCT) is gradually introduced at forensic institutes. Image reconstruction software can increase diagnostic potential in CT by increasing distinction between structures and reduction of artifacts. The aim of this study was to develop and evaluate novel image reconstruction parameters for postmortem conditions, to increase image quality and diagnostic potential of CT scans. Method Twenty PMCT scans of deceased hereof two in severe decay were subjected to four reconstruction techniques: a standard reconstruction algorithm, the detail reconstruction algorithm and two novel algorithms based on the standard algorithm, but with different Hounsfield settings. Image quality was evaluated by visual grading analysis (VGA) by four forensic radiologist observers. Results The VGA did not prove that any of the reconstruction techniques were superior to the others. For standard and detail, the two pre-defined reconstruction algorithms, VGA scores were indiscernible and were superior to the equally indiscernible Hounsfield reconstructions on parameters translated into Sharpness and Low Contrast Resolution. The two alternative Hounsfield settings were superior with respect to Noise and Artifacts/Beam Hardening. Conclusion The study elucidates the possiblity for multiple reconstructions specialized for PMCT conditions, to accommodate the special conditions when working with the deceased. Despite the lack of clear improvements in the tested reconstructions, this study provides an insight into some of the possibilities of improving PMCT quality using reconstruction techniques.
Collapse
Affiliation(s)
| | - Peter Mygind Leth
- Institute of Forensic Medicine, University of Southern Denmark, Odense, Denmark
| | | | - Dina Maria Bech
- Health Sciences Research Centre, University College Lillebaelt, Odense, Denmark
| | | | - Svea Deppe Mørup
- Health Sciences Research Centre, University College Lillebaelt, Odense, Denmark
| | - Anette Koch Holst
- Department of Radiology, Odense University Hospital, Odense, Denmark
| | - Lene Bak
- Department of Radiology, Odense University Hospital, Odense, Denmark
| | - Mette R. Poulsen
- Department of Radiology, Odense University Hospital, Odense, Denmark
| | | | - Dennis Lund Hansen
- Department of Hematology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Helle Precht
- Health Sciences Research Centre, University College Lillebaelt, Odense, Denmark
- Department of Radiology, Lillebaelt Hospital, Kolding, Denmark
- Department of Regional Health Research, University of Southern Denmark, Kolding, Denmark
| |
Collapse
|
2
|
Michaud K, Jacobsen C, Basso C, Banner J, Blokker BM, de Boer HH, Dedouit F, O'Donnell C, Giordano C, Magnin V, Grabherr S, Suvarna SK, Wozniak K, Parsons S, van der Wal AC. Application of postmortem imaging modalities in cases of sudden death due to cardiovascular diseases-current achievements and limitations from a pathology perspective : Endorsed by the Association for European Cardiovascular Pathology and by the International Society of Forensic Radiology and Imaging. Virchows Arch 2023; 482:385-406. [PMID: 36565335 PMCID: PMC9931788 DOI: 10.1007/s00428-022-03458-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 11/11/2022] [Accepted: 11/15/2022] [Indexed: 12/25/2022]
Abstract
Postmortem imaging (PMI) is increasingly used in postmortem practice and is considered a potential alternative to a conventional autopsy, particularly in case of sudden cardiac deaths (SCD). In 2017, the Association for European Cardiovascular Pathology (AECVP) published guidelines on how to perform an autopsy in such cases, which is still considered the gold standard, but the diagnostic value of PMI herein was not analyzed in detail. At present, significant progress has been made in the PMI diagnosis of acute ischemic heart disease, the most important cause of SCD, while the introduction of postmortem CT angiography (PMCTA) has improved the visualization of several parameters of coronary artery pathology that can support a diagnosis of SCD. Postmortem magnetic resonance (PMMR) allows the detection of acute myocardial injury-related edema. However, PMI has limitations when compared to clinical imaging, which severely impacts the postmortem diagnosis of myocardial injuries (ischemic versus non-ischemic), the age-dating of coronary occlusion (acute versus old), other potentially SCD-related cardiac lesions (e.g., the distinctive morphologies of cardiomyopathies), aortic diseases underlying dissection or rupture, or pulmonary embolism. In these instances, PMI cannot replace a histopathological examination for a final diagnosis. Emerging minimally invasive techniques at PMI such as image-guided biopsies of the myocardium or the aorta, provide promising results that warrant further investigations. The rapid developments in the field of postmortem imaging imply that the diagnosis of sudden death due to cardiovascular diseases will soon require detailed knowledge of both postmortem radiology and of pathology.
Collapse
Affiliation(s)
- Katarzyna Michaud
- University Center of Legal Medicine Lausanne - Geneva, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
| | - Christina Jacobsen
- Section of Forensic Pathology, Department of Forensic Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Cristina Basso
- Cardiovascular Pathology Unit, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Jytte Banner
- Section of Forensic Pathology, Department of Forensic Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | - Hans H de Boer
- Department of Forensic Medicine, Victorian Institute of Forensic Medicine, Monash University, Melbourne, Australia
| | - Fabrice Dedouit
- GRAVIT, Groupe de Recherche en Autopsie Virtuelle et Imagerie Thanatologique, Forensic Department, University Hospital, Rangueil, Toulouse, France
| | - Chris O'Donnell
- Department of Forensic Medicine, Victorian Institute of Forensic Medicine, Monash University, Melbourne, Australia
| | - Carla Giordano
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Virginie Magnin
- University Center of Legal Medicine Lausanne - Geneva, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Geneva University Hospital, University of Geneva, Geneva, Switzerland
| | - Silke Grabherr
- University Center of Legal Medicine Lausanne - Geneva, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Geneva University Hospital, University of Geneva, Geneva, Switzerland
| | - S Kim Suvarna
- Department of Histopathology, Northern General Hospital, The University of Sheffield, Sheffield, UK
| | - Krzysztof Wozniak
- Department of Forensic Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Sarah Parsons
- Department of Forensic Medicine, Victorian Institute of Forensic Medicine, Monash University, Melbourne, Australia
| | - Allard C van der Wal
- Department of Pathology, Amsterdam UMC, Academic Medical Center, Amsterdam, The Netherlands.
| |
Collapse
|
3
|
Fujimoto K, Gonoi W, Ishida M, Okimoto N, Nyunoya K, Abe H, Ushiku T, Abe O. Association between postmortem computed tomography value of cerebrospinal fluid and time after death: A longitudinal study of antemortem and postmortem computed tomography. J Forensic Leg Med 2023; 93:102461. [PMID: 36470057 DOI: 10.1016/j.jflm.2022.102461] [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: 08/18/2022] [Revised: 11/16/2022] [Accepted: 11/25/2022] [Indexed: 12/03/2022]
Abstract
This study was designed to examine the antemortem factors affecting cerebrospinal fluid (CSF) Hounsfield Units (HU) on postmortem computed tomography (PMCT) compared to the antemortem CT (AMCT). Fifty-five participants without brain lesions who died at a university hospital and underwent AMCT, PMCT, and an autopsy were enrolled. We recorded age, sex, time after death, the CSF HU on AMCT and PMCT at multiple measuring points, 4-point-scale brain atrophy grade on AMCT, and the cella media index. We tested the effects of CSF HU factors observed on PMCT. No significant differences were observed between CSF HUs at any of the PMCT measurement points. The average CSF HU on PMCT was positively correlated with the natural logarithm of the time after death (Pearson's correlation coefficient, 0.81; p < 0.001). No other factors showed correlative relationships. Up until approximately 12 h after death, the CSF HU on PMCT depended only on the time since death.
Collapse
Affiliation(s)
- Kotaro Fujimoto
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Wataru Gonoi
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
| | - Masanori Ishida
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Naomasa Okimoto
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Keisuke Nyunoya
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroyuki Abe
- Department of Pathology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Tetsuo Ushiku
- Department of Pathology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Osamu Abe
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| |
Collapse
|
4
|
Krassner MM, Kauffman J, Sowa A, Cialowicz K, Walsh S, Farrell K, Crary JF, McKenzie AT. Postmortem changes in brain cell structure: a review. FREE NEUROPATHOLOGY 2023; 4:4-10. [PMID: 37384330 PMCID: PMC10294569 DOI: 10.17879/freeneuropathology-2023-4790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 05/15/2023] [Indexed: 06/30/2023]
Abstract
Brain cell structure is a key determinant of neural function that is frequently altered in neurobiological disorders. Following the global loss of blood flow to the brain that initiates the postmortem interval (PMI), cells rapidly become depleted of energy and begin to decompose. To ensure that our methods for studying the brain using autopsy tissue are robust and reproducible, there is a critical need to delineate the expected changes in brain cell morphometry during the PMI. We searched multiple databases to identify studies measuring the effects of PMI on the morphometry (i.e. external dimensions) of brain cells. We screened 2119 abstracts, 361 full texts, and included 172 studies. Mechanistically, fluid shifts causing cell volume alterations and vacuolization are an early event in the PMI, while the loss of the ability to visualize cell membranes altogether is a later event. Decomposition rates are highly heterogenous and depend on the methods for visualization, the structural feature of interest, and modifying variables such as the storage temperature or the species. Geometrically, deformations of cell membranes are common early events that initiate within minutes. On the other hand, topological relationships between cellular features appear to remain intact for more extended periods. Taken together, there is an uncertain period of time, usually ranging from several hours to several days, over which cell membrane structure is progressively lost. This review may be helpful for investigators studying human postmortem brain tissue, wherein the PMI is an unavoidable aspect of the research.
