European Radiology

, Volume 23, Issue 7, pp 1829–1835

Post-mortem computed tomography compared to forensic autopsy findings: a French experience

  • Isabelle Le Blanc-Louvry
  • Sophie Thureau
  • Cathia Duval
  • Frédérique Papin-Lefebvre
  • Jacques Thiebot
  • Jean Nicolas Dacher
  • Cyril Gricourt
  • Emmanuel Touré
  • Bernard Proust
Computed Tomography

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.

Keywords

Post-mortem CT Autopsy Cause of death Prospective studies Diagnostic tool 

References

  1. 1.
    Poulsen K, Somonsen J (2007) Computed tomography as routine in connection with medico-legal autopsy. Forensic Sci Int 171:190–197CrossRefPubMedGoogle Scholar
  2. 2.
    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 22:1–7Google Scholar
  3. 3.
    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 9:699–702PubMedGoogle Scholar
  4. 4.
    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 12:869–887CrossRefPubMedGoogle Scholar
  5. 5.
    O’Donnell C, Rotman A, Collett S, Woodford N (2007) Current status of routine postmortem CT in Melbourne, Australia. Forensic Int Sci Med Pathol 3:226–232CrossRefGoogle Scholar
  6. 6.
    Thali MJ, Jackowski C, Oesterhelweg L, Ross SG, Dirnhofer R (2007) VIRTOPSY - the Swiss virtual autopsy approach. Leg Me 9:100–104CrossRefGoogle Scholar
  7. 7.
    Scholing M et al (2009) The value of postmortem computed tomography as an alternative for autopsy in trauma victims: a systematic review. Eur Radiol 19:2333–2341CrossRefPubMedGoogle Scholar
  8. 8.
    Saukko P, Knight B (2004) The pathophysiology of death. In: Knight’s forensic pathology, 3rd edn. Oxford University Press, New York, pp 52–97Google Scholar
  9. 9.
    Landis GR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174CrossRefPubMedGoogle Scholar
  10. 10.
    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 173:21–35CrossRefPubMedGoogle Scholar
  11. 11.
    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 195:1051–1056CrossRefPubMedGoogle Scholar
  12. 12.
    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 41:736–748CrossRefPubMedGoogle Scholar
  13. 13.
    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 83:89–90CrossRefGoogle Scholar
  14. 14.
    Jeffery AJ (2010) The role of computed tomography in adult postmortem examinations: an overview. Diagn Histopathol 16:546–551CrossRefGoogle Scholar
  15. 15.
    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 22:501–551CrossRefPubMedGoogle Scholar
  16. 16.
    Levy AD, Harcke HT, Mallak CT (2010) Postmortem imaging: MDCT features of postmortem change and decomposition. Am Forensic Med Pathol 31:12–17CrossRefGoogle Scholar
  17. 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 149:11–23CrossRefPubMedGoogle Scholar
  18. 18.
    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 25:791–802Google Scholar
  19. 19.
    Weustink AC, Hunink MGM, van Dijke CF, Renken NS, Krestin GP, Oosterhuis JW (2009) Minimally invasive autopsy: an alternative to conventional autopsy? Radiology 250:897–904CrossRefPubMedGoogle Scholar
  20. 20.
    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 240:522–528CrossRefPubMedGoogle Scholar
  21. 21.
    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 22:152–160CrossRefPubMedGoogle Scholar
  22. 22.
    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 156:123–130CrossRefPubMedGoogle Scholar
  23. 23.
    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 243:62–68CrossRefGoogle Scholar
  24. 24.
    DiMaio VJ, DiMaio D (2001) Death by drowning. In: Forensic pathology, 2nd edn. CRC, New York, pp 416–422Google Scholar
  25. 25.
    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 47:1326–1331PubMedGoogle Scholar

Copyright information

© European Society of Radiology 2013

Authors and Affiliations

  • Isabelle Le Blanc-Louvry
    • 1
  • Sophie Thureau
    • 1
  • Cathia Duval
    • 2
  • Frédérique Papin-Lefebvre
    • 3
  • Jacques Thiebot
    • 2
  • Jean Nicolas Dacher
    • 2
  • Cyril Gricourt
    • 1
  • Emmanuel Touré
    • 1
  • Bernard Proust
    • 1
  1. 1.Department of Forensic MedicineRouen University HospitalRouen CedexFrance
  2. 2.Department of RadiologyRouen University HospitalRouen CedexFrance
  3. 3.Department of Forensic MedicineCaen University HospitalCaenFrance

Personalised recommendations