Pulmonary thrombembolism as cause of death on unenhanced postmortem 3T MRI
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To investigate unenhanced postmortem 3-T MR imaging (pmMRI) for the detection of pulmonary thrombembolism (PTE) as cause of death.
In eight forensic cases dying from a possible cardiac cause but with homogeneous myocardium at cardiac pmMRI, additional T2w imaging of the pulmonary artery was performed before forensic autopsy. Imaging was carried out on a 3-T MR system in the axial and main pulmonary artery adapted oblique orientation in situ. In three cases axial T2w pmMRI of the lower legs was added. Validation of imaging findings was performed during forensic autopsy.
All eight cases showed homogeneous material of intermediate signal intensity within the main pulmonary artery and/or pulmonary artery branches. Autopsy confirmed the MR findings as pulmonary artery thrombembolism. At lower leg imaging unilateral dilated veins and subcutaneous oedema with or without homogeneous material of intermediate signal intensity within the popliteal vein were found.
Unenhanced pmMRI demonstrates pulmonary thrombembolism in situ. PmMR may serve as an alternative to clinical autopsy, especially when consent cannot be obtained.
• Postmortem MRI (pmMRI) provides an alternative to clinical autopsy
• Fatal pulmonary thrombembolism (PTE) can now be diagnosed using postmortem MRI (pmMRI).
• Special attention has to be drawn to the differentiation of postmortem clots.
KeywordsPostmortem magnetic resonance imaging Pulmonary thrombembolism Forensic imaging Postmortem imaging Natural death
The authors would like to thank the team of forensic examiners around Dr. Morten Keller-Sutter (Institute of Forensic Medicine Zürich) for the reliable support at case handling and autopsy validation. Funding: The study was supported in part by Philips Medical Switzerland.