Collapse
Affiliation(s)
- Margaret M. Krassner
- Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Friedman Brain Institute, Departments of Pathology, Neuroscience and Artificial Intelligence & Human Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Neuropathology Brain Bank & Research Core and Ronald M. Loeb Center for Alzheimer's Disease, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Justin Kauffman
- Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Friedman Brain Institute, Departments of Pathology, Neuroscience and Artificial Intelligence & Human Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Neuropathology Brain Bank & Research Core and Ronald M. Loeb Center for Alzheimer's Disease, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Allison Sowa
- Microscopy and Advanced Bioimaging Core, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Katarzyna Cialowicz
- Microscopy and Advanced Bioimaging Core, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Samantha Walsh
- Hunter College Libraries, CUNY Hunter College, New York, NY
| | - Kurt Farrell
- Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Friedman Brain Institute, Departments of Pathology, Neuroscience and Artificial Intelligence & Human Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Neuropathology Brain Bank & Research Core and Ronald M. Loeb Center for Alzheimer's Disease, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - John F. Crary
- Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Friedman Brain Institute, Departments of Pathology, Neuroscience and Artificial Intelligence & Human Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Neuropathology Brain Bank & Research Core and Ronald M. Loeb Center for Alzheimer's Disease, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Andrew T. McKenzie
- Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Friedman Brain Institute, Departments of Pathology, Neuroscience and Artificial Intelligence & Human Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Neuropathology Brain Bank & Research Core and Ronald M. Loeb Center for Alzheimer's Disease, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| |
Collapse
|
5
|
Moore M, Moharram M, Poon A, Tse R, Aitken-Buck HM, Lamberts RS, Coffey S. A simple and reproducible measure of adipose depots with non-contrast post-mortem computed tomography. IMAGING 2022. [DOI: 10.1556/1647.2022.00066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
AbstractBackground and aimObesity is associated with an increase in different adipose depots. The anatomic distribution of internal adipose confers different risks. Recently, significant interest has emerged in the expansion of epicardial adipose tissue (EAT) as a mediator of adverse cardiovascular events. Often, post-mortem examination remains the best method of investigating morphological changes in health and disease. This study aimed to develop a simple, reproducible, and non-invasive protocol for the measurement of internal adiposity using post-mortem computed tomography (PMCT).Patients and methods101 consecutive post-mortem subjects underwent non-contrast computed tomography scans. Measurements were performed using the open-source software 3D Slicer by a non-expert researcher. An expert radiologist and cardiologist verified the abdominal and cardiac sites of adiposity, respectively. We aimed to develop a protocol to measure total EAT, sub-depots of EAT, extra-pericardial adipose, visceral and subcutaneous adipose, and suprasternal adipose.ResultsWe found excellent reproducibility for our measures of total EAT, anterior right atrial EAT, extra-pericardial adipose, and visceral adipose tissue, with intraclass correlations between 0.82 and 0.99 for each measure. Due to a lack of suitable anatomical boundaries, other sub-depots of EAT, including in the interventricular groove, were not reproducible.ConclusionsQuantification of total EAT and anterior right atrial EAT are readily reproducible using 3D Slicer on post-mortem CT. They can be reliably measured by non-expert researchers with a small amount of training, and therefore be used to investigate morphological changes in adiposity in health and disease.
Collapse
Affiliation(s)
- Matthew Moore
- Department of Medicine, HeartOtago, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Mohammed Moharram
- Department of Medicine, HeartOtago, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Andre Poon
- Department of Radiology, Dunedin Hospital, Southern District Health Board, Dunedin, New Zealand
| | - Rexson Tse
- Department of Forensic Pathology, LabPLUS, Auckland City Hospital, Auckland, New Zealand
| | - Hamish M. Aitken-Buck
- Department of Physiology, HeartOtago, School of Biomedical Sciences, University of Otago, Dunedin, New Zealand
| | - Regis S. Lamberts
- Department of Physiology, HeartOtago, School of Biomedical Sciences, University of Otago, Dunedin, New Zealand
| | - Sean Coffey
- Department of Medicine, HeartOtago, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
- Department of Cardiology, Dunedin Hospital, Southern District Health Board, Dunedin, New Zealand
| |
Collapse
|
6
|
Wang B, Chen ZM, Zhang L, Zhou DD, Zhu WA, Wang Z, Wang L, Gao YB, Liu G, Chen WL, Cheng G, Huang F, Cheng ZH, Zhang HM. Development of a novel technique with a pigtail catheter and high-pressure injector for coronary postmortem computed tomography angiography. AUST J FORENSIC SCI 2022. [DOI: 10.1080/00450618.2022.2157045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Bo Wang
- College of Basic Medical Sciences, Jilin University, Changchun, Jilin, China
| | - Zhi-Ming Chen
- College of Basic Medical Sciences, Jilin University, Changchun, Jilin, China
| | - Lei Zhang
- The First Hospital, Jilin University, Changchun, Jilin, China
| | - Dan-Dan Zhou
- The First Hospital, Jilin University, Changchun, Jilin, China
| | - Wan-an Zhu
- The First Hospital, Jilin University, Changchun, Jilin, China
| | - Zhuo Wang
- The First Hospital, Jilin University, Changchun, Jilin, China
| | - Lijun Wang
- Public Security Judicial Identification Center, Changchun City Public Security Bureau, Changchun, Jilin, China
| | - Yan-Bin Gao
- Public Security Judicial Identification Center, Changchun City Public Security Bureau, Changchun, Jilin, China
| | - Gang Liu
- Institute of Forensic Science, Department of Public Security of Jilin Province, Changchun, Jilin, China
| | - Wei-Long Chen
- Institute of Forensic Science, Department of Public Security of Jilin Province, Changchun, Jilin, China
| | - Gen Cheng
- Neusoft Medical Systems Co., Ltd, Shenyang, Liaoning, China
| | - Feng Huang
- Shanghai Neusoft Medical Technology Co., Ltd, Shanghai, China
| | - Zhi-Hua Cheng
- The First Hospital, Jilin University, Changchun, Jilin, China
| | - Hui-Mao Zhang
- The First Hospital, Jilin University, Changchun, Jilin, China
| |
Collapse
|
7
|
Tijssen MPM, Hofman PAM, Robben SGF. Postmortem Fetal Temperature Estimation with Magnetic Resonance Imaging: Apparent Diffusion Coefficient Measurements in the Vitreous Body and Cerebrospinal Fluid. Top Magn Reson Imaging 2022; 31:25-30. [PMID: 36269228 DOI: 10.1097/rmr.0000000000000295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
OBJECTIVES Magnetic resonance imaging (MRI) is increasingly used in postmortem fetal imaging. Several factors influence the quality of MRI in this setting, such as small size, autolytic and maceration changes, and temperature. Knowing the fetal temperature at the time of scanning can improve the MRI interpretation. Temperature can be calculated using diffusion-weighted imaging with measurements of the apparent diffusion coefficient (ADC) in the cerebrospinal fluid (CSF). However, this is complicated by small ventricle size and hemorrhage and, therefore, may be unreliable in postmortem imaging. The current study evaluated the feasibility and reliability of using the ADC for temperature measurements of the vitreous body compared to that of CSF. MATERIALS AND METHODS Two lambs were scanned postmortem at five different time points over 28 hours. Furthermore, 10 stillborn fetuses were scanned once, at 4 to 62 hours after birth. The temperature was measured with a digital thermometer and calculated using the ADCs of the vitreous body (lambs and fetuses) and CSF (fetuses). RESULTS There was an excellent correlation between measured and calculated temperatures in vitreous bodies of lambs (r = 0.997, P < 0.001) and fetuses (r = 0.970, P < 0.001). The correlation between measured and calculated temperatures in the CSF was poor (r = 0.522, P = 0.122). CONCLUSION The calculation of the temperature based on the ADC of the vitreous body is feasible and reliable for postmortem fetal imaging.
Collapse
Affiliation(s)
- Maud P M Tijssen
- Department of Radiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | | | | |
Collapse
|
8
|
Hussein MN, Heinemann A, Shokry DA, Elgebely M, Pueschel K, Hassan FM. Postmortem computed tomography differentiation between intraperitoneal decomposition gas and pneumoperitoneum. Int J Legal Med 2021; 136:229-235. [PMID: 34708283 DOI: 10.1007/s00414-021-02732-7] [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: 04/29/2021] [Accepted: 10/18/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE The aim of this study is to investigate the ability of postmortem computed tomography (PMCT) to distinguish intraperitoneal decomposition gas from pneumoperitoneum due to intestinal perforation. METHODS This retrospective study investigated the factors affecting intraperitoneal gas in two groups of 14 decedents as detected by postmortem CT performed in the Department of Legal Medicine of Hamburg University. The first group died with a cause of death associated with intestinal perforation, and the second group with other different natural causes of death. These factors include postmortem interval, gas volume, gas distribution, radiology alteration index (RAI), and pneumoperitoneum-associated pathology. RESULTS The findings of this study showed the appearance of specific gas distribution patterns and a significant increase in gas volumes in the cases of intestinal perforation. Moreover, postmortem interval and the pneumoperitoneum-associated pathology could help distinguish postmortem-generated gas from pneumoperitoneum. CONCLUSION Based on the findings of this study, we propose that these findings can improve the proper detection of intestinal perforation cases in the future.
