Abstract
During the last years, post-mortem imaging has gradually been assumed within research in the field of forensic pathology. This role appears to be clearly and simply applied in the trauma field with the use of conventional radiography or Post Mortem Computed Tomography (PMCT). Recently, particular attention was paid to cardiovascular imaging using Post Mortem Magnetic Resonance Imaging (PMMRI). The present experimental study aims to: (i) confirm the efficacy of a Post Mortem Cardiac Resonance Imaging (PMCRI) study protocol for the study of human hearts collected during the autopsy; (ii) apply the defined protocol on subjects who died of “SCD (sudden cardiac death)”, to identify alterations that could guide subsequent sampling. Two hearts of healthy subjects (A: male 22 years; B: female 26 years), who died from causes other than SCD were collected and compared to hearts that belonged to SCD individuals (C: male, 47 years old; D: female, 44 years old; E: male; 72 years old). The exams were performed on a 1.5 T scanner (Philips Intera Achieva, Best, the Netherlands) on hearts collected during autopsy and after a 30-day formalin fixation. Two readers analyzed the obtained images blindly and after randomization. From the comparison between the data from imaging and the macroscopic and histological investigations carried out, the present study proved the effectiveness of a PMMRI protocol to study ex-situ hearts. Moreover, it suggested the following semeiology in post-mortem SCD cases: the hyperintense area with indistinct margins in the Short Tau Inversion Recovery (STIR) sequence was linked to edema or area of pathological fibers, whereas the hypointense area in the T2-FFE sequences was linked to fibrosis. PMMRI can provide a valuable benefit to post-mortem investigations, helping to distinctly improve the success rate of histological sampling and investigations, which remains the gold standard in the diagnosis of sudden death.
Highlights
It has not been long since Flach et al exclaimed “Times have changed!” [1], to underline the clear role that post-mortem imaging was gradually assuming within the forensic pathology field of research
In continuity with the previous ones, the present study proposed a protocol for Post Mortem Magnetic Resonance Imaging (PMMRI) that has demonstrated its applicability, with images that were evaluated as being of excellent quality
In a few cases examined, the proposed PMCMR-protocol was able to identify areas of altered signal, helping to distinctly improve the success rate of histological sampling and investigation
Summary
It has not been long since Flach et al exclaimed “Times have changed!” [1], to underline the clear role that post-mortem imaging was gradually assuming within the forensic pathology field of research. Female Male Female Male or post-mortem computed tomography (PMCT) [3] It is not surprising the growing interest in magnetic resonance and its ability to provide a high qualification of the tissue studied and excellent anatomical details with high-quality imaging, above all to characterize and identify alterations affecting the brain, heart, subcutaneous fat tissue, and abdominal organs [4]. Such is its potential that some authors believe it is the method capable of replacing the traditional autopsy [5]
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