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Postmortem imaging findings and cause of death determination compared with autopsy: a systematic review of diagnostic test accuracy and meta-analysis

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Abstract

Background

The aim of this study was to evaluate the sensitivity of postmortem computed tomography (PMCT), postmortem magnetic resonance imaging (PMMR) and PMCT angiography (PMCTA) compared with autopsy in cases of adult death investigations.

Methods

For this systematic review and meta-analysis, Embase, PubMed, Scopus, Web of Science and Medline were searched for eligible studies in October 2016; a follow-up literature search was conducted in March 2018. Studies referring to PMCT, PMCTA and/or PMMR of more than 3 cases with subsequent autopsy were included. Data were extracted from published texts in duplicate. The extracted outcomes were categorized as follows: soft tissue and organ findings, skeletal injuries, haemorrhages, abnormal gas accumulations and causes of death. The summary measure was sensitivity, if 3 or more studies were available. To combine studies, a random effects model was used. Variability and heterogeneity within the meta-analysis was assessed.

Results

Of 1053 studies, 66 were eligible, encompassing a total of 4213 individuals. For soft tissue and organ findings, there was a high pooled sensitivity with PMCTA (0.91, 95% CI 0.81–0.96), without evidence for between-study variability (Cochrane’s Q test p = 0.331, I2 = 24.5%). The pooled sensitivity of PMCT+PMMR was very high in skeletal injuries (0.97, CI 0.87–0.99), without evidence for variability (p = 0.857, I2 = 0.0%). In detecting haemorrhages, the pooled sensitivity for PMCT+PMMR was the highest (0.88, 95% CI 0.35–0.99), with strong evidence of heterogeneity (p < 0.05, I2 > 50%). Pooled sensitivity for the correct cause of death was the highest for PMCTA with 0.79 (95% CI 0.52–0.93), again with evidence of heterogeneity (p = 0.062, I2 > 50%).

Conclusion

Distinct postmortem imaging modalities can achieve high sensitivities for detecting various findings and causes of death. This knowledge should lead to a reasoned use of each modality. Both forensic evidence and in-hospital medical quality would be enhanced.

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References

  1. Brogdon BG (2010) Forensic radiology in historical perspective. In: MV MJT, Brogdon BG (eds) Brogdon’s forensic radiology, 2nd edn. CRC Press, Boca Raton, pp 3–7

    Chapter  Google Scholar 

  2. Thali MJ, Yen K, Schweitzer W, Vock P, Boesch C, Ozdoba C, Schroth G, Ith M, Sonnenschein M, Doernhoefer T, Scheurer E, Plattner T, Dirnhofer R (2003) Virtopsy, a new imaging horizon in forensic pathology: virtual autopsy by postmortem multislice computed tomography (MSCT) and magnetic resonance imaging (MRI) - a feasibility study. J Forensic Sci 48(2):386–403

    Article  PubMed  Google Scholar 

  3. Wichmann D, Heinemann A, Weinberg C, Vogel H, Hoepker WW, Grabherr S, Pueschel K, Kluge S (2014) Virtual autopsy with multiphase postmortem computed tomographic angiography versus traditional medical autopsy to investigate unexpected deaths of hospitalized patients: a cohort study. Ann Intern Med 160(8):534–541. https://doi.org/10.7326/M13-2211

    Article  PubMed  Google Scholar 

  4. Baglivo M, Winklhofer S, Hatch GM, Ampanozi G, Thali MJ, Ruder TD The rise of forensic and post-mortem radiology&#x2014;Analysis of the literature between the year 2000 and 2011. J Forensic Radiol Imaging 1(1):3–9. https://doi.org/10.1016/j.jofri.2012.10.003

    Article  Google Scholar 

  5. Burton EC, Mossa-Basha M (2012) To image or to autopsy? Ann Intern Med 156(2):158–159. https://doi.org/10.7326/0003-4819-156-2-201201170-00014

    Article  PubMed  Google Scholar 

  6. Morgan B, Rutty GN How does post-mortem imaging compare to autopsy, is this a relevant question? J Forensic Radiol Imaging 4:2–6. https://doi.org/10.1016/j.jofri.2015.11.003

    Article  Google Scholar 

  7. Daly B, Abboud S, Ali Z, Sliker C, Fowler D (2013) Comparison of whole-body post mortem 3D CT and autopsy evaluation in accidental blunt force traumatic death using the abbreviated injury scale classification. Forensic Sci Int 225(1–3):20–26

