Comparison of conventional autopsy and magnetic resonance imaging in determining the cause of sudden death in the young.

Rajesh Puranik,Belinda Gray,Johan Duflou,Helen Lackey,Laura Yeates,Geoffrey Parker,Christopher Semsarian

doi:10.1186/1532-429x-16-44

Abstract

BackgroundSudden death in the young is a tragic complication of a number of medical diseases. There is limited data regarding the utility of post-mortem Magnetic Resonance (MR) imaging and Computer Tomography (CT) scanning in determining the cause of sudden death. This study sought to compare the accuracy of post-mortem cross-sectional imaging (MR and CT) with the conventional autopsy in determining the cause of sudden death in the young.MethodsConsecutive patients from 2010 to 2012 (aged 1–35 years) who had sudden death were included. Patients were scanned by CT and 1.5 T MR imaging prior to the conventional autopsy being performed. The primary outcome was diagnostic congruence between imaging and conventional autopsy.ResultsIn 17 patients studied, the mean age at death was 23 ± 11 years, with a male predominance (n = 12; 71%). The most common cause of death was a primary cardiac pathology (n = 8; 47%), including ARVC (24%) and ischemic heart disease (12%). Non-cardiac causes identified included pulmonary embolism (6%), and aortic dissection (6%). MR imaging correctly identified the diagnosis in 12 patients who subsequently had positive findings at conventional autopsy, while the diagnosis in the remaining 5 cases remained unexplained. MR imaging was found to be highly sensitive (100%) with a high negative (100%) and positive (80%) predictive value.ConclusionsDedicated post-mortem MR imaging of the heart and brain is a useful modality in determining the cause of sudden death in children and young adults, particularly in situations where a conventional autopsy cannot be performed for logistic, cultural or personal reasons.

Highlights

Sudden death in the young is a tragic complication of a number of medical diseases
The investigators reported high discrepancy rates generally between radiology and conventional autopsy, which varied between 32-43% and may in part reflect the difference in Computer Tomography (CT) technology used (16 slice or less) and/or differing cardiac Magnetic Resonance (MR) imaging protocols performed
Common causes of sudden death cases were frequently missed on CT and MR imaging in the study, the overall impression was that CT and MR imaging may be useful in some circumstances compared with the traditional autopsy [18]

Summary

Introduction

Sudden death in the young is a tragic complication of a number of medical diseases. There is limited data regarding the utility of post-mortem Magnetic Resonance (MR) imaging and Computer Tomography (CT) scanning in determining the cause of sudden death. Amongst sudden deaths attributable to a cardiac cause, structural abnormalities are detected at autopsy in approximately 69% [3] These pathologies include ischemic heart disease, cardiomyopathy, myocarditis and aortic disease, all of which are routinely detected with cardiac imaging antemortem [2,3,4,5,6,7]. A single study comparing post-mortem CT and MR imaging in assessing cause of death in adults suggested CT may be more accurate in this setting [18] Whilst it seems that high-field MR imaging has a definite role in the diagnosis of sudden natural death in the fetus, the utility in older decedents remains less certain [19]

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Results

Conclusion