Skip to main content

Advertisement

SpringerLink
Log in

Evolution of post-mortem coronary imaging: from selective coronary arteriography to post-mortem CT-angiography and beyond

  • ETHICS AND FORENSIC RADIOLOGY
  • Published:
La radiologia medica Aims and scope Submit manuscript

Abstract

Since the 1970s, remarkable efforts have been made in the post-mortem coronary study, especially by angiography, as an added tool to diagnose heart-related deaths. In more recent times, post-mortem CT (PMCT) and post-mortem CT-angiography (PMCTA) have become an established practice in numerous forensic units, because of the undeniable advantages these diagnostic instruments can offer: data acquisition times are increasingly fast, costs have become lower and, once acquired, data can be re-utilized and re-evaluated at any given time. This review aims to chart the history of post-mortem cardiac imaging, highlighting its evolution both in terms of methodology and technology as well as the contribution that forensic radiology has been able to offer to forensic pathology, not as an alternative to autopsy but as a guide and aid when performing one. Finally, the latest advances in the study of cardiac deaths are explored, namely by cardiac post-mortem MRI (PMMR), able to visualize all the various stages of a myocardial infarction, post-mortem MRI-angiography (PMMRA), useful in investigating coronary artery pathology and post-mortem cardiac micro-CT, able to provide near-histological levels of myocardial, coronary and valvular detail.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Turillazzi E, Frati P, Pascale N, Pomara C, Grilli G, Viola RV, Fineschi V (2016) Multi-phase post-mortem CT-angiography: a pathologic correlation study on cardiovascular sudden death. J Geriatr Cardiol 13:855–865

    PubMed  PubMed Central  Google Scholar 

  2. 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 26:1159–1179

    Article  PubMed  Google Scholar 

  3. Priori SG, Aliot E, Blomstrom-Lundqvist C, Bossaert L, Breithardt G, Brugada P, Camm AJ, Cappato R, Cobbe SM, Di Mario C, Maron BJ, McKenna WJ, Pedersen AK, Ravens U, Schwartz PJ, Trusz-Gluza M, Vardas P, Wellens HJ, Zipes DP (2001) Task force on sudden cardiac death of the European Society of Cardiology. Eur Heart J 22:1374–1450

    Article  CAS  PubMed  Google Scholar 

  4. Basso C, Aguilera B, Banner J, Cohle S, d’Amati G, de Gouveia RH, di Gioia C, Fabre A, Gallagher PJ, Leone O, Lucena J, Mitrofanova L, Molina P, Parsons S, Rizzo S, Sheppard MN, Mier MPS, Kim Suvarna S, Thiene G, van der Wal A, Vink A, Michaud K (2017) Guidelines for autopsy investigation of sudden cardiac death: 2017 update from the Association for European Cardiovascular Pathology. Virchows Arch 6:691–705

    Article  Google Scholar 

  5. 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 64:211–217

    Article  PubMed  Google Scholar 

  6. Weustink AC, Hunink MG, van Dijke CF, Renken NS, Krestin GP, Oosterhuis JW (2009) Minimally invasive autopsy: an alternative to conventional autopsy? Radiology 250:897–904

    Article  PubMed  Google Scholar 

  7. Busardò FP, Frati P, Guglielmi G, Grilli G, Pinto A, Rotondo A, Panebianco V, Fineschi V (2015) Postmortem-computed tomography and postmortem-computed tomography-angiography: a focused update. Radiol Med 120:810–823

    Article  PubMed  Google Scholar 

  8. Saunders SL, Morgan B, Raj V, Rutty GN (2011) Post-mortem computed tomography angiography: past, present and future. Forensic Sci Med Pathol 7:271–277

    Article  PubMed  Google Scholar 

  9. Polacco M, Sedati P, Arena V, Pascali VL, Zobel BB, Oliva A, Rossi R (2015) Visualization of myocardial infarction by post-mortem single-organ coronary computed tomography: a feasibility study. Int J Legal Med 129:517–524

    Article  PubMed  Google Scholar 

  10. Luccioni R, Colonna J, Huguet JF, Ollivier H, Mosinger M (1971) Contribution of postmortem cornography to the medico-legal diagnosis of sudden deaths. Med Leg Dommage Corpor 4:3–14

    CAS  PubMed  Google Scholar 

  11. Coghill SB, Nicoll SM, McKimmie A, Houston I (1983) Revitalising post-mortem coronary angiography. J Clin Pathol 36:1406–1409

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Schultz TC (1987) Simple method for demonstrating coronary arteries at post-mortem examination. Am J Forensic Med Pathol 8:313–316

    Article  CAS  PubMed  Google Scholar 

  13. Piscitelli L, Esposito R, Vacchiano G, Romano L, Buccelli C, Romano C (1980) Valore della coronarografia post-mortem nella diagnosi di morte improvvisa da accidente cardio-vascolare. Riv It Med Leg 2:542–579