    Article  PubMed  Google Scholar 

  8. Kirchhoff SM, Scaparra EF, Grimm J, Scherr M, Graw M, Reiser MF, Peschel O (2016) Postmortem computed tomography (PMCT) and autopsy in deadly gunshot wounds-a comparative study. Int J Legal Med 130(3):819–826. https://doi.org/10.1007/s00414-015-1225-z

    Article  CAS  PubMed  Google Scholar 

  9. Inai K, Noriki S, Kinoshita K, Sakai T, Kimura H, Nishijima A, Iwasaki H, Naiki H (2016) Postmortem CT is more accurate than clinical diagnosis for identifying the immediate cause of death in hospitalized patients: a prospective autopsy-based study. Virchows Arch 469(1):101–109. https://doi.org/10.1007/s00428-016-1937-6

    Article  PubMed  Google Scholar 

  10. Leth PM, Struckmann H, Lauritsen J (2013) Interobserver agreement of the injury diagnoses obtained by postmortem computed tomography of traffic fatality victims and a comparison with autopsy results. Forensic Sci Int 225(1–3):15–19. https://doi.org/10.1016/j.forsciint.2012.03.028

    Article  PubMed  Google Scholar 

  11. Roberts IS, Traill ZC (2014) Minimally invasive autopsy employing post-mortem CT and targeted coronary angiography: evaluation of its application to a routine coronial service. Histopathology 64(2):211–217. https://doi.org/10.1111/his.12271

    Article  PubMed  Google Scholar 

  12. Westphal SE, Apitzsch JC, Penzkofer T, Kuhl CK, Mahnken AH, Knuchel R (2014) Contrast-enhanced postmortem computed tomography in clinical pathology: enhanced value of 20 clinical autopsies. Hum Pathol 45(9):1813–1823. https://doi.org/10.1016/j.humpath.2014.05.007

    Article  PubMed  Google Scholar 

  13. Thayyil S, Sebire NJ, Chitty LS, Wade A, Chong W, Olsen O, Gunny RS, Offiah AC, Owens CM, Saunders DE, Scott RJ, Jones R, Norman W, Addison S, Bainbridge A, Cady EB, Vita ED, Robertson NJ, Taylor AM (2013) Post-mortem MRI versus conventional autopsy in fetuses and children: a prospective validation study. Lancet 382(9888):223–233. https://doi.org/10.1016/s0140-6736(13)60134-8

    Article  PubMed  Google Scholar 

  14. Roberts IS, Benamore RE, Benbow EW, Lee SH, Harris JN, Jackson A, Mallett S, Patankar T, Peebles C, Roobottom C, Traill ZC (2012) Post-mortem imaging as an alternative to autopsy in the diagnosis of adult deaths: a validation study. Lancet 379(9811):136–142. https://doi.org/10.1016/S0140-6736(11)61483-9

    Article  PubMed  PubMed Central  Google Scholar 

  15. Ross SG, Thali MJ, Bolliger S, Germerott T, Ruder TD, Flach PM (2012) Sudden death after chest pain: feasibility of virtual autopsy with postmortem CT angiography and biopsy. Radiology 264(1):250–259. https://doi.org/10.1148/radiol.12092415

    Article  PubMed  Google Scholar 

  16. Pluchinotta FR, Porayette P, Zaidi AH, Baci J, Teot L, Sanders SP, Prabhu SP (2015) Postmortem imaging in congenital heart disease: preliminary experience. Acta Radiol 56(10):1264–1272. https://doi.org/10.1177/0284185114555047

    Article  PubMed  Google Scholar 

  17. Ampanozi G, Held U, Ruder TD, Ross SG, Schweitzer W, Fornaro J, Franckenberg S, Thali MJ, Flach PM (2016) Pulmonary thromboembolism on unenhanced postmortem computed tomography: feasibility and findings. Leg Med (Tokyo) 20:68–74. https://doi.org/10.1016/j.legalmed.2016.04.005

    Article  Google Scholar 

  18. Scholing M, Saltzherr TP, Fung Kon Jin PH, Ponsen KJ, Reitsma JB, Lameris JS, Goslings JC (2009) The value of postmortem computed tomography as an alternative for autopsy in trauma victims: a systematic review. Eur Radiol 19(10):2333–2341. https://doi.org/10.1007/s00330-009-1440-4

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Jalalzadeh H, Giannakopoulos GF, Berger FH, Fronczek J, van de Goot FR, Reijnders UJ, Zuidema WP (2015) Post-mortem imaging compared with autopsy in trauma victims--a systematic review. Forensic Sci Int 257:29–48. https://doi.org/10.1016/j.forsciint.2015.07.026

