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Postmortem CT and MRI findings of massive fat embolism

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Abstract

Objective

To elucidate postmortem computed tomography (PMCT) and postmortem magnetic resonance (PMMR) imaging findings suggesting massive fat embolism.

Materials and methods

Consecutive forensic cases with PMCT and PMMR scans of subjects prior to autopsy were assessed. For PMCT, 16- or 64-row multidetector CT scans were used; for PMMR, a 1.5 T system was used. MRI sequences of the chest area included T2- and T1-weighted fast spin-echo imaging, T2*-weighted imaging, T1-weighted 3-dimensional gradient-echo imaging with or without a fat-suppression pulse, short tau inversion recovery, and in-phase/opposed-phase imaging. At autopsy, forensic pathologists checked for pulmonary fat embolism with fat staining; Falzi’s grading system was used for classification.

Results

Of 31 subjects, four were excluded because fat staining for histopathological examination of the lung tissue could not be performed. In three of the remaining 27 subjects, histology revealed massive fat embolism (Falzi grade III) and the cause of death was considered to be associated with fat embolism. CT detected a “fat-fluid level” in the right heart or intraluminal fat in the pulmonary arterial branches in two subjects. MRI detected these findings more clearly in both subjects. In one subject, CT and MRI were both negative. There were no positive findings in the 24 subjects that were fat embolism–negative by histology.

Discussion and conclusion

In some subjects, a massive fat embolism can be suggested by postmortem imaging with a “fat-fluid level” in the right heart or intraluminal fat in the pulmonary arterial branches. PMMR potentially suggests fat embolism more clearly than PMCT.

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Abbreviations

3D-GRE T1WI:

T1-weighted 3-dimensional gradient-echo imaging

ARDS:

Acute respiratory distress syndrome

CHESS:

Chemical shift selective

CSI:

Chemical shift imaging

CT:

Computed tomography

FA:

Flip angle

FFE:

Fast field echo

FSE:

Fast spin-echo

GRE:

Gradient echo

HU:

Hounsfield unit

IDEAL:

Iterative decomposition with echo asymmetry and least squares

MRI:

Magnetic resonance imaging

MRS:

Magnetic resonance spectroscopy

PMCT:

Postmortem computed tomography

PMMR:

Postmortem magnetic resonance

SPAIR:

Spectral attenuated inversion recovery

SPIR:

Spectral presaturation with inversion recovery

TE:

Echo time

TR:

Repetition time

T1WI:

T1-weighted imaging

T2WI:

T2-weighted imaging

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Acknowledgments

The authors would like to thank Hisako Saitoh, Katsura Otsuka, Kazuhiro Kobayashi, Yuriko Odo, Miyuki Miura, Keisuke Okaba, Sayaka Nagasawa, Ayaka Sakuma, Shiori Kasahara, and Namiko Ishii for their technical support. We thank Libby Cone, MD, MA, and Andrea Baird, MD, from Edanz Group Japan (www.edanzediting.com/ac) for editing the drafts of this manuscript.

Funding

This work was supported by JSPS KAKENHI grant numbers JP16H06242 and JP26870102.

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Authors and Affiliations

  1. Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan

    Yohsuke Makino, Fumiko Chiba, Suguru Torimitsu, Shigeki Tsuneya & Hirotaro Iwase

  2. Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan

    Yohsuke Makino, Masatoshi Kojima, Maiko Yoshida, Ayumi Motomura, Go Inokuchi, Fumiko Chiba, Suguru Torimitsu, Yumi Hoshioka, Rutsuko Yamaguchi, Naoki Saito, Shumari Urabe & Hirotaro Iwase

  3. Department of Forensic Medicine, School of Medicine, International University of Health and Welfare, 4-3 Kozunomori, Narita, 286-8686, Japan

    Ayumi Motomura & Daisuke Yajima

  4. Department of Radiology, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8677, Japan

    Takuro Horikoshi

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  1. Yohsuke Makino
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Corresponding author

Correspondence to Yohsuke Makino.

Ethics declarations

This retrospective study was approved by the ethics committee of Chiba University (approved July 22, 2011, No. 1195). According to the Japanese Protection Guideline of Personal Information on Research Publication in Legal Medicine, this study was considered to have provided sufficient protection of privacy of the patients and their family, so we did not require informed consent from the next of kin.

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The authors declare that they have no conflict of interest.

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Makino, Y., Kojima, M., Yoshida, M. et al. Postmortem CT and MRI findings of massive fat embolism. Int J Legal Med 134, 669–678 (2020). https://doi.org/10.1007/s00414-019-02128-8

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