International Journal of Legal Medicine

, Volume 127, Issue 5, pp 991–996 | Cite as

Coronary optical coherence tomography: minimally invasive virtual histology as part of targeted post-mortem computed tomography angiography

  • David Adlam
  • Shiju Joseph
  • Claire Robinson
  • Clement Rousseau
  • Jade Barber
  • Mike Biggs
  • Bruno Morgan
  • Guy Rutty
Technical Note


Social, cultural and practical barriers to conventional invasive autopsy have led to considerable interest in the development of minimally invasive radiological techniques as an alternative to the invasive autopsy for determining the cause of death. Critical to accurate diagnosis in this context is detailed examination of coronary anatomy and pathology. Current computed tomography and magnetic resonance imaging approaches have significantly advanced minimally invasive autopsy practice but have limited spatial resolution. This prohibits assessment at a microscopic level, meaning that histological assessment is still required for detailed analysis of, for example, coronary plaque rupture or dissection. Coronary optical coherence tomography (OCT) is used in the living during percutaneous coronary interventions to provide high-resolution coronary imaging, but this technique for obtaining virtual histology has not, to date, been translated into minimally invasive autopsy practice. We present a first description of minimally invasive post-mortem coronary OCT and discuss the potential for this technique to advance current practice.


Forensic Post-mortem Computed tomography Angiography Coronary artery Optical coherence tomography 


