Application of postmortem imaging modalities in cases of sudden death due to cardiovascular diseases–current achievements and limitations from a pathology perspective

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.

Improving Traditional Post Mortem Healthcare—The Cross-Sectional Use of Blood-Based Biomarkers

“…The interview takes place within a short time of death; these data include symptoms, signs, and circumstances prior to death [48]. In settings where most deaths are otherwise undocumented, which typically means in low- While the cost of electronic data systems and the long wait between data collection and analysis appear to be the main disadvantages of verbal autopsies, post mortem imaging is hampered by a lack of direct visualization of the soft tissue, as well as postmortem artifacts that obscure the natural causes of death and can be misinterpreted as antemortem pathologies [40,43]. However, VA has been preferred recently in the COVID-19-related pandemic context, with a satisfying effect [44].…”

“…Accordingly, another accessible and recently developed modality of postmortem healthcare is a radiographic examination of the body after death-postmortem radiology. As much as they provide a strong complementary tool to the TA, imaging techniques used in everyday clinical work are applied to post mortem processing [43]. In cases where forensic radiology plays a primary ancillary role in the post mortem, this directs forensic pathologists to specific screening tests [52,53].…”

Postmortem magnetic resonance imaging findings of tricuspid atresia with ventricular and atrial septal defects and subvalvular pulmonic stenosis in a Japanese native Noma horse

“…However, in veterinary medicine, cardiac MRI can be challenging due to anesthesia-induced immobilization and variations in animal body size. Postmortem imaging has garnered attention in human forensic medicine for aiding the diagnosis of sudden death by visualizing cardiovascular abnormalities [ 1 , 3 , 13 ]. This report describes a postmortem MRI performed on the heart of a Noma horse foal that died suddenly.…”

“…In this case, the morphological structure of the cardiac malformation could be understood in 3D by postmortem MRI. Postmortem imaging, particularly MRI, has emerged as a useful adjunct tool to autopsies in cardiac evaluation [ 1 , 3 , 13 , 17 , 19 ]. This technique has the potential to contribute significantly to veterinary medicine research and knowledge advancement.…”