Diagnosis of coronary artery disease using minimally invasive autopsy: evaluation of a novel method of post-mortem coronary CT angiography

Evaluation of postmortem MDCT and MDCT-angiography for the investigation of sudden cardiac death related to atherosclerotic coronary artery disease

“…Their results showed relatively good correlation with autopsy findings. The disadvantage of this technique is related to the repositioning of the catheter after a CT control, often resulting in unsatisfactory filling of coronary arteries which necessitates turning of the patient with further injections and CT scanning [12]. We did not encounter any problems related to the positioning of the catheter or filling of coronary arteries, as the technique of PMPCTA is standardized and coronary arteries are visualized in all cases except those of massive aortic rupture.…”

“…Only a few recent studies have addressed this topic [12][13][14]. Saunders et al [13] presented the developmental stages for manual targeted in situ postmortem angiography using injections of air/Urografin Ò and demonstrated that large volumes of air and contrast can be injected without displacing the thrombi.…”

“…MDCT-angiography was carried out using the standardized protocol for MPMCTA [12] which was approved by the local ethics committee. Following the protocol, a native CT-scan was performed prior to any manipulation of the body with a 8-row CT-unit (CT LightSpeed 8, GE Healthcare, Milwaukee, WI, USA) using the following scan parameters: field of view (FOV) 50 cm, slice thickness 2.5 mm, interval of reconstruction 2 mm, 120 kVp, 280 mA and 150 s scan time.…”

“…Following the protocol, a native CT-scan was performed prior to any manipulation of the body with a 8-row CT-unit (CT LightSpeed 8, GE Healthcare, Milwaukee, WI, USA) using the following scan parameters: field of view (FOV) 50 cm, slice thickness 2.5 mm, interval of reconstruction 2 mm, 120 kVp, 280 mA and 150 s scan time. After the collection of post-mortem liquid samples for toxicological screening and analyses of cardiac biomarkers under CT-guidance [12], cannulation of the femoral vessel on one side was performed using cannulas (MAQUET Gmbh & Co. KG, Rastatt, Germany) with a diameter of 16-French for arteries and 18-French for veins. A recently developed pressure-controlled perfusion device (Virtangio Ò , Fumedica AG, Maquet Ò , Muri, Switzerland) was used to inject a mixture of contrast agent (Angiofil Ò , Fumedica AG, Muri, Switzerland) and paraffin oil (liquid paraffin obtained from the local pharmacy) according to the protocol proposed by Grabherr et al [16].…”

“…At the same time, some pioneer studies involving postmortem MDCTangiography and cardiac pathologies have recently been published [11][12][13] describing the potential to overcome these weaknesses. Several authors suggest that the major limitations concerning cardio-vascular pathology could be minimized by the introduction of postmortem angiography [12,14,15]. In our practice, native MDCT has become part of the routine investigation.…”