Post-mortem radiology—a new sub-speciality?

O’Donnell, Chris; Woodford, Noel

doi:10.1016/j.crad.2008.05.008

Cited by 203 publications

(96 citation statements)

References 38 publications

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“…To achieve the distinction between vital air embolism and gas from putrefaction on a post-mortem MDCT, it is essential to study the relationships between the pattern of gas distribution [1,11], the post-mortem interval, and the position of the cadaver at death [16]. To our knowledge, no basic studies have systematically investigated the distribution of post-mortem gas in the human body.…”

Section: Introductionmentioning

confidence: 99%

“…Although it has high sensitivity, the MDCT lacks specificity; it detects any gas [16]. Thus, forensic pathologists are confronted with new findings, but no way to differentiate between the gas formed during post-mortem putrefaction [1,11] and that due to vital air embolism.…”

Section: Introductionmentioning

confidence: 99%

“…Currently, few individuals have the knowledge required to interpret post-mortem images, particularly for distinguishing post-mortem artifacts due to gas. Forensic pathologists lack practitioner experience in imaging analysis, and radiologists must be aware of the differences between post-mortem and clinical images [1,2].…”

Section: Introductionmentioning

confidence: 99%

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Distribution of artifactual gas on post-mortem multidetector computed tomography (MDCT)

et al. 2011

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Purpose We investigated the incidence and distribution of post-mortem gas detected with multidetector computed tomography (MDCT) to identify factors that could distinguish artifactual gas from cardiac air embolism. Material and methods MDCT data of 119 cadavers were retrospectively examined. Gas was semiquantitatively assessed in selected blood vessels, organs, and body spaces (82 total sites). Results Seventy-four of the 119 cadavers displayed gas (62.2%; CI 95% 52.8-70.9), and 56 (75.7%) displayed gas in the heart. Most gas was detected in the hepatic parenchyma (40%), right heart (38% ventricle, 35% atrium), inferior vena cava (30% infrarenally, 26% suprarenally), hepatic veins (26% left, 29% middle, 22% right), and portal spaces (29%). Male cadavers displayed gas more frequently than female cadavers. Gas was detected 5-84 hours after death; therefore, the post-mortem interval could not reliably predict gas distribution (rho=0.719, p<0.0001). We found that a large amount of putrefaction-generated gas in the right heart was associated with aggregated gas bubbles in the hepatic parenchyma (sensitivity=100%, specificity=89.7%). In contrast, gas in the left heart (sensitivity=41.7%, specificity=100%) or in periumbilical subcutaneous tissues (sensitivity=50%, specificity=96.3%) could not predict gas due to putrefaction. Conclusion This study is the first to show that the appearance of post-mortem gas follows a specific distribution pattern. An association between intracardiac gas and hepatic parenchymal gas could distinguish between post-mortem-generated gas and vital air embolism. We propose that this finding provides a key for diagnosing death due to cardiac air embolism.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Distribution of artifactual gas on post-mortem multidetector computed tomography (MDCT)

et al. 2011

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“…As forensic pathologists often have little or no experience in imaging analysis, radiologists need to be trained in forensic imaging in order to identify usual radiologic signs related to postmortem changes [12]. We have previously demonstrated the quantification of cadaveric alteration and gas formation [13]; however, this procedure is time-consuming and requires qualified personnel.…”

Section: Introductionmentioning

confidence: 99%

Development and validation of a postmortem radiological alteration index: the RA-Index

et al. 2012

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This study aimed to derive an index quantifying the state of alteration of cadavers by quantifying the presence of gas in the body using postmortem multidetector computed tomography (MDCT) imaging, and to validate the index by defining its sensitivity and specificity. The RA (radiological alteration)-index was derived from postmortem MDCT data from 118 nontraumatically deceased people. To validate the index, 100 additional scanned bodies (50 % traumatically deceased) were retrospectively examined by two independent observers. Presence of gas at 82 sites was assessed by a radiologist, whereas a forensic pathologist only investigated the seven sites used for the RA-index. The RA-index was highly correlated to the overall presence of gas in all 82 sites (R 2 00.98 in the derivation set and 0.85 in the validation set). Semiquantitative evaluation of gas presence in each site showed moderate reliability (Cohen's kappa range, 0.41-0.78); nevertheless, the overall RA-index was very reliable (ICC 2,1 00.95; 95 % CI 0.92-0.96). Examiner using the RA-index detected heart cavities full of gas with a sensitivity of 100 % (95 % CI 51.7-100) and a specificity of 98.8 % (92.6-99.9). We conclude that determining the presence of gas at seven sites is a valid means to measure the distribution of gas due to cadaveric alteration in the entire body. The RA-index is rapid, easy-touse, and reliable for nonexperienced users, and it is a valid method to suspect the normal presence of gas from cadaveric alteration. MDCT can be used to screen for gas embolism and to give indications for gas composition analysis (gas chromatography).

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“…These techniques also require some experience in distinguishing post mortem changes, such as internal gas production from decomposition, from true ante mortem pathology. In this setting, post mortem radiology can be considered a new sub-speciality requiring specific experience and training [7]. Indeed, most clinical radiologists will likely have little to no experience in interpretation of post mortem images and the injuries typically seen in a forensic setting.…”

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confidence: 99%

The Impact of Advances in Post-Mortem Imaging on Forensic Practice

Ch¹

2013

JOURNAL OF FORENSIC SCIENCE & CRIMINOLOGY

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EditorialOpen AccessA large validation study from the UK of 182 cases comparing whole body CT and MRI with full autopsy revealed a 32% major discrepancy rate between radiology and autopsy findings. CT appeared to be a more accurate imaging technique than MRI for determination of cause of death. Common causes of sudden death were frequently missed by imaging; the most common errors being ischaemic heart disease, pulmonary embolism, pneumonia and intra-abdominal lesions. In general, CT provides better spatial resolution and demonstrates fractures and haemorrhages well, whereas MRI tends to provide better soft tissue detail [5].

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Post-mortem radiology—a new sub-speciality?

Cited by 203 publications

References 38 publications

Distribution of artifactual gas on post-mortem multidetector computed tomography (MDCT)

Distribution of artifactual gas on post-mortem multidetector computed tomography (MDCT)

Development and validation of a postmortem radiological alteration index: the RA-Index

The Impact of Advances in Post-Mortem Imaging on Forensic Practice

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