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

Abstract

Cadaver-specific postmortem computed tomography (PMCT) has become an integral part in anatomy teaching at several universities. Recently, the feasibility of contrast-enhanced (CE)-PMCT has been demonstrated. The purpose of this study was to identify particular strengths and weaknesses of both non-enhanced and contrast-enhanced PMCT compared to conventional cadaver dissection. First, the students' perception of the learning effectiveness of the three different modalities have been assessed using a 34-item survey (five-point Likert scale) covering all anatomy course modules. Results were compared using the nonparametric Friedman Test. Second, the most frequent artifacts in cadaver CT scans, were systematically analyzed in 122 PMCT and 31 CE-PMCT data sets to quantify method-related limitations and characteristics. Perfusion quality was assessed in 57 vascular segments (38 arterial and 19 venous). The survey was answered by n = 257/320 (80.3%) students. Increased learning benefits of PMCT/ CE-PMCT compared to cadaver dissection were found in osteology (2/3 categories, P < 0.001), head and neck (2/5 categories, P < 0.01), and brain anatomy (3/3 categories, P < 0.01). Contrastenhanced-PMCT was perceived particularly useful in learning vascular anatomy (10/10 categories, P < 0.01). Cadaver dissection received significantly higher scores compared to PMCT and CE-PMCT in all categories of the abdomen and thorax (7/7 categories, P < 0.001), as well as the majority of muscular anatomy (5/6 categories, P < 0.001). Frequent postmortem artifacts (total n = 28, native-phase n = 21, contrast injection-related n = 7) were identified and assessed. The results of this work contribute to the understanding of the value of integrating cadaver-specific PMCT in anatomy teaching. Anat Sci Educ 0: 1-12.

The role of anatomical context in soft‐tissue multi‐organ segmentation of cadaveric non‐contrast‐enhanced whole body CT

“…These models can be used by students to study form, function, and variation. 7,8 In the clinical setting, cadaveric CT has been used to improve surgical planning for the treatment of chronic back pain 9 and analysis of ankle cartilage thickness. 10 In a comparison between CT imaging and 2D radiographs, CT was better able to analyze dual-mobility cup placement for total hip arthroplasties.…”

“…While not a replacement for traditional dissection‐based courses, 3–6 the use of CT scans enables the identification, segmentation, and 3D modeling of important structures of interest. These models can be used by students to study form, function, and variation 7,8 …”

“…The inherent lack of contrast in cadaveric CT from tissue fixation, clotting, and lack of blood flow obscures clear definition of anatomical boundaries. Commercial cadaveric contrast agents such as BriteVu © , Angiofil © , and Lugol's Iodine are able to highlight specific areas, but these agents are expensive and can cause contrast pooling and other artifacts, especially within larger specimens such as the whole human body 7,20,21 . In addition, cadaveric specimens tend to have much higher amounts of variation in their organ structures due to various reasons such as differences in death and tissue fixation, demographics, pathologies present in the population, retained fetal lobulation, metal artifacts, and body positioning artifacts (Figure 1).…”

Efficacy of postmortem CT and tissue sampling in establishing the cause of death in clinical practice: a prospective observational study

“…1 Nowadays, however, autopsy plays an irreplaceable role in quality control and education. [2][3][4][5][6] In an era of growing accuracy and accessibility of antemortem diagnostics, however, waning interest in postmortem examination has resulted in steadily declining autopsy rates worldwide. [7][8][9][10][11][12] The most important reason to forego autopsy is the assumption that the cause of death (COD) was reliably derived from clinical observations and antemortem diagnostic procedures.…”