International Journal of Legal Medicine

, Volume 127, Issue 3, pp 639–652 | Cite as

Multi-phase postmortem CT angiography: recognizing technique-related artefacts and pitfalls

  • C. BruguierEmail author
  • P. J. Mosimann
  • P. Vaucher
  • A. Uské
  • F. Doenz
  • C. Jackowski
  • P. Mangin
  • S. Grabherr
Original Article


Background and purpose

Multi-phase postmortem CT angiography (MPMCTA) is increasingly being recognized as a valuable adjunct medicolegal tool to explore the vascular system. Adequate interpretation, however, requires knowledge about the most common technique-related artefacts. The purpose of this study was to identify and index the possible artefacts related to MPMCTA.

Material and methods

An experienced radiologist blinded to all clinical and forensic data retrospectively reviewed 49 MPMCTAs. Each angiographic phase, i.e. arterial, venous and dynamic, was analysed separately to identify phase-specific artefacts based on location and aspect.


Incomplete contrast filling of the cerebral venous system was the most commonly encountered artefact, followed by contrast agent layering in the lumen of the thoracic aorta. Enhancement or so-called oedematization of the digestive system mucosa was also frequently observed.


All MPMCTA artefacts observed and described here are reproducible and easily identifiable. Knowledge about these artefacts is important to avoid misinterpreting them as pathological findings.


Postmortem CT Postmortem angiography Artefacts Forensic radiology Minimally invasive autopsy 



This study was financially supported by the Promotion Agency for Innovation of the Swiss Confederation (KTI Nr.10221.1 PFIW-IW) and by the Fondation Leenaards, Lausanne, Switzerland.

Conflicts of interest

The authors have no conflicts of interest to disclose.