    Google Scholar 

  14. Smith M, Trummel DE, Dolz M, Cina SJ (1999) A simplified method for postmortem coronary angiography using gastrograffin. Arch Pathol Lab Med 123:885–888

    CAS  PubMed  Google Scholar 

  15. Ross SG, Bolliger SA, Ampanozi G, Oesterhelweg L, Thali MJ, Flach PM (2014) Postmortem CT angiography: capabilities and limitations in traumatic and natural causes of death. Radiographics 34:830–846

    Article  PubMed  Google Scholar 

  16. Grabherr S, Djonov V, Yen K, Thali MJ, Dirnhofer R (2007) Postmortem angiography: review of former and current methods. AJR Am J Roentgenol 188:832–838

    Article  PubMed  Google Scholar 

  17. 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 264:250–259

    Article  PubMed  Google Scholar 

  18. Robinson C, Barber J, Amoroso J, Morgan B, Rutty G (2013) Pump injector system applied to targeted post-mortem coronary artery angiography. Int J Legal Med 127:661–666

    Article  PubMed  Google Scholar 

  19. Grabherr S, Djonov V, Friess A, Thali MJ, Ranner G, Vock P, Dirnhofer R (2006) Postmortem angiography after vascular perfusion with diesel oil and a lipophilic contrast agent. AJR Am J Roentgenol 187:W515–W523

    Article  PubMed  Google Scholar 

  20. Jackowski C, Persson A, Thali MJ (2008) Whole body postmortem angiography with a high viscosity contrast agent solution using poly ethylene glycol as contrast agent dissolver. J Forensic Sci 53:465–468

    Article  PubMed  Google Scholar 

  21. Roberts IS, Benamore RE, Peebles C, Roobottom C, Traill ZC (2011) Diagnosis of coronary artery disease using minimally invasive autopsy: evaluation of a novel method of post-mortem coronary CT angiography. Clin Radiol 66:645–650

    Article  CAS  PubMed  Google Scholar 

  22. Raj V, Saunders S, Morgan B, Rutty G (2011) Post-mortem coronary CT angiography: a leicester perspective. Clin Radiol 66:897

    Article  CAS  PubMed  Google Scholar 

  23. Saunders SL, Morgan B, Raj V, Robinson CE, Rutty GN (2011) Targeted post-mortem computed tomography cardiac angiography: proof of concept. Int J Legal Med 125:609–616

    Article  PubMed  Google Scholar 

  24. Chevallier C, Doenz F, Vaucher P, Palmiere C, Dominguez A, Binaghi S, Mangin P, Grabherr S (2013) Postmortem computed tomography angiography vs. conventional autopsy: advantages and inconveniences of each method. Int J Legal Med 127:981–989

    Article  PubMed  Google Scholar 

  25. Grabherr S, Grimm J, Dominguez A, Vanhaebost J, Mangin P (2014) Advances in post-mortem CT-angiography. Br J Radiol 87:1036

    Article  Google Scholar 

  26. Grabherr S, Doenz F, Steger B, Dirnhofer R, Dominguez A, Sollberger B, Gygax E, Rizzo E, Chevallier C, Meuli R, Mangin P (2011) Multi-phase post-mortem CT angiography: development of a standardized protocol. Int J Legal Med 125:791–802

    Article  PubMed  Google Scholar 

  27. 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 379:136–142

    Article  PubMed  PubMed Central  Google Scholar 

  28. Jackowski C, Bolliger S, Aghayev E, Christe A, Kilchoer T, Aebi B, Périnat T, Dirnhofer R, Thali MJ (2006) Reduction of postmortem angiography-induced tissue edema by using polyethylene glycol as a contrast agent dissolver. J Forensic Sci 51:1134–1137

    Article  PubMed  Google Scholar 

  29. Ross S, Spendlove D, Bolliger S, Christe A, Oesterhelweg L, Grabherr S, Thali MJ, Gygax E (2008) Postmortem whole-body CT angiography: evaluation of two contrast media solutions. AJR Am J Roentgenol 190:1380–1389

    Article  PubMed  Google Scholar 

  30. Jolibert M, Cohen F, Bartoli C, Boval C, Vidal V, Gaubert JY, Moulin G, Petit P, Bartoli JM, Leonetti G, Gorincour G (2011) Postmortem CT-angiography: feasibility of US-guided vascular access. J Radiol 92:446–449

    Article  CAS  PubMed  Google Scholar 

  31. Pomara C, Bello S, Grilli G, Guglielmi G, Turillazzi E (2015) Multi-phase postmortem CT angiography (MPMCTA): a new axillary approach suitable in fatal thromboembolism. Radiol Med 120:670–673

