Adult post-mortem imaging in traumatic and cardiorespiratory death and its relation to clinical radiological imaging

Morgan, Bruno; Adlam, David; Robinson, Claire; Pakkal, Mini; Rutty, Guy N.

doi:10.1259/bjr.20130662

Cited by 21 publications

(9 citation statements)

References 96 publications

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“…The results obtained from these various studies strongly suggest a potential role of OCT in the study of coronary artery disease and of sudden cardiac death, even in forensic caseworks as a supplementary diagnostic tool [15,16].…”

Section: Heart and Coronarymentioning

confidence: 85%

Optical coherence tomography in forensic sciences: a review of the literature

Nioi

Napoli

Mayerson

et al. 2019

Forensic Sci Med Pathol

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Optical coherence tomography (OCT) is an interferometric imaging technique that has revolutionized clinical ophthalmology since the first half of the 1990's. Despite this approach being successfully employed in ophthalmology and having great potential in forensic cases, its use in different forensic fields appears to be quite limited. In this review we reviewed the scientific literature regarding the application of OCT in forensic science and legal medicine from 1995 to 2019. Our research showed the usefulness of this approach for the study of coronary injuries, postmortem ocular changes, forensic entomology, and several other applications of specific forensic interest (the study of blood stains, fingerprints, and hair bulbs for personal identification, as well as the study of materials found in the crime scene for comparation, or anti-fraud investigation). The creation of specific 'ad hoc' devices and a better knowledge of this type of technology by pathologists will be a fundamental step to continue to develop the use of OCT forensic fields.

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Section: Heart and Coronarymentioning

confidence: 85%

Optical coherence tomography in forensic sciences: a review of the literature

Nioi

Napoli

Mayerson

et al. 2019

Forensic Sci Med Pathol

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“…On the other hand, putrefactive gas should not be mistaken for pathologic gas collections that may have contributed or caused the death, such as air embolism, pneumothorax or pneumoperitoneum [22][23][24][25][26].…”

Section: Discussionmentioning

confidence: 99%

“…Gas formation is a hallmark feature of putrefaction, since gaseous bloating in advanced decomposed bodies is determined by vascular and intra-parenchymatous gases. PMCT allows to detect exact localization of post-mortem gas in the whole body, even in very small amounts, and to distinguish between normal decomposition processes and pathologic gas collections that may have contributed to causing the death, such as air embolism, pneumothorax or pneumoperitoneum [18][19][20][21][22][23][24][25][26][27][28][29].…”

Section: Introductionmentioning

confidence: 99%

Post-mortem computed tomography (PMCT) radiological findings and assessment in advanced decomposed bodies

et al. 2019

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The aim of the study is to report radiological findings and features in advanced decomposed bodies obtained by post-mortem computed tomography (PMCT) with autopsy correlation. Materials and methods This retrospective descriptive multicentric study included 41 forensic cases examined between May 2013 and November 2016. All the bodies were PMCT-scanned prior to autopsy, and internal putrefactive state was determined using the radiological alteration index (RAI) by a radiologist with expertise in forensic radiology and a forensic pathologist trained in forensic imaging. After PMCT scans, grade of external putrefaction (GEP) was assigned during the external examination and the complete autopsy was performed by forensic pathologists. Results The PMCT images evaluation revealed that the RAI index was > 61 in all bodies, corresponding to a moderatemassive presence of putrefactive gas. The gas grade was > II in correspondence of the major vessels, heart cavities, liver parenchyma, vertebra L3 and subcutaneous pectoral tissues, and varied from I to III in correspondence of the kidney. Cadaveric external examination revealed the presence of advanced transformative phenomena, with a GEP3 and GEP4 in most of the cases, with body swelling, eyes and tongue protrusion, body fluids expulsion and fat liquefaction. Conclusion Radiological imaging by PMCT as an adjunct to autopsy in advanced decomposed bodies represents a useful tool in detecting post-mortem gas, even in very small amounts. A correct interpretation process of the PMCT data is essential to avoid images pitfalls, due to natural decomposition that can be mistaken for pathologic processes.

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“…Postmortem imaging of treated coronary arteries appears especially useful and is recommended. According to the literatures [4,30,53], PMCT allows for the detection of coronary stents, which could be difficult to visualize at autopsy in the presence of severe calcifications. MPMCTA can demonstrate the patency of coronary bypass grafts and help guide the dissection technique during autopsy [2,5,49,54].…”

Section: Coronary Calcificationsmentioning

confidence: 99%

Postmortem imaging as a complementary tool for the investigation of cardiac death

Michaud

Genet

Sabatasso

et al. 2019

Forensic Sciences Research

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In the past 2 decades, modern radiological methods, such as multiple detector computed tomography (MDCT), MDCT-angiography, and cardiac magnetic resonance imaging (MRI) were introduced into postmortem practice for investigation of sudden death (SD), including cases of sudden cardiac death (SCD). In forensic cases, the underlying cause of SD is most frequently cardiovascular with coronary atherosclerotic disease as the leading cause. There are many controversies about the role of postmortem imaging in establishing the cause of death and especially the value of minimally invasive autopsy techniques. This paper discusses the state of the art for postmortem radiological evaluation of the heart compared to classical postmortem examination, especially in cases of SCD. In SCD cases, postmortem CT is helpful to estimate the heart size and to visualize haemopericardium and calcified plaques and valves, as well as to identify and locate cardiovascular devices. Angiographic methods are useful to provide a detailed view of the coronary arteries and to analyse them, especially regarding the extent and location of stenosis and obstruction. In postsurgical cases, it allows verification and documentation of the patency of stents and bypass grafts before opening the body. Postmortem MRI is used to investigate soft tissues such as the myocardium, but images are susceptible to postmortem changes and further work is necessary to increase the understanding of these radiological aspects, especially of the ischemic myocardium. In postsurgery cases, the value of postmortem imaging of the heart is reportedly for the diagnostic and documentation purposes. The implementation of new imaging methods into routine postmortem practice is challenging, as it requires not only an investment in equipment but, more importantly, investment in the expertise of interpreting the images. Once those requirements are implemented, however, they bring great advantages in investigating cases of SCD, as they allow documentation of the body, orientation of sampling for further analyses and gathering of other information that cannot be obtained by conventional autopsy such as a complete visualization of the vascular system using postmortem angiography. KEY POINTSThere are no established guidelines for the interpretation of postmortem imaging examination of the heart At present, postmortem imaging methods are considered as less accurate than the autopsy for cardiac deaths Postmortem imaging is useful as a complementary tool for cardiac deaths There is still a need to validate postmortem imaging in cardiac deaths by comparing with autopsy findings ARTICLE HISTORY

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Adult post-mortem imaging in traumatic and cardiorespiratory death and its relation to clinical radiological imaging

Cited by 21 publications

References 96 publications

Optical coherence tomography in forensic sciences: a review of the literature

Optical coherence tomography in forensic sciences: a review of the literature

Post-mortem computed tomography (PMCT) radiological findings and assessment in advanced decomposed bodies

Postmortem imaging as a complementary tool for the investigation of cardiac death

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