    Article  PubMed  Google Scholar 

  20. Thayyil S, Chandrasekaran M, Chitty LS, Wade A, Skordis-Worrall J, Bennett-Britton I, Cohen M, Withby E, Sebire NJ, Robertson NJ, Taylor AM (2010) Diagnostic accuracy of post-mortem magnetic resonance imaging in fetuses, children and adults: a systematic review. Eur J Radiol 75(1):e142–e148. https://doi.org/10.1016/j.ejrad.2009.10.007

    Article  PubMed  Google Scholar 

  21. Ahmad MU, Sharif KA, Qayyum H, Ehsanullah B, Balyasnikova S, Wale A, Shanmuganandan A, Siddiqui MRS, Athanasiou T, Kemp GJ (2017) Assessing the use of magnetic resonance imaging virtopsy as an alternative to autopsy: a systematic review and meta-analysis. Postgrad Med J 93(1105):671–678. https://doi.org/10.1136/postgradmedj-2017-134945

    Article  PubMed  Google Scholar 

  22. Blokker BM, Wagensveld IM, Weustink AC, Oosterhuis JW, Hunink MG (2016) Non-invasive or minimally invasive autopsy compared to conventional autopsy of suspected natural deaths in adults: a systematic review. Eur Radiol 26(4):1159–1179. https://doi.org/10.1007/s00330-015-3908-8

    Article  PubMed  Google Scholar 

  23. Moher D, Liberati A, Tetzlaff J, Altman DG, Group P (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 6(7):e1000097. https://doi.org/10.1371/journal.pmed.1000097

    Article  PubMed  PubMed Central  Google Scholar 

  24. McInnes MDF, Moher D, Thombs BD, McGrath TA, Bossuyt PM, Clifford T, Cohen JF, Deeks JJ, Gatsonis C, Hooft L, Hunt HA, Hyde CJ, Korevaar DA, Leeflang MMG, Macaskill P, Reitsma JB, Rodin R, Rutjes AWS, Salameh JP, Stevens A, Takwoingi Y, Tonelli M, Weeks L, Whiting P, Willis BH (2018) Preferred reporting items for a systematic review and meta-analysis of diagnostic test accuracy studies: the PRISMA-DTA statement. Jama 319(4):388–396. https://doi.org/10.1001/jama.2017.19163

    Article  PubMed  Google Scholar 

  25. Whiting P, Rutjes AW, Reitsma JB, Bossuyt PM, Kleijnen J (2003) The development of QUADAS: a tool for the quality assessment of studies of diagnostic accuracy included in systematic reviews. BMC Med Res Methodol 3:25. https://doi.org/10.1186/1471-2288-3-25

    Article  PubMed  PubMed Central  Google Scholar 

  26. Viechtbauer W (2007) Hypothesis tests for population heterogeneity in meta-analysis. Br J Math Stat Psychol 60:29–60. https://doi.org/10.1348/000711005x64042

    Article  PubMed  Google Scholar 

  27. Sterne JAC, Sutton AJ, Ioannidis JPA, Terrin N, Jones DR, Lau J, Carpenter J, Rucker G, Harbord RM, Schmid CH, Tetzlaff J, Deeks JJ, Peters J, Macaskill P, Schwarzer G, Duval S, Altman DG, Moher D, Higgins JPT (2011) Recommendations for examining and interpreting funnel plot asymmetry in meta-analyses of randomised controlled trials. Br Med J:343. https://doi.org/10.1136/bmj.d4002

    Article  PubMed  Google Scholar 

  28. Duval S, Tweedie R (2000) Trim and fill: a simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics 56(2):455–463. https://doi.org/10.1111/j.0006-341X.2000.00455.x

    Article  CAS  PubMed  Google Scholar 

  29. R: A language and environment for statistical computing. R Foundation for Statistical Computing (2017) https://www.R-project.org/

  30. Aghayev E, Christe A, Sonnenschein M, Yen K, Jackowski C, Thali MJ, Dirnhofer R, Vock P (2008) Postmortem imaging of blunt chest trauma using CT and MRI comparison with autopsy. J Thorac Imaging 23(1):20–27. https://doi.org/10.1097/RTI.0b013e31815c85d6

    Article  PubMed  Google Scholar 

  31. Aghayev E, Thali MJ, Jackowski C, Sonnenschein M, Dirnhofer R, Yen K (2008) MRI detects hemorrhages in the muscles of the back in hypothermia. Forensic Sci Int 176(2–3):183–186. https://doi.org/10.1016/j.forsciint.2007.08.008