  1. 1.
    Death NCEiPOa (2006) The coroner’s autopsy: do we deserve better?Google Scholar
  2. 2.
    Gaensbacher S, Waldhoer T, Berzlanovich A (2012) The slow death of autopsies: a retrospective analysis of the autopsy prevalence rate in Austria from 1990 to 2009. Eur J Epidemiol 27(7):577–580PubMedCrossRefGoogle Scholar
  3. 3.
    Smith CJ, Scott SM, Wagner BM (1998) The necessary role of the autopsy in cardiovascular epidemiology. Hum Pathol 29(12):1469–1479PubMedCrossRefGoogle Scholar
  4. 4.
    Vernooij MW (2012) Minimally invasive autopsy: the technological revival of autopsy? Eur J Epidemiol 27(7):487–488PubMedCrossRefGoogle Scholar
  5. 5.
    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):1051–1056PubMedCrossRefGoogle Scholar
  6. 6.
    Dirnhofer R, Jackowski C, Vock P, Potter K, Thali MJ (2006) VIRTOPSY: minimally invasive, imaging-guided virtual autopsy. RadioGraphics 26(5):1305–1333PubMedCrossRefGoogle Scholar
  7. 7.
    Fan JK, Tong DK, Poon JT, Lo OS, Beh PS, Patil NG, Law WL (2010) Multimodality minimally invasive autopsy—a feasible and accurate approach to post-mortem examination. Forensic Sci Int 195(1–3):93–98PubMedCrossRefGoogle Scholar
  8. 8.
    Weustink AC, Hunink MG, van Dijke CF, Renken NS, Krestin GP, Oosterhuis JW (2009) Minimally invasive autopsy: an alternative to conventional autopsy? Radiology 250(3):897–904PubMedCrossRefGoogle Scholar
  9. 9.
    Wichmann D, Obbelode F, Vogel H, Hoepker WW, Nierhaus A, Braune S, Sauter 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 Int Med 156(2):123–130PubMedCrossRefGoogle Scholar
  10. 10.
    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):136–142PubMedCrossRefGoogle Scholar
  11. 11.
    Grabherr S, Djonov V, Yen K, Thali MJ, Dirnhofer R (2007) Postmortem angiography: review of former and current methods. AJR Am J Roentgenol 188(3):832–838PubMedCrossRefGoogle Scholar
  12. 12.
    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(6):791–802PubMedCrossRefGoogle Scholar
  13. 13.
    Grabherr S, Gygax E, Sollberger B, Ross S, Oesterhelweg L, Bolliger S, Christe A, Djonov V, Thali MJ, Dirnhofer R (2008) Two-step postmortem angiography with a modified heart-lung machine: preliminary results. AJR Am J Roentgenol 190(2):345–351PubMedCrossRefGoogle Scholar
  14. 14.
    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(2):465–468PubMedCrossRefGoogle Scholar
  15. 15.
    Jackowski C, Sonnenschein M, Thali M, Aghayev E, von Allmen G, Yen K (2008) Virtopsy: postmortem minimally invasive angiography using cross section techniques—implementation and preliminary results. J Forensic Sci 50(1175–1186)Google Scholar
  16. 16.
    Lizuka K, Sakamoto N, Kawasaki H, Miyoshi T, Komatuzaki A, Kikuchi S (2009) Usefulness of contrast-enhanced post-mortem CT. Innervision 24(89–92)Google Scholar
  17. 17.
    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 Imaging 28(7):1807–1822CrossRefGoogle Scholar
  18. 18.
    Roberts IS, Benamore RE, Peebles C, Roobottom C, Traill ZC (2011) Technical report: diagnosis of coronary artery disease using minimally invasive autopsy: evaluation of a novel method of post-mortem coronary CT angiography. Clin Radiol 66(7):645–650PubMedCrossRefGoogle Scholar
  19. 19.
    Robinson C, Barber J, Amoroso J, Morgan B, Rutty G (2012) Pump injector system applied to targeted post-mortem coronary artery angiography. Int J legal MedGoogle Scholar
  20. 20.
    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(5):1380–1389PubMedCrossRefGoogle Scholar
  21. 21.
    Rutty G, Saunders S, Morgan B, Raj V (2012) Targeted cardiac post-mortem computed tomography angiography: a pictorial review. Forensic Sci Med Pathol 8(1):40–47PubMedCrossRefGoogle Scholar
  22. 22.
    Sakamoto N, Senoo S, Uemura Y (2009) Case report: cardiopulmonary arrest on arrival case which underwent contrast-enhanced post-mortem CT. KANTO. J Jpn Assoc Acute Med 30:114–115Google Scholar
  23. 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(4):609–616PubMedCrossRefGoogle Scholar
  24. 24.
    Morgan B, Biggs MJ, Barber J, Raj V, Amoroso J, Hollingbury FE, Robinson C, Rutty GN (2012) Accuracy of targeted post-mortem computed tomography coronary angiography compared to assessment of serial histological sections. Int J Legal Med. doi:10.1007/s00414-012-0790-7
  25. 25.
    Prati F, Regar E, Mintz GS, Arbustini E, Di Mario C, Jang IK, Akasaka T, Costa M, Guagliumi G, Grube E, Ozaki Y, Pinto F, Serruys PW (2010) Expert review document on methodology, terminology, and clinical applications of optical coherence tomography: physical principles, methodology of image acquisition, and clinical application for assessment of coronary arteries and atherosclerosis. Eur Heart J 31(4):401–415PubMedCrossRefGoogle Scholar
  26. 26.
    Adlam D, Antoniades C, Lee R, Diesch J, Shirodaria C, Taggart D, Leeson P, Channon KM (2011) OCT characteristics of saphenous vein graft atherosclerosis. JACC Cardiovasc Imaging 4(7):807–809PubMedCrossRefGoogle Scholar
  27. 27.
    Adlam D, Ayers R, Channon KM (2009) Intimal dissection causing late thrombosis of a covered stent: optical coherence tomography appearances. Circ Cardiovasc Interv 2(4):359–360PubMedCrossRefGoogle Scholar
  28. 28.
    Adlam D, Channon KM (2011) Radial artery graft string sign due to lumen obliteration by neointima: insight from optical coherence tomography. JACC Cardiovasc Interv 4(5):586–587PubMedCrossRefGoogle Scholar
  29. 29.
    Adlam D, Hutchings D, Channon KM (2011) Optical coherence tomography-guided stenting of a large coronary aneurysm: images at implantation and at 6 months. J Invasive Cardiol 23(4):168–169PubMedGoogle Scholar
  30. 30.
    Lee R, Antoniades C, Adlam D, Channon KM (2011) Treatment of recurrent vein graft “stent-in-stent” re-stenosis guided by optical coherence tomography. Int J Cardiol 156(1):e20–e21PubMedCrossRefGoogle Scholar
  31. 31.
    Saunders SL, Amoroso J, Morgan B, Rutty G (2012) Consent of the recently bereaved to post-mortem targeted angiography research: 207 adult cases. J Clin Pathol. doi:10.1136/jclinpath-2012-201250
  32. 32.
    Kume T, Akasaka T, Kawamoto T, Ogasawara Y, Watanabe N, Toyota E, Neishi Y, Sukmawan R, Sadahira Y, Yoshida K (2006) Assessment of coronary arterial thrombus by optical coherence tomography. Am J Cardiol 97(12):1713–1717PubMedCrossRefGoogle Scholar
  33. 33.
    Kume T, Akasaka T, Kawamoto T, Okura H, Watanabe N, Toyota E, Neishi Y, Sukmawan R, Sadahira Y, Yoshida K (2006) Measurement of the thickness of the fibrous cap by optical coherence tomography. Am Heart J 152:e751–e754, 755CrossRefGoogle Scholar
  34. 34.
    Kume T, Akasaka T, Kawamoto T, Watanabe N, Toyota E, Neishi Y, Sukmawan R, Sadahira Y, Yoshida K (2005) Assessment of coronary intima—media thickness by optical coherence tomography: comparison with intravascular ultrasound. Cir J: Off J Jpn Circ So 69(8):903–907Google Scholar
  35. 35.
    Kume T, Akasaka T, Kawamoto T, Watanabe N, Toyota E, Neishi Y, Sukmawan R, Sadahira Y, Yoshida K (2006) Assessment of coronary arterial plaque by optical coherence tomography. Am J Cardiol 97(8):1172–1175PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • David Adlam
    • 1
  • Shiju Joseph
    • 1
  • Claire Robinson
    • 2
  • Clement Rousseau
    • 1
  • Jade Barber
    • 3
  • Mike Biggs
    • 3
  • Bruno Morgan
    • 2
  • Guy Rutty
    • 3
  1. 1.Department of Cardiovascular SciencesGlenfield HospitalLeicesterUK
  2. 2.Imaging DepartmentUniversity Hospitals of LeicesterLeicesterUK
  3. 3.East Midlands Forensic Pathology UnitLeicesterUK

Personalised recommendations