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Visualization of myocardial infarction by post-mortem single-organ coronary computed tomography: a feasibility study

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Abstract

Introduction

Post-mortem imaging is increasingly used in forensic field in cases of natural deaths related to cardiovascular diseases, which represent the most common causes of death in developed countries. While radiological examination is generally considered to be a good complement for conventional autopsy, it was thought to have limited application in cardiovascular pathology. The aim of this study was to investigate the role of post-mortem multidetector coronary artery computed tomography in cases of sudden death in adults.

Materials and methods

We have enrolled 11 cases, all of whom were negative for macroscopic extra-cardiac lethal findings after standard autopsy procedure. Later, from the same individuals, isolated single-organ post-mortem computed tomography coronarography (PMCTA), using an iodinated non-ionic contrast medium, was achieved. After computed tomography examination, all the isolated hearths were carried to the forensic pathologist, and a conventional histology assessment was performed on them.

Results

In 7 out of 11 of cadavers, a final diagnosis of myocardial infarction was made after a complete autopsy and histology procedures. Isolated hearts underwent PMCTA scanning and was confirmed in 6/11 cases, with the autopsy findings showing the presence and the localization of occlusions or severe stenoses and the extension of the myocardial hypoxic area by the extravasation of contrast medium as well.

Conclusion

Isolated single-organ PMCTA could be considered a valid and useful tool in addition to traditional autopsy investigation (macroscopic sections and histology) in identifying the cause of death by recognizing the presence and degree of coronary artery disease and myocardial infarction area visualization.

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References

  1. Sen-Chowdhry S, McKenna WJ (2006) Sudden cardiac death in the young: a strategy for prevention by targeted evaluation. Cardiology 105:196–206

    Article  PubMed  Google Scholar 

  2. Partemi S, Berne PM, Batlle M, Berruezo A, Mont L, Riuró H, Ortiz JT, Roig E, Pascali VL, Brugada R, Brugada J, Oliva A (2010) Analysis of mRNA from human heart tissue and putative applications in forensic molecular pathology. Forensic Sci Int 203(1–3):99–105

    Article  CAS  PubMed  Google Scholar 

  3. Chugh SS, Reinier K, Teodorescu C, Evanado A, Kehr E, Al Samara M, Mariani R, Gunson K, Jui J (2008) Epidemiology of sudden cardiac death: clinical and research implications. Prog Cardiovasc Dis 51(3):213–228

    Article  PubMed Central  PubMed  Google Scholar 

  4. Thomas AC, Knapman PA, Krikler DM, Davies MJ (1988) Community study of the causes of ‘natural’ sudden death. BMJ 297:1453–1456

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  5. Leach IH, Blundell JW, Rowley JM, Turner DR (1995) Acute ischaemic lesions in death due to ischaemic heart disease. An autopsy study of 333 cases of out-of-hospital death. Eur Heart J 16:1181–1185

    CAS  PubMed  Google Scholar 

  6. Priori SG, Aliot E, Blomstrom-Lundqvist C, Bossaert L, Breithardt G, Brugada P, Camm AJ, Cappato R, Cobbe SM, Di Mario C, Maron BJ, McKenna WJ, Pedersen AK, Ravens U, Schwartz PJ, Trusz-Gluza M, Vardas P, Wellens HJJ, Zipes DP (2001) Task force on sudden cardiac death of the European Society of Cardiology. Eur Heart J 22:1374–1450

    Article  CAS  PubMed  Google Scholar 

  7. Priori SG, Aliot E, Blomstrom-Lundqvist C, Bossaert L, Breithardt G, Brugada P et al (2003) Update of the guidelines on sudden cardiac death of the European Society of Cardiology. Eur Heart J 24:13–15

    Article  PubMed  Google Scholar 

  8. Urbania TH, Hope MD, Huffaker SD, Reddy GP (2009) Role of computed tomography in the evaluation of acute chest pain. J Cardiovasc Comput Tomogr 3(1 Suppl):S13–S22

