Postmortem Angiography After Vascular Perfusion with Diesel Oil and a Lipophilic Contrast Agent

Grabherr, Silke; Djonov, Valentin; Frieß, A. E.; Thali, Michael J.; Ranner, G.; Vock, Peter; Dirnhofer, Richard

doi:10.2214/ajr.05.1394

Cited by 90 publications

(92 citation statements)

References 15 publications

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“…A recently developed pressure-controlled perfusion device (Virtangio Ò , Fumedica AG, Maquet Ò , Muri, Switzerland) was used to inject a mixture of contrast agent (Angiofil Ò , Fumedica AG, Muri, Switzerland) and paraffin oil (liquid paraffin obtained from the local pharmacy) according to the protocol proposed by Grabherr et al [16]. This oily contrast has an appropriated viscosity for the perfusion of human bodies [19], allowing for optimal perfusion conditions for high-resolution The radiological interpretations of all images were performed by both a board certified radiologist specialized in vascular radiology and a board certified forensic pathologist trained in forensic imaging. They were both blinded to the autopsy results.…”

Section: Radiological Examination and Interpretationmentioning

confidence: 99%

Evaluation of postmortem MDCT and MDCT-angiography for the investigation of sudden cardiac death related to atherosclerotic coronary artery disease

Michaud

Grabherr

Doenz

et al. 2012

Int J Cardiovasc Imaging

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101

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The goal of this study was to evaluate the diagnostic value of postmortem multi-computed tomography (MDCT) and MDCT-angiography for sudden cardiac deaths related to ischemic heart disease. Twenty three cases were selected based on clinical history and the results of native MDCT, multiphase post-mortem CT-angiography and conventional autopsy were compared. Radiological examination showed calcification of coronary arteries in 78% of the cases, most of which were not detailed at autopsy. MDCT-angiography allowed better visualization of the coronary arteries than MDCT and permitted the evaluation of stenoses and occlusions. Of the 14 cases of coronary thrombosis detected at conventional autopsy, 11 were visible as stop of perfusion with CT-angiography and three were found to be partly perfused. One case had an old thrombosis with collateral circulation. One case had a coronary artery postmortem clot found with MDCT-angiography. Coronary artery calcifications are more easily detected and documented with radiological examination than with conventional autopsy. MDCT is of limited diagnostic value for ischemic heart disease. MDCT-angiography, when correctly interpreted, is a reasonable tool to view the morphology of coronary arteries, rule out significant coronary artery stenoses, identify occlusions and direct sampling for histological examination.

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Section: Radiological Examination and Interpretationmentioning

confidence: 99%

Evaluation of postmortem MDCT and MDCT-angiography for the investigation of sudden cardiac death related to atherosclerotic coronary artery disease

Michaud

Grabherr

Doenz

et al. 2012

Int J Cardiovasc Imaging

Self Cite

101

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“…30 A first feasibility study, performed on an animal model, showed the success of the concept in using diesel oil as a perfusate and a roller pump as a perfusion device. 31 Multiple imaging at defined intervals permitted a dynamic visualization of the arterial, parenchymal and venous systems. This technique was later on adapted on a human model by changing the perfusion liquid and the injection technique.…”

Section: Post-mortem Angiography Goes Forensic Imaging-introduction Omentioning

confidence: 99%

Advances in post-mortem CT-angiography

Grabherr¹,

Grimm²,

Domínguez³

et al. 2014

BJR

119

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Performing a post-mortem multidetector CT (MDCT) scan has already become routine in some institutes of forensic medicine. To better visualize the vascular system, different techniques of post-mortem CT-angiography have been explored, which can essentially be divided into partial-and whole-body angiography techniques. Probably the most frequently applied technique today is the so-called multiphase post-mortem CT-angiography (MPMCTA) a standardized method for investigating the vessels of the head, thorax and abdomen. Different studies exist, describing its use for medicolegal investigations, and its advantages as well as its artefacts and pitfalls. With the aim to investigate the performance of PMCTA and to develop and validate techniques, an international working group was created in 2012 called the "Technical Working Group Post-mortem Angiography Methods" (TWGPAM). Beyond its primary perspective, the goals of this group include creating recommendations for the indication of the investigation and for the interpretation of the images and to distribute knowledge about PMCTA. This article provides an overview about the different approaches that have been developed and tested in recent years and an update about ongoing research in this field. It will explain the technique of MPMCTA in detail and give an outline of its indications, application, advantages and limitations.

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“…It is yellowish, nearly odourless and stable under normal conditions (room temperature). The advantages of using oily liquids for the injection into vessels are well known and have been described in a previous article [40] that stated that combining an oily perfusate with a lipophilic contrast agent allows postmortem circulation to be established and the performance of subsequent high-resolution angiography to be carried out. Microscopic studies reported in the same article revealed that the oil may block the capillary region due to fatty embolism, which is especially vulnerable to postmortem permeability.…”

Section: Discussionmentioning

confidence: 99%

“…In order to perfuse a human body, paraffinum liquidum has proven to be the most appropriate [2]. The use of the more viscous paraffinum perliquidum however, may lead to significant extravasations, especially in regions with high autolytic activities such as the pancreas and gastric mucosa [40,42]. By diluting Angiofil Ò with a solvent such as decane, its viscosity can be decreased so as to enter the capillar-ies and become a contrast agent used in microangiography [43].By using Angiofil Ò together with paraffinum liquidum as solvent, as proposed according to the standardized protocol of PMCTA, the kinematic viscosity of the mixture is around 67-74 mm 2 /s (measured at 40 °C).…”

Section: Discussionmentioning

confidence: 99%

Postmortem biochemistry performed on vitreous humor after postmortem CT-angiography

et al. 2012

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a b s t r a c tPostmortem angiography is becoming increasingly essential in forensic pathology as an adjunct to con-ventional autopsy. Despite the numerous advantages of this technique, some questions have been raised regarding the influence of the contrast agent injected on the results of toxicological and biochemical anal-yses. The aim of this study was to investigate the effect of the injection of the contrast agent Angiofil Ò , mixed with paraffin oil, on the results of postmortem biochemical investigations performed on vitreous humor. Postmortem biochemical investigations were performed on vitreous samples collected from bodies that had undergone postmortem angiography (n = 50) and from a control group (n = 50). Two vit-reous samples were analyzed for each group and the results compared. Glucose, urea, creatinine, 3-b-hydroxybutyrate, sodium and chloride were tested. Different values were observed between the first and second samples in each group. However, these differences were not clinically relevant, suggesting that the injection of this contrast agent mixture does not modify the concentration of the analyzed sub-stances in the vitreous humor.

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Postmortem Angiography After Vascular Perfusion with Diesel Oil and a Lipophilic Contrast Agent

Abstract: After establishing a postmortem circulation by diesel oil perfusion, angiography can be performed by injection of Lipiodol Ultra Fluide. The resolution of the images obtained up to 3 days after death is comparable to that achieved in clinical angiography.

Cited by 90 publications

References 15 publications

Evaluation of postmortem MDCT and MDCT-angiography for the investigation of sudden cardiac death related to atherosclerotic coronary artery disease

Evaluation of postmortem MDCT and MDCT-angiography for the investigation of sudden cardiac death related to atherosclerotic coronary artery disease

Advances in post-mortem CT-angiography

Postmortem biochemistry performed on vitreous humor after postmortem CT-angiography

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