    Article  PubMed  Google Scholar 

  32. Aghayev E, Yen K, Sonnenschein M, Jackowski C, Thali M, Vock P, Dirmhofer R (2005) Pneumomediastinum and soft tissue emphysema of the neck in postmortem CT and MRI; a new vital sign in hanging? Forensic Sci Int 153(2–3):181–188. https://doi.org/10.1016/j.forsciint.2004.09.124

    Article  PubMed  Google Scholar 

  33. Aghayev E, Yen K, Sonnenschein M, Ozdoba C, Thali M, Jackowski C, Dirnhofer R (2004) Virtopsy post-mortem multi-slice computed tomography (MSCT) and magnetic resonance imaging (MRI) demonstrating descending tonsillar herniation: comparison to clinical studies. Neuroradiology 46(7):559–564

    Article  PubMed  Google Scholar 

  34. Ampanozi G, Thali YA, Schweitzer W, Hatch GM, Ebert LC, Thali MJ, Ruder TD (2017) Accuracy of non-contrast PMCT for determining cause of death. Forensic Sci Med Pathol 13(3):284–292

    Article  PubMed  Google Scholar 

  35. Andenmatten MA, Thali MJ, Kneubuehl BP, Oesterhelweg L, Ross S, Spendlove D, Bolliger SA (2008) Gunshot injuries detected by post-mortem multislice computed tomography (MSCT): a feasibility study. Leg Med (Tokyo) 10(6):287–292. https://doi.org/10.1016/j.legalmed.2008.03.005

    Article  CAS  Google Scholar 

  36. Añon J, Remonda L, Spreng A, Scheurer E, Schroth G, Boesch C, Thali M, Dirnhofer R, Yen K (2008) Traumatic extra-axial hemorrhage: correlation of postmortem MSCT, MRI, and forensic-pathological findings. J Magn Reson Imaging 28(4):823–836. https://doi.org/10.1002/jmri.21495

    Article  PubMed  Google Scholar 

  37. Apitzsch JC, Westphal S, Penzkofer T, Kuhl CK, Knuchel R, Mahnken AH (2014) The use of contrast-enhanced post mortem CT in the detection of cardiovascular deaths. PLoS ONE 9(4):e93101. https://doi.org/10.1371/journal.pone.0093101

    Article  CAS  PubMed  Google Scholar 

  38. Araki A, Ishikawa N, Takami S, Ishikawa N, Amano C, Takeshita H, Maruyama R (2016) Interpretation of postmortem head computed tomography for non-traumatic in-hospital deaths by non-radiologists: a preliminary study. Springerplus 5(1):978. https://doi.org/10.1186/s40064-016-2653-z

    Article  PubMed  Google Scholar 

  39. Bakar NA, Shairi NA, Mohammad Nor MH, Zainon KA (2016) The sensitivity, specificity and predictive values of post mortem computed tomography in detecting liver and splenic injury due to road traffic accident. Med J Malaysia 71(1):1–7

    Google Scholar 

  40. Berger N, Ampanozi G, Schweitzer W, Ross SG, Gascho D, Ruder TD, Thali MJ, Flach PM (2015) Racking the brain: detection of cerebral edema on postmortem computed tomography compared with forensic autopsy. Eur J Radiol 84(4):643–651. https://doi.org/10.1016/j.ejrad.2014.12.014

    Article  PubMed  Google Scholar 

  41. Bolliger SA, Filograna L, Spendlove D, Thali MJ, Dirnhofer S, Ross S (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(5):1051–1056. https://doi.org/10.2214/AJR.10.4600

    Article  PubMed  Google Scholar 

  42. Burke MP, Bedford P, Baber Y (2014) Can forensic pathologists diagnose pulmonary thromboembolism on postmortem computed tomography pulmonary angiography? Am J Forensic Med Pathol 35(2):124–131

    Article  PubMed  Google Scholar 

  43. Carballeira Alvarez A, Mancini J, Tuchtan-Torrents L, Gach P, Bartoli C, Desfeux J, Piercecchi MD, Gorincour G (2018) Diagnostic value of unenhanced postmortem computed tomography in the detection of traumatic abdominal injuries. Diagn Interv Imaging 99:397–402. https://doi.org/10.1016/j.diii.2017.12.015

    Article  CAS  PubMed  Google Scholar 

  44. Cha JG, Kim DH, Kim DH, Paik SH, Park JS, Park SJ, Lee HK, Hong HS, Choi DL, Yang KM, Chung NE, Lee BW, Seo JS (2010) Utility of postmortem autopsy via whole-body imaging: initial observations comparing MDCT and 3.0 T MRI findings with autopsy findings. Korean J Radiol 11(4):395–406. https://doi.org/10.3348/kjr.2010.11.4.395

