Epicardial adipose tissue volume estimation by postmortem computed tomography of eviscerated hearts

Abstract

Epicardial adipose tissue (EAT) may play a role in the development of coronary artery disease. The purpose of this study was to evaluate a method based on postmortem computed tomography (PMCT) for the estimation of EAT volume. We PMCT-scanned the eviscerated hearts of 144 deceased individuals, who underwent a medicolegal autopsy. Using Mimics® we performed segmentation of the images and obtained the volumes of EAT and myocardium. Total heart volume was calculated by adding the volumes of EAT and myocardium. Total heart weight, including EAT, myocardium and attached vessels, was measured during autopsy. Inter-observer analysis was performed on 30 randomly chosen subjects. We included 132 individuals in the results (age range: 22-94 years; 56% men). Twelve individuals were excluded due to inadequate PMCT scanning. Median EAT volume was 73.0 mL (Interquartile range; IQR: 45.6-113.7 mL) in men and 64.8 mL (IQR: 44.0-98.0 mL) in women, which accounted for 20.4 ± 10.2% and 21.9 ± 9.5% of total heart volume, respectively. This corresponded with former autopsy studies. Total heart volume measured by PMCT was highly correlated with heart weight (R = 90%). Mean inter-observer difference of EAT volume was -1.7 mL (95% limits of agreement: -37.0-33.6 mL), with an Intra Class Correlation of 0.91. It was possible to estimate EAT volume using PMCT on eviscerated human hearts. Our method was fast and accurate with good inter-observer agreement. This is a useful method to determine EAT at autopsy, and we will apply this method in future research.

Artificial intelligence based automatic quantification of epicardial adipose tissue suitable for large scale population studies

“…Differences between our estimates and those of Eisenberg are quite large and probably not fully explained by the omission of the most inferior part of the epicardial tissue in their work. An interesting work by Hindsø 31 reports EATV from forensic autopsy material and again shows substantially lower EATV than in our current report, despite similar weight and BMI. The degree to which post mortem data on EATV can be compared to in vivo data is not known.…”

“…The majority of works employ semi-automated methods for EAT quantification (weighted average 99.1 ml), whereas the two publications relying on automated quantification show among the lowest amounts of EATV. One publication on necropsy material 31 containing no other adipose tissue than EAT shows the lowest EATV, slightly below 70 ml, when male and female subjects are pooled.…”

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

“…One person conducted the manual segmentation and this is a limitation. However, CTR measurements and volumetric organ measurements have shown high interrater agreements [2,3,6,30,31]. Secondly, not all possible causes of death were assessed and hypothermia group was very small so the two hypothermia cases which fulfilled the inclusion criteria had to be excluded from the analysis.…”

Clinical Anatomy and Medical Malpractice—A Narrative Review with Methodological Implications

“…Post-mortem imaging applied to single organs or structures (X-ray, CT, MR, angiography, eventually with casts) is frequently involved in forensic pathology and may also give further information about anatomy. Hindso et al [ 85 ] demonstrated the accuracy of post-mortem CT for the measurement of the volumes of epicardial adipose tissue and myocardium in eviscerated hearts. In addition, post-mortem imaging of explanted larynxes after forensic autopsy have been proposed [ 86 ] and in a forensic case we involved post-mortem CT for better detailing of a laryngeal anatomical variation (differential diagnosis with traumatic finding) [ 87 ].…”