State of the Art on the Role of Postmortem Computed Tomography Angiography and Magnetic Resonance Imaging in the Diagnosis of Cardiac Causes of Death: A Narrative Review

Abstract

The need of a minimally invasive approach, especially in cases of cultural or religious oppositions to the internal examination of the body, has led over the years to the introduction of postmortem CT (PMCT) methodologies within forensic investigations for the comprehension of the cause of death in selected cases (e.g., traumatic deaths, acute hemorrhages, etc.), as well as for personal identification. The impossibility to yield clear information concerning the coronary arteries due to the lack of an active circulation to adequately distribute contrast agents has been subsequently overcome by the introduction of coronary-targeted PMCT Angiography (PMCTA), which has revealed useful in the detection of stenoses related to calcifications and/or atherosclerotic plaques, as well as in the suspicion of thrombosis. In parallel, due to the best ability to study the soft tissues, cardiac postmortem MR (PMMR) methodologies have been further implemented, which proved suitable for the detection and aging of infarcted areas, and for cardiomyopathies. Hence, the purpose of the present work to shed light on the state of the art concerning the value of both coronary-targeted PMCTA and PMMR in the diagnosis of coronary artery disease and/or myocardial infarction as causes of death, further evaluating their suitability as alternatives or complementary approaches to standard autopsy and histologic investigations.

Morphological and Genetic Aspects for Post-Mortem Diagnosis of Hypertrophic Cardiomyopathy: A Systematic Review

“…Cardiac imaging using PMCT and PMMR, as also recognized by the Association for European Cardiovascular Pathology, can have an added value in contributing to the diagnosis of sudden cardiac death due to HCM [2,86]. A study analyzing cases of SCD underlined the usefulness of PMCT angiography, which can provide data suggesting the presence of HCM such as the left ventricular hypertrophy and the asymmetrical septal hypertrophy associated with hypervascularity in the upper portion of the septum [27].…”

Arrhythmogenic Right Ventricular Cardiomyopathy Post-Mortem Assessment: A Systematic Review

“…Furthermore, although in absence of movement artefacts, it is possible to find traits attributable to post-mortem transformative phenomena, such as putrefaction or due to the variation in body temperature [ 26 ]. The post-mortem radiological diagnosis of cardiomyopathies makes use of PMCT, PMCTA and PMMRI, although their application is still highly debated [ 27 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 ].…”

Bleeding-Source Exploration in Subdural Hematoma: Observational Study on the Usefulness of Postmortem Computed Tomography Angiography

“…This limits the application of PMCT in the diagnosis of spontaneous death, particularly coronary artery ischemic disease [ 1 , 3 , 4 , 5 , 6 , 7 ]. To overcome this limitation, PMCT angiography (PMCTA) has been introduced [ 8 ].…”