Skip to main content
SpringerLink
Log in

Ventilated postmortem computed tomography in children: feasibility and initial experience

  • Original Article
  • Published:
International Journal of Legal Medicine Aims and scope Submit manuscript

Abstract

Objectives

Ventilated postmortem computed tomography (vPMCT) is associated with improved pulmonary imaging compared to standard PMCT in adults. We aimed to evaluate the feasibility of performing ventilated PMCT in children.

Methods

Postmortem thoracic CT was performed before (PMCT) and after ventilation (vPMCT). We used a range of mouthpieces, including endotracheal tubes, bag and mask and laryngeal mask airway (LMA). Hounsfield units of the lungs at PMCT were measured for normal and abnormal lung areas, before and after ventilation. All patients underwent full conventional autopsy and histology.

Results

Twelve patients underwent ventilated PMCT, median age 52 days (range 3–304 days). Ventilated PMCT provided diagnostic lung images in all 12 cases, compared to only three unventilated PMCT examinations (p < 0.005). In all cases, ventilated PMCT improved the image quality of aerated lungs irrespective of the method used. Average lung Hounsfield units decreased significantly with ventilation from pre-vPMCT values (−134.1 ± 215.1 vs post-vPMCT −531.8 ± 190.1; p < 0.001). LMA with continuous positive pressure ventilation subjectively provided the best results.

Conclusion

Ventilated PMCT significantly improves lung aeration in children and can aid recognition of areas of abnormality in paediatric lungs. Such advances will improve accuracy and uptake of imaging-assisted autopsies in children.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig 3
Fig. 4
Fig. 5

Similar content being viewed by others

Abbreviations

HU:

Hounsfield units

LMA:

Laryngeal mask airway

PEEP:

Positive end expiratory pressure

(PM)MR:

(Postmortem) magnetic resonance imaging

vPMCT:

Ventilated postmortem computed tomography

References

  1. Thayyil S, Sebire NJ, Chitty LS, Wade A, Chong WK, for the MARIAS collaborative group et al (2013) Post-mortem MRI versus conventional autopsy in fetuses and children: a prospective validation study. Lancet 382:223–233

    Article  PubMed  Google Scholar 

  2. Arthurs OJ, Thayyil S, Olsen OE, Addison S, Wade A, Jones R, Norman W, Scott RJ, Robertson NJ, Taylor AM, Chitty LS, Sebire NJ, Owens CM (2014) Diagnostic accuracy of post-mortem MRI for thoracic abnormalities in fetuses and children. Eur Radiol 24:2876–2884

    Article  PubMed Central  PubMed  Google Scholar 

  3. Germerott T, Preiss US, Ebert LC et al (2010) A new approach in virtopsy: postmortem ventilation in multislice computed tomography. Legal Med (Tokyo) 12:276–279

    Article  Google Scholar 

  4. Germerott T, Flach PM, Preiss US, Ross SG, Thali MJ (2012) Postmortem ventilation: a new method for improved detection of pulmonary pathologies in forensic imaging. Legal Med (Tokyo) 14:223–228

    Article  Google Scholar 

  5. Robinson C, Biggs MJ, Amoroso J, Pakkal M, Morgan B, Rutty GN (2014) Post-mortem computed tomography ventilation; simulating breath holding. Int J Legal Med 128:139–146

    Article  CAS  PubMed  Google Scholar 

  6. Rutty GN, Biggs MJP, Brough A, Robinson C, Mistry R, Amoroso J, Deshpande A, Morgan B (2015) Ventilated post-mortem computed tomography through the use of a definitive airway. Int J Legal Med 129(2):325–334, IJLM-D-14-00316

    Article  PubMed  Google Scholar 

  7. Arthurs OJ, Taylor AM, Sebire NJ (2013) The less invasive perinatal autopsy: current status and future directions. Fetal Matern Med Rev 24:45–59

    Article  Google Scholar 

  8. Royal College of Pathologists Working Party on the Autopsy (2006) Guidelines on autopsy practice: scenario 9: stillborn infant (singleton). June 2006. http://www.rcpath.org/Resources/RCPath/ Migrated_Resources/Documents/G/G001Autopsy-Stillbirths-Jun06.pdf. Accessed Jan 2015

  9. Sebire NJ, Weber MA, Thayyil S, Mushtaq I, Taylor A, Chitty LS (2012) Minimally invasive perinatal autopsies using magnetic resonance imaging and endoscopic postmortem examination (“keyhole autopsy”): feasibility and initial experience. J Matern Fetal Neonatal Med 25:513–518

    Article  PubMed  Google Scholar 

  10. Shiotani S, Kobayashi T, Hayakawa H, Kikuchi K, Kohno M (2011) Postmortem pulmonary edema: a comparison between immediate and delayed postmortem computed tomography. Legal Med (Tokyo) 13:151–155

    Article  Google Scholar 

  11. Hyodoh H, Shimizu J, Watanabe S, Okazaki S, Mizuo K, Inoue H (2015) Time-related course of pleural space fluid collection and pulmonary aeration on postmortem computed tomography (PMCT). Legal Med (Tokyo). doi:10.1016/j.legalmed.2015.01.002

    Google Scholar 

  12. Proisy M, Marchand AJ, Loget P et al (2013) Whole-body post-mortem computed tomography compared with autopsy in the investigation of unexpected death in infants and children. Eur Radiol 23:1711–1719

    Article  PubMed  Google Scholar 

  13. Noda Y, Yoshimura K, Tsuji S et al (2013) Postmortem computed tomography imaging in the investigation of nontraumatic death in infants and children. Biomed Res Int 2013:327903

    Article  PubMed Central  PubMed  Google Scholar 

  14. Sieswerda-Hoogendoorn T, Soerdjbalie-Maikoe V, de Bakker H, van Rijn RR (2014) Postmortem CT compared to autopsy in children; concordance in a forensic setting. Int J Legal Med 128:957–965

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

OA is funded by an NIHR Clinician Scientist AWARD, and NJS is funded by an NIHR Senior Investigator award, Great Ormond Street Children’s Charity and the Great Ormond Street Hospital Biomedical Research Centre.

This article presents independent research funded by the National Institute for Health Research (NIHR) and supported by the Great Ormond Street Hospital Biomedical Research Centre. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.

Ethical standards

This study complies with the current laws and ethical standards required in the UK.

Conflict of interest

The authors declare that they have no conflicts of interest.

Author information

Authors and Affiliations

  1. Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK

    Owen J Arthurs & Anna Guy

  2. UCL Institute of Child Health, London, UK

    Owen J Arthurs & Neil J Sebire

  3. Department of Histopathology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK

    Liina Kiho & Neil J Sebire

Authors
  1. Owen J Arthurs
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Anna Guy
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Liina Kiho
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Neil J Sebire
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Owen J Arthurs.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Arthurs, O.J., Guy, A., Kiho, L. et al. Ventilated postmortem computed tomography in children: feasibility and initial experience. Int J Legal Med 129, 1113–1120 (2015). https://doi.org/10.1007/s00414-015-1189-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00414-015-1189-z

Keywords

Search

Navigation