  1. 1.
    Grabherr S, Djonov V, Yen K et al (2007) Postmortem angiography: review of former and current methods. AJR 188:832–838PubMedCrossRefGoogle Scholar
  2. 2.
    Schoenmackers J (1960) Technique of postmortem angiography with reference to related methods of postmortem blood vessel demonstration [in German]. Ergebn Allg Pathol Anat 39:53–151Google Scholar
  3. 3.
    Schlesinger JM (1938) An injection plus dissection study of coronary artery occlusions and anastomosis. Am Heart J 15:528–568CrossRefGoogle Scholar
  4. 4.
    Dirnhofer R et al (2006) VIRTOPSY: minimally invasive, imaging-guided virtual autopsy. Radiographics 26(5):1305–1333PubMedCrossRefGoogle Scholar
  5. 5.
    Thali M, Dirnhofer R, Vock P (eds) (2009) The virtopsy approach: 3D optical and radiological scanning and reconstruction in forensic medicine. CRC, New YorkGoogle Scholar
  6. 6.
    Jeffery AJ (2010) The role of computed tomography in adult post-mortem examinations: an overview. Diagn Histopathol 16(12):546–551CrossRefGoogle Scholar
  7. 7.
    O’Donnell C (2010) An image of sudden death: utility of routine post-mortem computed tomography scanning in medico-legal autopsy practice. Diagn Histopathol 16(12):552–555CrossRefGoogle Scholar
  8. 8.
    Weustink AC et al (2009) Minimally invasive autopsy: an alternative to conventional autopsy? Radiology 250(3):897–904PubMedCrossRefGoogle Scholar
  9. 9.
    Poulsen K, Simonsen J (2007) Computed tomography as a routine in connection with medico-legal autopsies. Forensic Sci Int 171(2–3):190–197PubMedCrossRefGoogle 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) Postmortem imaging as an alternative to autopsy in the diagnosis of adult deaths: a validation study. Lancet 379(9811):136–142PubMedCrossRefGoogle Scholar
  11. 11.
    Saunders S et al (2010) Post-mortem computed tomography angiography: past, present and future. Forensic Sci Med Pathol 7:271–277PubMedCrossRefGoogle Scholar
  12. 12.
    Grabherr S, Djonov V, Friess A et al (2006) Postmortem angiography after vascular perfusion with diesel oil and a lipophilic contrast agent. AJR 187:W515–W523PubMedCrossRefGoogle Scholar
  13. 13.
    Jackowski C, Thali M, Sonnenschein M et al (2005) Virtopsy: postmortem minimally invasive angiography using cross section techniques—implementation and preliminary results. J Forensic Sci 50:1175–1186PubMedCrossRefGoogle Scholar
  14. 14.
    Grabherr S et al (2008) Two-step postmortem angiography with a modified heart lung machine: preliminary results. AJR 190(2):345–351PubMedCrossRefGoogle Scholar
  15. 15.
    Ross S, Spendlove D, Bolliger S (2008) Postmortem whole-body CT angiography: evaluation of two contrast media solutions. AJR 190:1380–1389PubMedCrossRefGoogle Scholar
  16. 16.
    Roberts ISD, Peebles C, Roobottom C, Traill ZC (2011) Diagnosis of coronary artery disease using minimally invasive autopsy: evaluation of a novel method of postmortem coronary CT angiography. Clin Radiol 66(7):645–650PubMedCrossRefGoogle Scholar
  17. 17.
    Saunders S, Morgan B, Raj V, Robinson C, Rutty G (2011) Targeted postmortem computed tomography cardiac angiography: proof of concept. Int J Leg Med 125:609–616CrossRefGoogle Scholar
  18. 18.
    Grabherr S et al (2010) Multi-phase post-mortem CT angiography: development of a standardized protocol. Int J Leg Med 125:791–802CrossRefGoogle Scholar
  19. 19.
    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 28:1807–1822PubMedCrossRefGoogle Scholar
  20. 20.
    Palmiere C (2012) Detection of hemorrhage source: the diagnostic value of post-mortem CT angiography. Forensic Sci Int 222:33–39. doi: 10.1016/j.forsciint.2012.04.031 PubMedCrossRefGoogle Scholar
  21. 21.
    Zerlauth JB, Doenz F, Dominguez A, Palmiere C, Uské A, Meuli R, Grabherr S (2013) Surgical interventions with fatal outcome: utility of multi-phase postmortem CT angiography. Forensic Sci Int 225:32–41PubMedCrossRefGoogle Scholar
  22. 22.
    Batra P, Bigoni B, Manning J, Aberle DR, Brown K, Hart E, Goldin J (2000) Pitfalls in the diagnosis of thoracic aortic dissection at CT angiography. Radiographics 20(2):309–320PubMedGoogle Scholar
  23. 23.
    Wittram C, Maher MM, Yoo AJ, Kalra MK, Shepard J-A O, McLoud TC (2004) CT angiography of pulmonary embolism: diagnostic criteria and causes of misdiagnosis. Radiographics 24:1219–1238. doi: 10.1148/rg.245045008 PubMedCrossRefGoogle Scholar
  24. 24.
    Schneider B, Chevallier C, Dominguez A, Bruguier C, Elandoy C, Mangin P, Grabherr S (2012) The forensic radiographer: a new member in the medico-legal team. Am J Forensic Med Pathol Am J Forensic Med Pathol 33(1):30–36CrossRefGoogle Scholar
  25. 25.
    Anonymous (2000) Recommendation no R(99)3 of the committee of ministers to member states on the harmonization of medico-legal autopsy rules. Council of Europe, Committee of Ministers. Adopted by the Committee of Ministers on 2 February 1999 at the 658th meeting of the Ministers’ DeputiesGoogle Scholar
  26. 26.
    Brinkmann B (1999) Harmonisation of medico-legal autopsy rules. Int J Legal Med 113(1):1–14PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • C. Bruguier
    • 1
    • 2
    Email author
  • P. J. Mosimann
    • 2
  • P. Vaucher
    • 3
  • A. Uské
    • 2
  • F. Doenz
    • 2
  • C. Jackowski
    • 4
  • P. Mangin
    • 1
  • S. Grabherr
    • 1
  1. 1.University Centre of Legal Medicine, Lausanne–Geneva, University Hospital of LausanneLausanneSwitzerland
  2. 2.Department of Diagnostic and Interventional RadiologyUniversity Hospital of LausanneLausanneSwitzerland
  3. 3.University Centre of Legal Medicine, Lausanne–Geneva, University of GenevaGeneva 4Switzerland
  4. 4.Center for Forensic Imaging, Institute of Forensic MedicineUniversity of BernBernSwitzerland

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