    Article  PubMed  PubMed Central  Google Scholar 

  45. Christe A, Ross S, Oesterhelweg L, Spendlove D, Bolliger S, Vock P, Thali MJ (2009) Abdominal trauma--sensitivity and specificity of postmortem noncontrast imaging findings compared with autopsy findings. J Trauma 66(5):1302–1307. https://doi.org/10.1097/TA.0b013e31818c1441

    Article  PubMed  Google Scholar 

  46. de Boer HH, Dedouit F, Chappex N, van der Wal AC, Michaud K (2017) Sudden aortic death-proposal for a comprehensive diagnostic approach in forensic and in clinical pathology practice. Int J Legal Med 131(6):1565–1572. https://doi.org/10.1007/s00414-017-1560-3

    Article  PubMed  Google Scholar 

  47. Donchin Y, Rivkind AI, Bar-Ziv J, Hiss J, Almog J, Drescher M, Gabram SGA (1994) Utility of postmortem computed tomography in trauma victims. J Trauma 37(4):552–556

    Article  CAS  PubMed  Google Scholar 

  48. Filograna L, Ross S, Bolliger S, Germerott T, Preiss U, Flach PM, Thali M (2011) Blood aspiration as a vital sign detected by postmortem computed tomography imaging. J Forensic Sci 56(3):630–637. https://doi.org/10.1111/j.1556-4029.2011.01704.x

    Article  PubMed  Google Scholar 

  49. Flach PM, Egli TC, Bolliger SA, Berger N, Ampanozi G, Thali MJ, Schweitzer W (2014) “Blind spots” in forensic autopsy: improved detection of retrobulbar hemorrhage and orbital lesions by postmortem computed tomography (PMCT). Leg Med (Tokyo) 16(5):274–282. https://doi.org/10.1016/j.legalmed.2014.06.003

    Article  CAS  Google Scholar 

  50. Hoey BA, Cipolla J, Grossman MD, McQuay N, Shukla PR, Stawicki SP, Stehly C, Hoff WS (2007) Postmortem computed tomography, “CATopsy”, predicts cause of death in trauma patients. J Trauma 63(5):979–985 discussion 985-976

    Article  PubMed  Google Scholar 

  51. Iwase H, Yamamoto S, Yajima D, Hayakawa M, Kobayashi K, Otsuka K, Sato K, Motani H, Kasahara S, Ito H (2009) Can cervical spine injury be correctly diagnosed by postmortem computed tomography? Leg Med (Tokyo) 11(4):168–174

    Article  Google Scholar 

  52. Jackowski C, Grabherr S, Schwendener N (2013) Pulmonary thrombembolism as cause of death on unenhanced postmortem 3T MRI. Eur Radiol 23(5):1266–1270. https://doi.org/10.1007/s00330-012-2728-3

    Article  PubMed  Google Scholar 

  53. Jackowski C, Schwendener N, Grabherr S, Persson A (2013) Post-mortem cardiac 3-T magnetic resonance imaging: visualization of sudden cardiac death? J Am Coll Cardiol 62(7):617–629. https://doi.org/10.1016/j.jacc.2013.01.089

    Article  PubMed  Google Scholar 

  54. Jackowski C, Warntjes MJ, Berge J, Bar W, Persson A (2011) Magnetic resonance imaging goes postmortem: noninvasive detection and assessment of myocardial infarction by postmortem MRI. Eur Radiol 21(1):70–78. https://doi.org/10.1007/s00330-010-1884-6

    Article  PubMed  Google Scholar 

  55. Jacobsen C, Lynnerup N (2010) Craniocerebral trauma - congruence between post-mortem computed tomography diagnoses and autopsy results. A 2-year retrospective study. Forensic Sci Int 194(1–3):9–14

    Article  PubMed  Google Scholar 

  56. Jeffery A, Raj V, Morgan B, West K, Rutty GN (2011) The criminal justice system’s considerations of so-called near-virtual autopsies: the East Midlands experience. J Clin Pathol 64(8):711–717. https://doi.org/10.1136/jclinpath-2011-200008

    Article  CAS  PubMed  Google Scholar 

  57. Kasahara S, Makino Y, Hayakawa M, Yajima D, Ito H, Iwase H (2012) Diagnosable and non-diagnosable causes of death by postmortem computed tomography: a review of 339 forensic cases. Leg Med (Tokyo) 14(5):239–245

