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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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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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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DOI: https://doi.org/10.1007/s00414-019-02128-8