    Article  PubMed  Google Scholar 

  32. Sakamoto N, Senoo S, Kamimura Y, Uemura K (2009) Case report: cardiopulmonary arrest on arrival case which underwent contrast-enhanced postmortem CT. J Jpn Assoc Acute Med 30:114–115

    Google Scholar 

  33. Iizuka K, Sakamoto M, Kawasaki H, Miyoshi T, Komatsuzaki A, Kikuchi S (2009) Examination of the usefulness of the contrast-enhanced post mortem CT imaging diagnosis. Innervision 24:89–92

    Google Scholar 

  34. Shao Y, Wan L, Zhang J, Li Z, Liu N, Huang P, Zou D, Chen Y (2017) Post-mortem computed tomography angiography using left ventricle cardiac puncture: a whole-body, angiographic approach. PLoS ONE 12:e0183408

    Article  PubMed  PubMed Central  Google Scholar 

  35. 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 Cardiovasc Imaging 28:1807–1822

    Article  PubMed  Google Scholar 

  36. Palmiere C, Lobrinus JA, Mangin P, Grabherr S (2013) Detection of coronary thrombosis after multi-phase postmortem CT-angiography. Leg Med (Tokyo) 15:12–18

    Article  Google Scholar 

  37. Michaud K, Grabherr S, Jackowski C, Bollmann MD, Doenz F, Mangin P (2014) Postmortem imaging of sudden cardiac death. Int J Legal Med 128:127–137

    Article  PubMed  Google Scholar 

  38. Palmiere C, Egger C, Grabherr S, Jaton-Ogay K, Greub G (2015) Postmortem angiography using femoral cannulation and postmortem microbiology. Int J Legal Med 129:861–867

    Article  PubMed  Google Scholar 

  39. Palmiere C, Grabherr S, Augsburger M (2015) Postmortem computed tomography angiography, contrast medium administration and toxicological analyses in urine. Leg Med (Tokyo) 17:157–162

    Article  CAS  Google Scholar 

  40. Apitzsch JC, Westphal S, Penzkofer T, Kuhl CK, Knüchel R, Mahnken AH (2014) The use of contrast-enhanced post mortem CT in the detection of cardiovascular deaths. PLoS ONE 9:e93101

    Article  PubMed  PubMed Central  Google Scholar 

  41. Bruguier C, Mosimann PJ, Vaucher P, Uské A, Doenz F, Jackowski C, Mangin P, Grabherr S (2013) Multi-phase postmortem CT angiography: recognizing technique-related artefacts and pitfalls. Int J Legal Med 127:639–652

    Article  CAS  PubMed  Google Scholar 

  42. Rahalkar AM, Rahalkar MD (2009) Pictorial essay: coronary artery variants and anomalies. Indian J Radiol Imaging 19:49–53

    Article  PubMed  PubMed Central  Google Scholar 

  43. Vullo A, Panebianco V, Cannavale G, Aromatario M, Cipolloni L, Frati P, Santurro A, Vullo F, Catalano C, Fineschi V (2016) Post-mortem magnetic resonance foetal imaging: a study of morphological correlation with conventional autopsy and histopathological findings. Radiol Med 121:847–856

    Article  PubMed  Google Scholar 

  44. 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 62:617–629

    Article  PubMed  Google Scholar 

  45. Ruder TD, Thali MJ, Hatch GM (2014) Essentials of forensic post-mortem MR imaging in adults. Br J Radiol 87:20130567

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  46. Ruder TD, Hatch GM, Ebert LC, Flach PM, Ross S, Ampanozi G, Thali MJ (2012) Whole body postmortem magnetic resonance angiography. J Forensic Sci 57:778–782

    Article  PubMed  Google Scholar 

  47. Fais P, Giraudo C, Viero A, Miotto D, Bortolotti F, Tagliaro F, Montisci M, Cecchetto G (2016) Micro computed tomography features of laryngeal fractures in a case of fatal manual strangulation. Leg Med (Tokyo) 18:85–89

    Article  Google Scholar 

  48. Fukutake K, Ishiwatari T, Takahashi H, Tsuchiya K, Okubo Y, Shinozaki M, Tochigi N, Wakayama M, Nemoto T, Shibuya K, Wada A (2015) Investigation of ossification in the posterior longitudinal ligament using micro-focus X-ray CT scanning and histological examination. Diagn Pathol 10:205

    Article  PubMed  PubMed Central  Google Scholar 

  49. Appleby J, Rutty GN, Hainsworth SV, Woosnam-Savage RC, Morgan B, Brough A, Earp RW, Robinson C, King TE, Morris M, Buckley R (2015) Perimortem trauma in King Richard III: a skeletal analysis. Lancet 386:253–259