    Article  Google Scholar 

  58. Kempter M, Ross S, Spendlove D, Flach PM, Preiss U, Thali MJ, Bolliger SA (2009) Post-mortem imaging of laryngohyoid fractures in strangulation incidents: first results. Leg Med (Tokyo) 11(6):267–271. https://doi.org/10.1016/j.legalmed.2009.07.005

    Article  CAS  Google Scholar 

  59. Le Blanc-Louvry I, Thureau S, Duval C, Papin-Lefebvre F, Thiebot J, Dacher JN, Gricourt C, Toure E, Proust B (2013) Post-mortem computed tomography compared to forensic autopsy findings: a French experience. Eur Radiol 23(7):1829–1835. https://doi.org/10.1007/s00330-013-2779-0

    Article  PubMed  Google Scholar 

  60. Leth PM (2009) Computerized tomography used as a routine procedure at postmortem investigations. Am J Forensic Med Pathol 30(3):219–222. https://doi.org/10.1097/PAF.0b013e318187e0af

    Article  PubMed  Google Scholar 

  61. Leth PM, Thomsen J (2013) Experience with post-mortem computed tomography in Southern Denmark 2006-11. J Forensic Radiol Imaging 1(4):161–166

    Article  Google Scholar 

  62. Levy AD, 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(2):522–528

    Article  PubMed  Google Scholar 

  63. Makino Y, Yokota H, Hayakawa M, Yajima D, Inokuchi G, Nakatani E, Iwase H (2014) Spinal cord injuries with normal postmortem CT findings: a pitfall of virtual autopsy for detecting traumatic death. AJR Am J Roentgenol 203(2):240–244

    Article  PubMed  Google Scholar 

  64. Michaud K, Grabherr S, Doenz F, Mangin P (2012) Evaluation of postmortem MDCT and MDCT-angiography for the investigation of sudden cardiac death related to atherosclerotic coronary artery disease. Int J Cardiovas Imag 28(7):1807–1822

    Article  Google Scholar 

  65. Mokrane FZ, Savall F, Rerolle C, Blanc A, St Martin P, Rousseau H, Rouge D, Telmon N, Dedouit F (2014) The usefulness of post-mortem CT angiography in injuries caused by falling from considerable heights: three fatal cases. Diagn Interv Imag 95(11):1085–1090. https://doi.org/10.1016/j.diii.2013.08.010

    Article  Google Scholar 

  66. Moskala A, Wozniak K, Kluza P, Romaszko K, Lopatin O (2017) Usefulness of post mortem computed tomography versus conventional forensic autopsy of road accident victims (drivers and passengers). Arch Med Sadowej Kryminol 67(2):91–103. https://doi.org/10.5114/amsik.2017.71451

    Article  PubMed  Google Scholar 

  67. Palmiere C, Lobrinus JA, Mangin P, Grabherr S (2013) Detection of coronary thrombosis after multi-phase postmortem CT-angiography. Leg Med (Tokyo) 15(1):12–18. https://doi.org/10.1016/j.legalmed.2012.08.005

    Article  Google Scholar 

  68. Paperno S, Riepert T, Krug B, Rothschild MA, Schultes A, Staak M, Lackner L (2005) Value of postmortem computed tomography in comparison to autopsy. Rofo 177(1):130–136

    Article  CAS  PubMed  Google Scholar 

  69. Patriquin L, Kassarjian A, O’Brien M, Andry C, Eustace S (2001) Postmortem whole-body magnetic resonance imaging as an adjunct to autopsy: preliminary clinical experience. J Magn Reson Imaging 13(2):277–287

    Article  CAS  PubMed  Google Scholar 

  70. Puranik R, Gray B, Lackey H, Yeates L, Parker G, Duflou J, Semsarian C (2014) Comparison of conventional autopsy and magnetic resonance imaging in determining the cause of sudden death in the young. J Cardiovasc Magn Reson 16:44. https://doi.org/10.1186/1532-429X-16-44

    Article  PubMed  Google Scholar 

  71. Roberts IS, Benbow EW, Bisset R, Jenkins JP, Lee SH, Reid H, Jackson A (2003) Accuracy of magnetic resonance imaging in determining cause of sudden death in adults: comparison with conventional autopsy. Histopathology 42(5):424–430

    Article  CAS  PubMed  Google Scholar 

  72. Ross S, Ebner L, Flach P, Brodhage R, Bolliger SA, Christe A, Thali MJ (2012) Postmortem whole-body MRI in traumatic causes of death. AJR Am J Roentgenol 199(6):1186–1192. https://doi.org/10.2214/AJR.12.8767

