Abstract
Objectives
The principal aim of our study was to establish concordance between post-mortem CT (PMCT) and forensic standard autopsy (SA) in detecting lesions according to different anatomical regions. A secondary aim was to determine the efficacy of PMCT in showing lethal lesions.
Methods
PMCTs were compared with autopsies in 236 cadavers in different contexts of death. PMCT findings were assessed by two independent radiologists.
Results
Concordance between PMCT and autopsy was almost perfect in showing skull, basal skull and hyoid bone fractures as well as in detecting facial, vertebral or pelvic fractures. Both examinations were discordant in demonstrating some intracranial injuries, vascular or organ wounds (more findings showed by autopsy), as well in showing free air in anatomical cavities (more findings detected by PMCT). Moreover, PMCT was effective in determining lethal lesions in the context of craniofacial trauma or after a gunshot wound. Concordance between the findings of the two radiologists was almost perfect for each type of lesion.
Conclusion
PMCT could be considered as effective as SA in determining the cause of death in certain traumatic events. It was also effective in showing lethal lesions and could be a useful tool in reducing the number of SA.
Key Points
• Post-mortem CT is increasingly performed as an alternative/adjunct to formal autopsy.
• More modern CT systems provide greater anatomical scope.
• PMCT can usually determine the cause of most deaths following trauma.
• Prospective studies are still required to establish an algorithm for forensic CT.
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References
Poulsen K, Somonsen J (2007) Computed tomography as routine in connection with medico-legal autopsy. Forensic Sci Int 171:190–197
Roberts ISD, Benamore RE, Benbow EW, Lee S, Harris JN, Jackson A, Mallett S, Patankar T, Pebbles C, Roobottom C, Traill Z (2011) Postmortem imaging as an alternative to autopsy in the diagnosis of adult deaths: a validation study. Lancet 22:1–7
Levy G, Goldstein L, Blachar A, Apter S, Barenboim E, Bar-Dayan Y, Shamais A, Atar E (2007) Postmortem computed tomography in victims of military air mishaps: radiological-pathological correlation of CT findings. Isr Med Assoc J 9:699–702
Ljung P, Winskog C, Perssen A, Lundström C, Ynnerman A (2006) Full body virtual autopsies using a state-of-the-art volume rendering pipeline. IEEE Trans Vis Comput Graph 12:869–887
O’Donnell C, Rotman A, Collett S, Woodford N (2007) Current status of routine postmortem CT in Melbourne, Australia. Forensic Int Sci Med Pathol 3:226–232
Thali MJ, Jackowski C, Oesterhelweg L, Ross SG, Dirnhofer R (2007) VIRTOPSY - the Swiss virtual autopsy approach. Leg Me 9:100–104
Scholing M et al (2009) The value of postmortem computed tomography as an alternative for autopsy in trauma victims: a systematic review. Eur Radiol 19:2333–2341
Saukko P, Knight B (2004) The pathophysiology of death. In: Knight’s forensic pathology, 3rd edn. Oxford University Press, New York, pp 52–97
Landis GR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174
Yen K, Lovblad KO, Scheurer E, Ozdoba C, Thali MJ, Aghayev E, Jackowski C, Anon J, Frickey N, Zwygart K, Weis J, Dirnhofer R (2007) Post-mortem forensic neuroimaging: correlation of MSCT and MRI findings with autopsy results. Forensic Sci Int 173:21–35
Bolliger SA, Thali MJ, Ross S, Buck U, Naether S, Vock P (2010) Postmortem imaging-guided biopsy as an adjuvant to minimally invasive autopsy with CT and postmortem angiography: a feasibility study. AJR Am J Roentgenol 195:1051–1056
Hong TS, Reyes JA, Moineddin R, Chiasson DA, Berdon WE, Babyn PS (2011) Value of postmortem thoracic CT over radiography in imaging of pediatric rib fractures. Pediatr Radiol 41:736–748
Oberladstaetter D, Braun P, Freund MC, Rabl W, Paal P, Baubin M (2012) Autopsy is more sensitive than computed tomography in detection of LUCAS-CPR related non-dislocated chest fractures. Resuscitation 83:89–90
Jeffery AJ (2010) The role of computed tomography in adult postmortem examinations: an overview. Diagn Histopathol 16:546–551
Yen K, Thali MJ, Aghayev E, Jackowski C, Schweitzer W, Boesch C, Vock P, Dirnhofer R, Sonnenschein M (2005) Strangulation signs: initial correlation of MRI, MSCT, and forensic neck findings. J Magn Reson Imaging 22:501–551
Levy AD, Harcke HT, Mallak CT (2010) Postmortem imaging: MDCT features of postmortem change and decomposition. Am Forensic Med Pathol 31:12–17
Jackowski C, Schweitzer W, Thali M, Yen K, Aghayev E, Sonnenschein M, Vock P, Dirnhofer R (2005) Virtopsy: post-mortem imaging of the human heart in situ using MSCT and MRI. Forensic Sci Int 149:11–23
Grabherr S, Doenz F, Steger B, Dirnhoher R, Dominguez A, Sollberger B, Gygax E, Rizzo E, Chevallier C, Meuli R, Mangin P (2012) Multi-phase post-mortem CT angiography: development of a standardized protocol. Int J Legal Med 25:791–802
Weustink AC, Hunink MGM, van Dijke CF, Renken NS, Krestin GP, Oosterhuis JW (2009) Minimally invasive autopsy: an alternative to conventional autopsy? Radiology 250:897–904
Levy G, Abbott RM, Mallak CT, Getz JM, Harcke HT, Champion HR, Pearse LA (2006) Virtual autopsy: preliminary experience in high-velocity gunshot wound victims. Radiology 240:522–528
Takahashi N, Higuchi T, Shiotani M, Hirose Y, Shibuya H, Yamammouchi H, Hashidate H, Funayama K (2012) The effectiveness of postmortem multidetector computed tomography in the detection of fatal findings related to cause of non-traumatic death in the emergency department. Eur Radiol 22:152–160
Wichmann D, Obbelode F, Vogel H, Hoepker WW, Nierhaus A, Braune S, Suater G, Pueschel K, Kluge S (2012) Virtual autopsy as an alternative to traditional medical autopsy in the intensive care unit: a prospective cohort study. Ann Intern Med 156:123–130
Levy AD, Harcke HT, Getz JM, Mallak CT, Curaso JL, Pearse L, Frasier AA, Galvin JR (2007) Virtual autopsy: two- and three-dimensional multidetector CT findings in drowning with autopsy comparison. Radiology 243:62–68
DiMaio VJ, DiMaio D (2001) Death by drowning. In: Forensic pathology, 2nd edn. CRC, New York, pp 416–422
Thali MJ, Yen K, Plattner T, Schweitzer W, Vock P, Ozdoba C, Dirnhofer R (2002) Charred body: virtual autopsy with multi-slice computed tomography and magnetic resonance imaging. J Forensic Sci 47:1326–1331
Acknowledgments
The authors are most grateful to Richard Medeiros, Rouen University Hospital Medical Editor, for his valuable editing of the manuscript.
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Le Blanc-Louvry, I., Thureau, S., Duval, C. et al. Post-mortem computed tomography compared to forensic autopsy findings: a French experience. Eur Radiol 23, 1829–1835 (2013). https://doi.org/10.1007/s00330-013-2779-0
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DOI: https://doi.org/10.1007/s00330-013-2779-0