Postmortem cardiac magnetic resonance in sudden cardiac death

Abstract

Postmortem imaging is increasingly used in forensic practice as good complementary tool to conventional autopsy investigations. Over the last decade, postmortem cardiac magnetic resonance (PMCMR) imaging was introduced in forensic investigations of natural deaths related to cardiovascular diseases, which represent the most common causes of death in developed countries. Postmortem CMR application has yielded interesting results in ischemic myocardium injury investigations and in visualizing other pathological findings in the heart. This review presents the actual state of postmortem imaging for cardiovascular pathologies in cases of sudden cardiac death (SCD), taking into consideration both the advantages and limitations of PMCMR application.

Sudden Cardiac Death and Ex-Situ Post-Mortem Cardiac Magnetic Resonance Imaging: A Morphological Study Based on Diagnostic Correlation Methodology

“…PMMRI, indeed, among the other techniques, is still the least studied and of rare application to forensic pathology, and the first reason is certainly the complexity of its technology [ 13 , 14 ]. In fact, to obtain satisfactory results, it is necessary to adapt the acquisition protocols that must balance the visual field and the resolution obtained (the smaller the visual field, the better the resolution); thus, the examination time required to perform a high-quality PMMRI exam is an important limiting factor.…”

Diagnostik von messenger Ribonukleinsäure (mRNA) severe acute respiratory syndrome-corona virus‑2 (SARS-CoV‑2) impfassoziierten Myokarditiden – ein systematischer Review

“…So, cardiac MRI might be the most important diagnostic tool in a clinical setting [ 46 ], although in early stages of inflammation MRI is restricted [ 47 ]. In the postmortem setting MRI is not yet elaborated for the diagnosis of myocarditis [ 48 ].…”

“…Nevertheless, histology, especially immunohistology, is mandatory for the diagnosis of myocarditis [ 44 , 53 , 54 ]. The importance of histology in the postmortem setting is strengthened by postmortem limitations of MRI [ 48 ] and an almost unrestricted access to myocardial tissue during autopsy. Thus, histology is the key to the diagnosis of myocarditis in the (forensic) pathological setting allowing identification of predisposed areas, characterization of the inflammatory lesions, and detection of small (potentially early and subclinical) lesions.…”

Post-Mortem Cardiac Magnetic Resonance for the Diagnosis of Hypertrophic Cardiomyopathy

“…In the last few years, post-mortem CMR (PMCMR) is being used as emerging technique for postmortem radiological investigation of cardiovascular pathologies. PMCMR of explanted heart or of the entire body overcame limitations of spatial resolution permitting to acquire sub-millimetric high resolution images (7).…”

“…Using high resolution whole heart 3d-SSFP pulse sequence, PMCMR provide information of cardiac morphology with the identification of ventricular abnormalities associated with HCM (as coronary bridge, crypts, diverticuli, aneurysm, asymmetric or symmetric wall hypertrophy, papillary muscle abnormalities, valvular abnormalities, etc) and gives quantitative parameters as ventricular mass, volumes and atrial dimensions (7).…”