Collapse
Affiliation(s)
- Maged Nabil Hussein
- Forensic Medicine Authority, Ministry of Justice, 14 Berium Eltonsy Street, Elsayda Zainb, Cairo, Egypt.
| | - Axel Heinemann
- Department of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg University, Butenfeld 34, 22529, Hamburg, Germany
| | - Dina Ali Shokry
- Forensic Medicine & Clinical Toxicology Department, Faculty of Medicine, Cairo University, kasr Alainy Street, Cairo, 11562, Egypt
| | - Mohamed Elgebely
- Lecturer of Forensic Medicine & Clinical Toxicology Department, Faculty of Medicine, Suez University, Cairo-suez road, 41522, Al-salam city, Egypt
| | - Klaus Pueschel
- Department of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg University, Butenfeld 34, 22529, Hamburg, Germany
| | - Fatma Mohamed Hassan
- Forensic Medicine & Clinical Toxicology Department, Faculty of Medicine, Cairo University, kasr Alainy Street, Cairo, 11562, Egypt
| |
Collapse
|
9
|
Ishida M, Gonoi W, Abe H, Shirota G, Fujimoto K, Okimoto N, Ushiku T, Abe O. Longitudinal comparison of ascites attenuation between antemortem and postmortem computed tomography. Forensic Sci Int 2021; 321:110727. [PMID: 33636473 DOI: 10.1016/j.forsciint.2021.110727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 01/02/2021] [Accepted: 02/15/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To investigate the changes in ascites attenuation between antemortem (AMCT) and postmortem computed tomography (PMCT) analyses of the same subjects. METHODS Thirty-five subjects who underwent unenhanced or enhanced AMCT within 7 days before death, unenhanced PMCT, and autopsy were evaluated. In each subject, ascites attenuation was measured at similar sites on AMCT and PMCT. Attenuation changes were evaluated in 42 unenhanced AMCT/PMCT site pairs (23 subjects) and 20 enhanced AMCT/PMCT site pairs (12 subjects). Factors contributing to CT attenuation changes were also assessed, including the time interval between AMCT and PMCT, serum albumin level, estimated glomerular filtration rate, and ascites volume. RESULTS Significantly elevated CT attenuation was observed between enhanced AMCT and PMCT (12.2 ± 6.3 vs. 18.7 ± 10.4 Hounsfield units; paired t-test, p = 0.006), but not between unenhanced AMCT and PMCT (13.5 ± 8.9 vs. 13.4 ± 9.3; p = 0.554). A significant inverse association was observed between the degree of CT attenuation change and the time interval between enhanced AMCT and PMCT (Spearman's rank correlation coefficient, r = -0.56, p = 0.01). CONCLUSIONS We confirmed an elevated level of ascites attenuation on PMCT relative to AMCT in subjects who underwent enhanced AMCT shortly before death.
Collapse
Affiliation(s)
- Masanori Ishida
- 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
| | - Hiroyuki Abe
- Department of Pathology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Go Shirota
- Department of Radiology, 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
| | - Naomasa Okimoto
- 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
| |
Collapse
|
10
|
Head and Brain Postmortem Computed Tomography-Autopsy Correlation in Hospital Deaths. Am J Forensic Med Pathol 2021; 41:163-175. [PMID: 32618580 DOI: 10.1097/paf.0000000000000538] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The use of postmortem computed tomography (PMCT) to support autopsy pathology has increased in recent decades. To some extent, PMCT has also been contemplated as a potential alternative to conventional postmortem examination. The purpose of this study was to investigate the ability of PMCT to detect specific pathologic findings in the head and brain in natural hospital deaths.We examined postmortem CT images and autopsy data from 31 subjects who died at SUNY (State University of New York) Upstate University Hospital between 2013 and 2018. Each subject underwent a noncontrast PMCT and a traditional autopsy. A neuroradiologist analyzed PMCT images for head and brain abnormalities. The autopsies were performed by pathologists who were aware of the radiology results.In our series, PMCT was able to detect the majority of the significant space-occupying lesions, although it was not always reliable in ascertaining their nature. Postmortem computed tomography revealed findings usually challenging to detect at autopsy. Unfortunately, there were also situations in which PMCT was misleading, showing changes that were difficult to interpret, or that could be related to postmortem events. Therefore, we conclude PMCT should be used as an adjunct rather than a substitute to autopsy.
Collapse
|
11
|
Tsuneya S, Makino Y, Chiba F, Kojima M, Yoshida M, Kishimoto T, Mukai H, Hattori S, Iwase H. Postmortem magnetic resonance imaging revealed bilateral globi pallidi lesions in a death associated with prolonged carbon monoxide poisoning: a case report. Int J Legal Med 2021; 135:921-928. [PMID: 33447889 DOI: 10.1007/s00414-021-02506-1] [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: 08/05/2020] [Accepted: 01/08/2021] [Indexed: 11/28/2022]
Abstract
A man and a woman were found dead in the same car with a burned coal briquette. The cause of death of the woman was assigned to acute carbon monoxide (CO) poisoning without difficulty based on typical findings associated with this condition, including elevation of carboxyhaemoglobin (COHb). However, the man had an unremarkable elevation of COHb and a higher rectal temperature compared to that of the woman. Postmortem computed tomography (PMCT) revealed ambiguous low-density areas in the bilateral globi pallidi. Further analysis by postmortem magnetic resonance (PMMR) imaging showed these lesions more clearly; the lesions appeared as marked high signal intensity areas on both the T2-weighted images and the fluid-attenuated inversion recovery sequences. A subsequent autopsy revealed signs of pneumonia, dehydration, starvation, and hypothermia, suggesting that the man died from prolonged CO poisoning. Both globi pallidi contained grossly ambiguous lesions, and a detailed neuropathologic investigation revealed these lesions to be coagulative necrotic areas; this finding was compatible with a diagnosis of prolonged CO poisoning. This case report shows that postmortem imaging, especially PMMR, is useful for detecting necrotic lesions associated with prolonged CO poisoning. This report further exemplifies the utility of PMMR for detecting brain lesions, which may be difficult to detect by macroscopic analysis.
Collapse
Affiliation(s)
- Shigeki Tsuneya
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.,Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Yohsuke Makino
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan. .,Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan.
| | - Fumiko Chiba
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.,Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Masatoshi Kojima
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Maiko Yoshida
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Takashi Kishimoto
- Department of Molecular Pathology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8677, Japan
| | - Hiroki Mukai
- Department of Radiology, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8677, Japan
| | - Shinya Hattori
- Department of Radiology, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8677, Japan
| | - Hirotaro Iwase
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.,Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| |
Collapse
|
12
|
Kniep I, Lutter M, Ron A, Edler C, Püschel K, Ittrich H, Heller M, Heinemann A. [Postmortem imaging of the lung in cases of COVID-19 deaths]. Radiologe 2020; 60:927-933. [PMID: 32809036 PMCID: PMC7433282 DOI: 10.1007/s00117-020-00733-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
CLINICAL/METHODOLOGICAL ISSUE COVID-19 is a new viral disease that is associated with inflammatory pulmonary changes which can be detected in computed tomography (CT). So far postmortem CT (PMCT) has not been used as a screening instrument for the evaluation of deaths with and without autopsy. In this respect, its validity has to be proved in comparison to clinical-radiological experiences. STANDARD RADIOLOGICAL METHODS Postmortem CT METHODICAL INNOVATIONS: So far, PMCT can be regarded as a methodological innovation that has not yet been sufficiently evaluated for pneumonia. PERFORMANCE CT in clinical routine has a high sensitivity for pneumonia. However, to what extent postmortem artifacts are relevant to PMCT still has to be determined. ACHIEVEMENTS There is still no standard procedure for the postmortem radiological diagnosis of COVID-19 disease. Despite postmortem artifacts, PMCT can provide valuable information about the presence of pneumonia with interstitial character, especially without autopsy. PRACTICAL RECOMMENDATIONS PMCT is particularly useful in the assessment of suspected cases of COVID-19 pneumonia for morphological assessment in the context of monitoring deaths in the current pandemic situation.
