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International Journal of Legal Medicine

, Volume 127, Issue 3, pp 661–666 | Cite as

Pump injector system applied to targeted post-mortem coronary artery angiography

  • Claire Robinson
  • Jade Barber
  • Jasmin Amoroso
  • Bruno Morgan
  • Guy RuttyEmail author
Technical Note

Abstract

Targeted post-mortem computed tomography angiography (PMCTA) is one of several methods described that can be used to investigate the coronary arteries after death. Previously, this particular method has involved the manual injection of contrast media. However, manual systems do not mimic physiological conditions (arterial pressure) and may not provide optimal contrast, as iodinated contrast medium dissipates rapidly from the intra- to the extra-vascular space. To try and overcome these problems, we now report the use of a clinical automatic pump injector for targeted PMCTA. We present our final protocol for this pump system developed from experience of 74 cases, showing how these clinical pumps can be translated from clinical into autopsy practice for the injection of air and positive contrast media to visualise the coronary arteries of cadavers.

Keywords

Forensic Autopsy Post-mortem Targeted Angiography Computed tomography Air Contrast Pump injector 

Notes

Acknowledgments

This project is funded by a National Institute of Health (Research for Innovation, Speculation and Creativity) research grant (Grant Reference Number: RC-PG-0309-10052). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.

We wish to thank the relatives who consented for their recently departed loved ones to be part of this study. We wish to thank H.M. Coroner offices for North and South Leicestershire for their support of this project as well as our study co-ordinator T Visser and the porters, morticians and radiographers, who support this project.

Conflict of interest

This study has an associated patent pending related to the development of a cadaver-specific angiography catheter and the protocol related to its use.

References

  1. 1.
    Dirnhofer R, Jackowski C, Vock P, Potter K, Thali MJ (2006) VIRTOPSY: minimally invasive, imaging-guided virtual autopsy. Radiographics 26:1305–1333PubMedCrossRefGoogle Scholar
  2. 2.
    Thali M, Dirnhofer R, Vock P (eds) (2009) The virtopsy approach: 3D optical and radio- logical scanning and reconstruction in forensic medicine. CRC, New YorkGoogle Scholar
  3. 3.
    Weustink AC, Hunink MGM, van Dijke CF, Renken NS, Krestin GP, Oosterhuis JW (2009) Minimally invasive autopsy: an alternative to conventional autopsy? Radiology 250:897–904PubMedCrossRefGoogle Scholar
  4. 4.
    Jeffery AJ (2010) The role of computed tomography in adult postmortem examinations: an overview. Diagn Histopathol 16:546–551CrossRefGoogle Scholar
  5. 5.
    O'Donnell C (2010) An image of sudden death: utility of routine postmortem computed tomography scanning in medico-legal autopsy practice. Diagn Histopathol 16:552–555CrossRefGoogle Scholar
  6. 6.
    Jacobsen C, Lynnerup N (2010) Craniocerebral trauma—congruence between postmortem computed tomography diagnoses and autopsy results: a 2-year retrospective study. Forensic Sci Int 194:9–14PubMedCrossRefGoogle Scholar
  7. 7.
    Roberts ISD, Benamore RE, Benbow EW, Lee SH, Harris JN, Jackson A, Mallett S, Patankar T, Peebles C, Roobottom C, Traill ZC (2012) Postmortem imaging as an alternative to autopsy in the diagnosis of adult deaths: a validation study. Lancet 379:136–142PubMedCrossRefGoogle Scholar
  8. 8.
    Sakamoto N, Senoo S, Uemura Y et al (2009) Case report: cardiopulmonary arrest on arrival case which underwent contrast-enhanced post-mortem CT. KANTO. J Japanese Association Acute Med 30:114–115Google Scholar
  9. 9.
    Lizuka K, Sakamoto N, Kawasaki H, Miyoshi T, Komatuzaki A, Kikuchi S (2009) Usefulness of contrast-enhanced post-mortem CT. Innervision 24:89–92Google Scholar
  10. 10.
    Grabherr S, Gygax E, Sollberger B, Ross S, Oesterhelweg L, Bolliger S et al (2008) Two-step postmortem angiography with a modified heart–lung machine: preliminary results. Am J Roentgenol 190:345–351CrossRefGoogle Scholar
  11. 11.
    Ross S, Spendlove D, Bolliger S, Christe A, Oesterhelweg L, Grabherr S et al (2008) Postmortem whole-body CT angiography: evaluation of two contrast media solutions. AJR Am J Roentgenol 190:1380–1389PubMedCrossRefGoogle Scholar
  12. 12.
    Grabherr S, Djonov V, Yen K, Thali MJ, Dirnhofer R (2007) Postmortem angiography: review of former and current methods. Am J Roentgenol 188:832–838CrossRefGoogle Scholar
  13. 13.
    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
  14. 14.
    Jackowski C, Sonnenschein M, Thali MJ, Aghayev E, von Allmen G, Yen K et al (2008) Virtopsy: postmortem minimally invasive angiography using cross section techniques—implementation and preliminary results. J Forensic Sci 50:1175–1186Google Scholar
  15. 15.
    Grabherr S, Doenz F, Steger B, Dirnhofer R, Dominguez A, Sollberger B et al (2010) Multi-phase post-mortem CT angiography: development of a standardized protocol. Int J Legal Med 125:791–802PubMedCrossRefGoogle Scholar
  16. 16.
    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(7):1807–1822PubMedCrossRefGoogle Scholar
  17. 17.
    Saunders SL, Morgan B, Raj V, Robinson C, Rutty GN (2011) Targeted post-mortem computed tomography cardiac angiography: proof of concept. Int J Legal Med 125:609–616PubMedCrossRefGoogle Scholar
  18. 18.
    Rutty GN, Saunders S, Morgan B, Raj V (2012) Targeted cardiac post-mortem computed tomography angiography: a pictorial review. Forensic Sci Med Pathol 8:40–47PubMedCrossRefGoogle Scholar
  19. 19.
    Roberts ISD, Benamore RE, Peebles C, Roobottom C, Traill ZC (2011) Diagnosis of coronary artery disease using a minimally invasive autopsy: evaluation of a novel method of post-mortem coronary CT angiography. Clin Radiol 66:645–650PubMedCrossRefGoogle Scholar
  20. 20.
    Coghill SB, Nicoll SM, McKimmie A, Houston I, Matthew BM (1983) Revitalising postmortem coronary angiography. J Clin Pathol 36:1406–1409PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  • Claire Robinson
    • 1
  • Jade Barber
    • 2
  • Jasmin Amoroso
    • 2
  • Bruno Morgan
    • 1
  • Guy Rutty
    • 2
    Email author
  1. 1.Imaging Department, Leicester Royal InfirmaryUniversity Hospitals of LeicesterLeicesterUK
  2. 2.East Midlands Forensic Pathology UnitLeicester Royal InfirmaryLeicesterUK

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