    Article  PubMed  Google Scholar 

  9. Mowatt G, Cook JA, Hillis GS et al (2008) 64-Slice computed tomography angiography in the diagnosis and assessment of coronary artery disease: systematic review and meta-analysis. Heart 94(11):1386–1393

    Article  CAS  PubMed  Google Scholar 

  10. Sparrow PJ, Merchant N, Provost YL, Doyle DJ, Nguyen ET (2009) Paul NS CT and MR imaging findings in patients with acquired heart disease at risk for sudden cardiac death. RadioGraphics 29(3):805–823

    Article  PubMed  Google Scholar 

  11. Campuzano O, Allegue C, Partemi S, Iglesias A, Oliva A, Brugada R (2014) Negative autopsy and sudden cardiac death. Int J Legal Med 128:599–606

  12. Oliva A, Brugada R, D’Aloja E, Boschi I, Partemi S, Brugada J, Pascali VL (2011) State of the art in forensic investigation of sudden cardiac death. Am J Forensic Med Pathol 32(1):1–16

    Article  PubMed  Google Scholar 

  13. Madea B, Saukko P, Oliva A, Musshoff F (2010) Molecular pathology in forensic medicine—introduction. Forensic Sci Int 203(1–3):3–14

    Article  CAS  PubMed  Google Scholar 

  14. Michaud K, Grabherr S, Jackowski C, Bollmann MD, Doenz F, Mangin P (2014) Postmortem imaging of sudden cardiac death. Int J Legal Med 128(1):127–137

    Article  PubMed  Google Scholar 

  15. 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):1807–1822

    Article  PubMed  Google Scholar 

  16. Thali MJ, Dirnhofer R, Vock P (2009) The virtopsy approach: 3D optical and radiological scanning and reconstruction in forensic medicine. CRC Press, London

    Book  Google Scholar 

  17. Grabherr S, Gygax E, Sollberger B et al (2008) Two-step post-mortem angiography with a modified heart–lung machine: preliminary results. AJR 190(2):345–351

    Article  PubMed  Google Scholar 

  18. Ross S, Spendlove D, Bolliger S, Christe A, Oesterhelweg L, Grabherr S et al (2008) Post-mortem whole-body CT angiography: evaluation of two contrast media solutions. Am J Roentgenol 190:1380–1389

    Article  Google Scholar 

  19. Grabherr S, Djonov V, Yen K, Thali MJ, Dirnhofer R (2007) Postmortem angiography: review of former and current methods. Am J Roentgenol 188(3):832–838

    Article  Google Scholar 

  20. Jackowski C, Persson A, Thali MJ (2008) Whole body post-mortem angiography with a high viscosity contrast agent solution using poly ethylene glycol as contrast agent dissolver. J Forensic Sci 53:465–468

    Article  PubMed  Google Scholar 

  21. Jackowski C, Sonnenschein M, Thali MJ, Aghayev E, von Allmen G, Yen K et al (2005) Virtopsy: post-mortem minimally invasive angiography using cross section techniques—implementation and preliminary results. J Forensic Sci 50:1175–1186

    Article  PubMed  Google Scholar 

  22. Rutty G, Saunders S, Morgan B, Raj V (2012) Targeted cardiac post-mortem computed tomography angiography: a pictorial review. Forensic Sci Med Pathol 8:40–47

    Article  PubMed  Google Scholar 

  23. Ross SG, Thali MJ, Bolliger S, Germerott T, Ruder TD, Flach PM (2012) Feasibility of virtual autopsy with postmortem CT angiography and biopsy. Radiology 264: (1)

  24. Jackowski C, Schwendener N, Grabherr S, Persson A (2013) Post-mortem cardiac 3-T magnetic resonance imaging: visualization of sudden cardiac death? J Am Coll Cardiol 62(7):617–629