Collapse
Affiliation(s)
- I Kniep
- Institut für Rechtsmedizin, Universitätsklinikum Hamburg-Eppendorf, Butenfeld 34, 22529, Hamburg, Deutschland.
| | - M Lutter
- Institut für Rechtsmedizin, Universitätsklinikum Hamburg-Eppendorf, Butenfeld 34, 22529, Hamburg, Deutschland
| | - A Ron
- Institut für Rechtsmedizin, Universitätsklinikum Hamburg-Eppendorf, Butenfeld 34, 22529, Hamburg, Deutschland
| | - C Edler
- Institut für Rechtsmedizin, Universitätsklinikum Hamburg-Eppendorf, Butenfeld 34, 22529, Hamburg, Deutschland
| | - K Püschel
- Institut für Rechtsmedizin, Universitätsklinikum Hamburg-Eppendorf, Butenfeld 34, 22529, Hamburg, Deutschland
| | - H Ittrich
- Klinik und Poliklinik für Diagnostische und Interventionelle Radiologie und Nuklearmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - M Heller
- Institut für Rechtsmedizin, Universitätsklinikum Hamburg-Eppendorf, Butenfeld 34, 22529, Hamburg, Deutschland
| | - A Heinemann
- Institut für Rechtsmedizin, Universitätsklinikum Hamburg-Eppendorf, Butenfeld 34, 22529, Hamburg, Deutschland
| |
Collapse
|
13
|
Herr N, Lombardo P, Jackowski C, Zech WD. Diagnosis of pulmonary infarction in post-mortem computed tomography and post-mortem magnetic resonance imaging-a technical note. Int J Legal Med 2020; 134:1817-1821. [PMID: 32239316 DOI: 10.1007/s00414-020-02273-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 03/12/2020] [Indexed: 12/22/2022]
Abstract
Pulmonary thromboembolism may be accompanied by pulmonary infarction. Even though pulmonary thromboembolism (PTE) is a frequently found cause of death at autopsy, pulmonary infarction accompanying PTE is a less common finding and may therefore easily be misinterpreted as infectious or cancerous lung disease. Appearance of pulmonary infarction in post-mortem imaging and acquisition parameters helping to identify pulmonary infarctions are not described yet. Based on a case of a 50-year-old man who died due to PTE and presented pulmonary infarction, we suggest using a pulmonary algorithm in post-mortem computed tomography combined with post-mortem magnetic resonance imaging of the lungs using conventional T1- and T2-weighted sequences.
Collapse
Affiliation(s)
- Nicolas Herr
- Institute of Forensic Medicine, University of Bern, Bühlstrasse 20, 3012, Bern, Switzerland
| | - Paolo Lombardo
- Institute of Forensic Medicine, University of Bern, Bühlstrasse 20, 3012, Bern, Switzerland.,Department of Diagnostic, Interventional and Pediatric Radiology, University of Bern, Inselspital, Freiburgstrasse 10, 3010, Bern, Switzerland
| | - Christian Jackowski
- Institute of Forensic Medicine, University of Bern, Bühlstrasse 20, 3012, Bern, Switzerland
| | - Wolf Dieter Zech
- Institute of Forensic Medicine, University of Bern, Bühlstrasse 20, 3012, Bern, Switzerland.
| |
Collapse
|
14
|
Coolen T, Lolli V, Sadeghi N, Rovai A, Trotta N, Taccone FS, Creteur J, Henrard S, Goffard JC, Dewitte O, Naeije G, Goldman S, De Tiège X. Early postmortem brain MRI findings in COVID-19 non-survivors. Neurology 2020; 95:e2016-e2027. [PMID: 32546654 DOI: 10.1212/wnl.0000000000010116] [Citation(s) in RCA: 171] [Impact Index Per Article: 42.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 06/09/2020] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is considered to have potential neuroinvasiveness that might lead to acute brain disorders or contribute to respiratory distress in patients with coronavirus disease 2019 (COVID-19). This study investigates the occurrence of structural brain abnormalities in non-survivors of COVID-19 in a virtopsy framework. METHODS In this prospective, monocentric, case series study, consecutive patients who fulfilled the following inclusion criteria benefited from an early postmortem structural brain MRI: death <24 hours, SARS-CoV-2 detection on nasopharyngeal swab specimen, chest CT scan suggestive of COVID-19, absence of known focal brain lesion, and MRI compatibility. RESULTS Among the 62 patients who died of COVID-19 from March 31, 2020, to April 24, 2020, at our institution, 19 decedents fulfilled the inclusion criteria. Parenchymal brain abnormalities were observed in 4 decedents: subcortical microbleeds and macrobleeds (2 decedents), cortico-subcortical edematous changes evocative of posterior reversible encephalopathy syndrome (PRES; 1 decedent), and nonspecific deep white matter changes (1 decedent). Asymmetric olfactory bulbs were found in 4 other decedents without downstream olfactory tract abnormalities. No brainstem MRI signal abnormality was observed. CONCLUSIONS Postmortem brain MRI demonstrates hemorrhagic and PRES-related brain lesions in non-survivors of COVID-19. SARS-CoV-2-related olfactory impairment seems to be limited to olfactory bulbs. Brainstem MRI findings do not support a brain-related contribution to respiratory distress in COVID-19.
Collapse
Affiliation(s)
- Tim Coolen
- From the Department of Radiology (T.C., V.L., N.S.), Department of Nuclear Medicine (A.R., N.T., S.G., X.D.T.), Intensive Care Unit (F.S.T., J.C.), Department of Internal Medicine (S.H., J.-C.G.), Department of Neurosurgery (O.D.W.), and Department of Neurology (G.N.), CUB Hôpital Erasme, and Laboratoire de Cartographie fonctionnelle du Cerveau (T.C., V.L., A.R., N.T., S.G., X.D.T.), UNI-ULB Neuroscience Institute, Université libre de Bruxelles, Brussels, Belgium
| | - Valentina Lolli
- From the Department of Radiology (T.C., V.L., N.S.), Department of Nuclear Medicine (A.R., N.T., S.G., X.D.T.), Intensive Care Unit (F.S.T., J.C.), Department of Internal Medicine (S.H., J.-C.G.), Department of Neurosurgery (O.D.W.), and Department of Neurology (G.N.), CUB Hôpital Erasme, and Laboratoire de Cartographie fonctionnelle du Cerveau (T.C., V.L., A.R., N.T., S.G., X.D.T.), UNI-ULB Neuroscience Institute, Université libre de Bruxelles, Brussels, Belgium
| | - Niloufar Sadeghi
- From the Department of Radiology (T.C., V.L., N.S.), Department of Nuclear Medicine (A.R., N.T., S.G., X.D.T.), Intensive Care Unit (F.S.T., J.C.), Department of Internal Medicine (S.H., J.-C.G.), Department of Neurosurgery (O.D.W.), and Department of Neurology (G.N.), CUB Hôpital Erasme, and Laboratoire de Cartographie fonctionnelle du Cerveau (T.C., V.L., A.R., N.T., S.G., X.D.T.), UNI-ULB Neuroscience Institute, Université libre de Bruxelles, Brussels, Belgium
| | - Antonin Rovai
- From the Department of Radiology (T.C., V.L., N.S.), Department of Nuclear Medicine (A.R., N.T., S.G., X.D.T.), Intensive Care Unit (F.S.T., J.C.), Department of Internal Medicine (S.H., J.-C.G.), Department of Neurosurgery (O.D.W.), and Department of Neurology (G.N.), CUB Hôpital Erasme, and Laboratoire de Cartographie fonctionnelle du Cerveau (T.C., V.L., A.R., N.T., S.G., X.D.T.), UNI-ULB Neuroscience Institute, Université libre de Bruxelles, Brussels, Belgium
| | - Nicola Trotta
- From the Department of Radiology (T.C., V.L., N.S.), Department of Nuclear Medicine (A.R., N.T., S.G., X.D.T.), Intensive Care Unit (F.S.T., J.C.), Department of Internal Medicine (S.H., J.-C.G.), Department of Neurosurgery (O.D.W.), and Department of Neurology (G.N.), CUB Hôpital Erasme, and Laboratoire de Cartographie fonctionnelle du Cerveau (T.C., V.L., A.R., N.T., S.G., X.D.T.), UNI-ULB Neuroscience Institute, Université libre de Bruxelles, Brussels, Belgium
| | - Fabio Silvio Taccone
- From the Department of Radiology (T.C., V.L., N.S.), Department of Nuclear Medicine (A.R., N.T., S.G., X.D.T.), Intensive Care Unit (F.S.T., J.C.), Department of Internal Medicine (S.H., J.-C.G.), Department of Neurosurgery (O.D.W.), and Department of Neurology (G.N.), CUB Hôpital Erasme, and Laboratoire de Cartographie fonctionnelle du Cerveau (T.C., V.L., A.R., N.T., S.G., X.D.T.), UNI-ULB Neuroscience Institute, Université libre de Bruxelles, Brussels, Belgium
| | - Jacques Creteur
- From the Department of Radiology (T.C., V.L., N.S.), Department of Nuclear Medicine (A.R., N.T., S.G., X.D.T.), Intensive Care Unit (F.S.T., J.C.), Department of Internal Medicine (S.H., J.-C.G.), Department of Neurosurgery (O.D.W.), and Department of Neurology (G.N.), CUB Hôpital Erasme, and Laboratoire de Cartographie fonctionnelle du Cerveau (T.C., V.L., A.R., N.T., S.G., X.D.T.), UNI-ULB Neuroscience Institute, Université libre de Bruxelles, Brussels, Belgium
