Abstract:Multiphase postmortem computed tomography angiography is a useful tool in the postmortem setting for investigating ischemically damaged myocardium.
“…In cases of gunshots, the path of the bullet through soft tissues and organs is highlighted by the extravasating contrast agent and can be easily shown to the court and understood by non-medical workers, while the exact location of projectiles is already documented by non-contrast PMCT. In cases of cardiovascular death, MPMCTA not only allows analysis of the coronary arteries but also provides more detailed information about the myocardium, accumulating in infarcted myocardium [ 59 ], guiding the autopsy and histological sampling [ 54 ]. Figure 2.…”
Section: The Methodsmentioning
confidence: 99%
“…PMMR is subject to artefacts, some specific to PMMR [ 59 ]. Vascular stasis and, in particular, venous stasis may mimic haemorrhage on T2-weighted sequences.…”
Modern post-mortem investigations use an increasing number of digital imaging methods, which can be collected under the term “post-mortem imaging”. Most methods of forensic imaging are from the radiology field and are therefore techniques that show the interior of the body with technologies such as X-ray or magnetic resonance imaging. To digitally image the surface of the body, other techniques are regularly applied, e.g. three-dimensional (3D) surface scanning (3DSS) or photogrammetry. Today's most frequently used techniques include post-mortem computed tomography (PMCT), post-mortem magnetic resonance imaging (PMMR), post-mortem computed tomographic angiography (PMCTA) and 3DSS or photogrammetry. Each of these methods has specific advantages and limitations. Therefore, the indications for using each method are different. While PMCT gives a rapid overview of the interior of the body and depicts the skeletal system and radiopaque foreign bodies, PMMR allows investigation of soft tissues and parenchymal organs. PMCTA is the method of choice for viewing the vascular system and detecting sources of bleeding. However, none of those radiological methods allow a detailed digital view of the body's surface, which makes 3DSS the best choice for such a purpose. If 3D surface scanners are not available, photogrammetry is an alternative. This review article gives an overview of different imaging techniques and explains their applications, advantages and limitations. We hope it will improve understanding of the methods.
“…In cases of gunshots, the path of the bullet through soft tissues and organs is highlighted by the extravasating contrast agent and can be easily shown to the court and understood by non-medical workers, while the exact location of projectiles is already documented by non-contrast PMCT. In cases of cardiovascular death, MPMCTA not only allows analysis of the coronary arteries but also provides more detailed information about the myocardium, accumulating in infarcted myocardium [ 59 ], guiding the autopsy and histological sampling [ 54 ]. Figure 2.…”
Section: The Methodsmentioning
confidence: 99%
“…PMMR is subject to artefacts, some specific to PMMR [ 59 ]. Vascular stasis and, in particular, venous stasis may mimic haemorrhage on T2-weighted sequences.…”
Modern post-mortem investigations use an increasing number of digital imaging methods, which can be collected under the term “post-mortem imaging”. Most methods of forensic imaging are from the radiology field and are therefore techniques that show the interior of the body with technologies such as X-ray or magnetic resonance imaging. To digitally image the surface of the body, other techniques are regularly applied, e.g. three-dimensional (3D) surface scanning (3DSS) or photogrammetry. Today's most frequently used techniques include post-mortem computed tomography (PMCT), post-mortem magnetic resonance imaging (PMMR), post-mortem computed tomographic angiography (PMCTA) and 3DSS or photogrammetry. Each of these methods has specific advantages and limitations. Therefore, the indications for using each method are different. While PMCT gives a rapid overview of the interior of the body and depicts the skeletal system and radiopaque foreign bodies, PMMR allows investigation of soft tissues and parenchymal organs. PMCTA is the method of choice for viewing the vascular system and detecting sources of bleeding. However, none of those radiological methods allow a detailed digital view of the body's surface, which makes 3DSS the best choice for such a purpose. If 3D surface scanners are not available, photogrammetry is an alternative. This review article gives an overview of different imaging techniques and explains their applications, advantages and limitations. We hope it will improve understanding of the methods.
“…Vascular occlusions in cases of myocardium infarction can be detected with high diagnostic confidence. Besides the analysis of coronary arteries, it has also proved useful for the detection of myocardium infarctions [ 20 ]. Pathologic enhancement of the myocardium (mean Hounsfield Units ≥ 95) is thought to be an indirect sign of a myocardial lesion if the technique of MPMCTA is applied and the certain contrast medium is used [ 12 ].…”
Targeted post-mortem computed tomography (PMCT) combined with coronary angiography has the potential to play a significant role in the investigation of sudden cardiac death. The authors utilized a targeted PMCT coronary angiography in a case involving a 53-year-old man who died from acute myocardial ischemia and cardiac decompensation which may result from coronary artery disease (CAD). The victim collapsed suddenly at work and died soon after arrival to hospital. The body was examined using PMCT and targeted PMCT coronary angiography. The left anterior descending coronary artery exhibited 75%–100% stenosis in the middle segment; however, the distal segment could not be clearly visualized. In addition, the left circumflex and right coronary artery exhibited calcification, atherosclerosis and an area of 50% stenosis. Signs of cardiogenic pulmonary oedema were also identified. The imaging results suggested that this individual had coronary atherosclerosis and probably died from CAD. The autopsy and histological examination revealed acute myocardial ischemia and myocardial scarring, confirming the cause of death while excluding other probabilities. In summary, targeted post-mortem computed tomography angiography (PMCTA) can visualize the arteries and estimate the degree of principal pathological changes. This method is a simple, reliable and sensitive technique for identifying the presence of coronary atherosclerosis. It is a valuable post-mortem forensic imaging method and should be recommended in the investigation of suspicious cardiac deaths.
“…Unenhanced PMCT is known to have a low diagnostic value for the detection of myocardial infarction, but PMCTA, namely MPMCTA, has recently been shown to be able to detect infarcted areas as regions of increased signal. In this sense, MPMCTA could help to identify affected regions for guiding and improving the sampling for microscopic examination [4,5,63,64]. However, few studies have been performed on the diagnostic value of MPMCTA for myocardial infarction/ischemia; therefore, further and larger investigations are needed before introducing it for this purpose as a routine procedure.…”
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 heart At present, postmortem imaging methods are considered as less accurate than the autopsy for cardiac deaths Postmortem imaging is useful as a complementary tool for cardiac deaths There is still a need to validate postmortem imaging in cardiac deaths by comparing with autopsy findings ARTICLE HISTORY
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