    Article  PubMed  Google Scholar 

  73. Scaparra E, Peschel O, Kirchhoff C, Reiser M, Kirchhoff SM (2016) Detection of blood aspiration in deadly head gunshots comparing postmortem computed tomography (PMCT) and autopsy. Eur J Med Res 21(1):43. https://doi.org/10.1186/s40001-016-0237-6

    Article  CAS  PubMed  Google Scholar 

  74. Schmitt-Sody M, Kurz S, Reiser M, Kanz KG, Kirchhoff C, Peschel O, Kirchhoff S (2016) Analysis of death in major trauma: value of prompt post mortem computed tomography (pmCT) in comparison to office hour autopsy. Scand J Trauma Resusc Emerg Med 24:38. https://doi.org/10.1186/s13049-016-0231-6

    Article  PubMed  Google Scholar 

  75. Schnider J, Thali MJ, Ross S, Oesterhelweg L, Spendlove D, Bolliger SA (2009) Injuries due to sharp trauma detected by post-mortem multislice computed tomography (MSCT): a feasibility study. Leg Med (Tokyo) 11(1):4–9. https://doi.org/10.1016/j.legalmed.2008.07.001

    Article  CAS  Google Scholar 

  76. Shirota G, Gonoi W, Ikemura M, Ishida M, Shintani Y, Abe H, Fukayama M, Higashida T, Okuma H, Abe O (2017) The pseudo-SAH sign: an imaging pitfall in postmortem computed tomography. Int J Legal Med 131(6):1647–1653. https://doi.org/10.1007/s00414-017-1651-1

    Article  PubMed  Google Scholar 

  77. Sifaoui I, Nedelcu C, Beltran G, Dupont V, Lebigot J, Gaudin A, Ridereau Zins C, Rouge Maillard C, Aube C (2017) Evaluation of unenhanced post-mortem computed tomography to detect chest injuries in violent death. Diagn Interv Imaging 98(5):393–400. https://doi.org/10.1016/j.diii.2016.08.019

    Article  CAS  PubMed  Google Scholar 

  78. Sochor MR, Trowbridge MJ, Boscak A, Maino JC, Maio RF (2008) Postmortem computed tomography as an adjunct to autopsy for analyzing fatal motor vehicle crash injuries: results of a pilot study. J Trauma 65(3):659–665. https://doi.org/10.1097/TA.0b013e3181238d66

    Article  PubMed  Google Scholar 

  79. Sonnemans LJP, Kubat B, Prokop M, Klein WM (2018) Can virtual autopsy with postmortem CT improve clinical diagnosis of cause of death? A retrospective observational cohort study in a Dutch tertiary referral centre. BMJ Open 8(3):e018834. https://doi.org/10.1136/bmjopen-2017-018834

    Article  PubMed  Google Scholar 

  80. Takahashi N, Higuchi T, Shiotani M, Hirose Y, Shibuya H, Yamanouchi 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(1):152–160. https://doi.org/10.1007/s00330-011-2248-6

    Article  PubMed  Google Scholar 

  81. Tartaglione T, Filograna L, Roiati S, Guglielmi G, Colosimo C, Bonomo L (2012) Importance of 3D-CT imaging in single-bullet cranioencephalic gunshot wounds. Radiol Med 117(3):461–470. https://doi.org/10.1007/s11547-011-0784-4

    Article  CAS  PubMed  Google Scholar 

  82. Thali MJ, Yen K, Vock P, Ozdoba C, Kneubuehl BP, Sonnenschein M, Dirnhofer R (2003) Image-guided virtual autopsy findings of gunshot victims performed with multi-slice computed tomography and magnetic resonance imaging and subsequent correlation between radiology and autopsy findings. Forensic Sci Int 138(1–3):8–16

    Article  PubMed  Google Scholar 

  83. Uhrenholt L, Boel LWT (2010) Contributions from forensic imaging to the investigation of upper cervical fractures. J Forensic Sci 55(6):1598–1602. https://doi.org/10.1111/j.1556-4029.2010.01527.x

    Article  PubMed  Google Scholar 

  84. Wagensveld IM, Blokker BM, Pezzato A, Wielopolski PA, Renken NS, von der Thusen JH, Krestin GP, Hunink MGM, Oosterhuis JW, Weustink AC (2018) Diagnostic accuracy of postmortem computed tomography, magnetic resonance imaging, and computed tomography-guided biopsies for the detection of ischaemic heart disease in a hospital setting. Eur Heart J Cardiovasc Imaging 19(7):739–748. https://doi.org/10.1093/ehjci/jey015

