Evaluation of the mediastinal-thoracic volume ratio on postmortem computed tomography

Abstract

Objectives The aim of this study was to measure the mediastinal-thoracic volume ratio (CTR_VOL) on PMCT as a more accurate version of traditional CTR, in order to assess the terminal positional relationship between the heart and lungs in the different causes of death with regard to age, gender, BMI, cardiomegaly, and lung expansion. Materials Two hundred fifty consecutive postmortem cases with pre-autopsy PMCT and full forensic autopsy were retrospectively evaluated. The lungs and the mediastinum were manually segmented on the PMCT data and the correspondent volumes were estimated in situ. CTR_VOL was calculated as the ratio of the mediastinal to the thoracic volume. The volume measurements were repeated by the same rater for the evaluation of the intrarater reliability. Age, gender, body weight and height, heart weight at autopsy, and cause of death were retrieved from the autopsy reports. Presence of lung expansion was radiologically evaluated in situ. Results CTR_VOL was positively associated with age and BMI but not with gender and was higher for cardiomegaly compared to normal hearts, lower for asphyxiation-related deaths compared to cardiac deaths and intoxications, and lower for cases with lung expansion. The intrarater reliability was excellent for the calculated volumes of both lungs and mediastinum. Conclusion The results of the present study support CTR_VOL as a tool to assess the relationship between the heart and lungs in situ, which differs significantly between the studied cause of death categories.

Thoracic mediastinal-occupying ratio predicts recovery and prognosis after lung transplantation

“…Cardiomegaly may be due to primary or secondary pulmonary hypertension (PH) or other underlying mechanisms. Although PH alone did not predict the clinical outcomes in this study, 73% of the patients had TMOR >30%, which was higher than that reported in normal individuals (mean ± standard deviation, 25% ± 6%) [ 7 ]; therefore, we set TMOR at 40% as a stratified standard in this study. Overall, TMOR is a parameter that integrates a relatively small chest cavity and large heart, both of which could be multifactorial.…”

“…These volumes were obtained using Synapse Vincent (Fuji Film Co., Ltd., Tokyo, Japan). Semi-auto extraction with a manual operation was used to obtain the volumes of the thoracic cage and mediastinum [ 7 , 8 ]. To ensure the quality of the extraction, all three-dimensional images were assessed by experienced thoracic surgeons (Nobuyuki Yoshiyasu and Masaaki Sato).…”

“…To ensure the quality of the extraction, all three-dimensional images were assessed by experienced thoracic surgeons (Nobuyuki Yoshiyasu and Masaaki Sato). The standard for a high TMOR was set at >40% based on the threshold for defining cardiomegaly in patients on postmortem CT [ 7 ]. A mediastinal shift was diagnosed when there was a large gap of greater than a 30° angle between the midsagittal line and the line joining the anterior aspect of the vertebral body and the centre of the aortic valve (Fig.…”

Non-invasive methods in autopsy in practice of pathologists and forensic experts: from the appearance to the present day

“…Посмертная КТ-ангиография обладает высокой визуализацией для выявления пороков развития сердечно-сосудистой системы у новорожденных [68]. Также возможно применение виртопсии в области антропо-и морфометрических исследований, например, для определения кардиоторакального соотношения [8,19]. Несмотря на то, что данные морфометрии сердца, основанные на аутопсии, могут значительно отличаться от оценки в рамках виртопсии, применение неинвазивных методов может быть дополнено разработкой современных протоколов оценивания изображения и внедрением подходящих морфометрических расчетов.…”