| | - Sophie Henrard
- From the Department of Radiology (T.C., V.L., N.S.), Department of Nuclear Medicine (A.R., N.T., S.G., X.D.T.), Intensive Care Unit (F.S.T., J.C.), Department of Internal Medicine (S.H., J.-C.G.), Department of Neurosurgery (O.D.W.), and Department of Neurology (G.N.), CUB Hôpital Erasme, and Laboratoire de Cartographie fonctionnelle du Cerveau (T.C., V.L., A.R., N.T., S.G., X.D.T.), UNI-ULB Neuroscience Institute, Université libre de Bruxelles, Brussels, Belgium
| | - Jean-Christophe Goffard
- From the Department of Radiology (T.C., V.L., N.S.), Department of Nuclear Medicine (A.R., N.T., S.G., X.D.T.), Intensive Care Unit (F.S.T., J.C.), Department of Internal Medicine (S.H., J.-C.G.), Department of Neurosurgery (O.D.W.), and Department of Neurology (G.N.), CUB Hôpital Erasme, and Laboratoire de Cartographie fonctionnelle du Cerveau (T.C., V.L., A.R., N.T., S.G., X.D.T.), UNI-ULB Neuroscience Institute, Université libre de Bruxelles, Brussels, Belgium
| | - Olivier Dewitte
- From the Department of Radiology (T.C., V.L., N.S.), Department of Nuclear Medicine (A.R., N.T., S.G., X.D.T.), Intensive Care Unit (F.S.T., J.C.), Department of Internal Medicine (S.H., J.-C.G.), Department of Neurosurgery (O.D.W.), and Department of Neurology (G.N.), CUB Hôpital Erasme, and Laboratoire de Cartographie fonctionnelle du Cerveau (T.C., V.L., A.R., N.T., S.G., X.D.T.), UNI-ULB Neuroscience Institute, Université libre de Bruxelles, Brussels, Belgium
| | - Gilles Naeije
- From the Department of Radiology (T.C., V.L., N.S.), Department of Nuclear Medicine (A.R., N.T., S.G., X.D.T.), Intensive Care Unit (F.S.T., J.C.), Department of Internal Medicine (S.H., J.-C.G.), Department of Neurosurgery (O.D.W.), and Department of Neurology (G.N.), CUB Hôpital Erasme, and Laboratoire de Cartographie fonctionnelle du Cerveau (T.C., V.L., A.R., N.T., S.G., X.D.T.), UNI-ULB Neuroscience Institute, Université libre de Bruxelles, Brussels, Belgium
| | - Serge Goldman
- From the Department of Radiology (T.C., V.L., N.S.), Department of Nuclear Medicine (A.R., N.T., S.G., X.D.T.), Intensive Care Unit (F.S.T., J.C.), Department of Internal Medicine (S.H., J.-C.G.), Department of Neurosurgery (O.D.W.), and Department of Neurology (G.N.), CUB Hôpital Erasme, and Laboratoire de Cartographie fonctionnelle du Cerveau (T.C., V.L., A.R., N.T., S.G., X.D.T.), UNI-ULB Neuroscience Institute, Université libre de Bruxelles, Brussels, Belgium
| | - Xavier De Tiège
- From the Department of Radiology (T.C., V.L., N.S.), Department of Nuclear Medicine (A.R., N.T., S.G., X.D.T.), Intensive Care Unit (F.S.T., J.C.), Department of Internal Medicine (S.H., J.-C.G.), Department of Neurosurgery (O.D.W.), and Department of Neurology (G.N.), CUB Hôpital Erasme, and Laboratoire de Cartographie fonctionnelle du Cerveau (T.C., V.L., A.R., N.T., S.G., X.D.T.), UNI-ULB Neuroscience Institute, Université libre de Bruxelles, Brussels, Belgium.
| |
Collapse
|
15
|
Effect of minimally invasive autopsy and ethnic background on acceptance of clinical postmortem investigation in adults. PLoS One 2020; 15:e0232944. [PMID: 32392247 PMCID: PMC7213690 DOI: 10.1371/journal.pone.0232944] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 04/25/2020] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES Autopsy rates worldwide have dropped significantly over the last five decades. Imaging based autopsies are increasingly used as alternatives to conventional autopsy (CA). The aim of this study was to investigate the effect of the introduction of minimally invasive autopsy, consisting of CT, MRI and tissue biopsies on the overall autopsy rate (of CA and minimally invasive autopsy) and the autopsy rate among different ethnicities. METHODS We performed a prospective single center before-after study. The intervention was the introduction of minimally invasive autopsy as an alternative to CA. Minimally invasive autopsy consisted of MRI, CT, and CT-guided tissue biopsies. Autopsy rates over time and the effect of introducing minimally invasive autopsy were analyzed with a linear regression model. We performed a subgroup analysis comparing the autopsy rates of two groups: a group of western-European ethnicity versus a group of other ethnicities. RESULTS Autopsy rates declined from 14.0% in 2010 to 8.3% in 2019. The linear regression model showed a significant effect of both time and availability of minimally invasive autopsy on the overall autopsy rate. The predicted autopsy rate in the model started at 15.1% in 2010 and dropped approximately 0.1% per month (β = -0.001, p < 0.001). Availability of minimally invasive autopsy increased the overall autopsy rate by 2.4% (β = 0.024, p < 0.001). The overall autopsy rate of people with an ethnic background other than western-European was significantly higher in years when minimally invasive autopsy was available compared to when it was not (22/176 = 12.5% vs. 81/1014 (8.0%), p = 0.049). CONCLUSIONS The introduction of the minimally invasive autopsy had a small, but significant effect on the overall autopsy rate. Furthermore, the minimally invasive autopsy appears to be more acceptable than CA among people with an ethnicity other than western-European.
Collapse
|
16
|
Postmortem computed tomography of gas gangrene with aortic gas in a dialysis patient. CEN Case Rep 2020; 9:308-312. [PMID: 32323214 PMCID: PMC7502096 DOI: 10.1007/s13730-020-00456-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Accepted: 02/11/2020] [Indexed: 12/05/2022] Open
Abstract
Recently, postmortem imaging is sometimes used as an alternative to conventional autopsy. However, there are few case reports of postmortem imaging of dialysis patients. Here, we report a fatal case of gas gangrene involving a 76-year-old man who underwent dialysis. He died suddenly before a diagnosis could be established. Immediately after his death, postmortem computed tomography (PMCT) revealed gas accumulation in his right upper extremity and ascending aorta. Gas gangrene progresses rapidly and may sometimes result in sudden death before it is diagnosed. In this case, PMCT findings were useful to diagnose gas gangrene. Intravascular gas is a common finding on PMCT and is generally caused by cardiopulmonary resuscitation and decomposition. However, the detection of gas in the ascending aorta by PMCT was not described previously. Moreover, Gram stain and culture of the exudate showed anaerobic Gram-positive bacilli which suggested that the gas generation in the blood was caused by Clostridia species. To the best our knowledge, this is the first report of a dialysis patient whose cause of death was determined as gas gangrene using PMCT.
Collapse
|
17
|
Chandy PE, Murray N, Khasanova E, Nasir MU, Nicolaou S, Macri F. Postmortem CT in Trauma: An Overview. Can Assoc Radiol J 2020; 71:403-414. [PMID: 32174147 DOI: 10.1177/0846537120909503] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
As forensic radiology sees an exponential gain in popularity, postmortem computed tomography (PMCT) is increasingly being used in the appropriate setting, either as preautopsy guidance or as part of complementary virtual autopsy protocol. Many articles have expounded the value it adds to forensic pathology in the general setting and the appropriate technical parameters to be used for optimum benefit. We aim to put forth a concise review on the role of PMCT specifically in trauma and the pitfalls to be aware of. Reviews have shown that presumed cause of death in trauma have been proven by autopsy to be wrong in about 30% cases. Radiology applied to postmortem investigation in unnatural deaths and more specifically in trauma shares many semiotic features with emergency radiology. Therefore, in the near future, emergency radiologists might be required to integrate this type of imaging in their regular practice. Although the predominant drawbacks are time-dependent, PMCT also has some difficulty in differentiating antemortem and postmortem events. However, in many such scenarios, PMCT and autopsy play a complementary role in arriving at conclusions, and we believe understanding the benefits and role in trauma is imperative considering the expanding usage of PMCT.
