Tissue microscopic changes and artifacts in multi-phase post-mortem computed tomography angiography in a hospital setting: A fatal case of systemic vasculitis

Capuani, Caroline; Guilbeau‐Frugier, Céline; Mokrane, Fatima-Zohra; Delisle, Marie–Bernadette; Marcheix, Bertrand; Rousseau, Hervé; Telmon, Norbert; Rougé, Daniel

doi:10.1016/j.forsciint.2014.06.039

Cited by 12 publications

(3 citation statements)

References 22 publications

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“…All observed artifacts have been described in detail [5] and some artifacts suggested by Berger et al, such as dislodging of fresh thrombus, have already been examined and are practically excluded if the technique is applied according to established standards [6]. We completely agree with the authors that any further occurrence of artifacts has to be reported in order to render the users of a specific technique attentive to its limitations [7]. But if artifacts associated with PMCTA are described, both scientific authors and readers must be careful to correctly identify the specific technique that produced them.…”

supporting

confidence: 70%

Pitfalls in post-mortem CT-angiography – Intravascular contrast induces post-mortem pericardial effusion

Grabherr

Wittig²,

Woźniak

et al. 2015

Legal Medicine

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supporting

confidence: 70%

Pitfalls in post-mortem CT-angiography – Intravascular contrast induces post-mortem pericardial effusion

Grabherr

Wittig²,

Woźniak

et al. 2015

Legal Medicine

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“…In the case of fat embolism in trauma or medical malpractice, e.g. after hip surgery, a PMCTA with an oily contrast agent mixture would obscure the vital fat embolism on histological examination due to its lipophilic nature [ 24 – 26 ]. The diagnosis of a (fatal) fat embolism is not possible with this type of angiography, but may be possible with a hydrophilic contrast agent mixture.…”

Section: Discussionmentioning

confidence: 99%

Development of a protocol for standardized use of a water-soluble contrast agent with polyethylene glycol in post-mortem CT angiography

Bruch,

Grabherr,

Bruguier

et al. 2024

Int J Legal Med

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Computed tomography angiography (PMCTA) is increasingly used in postmortem cases. Standardized validated protocols permit to compare different PMCTA images and make it more easily to defend a case in court. In addition to the well-known technique by Grabherr et al. (2011) which is using paraffin oil as a carrier substance, water-soluble polyethylene glycol 200 (PEG200) can be used in combination with the contrast agent Accupaque® 300. As to date, there exists no standardized protocol for the use of this contrast agent mixture, the aim of this study was to develop a protocol using it. Between 2012 and 2022, 23 PMCTA with PEG200 and Accupaque®300 were performed at the University Centre of Legal Medicine Lausanne (Switzerland) and the Institute of Forensic Medicine Munich (Germany). The images obtained were evaluated regarding the opacification of the vessels and possible artefacts. The best image quality was obtained with a mixing ratio of 1:15 (Accupaque®300:PEG200) and a perfusion volume of 1000 ml in the arterial, 1400 ml in the venous and 350 ml in the dynamic phase. The infusion rates described by Grabherr et al. were confirmed for the three phases. Overall, the opacification of the vessels was diagnostically sufficient. In 13 cases no opacification of the right coronary artery was observed due to a stratification artefact. By using the PMCTA protocol with PEG200 as a carrier, a good overall image quality can be achieved. This protocol offers the possibility to standardize PMCTA with PEG200.

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“…Only a few studies have investigated the influence of different contrast media. The available studies pertain exclusively to MPMCTA and TCA and their influence on toxicology [41,42], biochemistry [43], microbiology [44], genetics [45], histology, and fatty embolism evaluation [46,47]. Therefore, the recommendation remains that as many specimens as possible should be sampled prior to injection of the contrast medium, as described by Schneider et al [48].…”

Section: Oily Contrast Agent Mixturementioning

confidence: 99%

Application of contrast media in post-mortem imaging (CT and MRI)

et al. 2015

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The application of contrast media in post-mortem radiology differs from clinical approaches in living patients. Post-mortem changes in the vascular system and the absence of blood flow lead to specific problems that have to be considered for the performance of post-mortem angiography. In addition, interpreting the images is challenging due to technique-related and post-mortem artefacts that have to be known and that are specific for each applied technique. Although the idea of injecting contrast media is old, classic methods are not simply transferable to modern radiological techniques in forensic medicine, as they are mostly dedicated to single-organ studies or applicable only shortly after death. With the introduction of modern imaging techniques, such as post-mortem computed tomography (PMCT) and post-mortem magnetic resonance (PMMR), to forensic death investigations, intensive research started to explore their advantages and limitations compared to conventional autopsy. PMCT has already become a routine investigation in several centres, and different techniques have been developed to better visualise the vascular system and organ parenchyma in PMCT. In contrast, the use of PMMR is still limited due to practical issues, and research is now starting in the field of PMMR angiography. This article gives an overview of the problems in post-mortem contrast media application, the various classic and modern techniques, and the issues to consider by using different media.

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Tissue microscopic changes and artifacts in multi-phase post-mortem computed tomography angiography in a hospital setting: A fatal case of systemic vasculitis

Cited by 12 publications

References 22 publications

Pitfalls in post-mortem CT-angiography – Intravascular contrast induces post-mortem pericardial effusion

Pitfalls in post-mortem CT-angiography – Intravascular contrast induces post-mortem pericardial effusion

Development of a protocol for standardized use of a water-soluble contrast agent with polyethylene glycol in post-mortem CT angiography

Application of contrast media in post-mortem imaging (CT and MRI)

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