Common and Expected Postmortem CT Observations Involving the Brain: Mimics of Antemortem Pathology

Smith, Alice B.; Lattin, Grant E.; Berran, Philip J.; Harcke, H. Theodore

doi:10.3174/ajnr.a2966

Cited by 37 publications

(22 citation statements)

References 7 publications

(8 reference statements)

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“…However, we hypothesize that the control group cases in our study exhibited milder brain swelling because reperfusion was absent or limited to the agonal stage. Another factor associated with brain swelling is autolysis, which becomes obvious at 24 h after death [10,13]. We observed two cases with 19-and 30-day intervals between the hypoxic event and death who exhibited pathological findings indicating the so-called respirator brain, which is characterized by autolytic changes [14,15].…”

Section: Discussionmentioning

confidence: 96%

Can postmortem computed tomography detect antemortem hypoxic–ischemic encephalopathy?

Shirota

Ishida

Shintani

et al. 2016

Forensic Sci Med Pathol

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The purpose of this study was to evaluate the usefulness of brain postmortem computed tomography (PMCT) findings for the detection of global hypoxia or hypoperfusion leading to hypoxic-ischemic encephalopathy (HIE) prior to death. Cadavers of individuals who died from non-traumatic causes were subjected to PMCT and pathological autopsy. Cases with an episode of cardiopulmonary arrest, hypoxia, or hypoperfusion that required intensive respiratory management at least 24 h before death and exhibited findings of HIE in conventional autopsy (HIE group, n = 6) were compared with those without such episodes prior to death (control group; overall, n = 37; age-matched, n = 8) with regard to four parameters: (1) width of the central sulcus (CS), (2) attenuation difference at the basal ganglia (BG) level, (3) attenuation difference between cerebral gray matter (GM) and cerebral white matter (WM), and (4) attenuation difference between cerebellar GM and cerebral GM. The results revealed significant differences in the width of the CS (P < 0.001), attenuation difference at the BG level (P < 0.001), and attenuation difference between cerebral GM and cerebral WM (P = 0.009) between the HIE group and the overall control group. When the age-matched control group and the HIE group were compared, there was a significant difference in the width of the CS (P = 0.026) and attenuation difference at the BG level (P < 0.001). Our results suggest that effacement of the sulcus of the cerebral hemisphere and the loss of contrast at the BG level on brain PMCT indicate the existence of HIE prior to death.

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Section: Discussionmentioning

confidence: 96%

Can postmortem computed tomography detect antemortem hypoxic–ischemic encephalopathy?

Shirota

Ishida

Shintani

et al. 2016

Forensic Sci Med Pathol

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show abstract

“…Brain swelling and a loss of distinction between the gray matter (GM) and white matter (WM) are normal postmortem changes on postmortem CT. Takahashi et al ( 27 ) reported that postmortem brain autolysis may occur without concurrent vasogenic edema owing to hyperacute global ischemia in the absence of reperfusion; as a result, a subtle loss of distinction between the GM and WM can be detected on early postmortem CT. The ventricles and cisterns are sometimes visibly effaced because of mild swelling during the immediate postmortem period ( 27 28 ). The GM and WM densities are considerably higher on postmortem CT than on AMCT, which reflects the presence of severe hypoxic-anoxic encephalopathy before death.…”

Section: Gross Postmortem Ct Images Of the Brainmentioning

confidence: 99%

Common Postmortem Computed Tomography Findings Following Atraumatic Death: Differentiation between Normal Postmortem Changes and Pathologic Lesions

et al. 2015

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Computed tomography (CT) is widely used in postmortem investigations as an adjunct to the traditional autopsy in forensic medicine. To date, several studies have described postmortem CT findings as being caused by normal postmortem changes. However, on interpretation, postmortem CT findings that are seemingly due to normal postmortem changes initially, may not have been mere postmortem artifacts. In this pictorial essay, we describe the common postmortem CT findings in cases of atraumatic in-hospital death and describe the diagnostic pitfalls of normal postmortem changes that can mimic real pathologic lesions.

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“…On the other hand, radiologists have to be trained to think 'forensically' , as the interpretation of postmortem findings in the forensic setting is not the same as in clinical practice (Smith et al 2012). Radiologists should learn basic forensic principles.…”

Section: Sample Structure Of the Reportmentioning

confidence: 99%

“…Figures 9.4 and 9.5 show some of the normal PMCT characteristic images which should not be confused with pathologies (Smith et al 2012).…”

Section: Sample Structure Of the Reportmentioning

confidence: 99%

Autopsy

Knudsen¹,

Thomsen²,

Ampanozi³

et al. 2014

Handbook of Forensic Medicine

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Common and Expected Postmortem CT Observations Involving the Brain: Mimics of Antemortem Pathology

Cited by 37 publications

References 7 publications

Can postmortem computed tomography detect antemortem hypoxic–ischemic encephalopathy?

Can postmortem computed tomography detect antemortem hypoxic–ischemic encephalopathy?

Common Postmortem Computed Tomography Findings Following Atraumatic Death: Differentiation between Normal Postmortem Changes and Pathologic Lesions

Autopsy

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