Collapse
Affiliation(s)
- Poornima Elizabeth Chandy
- Emergency and Trauma Imaging Division, Department of Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nicolas Murray
- Emergency and Trauma Imaging Division, Department of Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Elina Khasanova
- Cardiothoracic Imaging Division, Department of Radiology, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Muhammad Umer Nasir
- Emergency and Trauma Imaging Division, Department of Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Savvas Nicolaou
- Emergency and Trauma Imaging Division, Department of Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Francesco Macri
- Emergency and Trauma Imaging Division, Department of Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
18
|
Hyodoh H, Matoba K, Murakami M, Saito A, Okuya N, Matoba T, Jin S. The infusion effect in postmortem lung CT. FORENSIC IMAGING 2020. [DOI: 10.1016/j.fri.2020.200367] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
19
|
Wagensveld IM, Hunink MGM, Wielopolski PA, van Kemenade FJ, Krestin GP, Blokker BM, Oosterhuis JW, Weustink AC. Hospital implementation of minimally invasive autopsy: A prospective cohort study of clinical performance and costs. PLoS One 2019; 14:e0219291. [PMID: 31310623 PMCID: PMC6634385 DOI: 10.1371/journal.pone.0219291] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 06/20/2019] [Indexed: 12/04/2022] Open
Abstract
Objectives Autopsy rates worldwide have dropped significantly over the last decades and imaging-based autopsies are increasingly used as an alternative to conventional autopsy. Our aim was to evaluate the clinical performance and cost of minimally invasive autopsy. Methods This study was part of a prospective cohort study evaluating a newly implemented minimally invasive autopsy consisting of MRI, CT, and biopsies. We calculated diagnostic yield and clinical utility—defined as the percentage successfully answered clinical questions—of minimally invasive autopsy. We performed minimally invasive autopsy in 46 deceased (30 men, 16 women; mean age 62.9±17.5, min-max: 18–91). Results Ninety-six major diagnoses were found with the minimally invasive autopsy of which 47/96 (49.0%) were new diagnoses. CT found 65/96 (67.7%) major diagnoses and MRI found 82/96 (85.4%) major diagnoses. Eighty-four clinical questions were asked in all cases. Seventy-one (84.5%) of these questions could be answered with minimally invasive autopsy. CT successfully answered 34/84 (40.5%) clinical questions; in 23/84 (27.4%) without the need for biopsies, and in 11/84 (13.0%) a biopsy was required. MRI successfully answered 60/84 (71.4%) clinical questions, in 27/84 (32.1%) without the need for biopsies, and in 33/84 (39.8%) a biopsy was required. The mean cost of a minimally invasive autopsy was €1296 including brain biopsies and €1087 without brain biopsies. Mean cost of CT was €187 and of MRI €284. Conclusions A minimally invasive autopsy, consisting of CT, MRI and CT-guided biopsies, performs well in answering clinical questions and detecting major diagnoses. However, the diagnostic yield and clinical utility were quite low for postmortem CT and MRI as standalone modalities.
Collapse
Affiliation(s)
- Ivo M. Wagensveld
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Department of Pathology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- * E-mail:
| | - M. G. Myriam Hunink
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Department of Clinical Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Centre for Health Decision Science, Harvard T.H. Chan School of Public Health, Harvard University, Boston, United States of America
| | - Piotr A. Wielopolski
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | | | - Gabriel P. Krestin
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Britt M. Blokker
- Department of Pathology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - J. Wolter Oosterhuis
- Department of Pathology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Annick C. Weustink
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Department of Pathology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| |
Collapse
|
20
|
Post-mortem computed tomography (PMCT) radiological findings and assessment in advanced decomposed bodies. Radiol Med 2019; 124:1018-1027. [PMID: 31254219 DOI: 10.1007/s11547-019-01052-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Accepted: 06/18/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE The aim of the study is to report radiological findings and features in advanced decomposed bodies obtained by post-mortem computed tomography (PMCT) with autopsy correlation. MATERIALS AND METHODS This retrospective descriptive multicentric study included 41 forensic cases examined between May 2013 and November 2016. All the bodies were PMCT-scanned prior to autopsy, and internal putrefactive state was determined using the radiological alteration index (RAI) by a radiologist with expertise in forensic radiology and a forensic pathologist trained in forensic imaging. After PMCT scans, grade of external putrefaction (GEP) was assigned during the external examination and the complete autopsy was performed by forensic pathologists. RESULTS The PMCT images evaluation revealed that the RAI index was > 61 in all bodies, corresponding to a moderate-massive presence of putrefactive gas. The gas grade was > II in correspondence of the major vessels, heart cavities, liver parenchyma, vertebra L3 and subcutaneous pectoral tissues, and varied from I to III in correspondence of the kidney. Cadaveric external examination revealed the presence of advanced transformative phenomena, with a GEP3 and GEP4 in most of the cases, with body swelling, eyes and tongue protrusion, body fluids expulsion and fat liquefaction. CONCLUSION Radiological imaging by PMCT as an adjunct to autopsy in advanced decomposed bodies represents a useful tool in detecting post-mortem gas, even in very small amounts. A correct interpretation process of the PMCT data is essential to avoid images pitfalls, due to natural decomposition that can be mistaken for pathologic processes.
Collapse
|
21
|
Takahashi N, Yajima K, Otaki M, Yoshikawa Y, Ishihara A, Sato Y, Higuchi T, Takatsuka H. Postmortem volume change of the spleen and kidney on early postmortem computed tomography: comparison with antemortem computed tomography. Jpn J Radiol 2019; 37:534-542. [PMID: 31069621 DOI: 10.1007/s11604-019-00841-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 04/22/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE To clarify an early postmortem change, we investigated the volume changes of the spleen and kidney on postmortem CT compared with antemortem CT in the same patients. MATERIALS AND METHODS We retrospectively evaluated the volumes of 56 spleens (56 cases) and 50 kidneys (25 cases) using antemortem and postmortem CT, which were performed within 168 min after death. We divided the cases of spleen analysis into a hemorrhagic group (n = 12) and a non-hemorrhagic group (n = 44). RESULTS The volumes of the organs before and after death were 101.0 ± 70.9 (cm3, mean ± standard deviation) and 81.1 ± 57.8 in spleens, 120.3 ± 49.2 and 109.2 ± 39.2 in kidneys, respectively. Both spleens and kidneys shrank after death (p < 0.05). The volumes of spleens before and after death were 111 ± 66.5 and 67.5 ± 27.7 in the hemorrhagic group, and 98.2 ± 72.5 and 84.9 ± 63.3 in the non-hemorrhagic group, respectively. The median value of the ratio of postmortem splenic volume to antemortem volume in the hemorrhagic group (65.0%) was smaller than the one in the non-hemorrhagic group (90.5%) (p < 0.05). CONCLUSION We demonstrated that spleens and kidneys significantly reduced in size after death. The rate of shrinkage of spleens in the hemorrhagic group significantly became larger than the one in the non-hemorrhagic group.
Collapse
Affiliation(s)
- Naoya Takahashi
- Department of Radiological Technology, Graduate School of Health Sciences, Niigata University, 2-746 Asahimachi-dori, Chuoku, Niigata, Niigata, 951-8518, Japan. .,Department of Diagnostic Radiology, Niigata City General Hospital, 463-7 Shumoku, Chuoku, Niigata, Niigata, 950-1197, Japan. .,Center for Cause of Death Investigation, Niigata University, 1-757 Asahimachi-dori, Chuoku, Niigata, Niigata, 951-8510, Japan.
