Assessment of Myocardial Ischemia Using Coronary Postmortem Computed Tomography Angiography Based on the Voronoi Algorithm: A Case Report

Abstract

Postmortem computed tomography angiography (PMCTA) is a valuable tool for diagnosing vascular conditions, such as hemorrhages, in trauma cases. This case report demonstrates the use of the Voronoi algorithm to assess myocardial ischemia using coronary PMCTA. A male in his 70s was found unconscious in a car after colliding with a traffic light pole. Despite medical interventions, including pericardial drainage and cardiopulmonary resuscitation, the patient died two hours later. PMCTA revealed significant filling defects in the left anterior descending artery (LAD), consistent with plaque rupture and narrowing observed during autopsy. The cause of death in this case was likely cardiac tamponade due to cardiac rupture secondary to myocardial infarction resulting from LAD stenosis. Cardiac perfusion areas were analyzed using the Voronoi algorithm, demonstrating a total myocardial volume of 151.9 mL in the left ventricle. Perfusion volumes were calculated as 92.9 mL (61.2%) for the LAD, 34.2 mL (22.5%) for the left circumflex artery, and 24.9 mL (16.4%) for the right coronary artery. The predicted ischemic volume distal to the LAD stenosis was estimated to be 49.8 mL (32.8%). Furthermore, the ischemic areas observed during autopsy macroscopically corresponded well with the predicted ischemic regions. This case highlights that combining PMCTA with the Voronoi algorithm provides an accurate method for assessing myocardial ischemic areas, offering a non-invasive approach to visualize and quantify perfusion and ischemic regions.