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Despite 75 to 90 % physician accuracy in determining the underlying cause of death, precision of determination of the immediate cause of death is approximately 40 %. In contrast, two thirds of immediate causes of death in hospitalized patients are correctly diagnosed by postmortem computed tomography (CT). Postmortem CT might provide an alternative approach to verifying the immediate cause of death. To evaluate the effectiveness of postmortem CT as an alternative method to determine the immediate cause of death in hospitalized patients, an autopsy-based prospective study was performed. Of 563 deaths from September 2011 to August 2013, 50 consecutive cadavers undergoing hospital autopsies with consent for additional postmortem CT at the University of Fukui were enrolled. The accuracy of determination of the immediate cause of death by postmortem CT was evaluated in these patients. Diagnostic discrepancy was also compared between radiologists and attending physicians. The immediate cause of death was correctly diagnosed in 37 of 50 subjects using postmortem CT (74 %), concerning 29 cases of respiratory failure, 4 of hemorrhage, 3 of liver failure and 1 of septic shock. Six cases of organ failure involving 13 patients were not identified as the cause of death by postmortem CT. Regarding the immediate cause of death, accuracy of clinical diagnosis was significantly lower than that of postmortem CT (46 vs 74 %, P < 0.01). Postmortem CT may be more useful than clinical diagnosis for identifying the immediate cause of death in hospitalized patients not undergoing autopsy.Electronic supplementary materialThe online version of this article (doi:10.1007/s00428-016-1937-6) contains supplementary material, which is available to authorized users.

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Although organ weight gives pathologists information about the pathogenesis of diseases at autopsy, the knowledge is rarely helpful in postmortem virtual autopsy by computed tomography (CT). To investigate the feasibility of liver weight estimation based on liver volume estimated from three-dimensional CT images and the specific gravity of liver, thirty cadavers who died in the University of Fukui Hospital and whose family members agreed to postmortem CT and autopsy were prospectively enrolled. Mean specific gravity of liver was 1.054 ± 0.009 g/mL (95% confidence interval: 1.0507-1.0573 g/mL). The specific gravity was positively correlated to Hounsfield unit (HU) values of less than 40 (cases with moderate to severe fatty deposition) and remained stable between 1.05 to 1.065 g/mL for HU values greater than 40 (cases with mild or no fatty change). The liver weight estimated by our formula corresponded well to the actual liver weight, and the correlation coefficient was 0.96 (P < 1 × 10 −13). The estimated liver weight calculated from estimated liver volume and the specific gravity of 1.055 g/mL was highly accurate, whereas the specific gravity should be reduced by 2%-3% in patients with an HU value less than 40 due to fatty deposition.Key words: autopsy, liver weight estimation, postmortem CT, specific gravity of liver Autopsy is useful for quality control, education, and epidemiological data in clinical medicine.1,2 More than a powerful tool for quality improvement in patient care, the autopsy generates accurate vital statistics, provides a better understanding of diseases, and drives progress in medicine. 3 The procedure, which has changed little since the 19th century, consists of macroscopic observation, such as evisceration and measurement of the major organs, followed by histological analysis. [4][5][6] Many physicians worldwide are concerned about decreased autopsy rates, 1,7 which are assumed to be at least partially caused by clinical disinterest. Indeed, the determination of organ measurements (e.g., organ weights) is rarely helpful in routine medical practice, although the results give pathologists information about underlying diseases and/or conditions of deceased patients. In contrast to the decrease in autopsy rates, the frequency of postmortem imaging is increasing as a supplement to the traditional autopsy. Postmortem computed tomography (CT) and magnetic resonance imaging (MRI) are useful for determining the cause of death in Japan [8][9][10][11] and in Western countries. 2,4,5 Since 1994, the frequency of living-donor liver transplantation has been increasing due to the lack of cadaveric liver donors.12,13 Reliable liver weight estimation in transplantation is crucial for the safety of donors and recipients. Therefore, several physicians sought to estimate the liver weight for living-donor liver transplantation.14,15 However, the estimation formula is based on the height and weight of the donor, 16 and the reliability of the formula is unknown. This is partly due to the difficulty in validating ...