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

Abstract

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.

Daily application of post-mortem computed tomography digital autopsy in a public mortuary

“…PMCT is sensitive in detecting these changes, but careful interpretation of the imaging is required to avoid diagnostic pitfalls. 18 We find that PMCT has utility as an adjunct in the examination of decomposing bodies and that there are instances where it allows an invasive examination to be dispensed with. Cartocci et al have suggested that the benefit of PMCT in these cases lies in the detection of putrefactive gas, 18 but we disagree and consider this to be of no benefit.…”

“…18 We find that PMCT has utility as an adjunct in the examination of decomposing bodies and that there are instances where it allows an invasive examination to be dispensed with. Cartocci et al have suggested that the benefit of PMCT in these cases lies in the detection of putrefactive gas, 18 but we disagree and consider this to be of no benefit. Rather, we consider that PMCT is helpful in identifying foreign bodies 19 such as pacemakers or other implanted devices, suggesting cardiac disease, and also plays a role in body identification.…”

“…Putrefactive decomposition gradually destroys the body as it progresses, and as such these bodies present a challenge to the pathologist. 18 Changes due to putrefaction that are evident radiologically develop rapidly after death, with gas formation in the heart, vessels, hepatic parenchyma and body cavities. PMCT is sensitive in detecting these changes, but careful interpretation of the imaging is required to avoid diagnostic pitfalls.…”

Strengths and Weaknesses of Non‐enhanced and Contrast‐enhanced Cadaver Computed Tomography Scans in the Teaching of Gross Anatomy in an Integrated Curriculum

“…Students have enough space to explore and study anatomical structures during cadaver dissection. Autolytic gas formation can cause limited data quality of some PMCT scans (Sapienza et al, 2017; Cartocci et al, 2019). This together may explain the comparably high scores of CCD for abdominal anatomy.…”

Translational deep phenotyping of deaths related to the COVID-19 pandemic: protocol for a prospective observational autopsy study

“… 103 The RAI is a semiquantitative estimation of the extent of postmortem gas formation in seven anatomical locations as graded from 1 to 3 on PMCT, and has been demonstrated to correlate well with the grade of external putrefaction. 104 …”