European Radiology

, Volume 23, Issue 5, pp 1266–1270 | Cite as

Pulmonary thrombembolism as cause of death on unenhanced postmortem 3T MRI

  • Christian JackowskiEmail author
  • Silke Grabherr
  • Nicole Schwendener
Forensic Medicine



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.

Key Points

• 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.


Postmortem 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.


  1. 1.
    Yen K, Sonnenschein M, Thali MJ et al (2005) Postmortem multislice computed tomography and magnetic resonance imaging of odontoid fractures, atlantoaxial distractions and ascending medullary edema. Int J Legal Med 119:129–136PubMedCrossRefGoogle Scholar
  2. 2.
    Yen K, Vock P, Christe A et al (2007) Clinical forensic radiology in strangulation victims: forensic expertise based on magnetic resonance imaging (MRI) findings. Int J Legal Med 121:115–123PubMedCrossRefGoogle Scholar
  3. 3.
    Aghayev E, Yen K, Sonnenschein M et al (2004) Virtopsy post-mortem multi-slice computed tomography (MSCT) and magnetic resonance imaging (MRI) demonstrating descending tonsillar herniation: comparison to clinical studies. Neuroradiology 46:559–564PubMedCrossRefGoogle Scholar
  4. 4.
    Jackowski C, Christe A, Sonnenschein M, Aghayev E, Thali MJ (2006) Postmortem unenhanced magnetic resonance imaging of myocardial infarction in correlation to histological infarction age characterization. Eur Heart J 27:2459–2467PubMedCrossRefGoogle Scholar
  5. 5.
    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 21:70–78PubMedCrossRefGoogle Scholar
  6. 6.
    Jackowski C, Hofmann K, Schwendener N, Schweitzer W, Keller-Sutter M (2012) Coronary thrombus and peracute myocardial infarction visualized by unenhanced postmortem MRI prior to autopsy. Forensic Sci Int 214:e19CrossRefGoogle Scholar
  7. 7.
    van Beek EJ, Wild JM, Fink C, Moody AR, Kauczor HU, Oudkerk M (2003) MRI for the diagnosis of pulmonary embolism. J Magn Reson Imaging 18:627–640PubMedCrossRefGoogle Scholar
  8. 8.
    Ohno Y, Koyama H, Matsumoto K et al (2010) Dynamic MR perfusion imaging: capability for quantitative assessment of disease extent and prediction of outcome for patients with acute pulmonary thromboembolism. J Magn Reson Imaging 31:1081–1090PubMedCrossRefGoogle Scholar
  9. 9.
    Ross S, Spendlove D, Bolliger S (2008) Postmortem whole-body CT angiography: evaluation of two contrast media solutions. AJR Am J Roentgenol 190:1380–1389PubMedCrossRefGoogle Scholar
  10. 10.
    Jackowski C, Thali M, Aghayev E et al (2006) Postmortem imaging of blood and its characteristics using MSCT and MRI. Int J Legal Med 120:233–240PubMedCrossRefGoogle Scholar
  11. 11.
    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 53:465–468PubMedCrossRefGoogle Scholar
  12. 12.
    Grabherr S, Doenz F, Steger B et al (2011) Multi-phase post-mortem CT angiography: development of a standardized protocol. Int J Legal Med 125:791–802PubMedCrossRefGoogle Scholar
  13. 13.
    Shojania KG, Burton EC (2008) The vanishing nonforensic autopsy. N Engl J Med 358:873–875PubMedCrossRefGoogle Scholar
  14. 14.
    Shojania KG, Burton EC, McDonald KM, Goldman L (2005) Overestimation of clinical diagnostic performance caused by low necropsy rates. Qual Saf Health Care 14:408–413PubMedCrossRefGoogle Scholar
  15. 15.
    Shojania KG, Burton EC (2004) The persistent value of the autopsy. Am Fam Physician 69:2540–2542PubMedGoogle Scholar

Copyright information

© European Society of Radiology 2012

Authors and Affiliations

  • Christian Jackowski
    • 1
    Email author
  • Silke Grabherr
    • 2
  • Nicole Schwendener
    • 1
  1. 1.Forensic Imaging Center BernInstitute of Forensic Medicine, University of BernBernSwitzerland
  2. 2.Centre universitaire de medicine legale, CHUV—University of LausanneLausanneSwitzerland

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