    Article  PubMed  Google Scholar 

  25. 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(20):2459–2467

    Article  PubMed  Google Scholar 

  26. Brinkmann B (1999) Harmonization of medico-legal autopsy rules. Committee of Ministers. Council of Europe. Int J Legal Med 113(1):1

    Article  CAS  PubMed  Google Scholar 

  27. Weissleder R, Wittenberg J, Harisinghani MG, Chen J (2007) Cardiac imaging: acquired heart disease. In: Primer of diagnostic imaging. 4th ed. Philadelphia, Pa: Mosby Elsevier; 149

  28. Lodge-Patch I (1951) The ageing of cardiac infarcts and its influence on cardiac rupture. Br Heart J 13:37–42

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  29. Berry CC (1992) The kappa statistic. JAMA 268(18):2513–2514

    Article  CAS  PubMed  Google Scholar 

  30. Grabherr S, Doenz F, Steger B, Dirnhofer R, Dominguez A, Sollberger B, Gygax E, Rizzo E, Chevallier C, Meuli R, Mangin P (2010) Multi-phase post-mortem CT angiography: development of a standardized protocol. Int J Legal Med: 1–12

  31. Roberts ISD, Benamore RE, Peebles C, Roobottom C, Traill ZC (2011) Diagnosis of coronary artery disease using minimally invasive autopsy: evaluation of a novel method of post-mortem coronary CT angiography. Clin Radiol 66(7):645–650

    Article  CAS  PubMed  Google Scholar 

  32. Saunders S, Morgan B, Raj V, Robinson C, Rutty G (2011) Targeted post-mortem computed tomography cardiac angiography: proof of concept. Int J Legal Med: 1–8

  33. 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 Hear J 27(20):2459–2467

    Article  Google Scholar 

  34. Jackowski C, Warntjes M, Berge J, Bär W, Persson A Magnetic resonance imaging goes postmortem: noninvasive detection and assessment of myocardial infarction by postmortem MRI. Eur Radiol 21(1): 70–78.

  35. Roberts ISD, Benamore RE, Benbow EW, Lee SH, Harris JN, Jackson A, Mallett S, Patankar T, Peebles C, Roobottom C, Traill ZC (2011) Post-mortem imaging as an alternative to autopsy in the diagnosis of adult deaths: a validation study. Lancet 379(9811):136–142

    Article  PubMed  Google Scholar 

  36. Schlesinger MJ (1938) An injection plus dissection study of coronary artery occlusions and anastomosis. Am Heart J 15:528–568

    Article  Google Scholar 

  37. Morgan B, Biggs MJ, Barber J, Raj V, Amoroso J, Hollingbury FE, Robinson C, Rutty GN (2013) Accuracy of targeted post-mortem computed tomography coronary angiography compared to assessment of serial histological sections. Int J Legal Med 127(4):809–817

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Institute of Public Health, Section of Legal Medicine, Catholic University, Rome, Italy

    Matteo Polacco, Vincenzo L. Pascali, Antonio Oliva & Riccardo Rossi

  2. Department of Radiology “Campus Bio-Medico” University, Rome, Italy

    Matteo Polacco, Pietro Sedati & Bruno Beomonte Zobel

  3. Institute of Pathological Anatomy, Catholic University, Rome, Italy

    Vincenzo Arena

Authors
  1. Matteo Polacco
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  2. Pietro Sedati
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  3. Vincenzo Arena
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  4. Vincenzo L. Pascali
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  5. Bruno Beomonte Zobel
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  6. Antonio Oliva
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  7. Riccardo Rossi
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Correspondence to Antonio Oliva.

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Antonio Oliva and Riccardo Rossi are co-senior authors.

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Polacco, M., Sedati, P., Arena, V. et al. Visualization of myocardial infarction by post-mortem single-organ coronary computed tomography: a feasibility study. Int J Legal Med 129, 517–524 (2015). https://doi.org/10.1007/s00414-014-1085-y

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  • DOI: https://doi.org/10.1007/s00414-014-1085-y

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