    Article  PubMed  Google Scholar 

  85. Westphal SE, Apitzsch J, Penzkofer T, Mahnken AH, Knuchel R (2012) Virtual CT autopsy in clinical pathology: feasibility in clinical autopsies. Virchows Arch 461(2):211–219. https://doi.org/10.1007/s00428-012-1257-4

    Article  PubMed  Google Scholar 

  86. Yen K, Sonnenschein M, Thali MJ, Ozdoba C, Weis J, Zwygart K, Aghayev E, Jackowski C, Dirnhofer R (2005) Postmortem multislice computed tomography and magnetic resonance imaging of odontoid fractures, atlantoaxial distractions and ascending medullary edema. Int J Legal Med 119(3):129–136

    Article  PubMed  Google Scholar 

  87. Zech WD, Jackowski C, Schwendener N, Brencicova E, Schuster F, Lombardo P (2016) Postmortem CT versus forensic autopsy: frequent discrepancies of tracheobronchial content findings. Int J Legal Med 130(1):191–198. https://doi.org/10.1007/s00414-015-1264-5

    Article  PubMed  Google Scholar 

  88. Moskala A, Wozniak K, Kluza P, Romaszko K, Lopatin O (2016) The importance of post-mortem computed tomography (PMCT) in confrontation with conventional forensic autopsy of victims of motorcycle accidents. Leg Med (Tokyo) 18:25–30. https://doi.org/10.1016/j.legalmed.2015.11.005

    Article  Google Scholar 

  89. Grabherr S, Heinemann A, Vogel H, Rutty G, Morgan B, Wozniak K, Dedouit F, Fischer F, Lochner S, Wittig H, Guglielmi G, Eplinius F, Michaud K, Palmiere C, Chevallier C, Mangin P, Grimm JM (2018) Postmortem CT angiography compared with autopsy: a forensic multicenter study. Radiology 288(1):270–276. https://doi.org/10.1148/radiol.2018170559

    Article  PubMed  Google Scholar 

  90. Eriksson A, Gustafsson T, Hoistad M, Hultcrantz M, Jacobson S, Mejare I, Persson A (2017) Diagnostic accuracy of postmortem imaging vs autopsy-a systematic review. Eur J Radiol 89:249–269. https://doi.org/10.1016/j.ejrad.2016.08.003

    Article  PubMed  Google Scholar 

  91. Leeflang MMG (2014) Systematic reviews and meta-analyses of diagnostic test accuracy. Clin Microbiol Infec 20(2):105–113. https://doi.org/10.1111/1469-0691.12474

    Article  CAS  Google Scholar 

  92. Sedgwick P, Marston L (2015) How to read a funnel plot in a meta-analysis. Bmj Br Med J:351. https://doi.org/10.1136/bmj.h4718

  93. Adelman A, Vasserman M, Graziani G, Kugel C, Meir K, Bdolah-Abram T, Krispin A (2018) Post-mortem computed tomography compared to medico-legal autopsy &#x2013; pathologies in the torso and limbs. J Forensic Radiol Imaging. https://doi.org/10.1016/j.jofri.2017.12.002

    Article  Google Scholar 

  94. Akobeng AK (2005) Principles of evidence based medicine. Arch Dis Child 90(8):837–840

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

The authors express their gratitude to Emma Louise Kessler, MD, for her generous donation to the Zurich Institute of Forensic Medicine, University of Zurich, Switzerland. They also express their thankfulness to Martina Gosteli, information specialist at the Main Library of the University Zurich, Switzerland, for the professional literature research.

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Authors and Affiliations

  1. Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, 8057, Zurich, Switzerland

    Garyfalia Ampanozi, Delaja Halbheer, Lars C. Ebert & Michael J. Thali

  2. Horten Centre, University of Zurich, Pestalozzistrasse 24, 8091, Zurich, Switzerland

    Ulrike Held

  3. Epidemiology, Biostatistics and Prevention Institute, Department of Biostatistics, University of Zurich, Hirschengraben 84, 8001, Zurich, Switzerland

    Ulrike Held

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  1. Garyfalia Ampanozi
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  4. Michael J. Thali
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  5. Ulrike Held
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Contributions

GA and DH selected the studies and extracted the data. UH performed the statistical analysis. GA and UH wrote the first draft of the manuscript. All authors (GA, DH, LE, MT, UH) contributed to writing the manuscript and approved its final version.

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Correspondence to Garyfalia Ampanozi.

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Ampanozi, G., Halbheer, D., Ebert, L.C. et al. Postmortem imaging findings and cause of death determination compared with autopsy: a systematic review of diagnostic test accuracy and meta-analysis. Int J Legal Med 134, 321–337 (2020). https://doi.org/10.1007/s00414-019-02140-y

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