The needle in the haystack: Histology of post-mortem computed tomography guided biopsies versus autopsy derived tissue

Latten, Bartholomeus G. H.; Bakers, Franciscus C.H.; Hofman, Paul; Hausen, Axel zur; Kubat, Bela

doi:10.1016/j.forsciint.2019.109882

Cited by 10 publications

(6 citation statements)

References 45 publications

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“…Minimal invasive autopsy (PMCT, PMCTA, and biopsy) achieved a 90.9% agreement [20]. Nonetheless, a recent study argues that biopsies are only an alternative when consent for an autopsy cannot be obtained, since they found that CT-guided post-mortem biopsies of the lungs had a mediocre predictive value [21].…”

Section: Discussionmentioning

confidence: 99%

Added value of post-mortem computed tomography (PMCT) to clinical findings for cause of death determination in adult “natural deaths”

et al. 2019

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The aim of this study was to investigate whether post-mortem computed tomography (PMCT) provides additional information regarding the cause of death and underlying diseases in a general practitioners' (GP), out-of-hospital population. Methods and materials Bodies donated to our anatomy department between January 2014 and January 2018, who consecutively underwent a total body PMCT and had given permission for retrieval of their medical records during life, were included. PMCT scans were assessed by a radiologist and compared with the cause of death as stated in the medical records. Discrepancies were analyzed with an adjusted Goldman classification. Results Ninety-three out of the 274 scanned donors during the inclusion period had given consent for the retrieval of their medical records, of which 79 GP's responded to the request thereof (31 men, 48 women, average age 72.8 years, range 36-99). PMCT identified 49 (62%) cases of cancer, 10 (12.7%) cardiovascular diseases, 8 (10.1%) severe organ failures, 5 (6.3%) cases with signs of pneumonia, 2 (2.5%) other causes, and 7 (8.9%) cases without an (underlying) definitive cause of death. Eleven major discrepancies on the Goldman classification scale, with possible relevance to survival between PMCT and GP records, were identified. Conclusion PMCT can have added value for the detection of additional findings regarding the cause of death in an out-ofhospital, GP's population, especially to identify or exclude major (previously non-diagnosed) underlying diseases.

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Section: Discussionmentioning

confidence: 99%

Added value of post-mortem computed tomography (PMCT) to clinical findings for cause of death determination in adult “natural deaths”

et al. 2019

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“…This provides the opportunity to evaluate peracute infarcts, which are difficult to detect macroscopically, for detectability by MRI or after sampling by other investigative techniques. However, it is also worth noting the general problems and challenges of image-guided postmortem biopsy, such as mediocre predictive values and needle placement accuracy [16,17]. Nevertheless, T 2 -weighted images do provide distinguishing features that allow detection of the infarct area and determination of the age stage, making noninvasive postmortem MRI a valuable tool for research.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic value of T1- and T2-weighted 3-Tesla MRI for postmortem detection and age stage classification of myocardial infarction

Gascho

Allmen

Landsmann

et al. 2023

Forensic Sci Med Pathol

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The aims of this study are to retrospectively evaluate the diagnostic value of T1- and T2-weighted 3-T magnetic resonance imaging (MRI) for postmortem detection of myocardial infarction (MI) in terms of sensitivity and specificity and to compare the MRI appearance of the infarct area with age stages. Postmortem MRI examinations (n = 88) were retrospectively reviewed for the presence or absence of MI by two raters blinded to the autopsy results. The sensitivity and specificity were calculated using the autopsy results as the gold standard. A third rater, who was not blinded to the autopsy findings, reviewed all cases in which MI was detected at autopsy for MRI appearance (hypointensity, isointensity, hyperintensity) of the infarct area and the surrounding zone. Age stages (peracute, acute, subacute, chronic) were assigned based on the literature and compared with the age stages reported in the autopsy reports. The interrater reliability between the two raters was substantial (κ = 0.78). Sensitivity was 52.94% (both raters). Specificity was 85.19% and 92.59%. In 34 decedents, autopsy identified an MI (peracute: n = 7, acute: n = 25, chronic: n = 2). Of 25 MI classified as acute at autopsy, MRI classified peracute in four cases and subacute in nine cases. In two cases, MRI suggested peracute MI, which was not detected at autopsy. MRI could help to classify the age stage and may indicate the area for sampling for further microscopic examination. However, the low sensitivity requires further additional MRI techniques to increase the diagnostic value.

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“…Few studies have been published regarding the diagnostic performance of PMCT combined with PMS in a non-forensic population. [23][24][25][26][27][28] These studies find 64%-97% agreement on the COD with autopsy, depending on imaging techniques, number of biopsies, definition of agreement and number of radiologists involved in reporting. However, none of the studies evaluate whether PMS with CT-guided biopsy has an added diagnostic value in establishing the COD when compared with clinical assessment only.…”

Section: How This Study Might Affect Research Practice or Policymentioning

confidence: 99%

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

et al. 2022

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AimsThe aim of this study is to evaluate whether agreement with autopsy-determined cause of death (COD) increases by use of postmortem CT (PMCT) or PMCT in combination with postmortem sampling (PMS), when compared with clinical assessment only.MethodsThis prospective observational study included deceased patients from the intensive care unit and internal medicine wards between October 2013 and August 2017. The primary outcome was percentage agreement on COD between the reference standard (autopsy) and the alternative postmortem examinations (clinical assessment vs PMCT or PMCT+PMS). In addition, the COD of patient groups with and without conventional autopsy were compared with respect to involved organ systems and pathologies.ResultsOf 730 eligible cases, 144 could be included for analysis: 63 underwent PCMT without autopsy and 81 underwent both PMCT and autopsy. Agreement with autopsy-determined COD was significantly higher for both PMCT with PMS (42/57, 74%), and PMCT alone (53/81, 65%) than for clinical assessment (40/81, 51%; p=0.007 and p=0.03, respectively). The difference in agreement between PMCT with PMS and PMCT alone was not significant (p=0.13). The group with autopsy had a significantly higher prevalence of circulatory system involvement and perfusion disorders, and a lower prevalence of pulmonary system involvement.ConclusionPMCT and PMS confer additional diagnostic value in establishing the COD. Shortcomings in detecting vascular occlusions and perfusion disorders and susceptibility to pulmonary postmortem changes could in future be improved by additional techniques. Both PMCT and PMS are feasible in clinical practice and an alternative when autopsy cannot be performed.

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The needle in the haystack: Histology of post-mortem computed tomography guided biopsies versus autopsy derived tissue

Cited by 10 publications

References 45 publications

Added value of post-mortem computed tomography (PMCT) to clinical findings for cause of death determination in adult “natural deaths”

Added value of post-mortem computed tomography (PMCT) to clinical findings for cause of death determination in adult “natural deaths”

Diagnostic value of T1- and T2-weighted 3-Tesla MRI for postmortem detection and age stage classification of myocardial infarction

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

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