| | - Keisuke Yajima
- Department of Radiological Technology, Graduate School of Health Sciences, Niigata University, 2-746 Asahimachi-dori, Chuoku, Niigata, Niigata, 951-8518, Japan.,Department of Radiological Technology, NTT Medical Center Tokyo, 5-9-22 Higashi-Gotanda, Shinagawa-ku, Tokyo, 141-8625, Japan
| | - Madoka Otaki
- Department of Radiological Technology, School of Health Sciences, Faculty of Medicine, Niigata University, 2-746 Asahimachi-dori, Chuoku, Niigata, Niigata, 951-8518, Japan.,Department of Radiological Technology, Niigata City General Hospital, 463-7 Shumoku, Chuoku, Niigata, Niigata, 950-1197, Japan
| | - Yurina Yoshikawa
- Department of Radiological Technology, School of Health Sciences, Faculty of Medicine, Niigata University, 2-746 Asahimachi-dori, Chuoku, Niigata, Niigata, 951-8518, Japan.,Department of Radiological Technology, St. Marianna University Yokohama City Seibu Hospital, 1197-1 Yasashicho, Asahiku, Yokohama, Kanagawa, 241-0811, Japan
| | - Ayumi Ishihara
- Department of Radiological Technology, School of Health Sciences, Faculty of Medicine, Niigata University, 2-746 Asahimachi-dori, Chuoku, Niigata, Niigata, 951-8518, Japan.,Department of Radiological Technology, University of Yamanashi Hospital, 1110, Shimokato, Chuo City, Yamanashi, 409-3898, Japan
| | - Yuki Sato
- Department of Radiological Technology, School of Health Sciences, Faculty of Medicine, Niigata University, 2-746 Asahimachi-dori, Chuoku, Niigata, Niigata, 951-8518, Japan.,Department of Radiological Technology, Fukushima Medical University Hospital, 1, Hikarigaoka, Fukushima, Fukushima, 960-1295, Japan
| | - Takeshi Higuchi
- Department of Diagnostic Radiology, Niigata City General Hospital, 463-7 Shumoku, Chuoku, Niigata, Niigata, 950-1197, Japan
| | - Hisakazu Takatsuka
- Center for Cause of Death Investigation, Niigata University, 1-757 Asahimachi-dori, Chuoku, Niigata, Niigata, 951-8510, Japan
| |
Collapse
|
22
|
Affiliation(s)
- Fumihiro Kitano
- Department of Rural Medicine, School of Medical Sciences, University of Fukui, Japan
| | - Kazuyuki Kinoshita
- Autopsy imaging Center, School of Medical Sciences, University of Fukui, Japan
- Department of Radiology, School of Medical Sciences, University of Fukui, Japan
| | - Sakon Noriki
- Department of Radiology, School of Medical Sciences, University of Fukui, Japan
- Division of Tumor Pathology, Department of Pathological Sciences, School of Medical Sciences, University of Fukui, Japan
| | - Kunihiro Inai
- Department of Radiology, School of Medical Sciences, University of Fukui, Japan
- Division of Molecular Pathology, Department of Pathological Sciences, School of Medical Sciences, University of Fukui, Japan
| |
Collapse
|
23
|
Blokker BM, Weustink AC, Wagensveld IM, von der Thüsen JH, Pezzato A, Dammers R, Bakker J, Renken NS, den Bakker MA, van Kemenade FJ, Krestin GP, Hunink MGM, Oosterhuis JW. Conventional Autopsy versus Minimally Invasive Autopsy with Postmortem MRI, CT, and CT-guided Biopsy: Comparison of Diagnostic Performance. Radiology 2018; 289:658-667. [PMID: 30251930 DOI: 10.1148/radiol.2018180924] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose To compare the diagnostic performance of minimally invasive autopsy with that of conventional autopsy. Materials and Methods For this prospective, single-center, cross-sectional study in an academic hospital, 295 of 2197 adult cadavers (mean age: 65 years [range, 18-99 years]; age range of male cadavers: 18-99 years; age range of female cadavers: 18-98 years) who died from 2012 through 2014 underwent conventional autopsy. Family consent for minimally invasive autopsy was obtained for 139 of the 295 cadavers; 99 of those 139 cadavers were included in this study. Those involved in minimally invasive autopsy and conventional autopsy were blinded to each other's findings. The minimally invasive autopsy procedure combined postmortem MRI, CT, and CT-guided biopsy of main organs and pathologic lesions. The primary outcome measure was performance of minimally invasive autopsy and conventional autopsy in establishing immediate cause of death, as compared with consensus cause of death. The secondary outcome measures were diagnostic yield of minimally invasive autopsy and conventional autopsy for all, major, and grouped major diagnoses; frequency of clinically unsuspected findings; and percentage of answered clinical questions. Results Cause of death determined with minimally invasive autopsy and conventional autopsy agreed in 91 of the 99 cadavers (92%). Agreement with consensus cause of death occurred in 96 of 99 cadavers (97%) with minimally invasive autopsy and in 94 of 99 cadavers (95%) with conventional autopsy (P = .73). All 288 grouped major diagnoses were related to consensus cause of death. Minimally invasive autopsy enabled diagnosis of 259 of them (90%) and conventional autopsy 224 (78%); 200 (69%) were found with both methods. At clinical examination, the cause of death was not suspected in 17 of the 99 cadavers (17%), and 124 of 288 grouped major diagnoses (43%) were not established. There were 219 additional clinical questions; 189 (86%) were answered with minimally invasive autopsy and 182 (83%) were answered with conventional autopsy (P = .35). Conclusion The performance of minimally invasive autopsy in the detection of cause of death was similar to that of conventional autopsy; however, minimally invasive autopsy has a higher yield of diagnoses. © RSNA, 2018 Online supplemental material is available for this article. See also the editorial by Krombach in this issue.
Collapse
Affiliation(s)
- Britt M Blokker
- From the Departments of Pathology (B.M.B., A.C.W., I.M.W., J.H.v.d.T., M.A.d.B., F.J.v.K., J.W.O.), Radiology and Nuclear Medicine (B.M.B., A.C.W., I.M.W., A.P., G.P.K., M.G.M.H., J.W.O.), Neurosurgery, Brain Tumor Center (R.D.), Intensive Care Adults (J.B.), and Clinical Epidemiology (M.G.M.H.), Erasmus MC University Medical Center, 's-Gravendijkwal 230, 3015 CE, Rotterdam, the Netherlands; Center for Health Decision Science, Harvard T. H. Chan School of Public Health, Harvard University, Boston, Mass (M.G.M.H.); Department of Pulmonary and Critical Care, Columbia University Medical Center, New York, NY (J.B.); Department of Radiology, Reinier de Graaf Gasthuis, Delft, the Netherlands (N.S.R.); and Department of Pathology, Maasstad Ziekenhuis, Rotterdam, the Netherlands (M.A.d.B.)
| | - Annick C Weustink
- From the Departments of Pathology (B.M.B., A.C.W., I.M.W., J.H.v.d.T., M.A.d.B., F.J.v.K., J.W.O.), Radiology and Nuclear Medicine (B.M.B., A.C.W., I.M.W., A.P., G.P.K., M.G.M.H., J.W.O.), Neurosurgery, Brain Tumor Center (R.D.), Intensive Care Adults (J.B.), and Clinical Epidemiology (M.G.M.H.), Erasmus MC University Medical Center, 's-Gravendijkwal 230, 3015 CE, Rotterdam, the Netherlands; Center for Health Decision Science, Harvard T. H. Chan School of Public Health, Harvard University, Boston, Mass (M.G.M.H.); Department of Pulmonary and Critical Care, Columbia University Medical Center, New York, NY (J.B.); Department of Radiology, Reinier de Graaf Gasthuis, Delft, the Netherlands (N.S.R.); and Department of Pathology, Maasstad Ziekenhuis, Rotterdam, the Netherlands (M.A.d.B.)
| | - Ivo M Wagensveld
- From the Departments of Pathology (B.M.B., A.C.W., I.M.W., J.H.v.d.T., M.A.d.B., F.J.v.K., J.W.O.), Radiology and Nuclear Medicine (B.M.B., A.C.W., I.M.W., A.P., G.P.K., M.G.M.H., J.W.O.), Neurosurgery, Brain Tumor Center (R.D.), Intensive Care Adults (J.B.), and Clinical Epidemiology (M.G.M.H.), Erasmus MC University Medical Center, 's-Gravendijkwal 230, 3015 CE, Rotterdam, the Netherlands; Center for Health Decision Science, Harvard T. H. Chan School of Public Health, Harvard University, Boston, Mass (M.G.M.H.); Department of Pulmonary and Critical Care, Columbia University Medical Center, New York, NY (J.B.); Department of Radiology, Reinier de Graaf Gasthuis, Delft, the Netherlands (N.S.R.); and Department of Pathology, Maasstad Ziekenhuis, Rotterdam, the Netherlands (M.A.d.B.)
| | - Jan H von der Thüsen
- From the Departments of Pathology (B.M.B., A.C.W., I.M.W., J.H.v.d.T., M.A.d.B., F.J.v.K., J.W.O.), Radiology and Nuclear Medicine (B.M.B., A.C.W., I.M.W., A.P., G.P.K., M.G.M.H., J.W.O.), Neurosurgery, Brain Tumor Center (R.D.), Intensive Care Adults (J.B.), and Clinical Epidemiology (M.G.M.H.), Erasmus MC University Medical Center, 's-Gravendijkwal 230, 3015 CE, Rotterdam, the Netherlands; Center for Health Decision Science, Harvard T. H. Chan School of Public Health, Harvard University, Boston, Mass (M.G.M.H.); Department of Pulmonary and Critical Care, Columbia University Medical Center, New York, NY (J.B.); Department of Radiology, Reinier de Graaf Gasthuis, Delft, the Netherlands (N.S.R.); and Department of Pathology, Maasstad Ziekenhuis, Rotterdam, the Netherlands (M.A.d.B.)
| | - Andrea Pezzato
- From the Departments of Pathology (B.M.B., A.C.W., I.M.W., J.H.v.d.T., M.A.d.B., F.J.v.K., J.W.O.), Radiology and Nuclear Medicine (B.M.B., A.C.W., I.M.W., A.P., G.P.K., M.G.M.H., J.W.O.), Neurosurgery, Brain Tumor Center (R.D.), Intensive Care Adults (J.B.), and Clinical Epidemiology (M.G.M.H.), Erasmus MC University Medical Center, 's-Gravendijkwal 230, 3015 CE, Rotterdam, the Netherlands; Center for Health Decision Science, Harvard T. H. Chan School of Public Health, Harvard University, Boston, Mass (M.G.M.H.); Department of Pulmonary and Critical Care, Columbia University Medical Center, New York, NY (J.B.); Department of Radiology, Reinier de Graaf Gasthuis, Delft, the Netherlands (N.S.R.); and Department of Pathology, Maasstad Ziekenhuis, Rotterdam, the Netherlands (M.A.d.B.)