    Article  Google Scholar 

  50. Bonney HE (2015) Richard III: skeletal evidence of perimortem trauma. Lancet 385:210

    Article  PubMed  Google Scholar 

  51. Kettner M, Potente S, Schulz B, Knauff P, Schmidt PH, Ramsthaler F (2014) Analysis of laryngeal fractures in decomposed bodies using microfocus computed tomography (mfCT). Forensic Sci Med Pathol 10:607–612

    Article  PubMed  Google Scholar 

  52. Thayyil S, Cleary JO, Sebire NJ, Scott RJ, Chong K, Gunny R, Owens CM, Olsen OE, Offiah AC, Parks HG, Chitty LS, Price AN, Yousry TA, Robertson NJ, Lythgoe MF, Taylor AM (2009) Postmortem examination of human fetuses: a comparison of whole body highfield. MRI at 9.4T with conventional MRI and invasive autopsy. Lancet 374:467–475

    Article  PubMed  Google Scholar 

  53. Hutchinson JC, Arthurs OJ, Ashworth MT, Ramsey AT, Mifsud W, Lombardi CM, Sebire NJ (2016) Clinical utility of postmortem microcomputed tomography of the fetal heart: diagnostic imaging vs macroscopic dissection. Ultrasound Obstet Gynecol 47:58–64

    Article  CAS  PubMed  Google Scholar 

  54. Dirnhofer R, Jackowski C, Vock P, Potter K, Thali MJ (2006) VIRTOPSY: minimally invasive, imaging-guided virtual autopsy. Radiographics 26:1305–1333

    Article  PubMed  Google Scholar 

  55. Poulsen K, Simonsen J (2007) Computed tomography as routine in connection with medico-legal autopsies. Forensic Sci Int 171:190–197

    Article  PubMed  Google Scholar 

  56. Flach PM, Gascho D, Schweitzer W, Ruder TD, Berger N, Ross SG, Thali MJ, Ampanozi G (2014) Imaging in forensic radiology: an illustrated guide for postmortem computed tomography technique and protocols. Forensic Sci Med Pathol 10:583–606

    Article  PubMed  Google Scholar 

  57. Lundström C, Persson A, Ross S, Ljung P, Lindholm S, Gyllensvärd F, Ynnerman A (2012) State-of-the-art of visualization in post-mortem imaging. APMIS 120:316–326

    Article  PubMed  Google Scholar 

  58. Bolliger SA, Thali MJ (2015) Imaging and virtual autopsy: looking back and forward. Philos Trans R Soc Lond B Biol Sci 370:1674

    Article  Google Scholar 

  59. Grabherr S, Grimm JM, Heinemann A (2016) Atlas of postmortem angiography. Springer, Switzerland

    Book  Google Scholar 

  60. Lee H, Park H, Cha JG, Lee S, Yang K (2015) Myocardial contrast defect associated with thrombotic coronary occlusion: pre-autopsy diagnosis of a cardiac death with post-mortem CT angiography. Korean J Radiol 16:1024–1028

    Article  PubMed  PubMed Central  Google Scholar 

  61. Pomara C, Fineschi V, Scalzo G, Guglielmi G (2009) Virtopsy versus digital autopsy: virtuous autopsy. Radiol Med 114:1367–1382

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy

    Emidio De Marco, Paola Frati, Raffaele La Russa, Alessandro Santurro, Matteo Scopetti & Vittorio Fineschi

  2. Department of Law, Economics, Management and Quantitative Methods, University of Sannio, Benevento, Italy

    Giuseppe Vacchiano, Paola Frati, Raffaele La Russa & Vittorio Fineschi

  3. Malzoni Clinical-Scientific Institute, Avellino, Italy

    Paola Frati, Raffaele La Russa & Vittorio Fineschi

  4. IRCCS Neuromed, Pozzilli, Italy

    Raffaele La Russa

  5. Department of Radiology, University of Foggia, Viale Luigi Pinto 1, 71100, Foggia, Italy

    Giuseppe Guglielmi

Authors
  1. Emidio De Marco
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Giuseppe Vacchiano
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Paola Frati
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Raffaele La Russa
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Alessandro Santurro
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Matteo Scopetti
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Giuseppe Guglielmi
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Vittorio Fineschi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Giuseppe Guglielmi.

Ethics declarations

Conflict of interest

The authors have no conflicts of interest to disclose.

Ethical standards

This article does not contain any studies with human participants performed by any of the authors.

Ethical approval

The present article obtained approval by Ethics Committee. All procedures involving human participants in this study have been carried out in accordance with The Code of Ethics of the Declaration of Helsinki.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

De Marco, E., Vacchiano, G., Frati, P. et al. Evolution of post-mortem coronary imaging: from selective coronary arteriography to post-mortem CT-angiography and beyond. Radiol med 123, 351–358 (2018). https://doi.org/10.1007/s11547-018-0855-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11547-018-0855-x

Keywords

Search

Navigation