| | - Ruben Dammers
- From the Departments of Pathology (B.M.B., A.C.W., I.M.W., J.H.v.d.T., M.A.d.B., F.J.v.K., J.W.O.), Radiology and Nuclear Medicine (B.M.B., A.C.W., I.M.W., A.P., G.P.K., M.G.M.H., J.W.O.), Neurosurgery, Brain Tumor Center (R.D.), Intensive Care Adults (J.B.), and Clinical Epidemiology (M.G.M.H.), Erasmus MC University Medical Center, 's-Gravendijkwal 230, 3015 CE, Rotterdam, the Netherlands; Center for Health Decision Science, Harvard T. H. Chan School of Public Health, Harvard University, Boston, Mass (M.G.M.H.); Department of Pulmonary and Critical Care, Columbia University Medical Center, New York, NY (J.B.); Department of Radiology, Reinier de Graaf Gasthuis, Delft, the Netherlands (N.S.R.); and Department of Pathology, Maasstad Ziekenhuis, Rotterdam, the Netherlands (M.A.d.B.)
| | - Jan Bakker
- From the Departments of Pathology (B.M.B., A.C.W., I.M.W., J.H.v.d.T., M.A.d.B., F.J.v.K., J.W.O.), Radiology and Nuclear Medicine (B.M.B., A.C.W., I.M.W., A.P., G.P.K., M.G.M.H., J.W.O.), Neurosurgery, Brain Tumor Center (R.D.), Intensive Care Adults (J.B.), and Clinical Epidemiology (M.G.M.H.), Erasmus MC University Medical Center, 's-Gravendijkwal 230, 3015 CE, Rotterdam, the Netherlands; Center for Health Decision Science, Harvard T. H. Chan School of Public Health, Harvard University, Boston, Mass (M.G.M.H.); Department of Pulmonary and Critical Care, Columbia University Medical Center, New York, NY (J.B.); Department of Radiology, Reinier de Graaf Gasthuis, Delft, the Netherlands (N.S.R.); and Department of Pathology, Maasstad Ziekenhuis, Rotterdam, the Netherlands (M.A.d.B.)
| | - Nomdo S Renken
- From the Departments of Pathology (B.M.B., A.C.W., I.M.W., J.H.v.d.T., M.A.d.B., F.J.v.K., J.W.O.), Radiology and Nuclear Medicine (B.M.B., A.C.W., I.M.W., A.P., G.P.K., M.G.M.H., J.W.O.), Neurosurgery, Brain Tumor Center (R.D.), Intensive Care Adults (J.B.), and Clinical Epidemiology (M.G.M.H.), Erasmus MC University Medical Center, 's-Gravendijkwal 230, 3015 CE, Rotterdam, the Netherlands; Center for Health Decision Science, Harvard T. H. Chan School of Public Health, Harvard University, Boston, Mass (M.G.M.H.); Department of Pulmonary and Critical Care, Columbia University Medical Center, New York, NY (J.B.); Department of Radiology, Reinier de Graaf Gasthuis, Delft, the Netherlands (N.S.R.); and Department of Pathology, Maasstad Ziekenhuis, Rotterdam, the Netherlands (M.A.d.B.)
| | - Michael A den Bakker
- From the Departments of Pathology (B.M.B., A.C.W., I.M.W., J.H.v.d.T., M.A.d.B., F.J.v.K., J.W.O.), Radiology and Nuclear Medicine (B.M.B., A.C.W., I.M.W., A.P., G.P.K., M.G.M.H., J.W.O.), Neurosurgery, Brain Tumor Center (R.D.), Intensive Care Adults (J.B.), and Clinical Epidemiology (M.G.M.H.), Erasmus MC University Medical Center, 's-Gravendijkwal 230, 3015 CE, Rotterdam, the Netherlands; Center for Health Decision Science, Harvard T. H. Chan School of Public Health, Harvard University, Boston, Mass (M.G.M.H.); Department of Pulmonary and Critical Care, Columbia University Medical Center, New York, NY (J.B.); Department of Radiology, Reinier de Graaf Gasthuis, Delft, the Netherlands (N.S.R.); and Department of Pathology, Maasstad Ziekenhuis, Rotterdam, the Netherlands (M.A.d.B.)
| | - Folkert J van Kemenade
- From the Departments of Pathology (B.M.B., A.C.W., I.M.W., J.H.v.d.T., M.A.d.B., F.J.v.K., J.W.O.), Radiology and Nuclear Medicine (B.M.B., A.C.W., I.M.W., A.P., G.P.K., M.G.M.H., J.W.O.), Neurosurgery, Brain Tumor Center (R.D.), Intensive Care Adults (J.B.), and Clinical Epidemiology (M.G.M.H.), Erasmus MC University Medical Center, 's-Gravendijkwal 230, 3015 CE, Rotterdam, the Netherlands; Center for Health Decision Science, Harvard T. H. Chan School of Public Health, Harvard University, Boston, Mass (M.G.M.H.); Department of Pulmonary and Critical Care, Columbia University Medical Center, New York, NY (J.B.); Department of Radiology, Reinier de Graaf Gasthuis, Delft, the Netherlands (N.S.R.); and Department of Pathology, Maasstad Ziekenhuis, Rotterdam, the Netherlands (M.A.d.B.)
| | - Gabriel P Krestin
- From the Departments of Pathology (B.M.B., A.C.W., I.M.W., J.H.v.d.T., M.A.d.B., F.J.v.K., J.W.O.), Radiology and Nuclear Medicine (B.M.B., A.C.W., I.M.W., A.P., G.P.K., M.G.M.H., J.W.O.), Neurosurgery, Brain Tumor Center (R.D.), Intensive Care Adults (J.B.), and Clinical Epidemiology (M.G.M.H.), Erasmus MC University Medical Center, 's-Gravendijkwal 230, 3015 CE, Rotterdam, the Netherlands; Center for Health Decision Science, Harvard T. H. Chan School of Public Health, Harvard University, Boston, Mass (M.G.M.H.); Department of Pulmonary and Critical Care, Columbia University Medical Center, New York, NY (J.B.); Department of Radiology, Reinier de Graaf Gasthuis, Delft, the Netherlands (N.S.R.); and Department of Pathology, Maasstad Ziekenhuis, Rotterdam, the Netherlands (M.A.d.B.)
| | - M G Myriam Hunink
- From the Departments of Pathology (B.M.B., A.C.W., I.M.W., J.H.v.d.T., M.A.d.B., F.J.v.K., J.W.O.), Radiology and Nuclear Medicine (B.M.B., A.C.W., I.M.W., A.P., G.P.K., M.G.M.H., J.W.O.), Neurosurgery, Brain Tumor Center (R.D.), Intensive Care Adults (J.B.), and Clinical Epidemiology (M.G.M.H.), Erasmus MC University Medical Center, 's-Gravendijkwal 230, 3015 CE, Rotterdam, the Netherlands; Center for Health Decision Science, Harvard T. H. Chan School of Public Health, Harvard University, Boston, Mass (M.G.M.H.); Department of Pulmonary and Critical Care, Columbia University Medical Center, New York, NY (J.B.); Department of Radiology, Reinier de Graaf Gasthuis, Delft, the Netherlands (N.S.R.); and Department of Pathology, Maasstad Ziekenhuis, Rotterdam, the Netherlands (M.A.d.B.)
| | - J Wolter Oosterhuis
- From the Departments of Pathology (B.M.B., A.C.W., I.M.W., J.H.v.d.T., M.A.d.B., F.J.v.K., J.W.O.), Radiology and Nuclear Medicine (B.M.B., A.C.W., I.M.W., A.P., G.P.K., M.G.M.H., J.W.O.), Neurosurgery, Brain Tumor Center (R.D.), Intensive Care Adults (J.B.), and Clinical Epidemiology (M.G.M.H.), Erasmus MC University Medical Center, 's-Gravendijkwal 230, 3015 CE, Rotterdam, the Netherlands; Center for Health Decision Science, Harvard T. H. Chan School of Public Health, Harvard University, Boston, Mass (M.G.M.H.); Department of Pulmonary and Critical Care, Columbia University Medical Center, New York, NY (J.B.); Department of Radiology, Reinier de Graaf Gasthuis, Delft, the Netherlands (N.S.R.); and Department of Pathology, Maasstad Ziekenhuis, Rotterdam, the Netherlands (M.A.d.B.)
| |
Collapse
|
24
|
Empty Delta Sign on Unenhanced Postmortem Computed Tomography Scan in Cerebral Venous Thrombosis. Am J Forensic Med Pathol 2018; 39:360-363. [PMID: 30024432 DOI: 10.1097/paf.0000000000000421] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Cerebral venous thrombosis is a rare condition which constitutes 0.5% to 2% of all types of stroke and carries a mortality of up to 20% to 50%. It leads to cerebral edema, infarction, hemorrhage and venous hypertension. Clinically the diagnosis is confirmed using enhanced computed tomography (CT) angiography which demonstrates an empty delta sign in cerebral veins, particularly in the superior sagittal sinus. However, postmortem CT (PMCT) findings on cerebral venous thrombosis have not been documented in the literature. We present a case report of a 69-year-old man who on unenhanced PMCT scan showed an empty delta sign in the cerebral veins. The empty delta sign was able to be demonstrated in unenhanced PMCT which can be explained by hyper attenuation of the dural veins at postmortem forming an internal contrast highlighting the thrombus.
Collapse
|