Abstract
ObjectivesTo evaluate the frequency of total-body CT and MR features of postmortem change in in-hospital deaths.Materials and methodsIn this prospective blinded cross-sectional study, in-hospital deceased adult patients underwent total-body postmortem CT and MR followed by image-guided biopsies. The presence of PMCT and PMMR features related to postmortem change was scored retrospectively and correlated with postmortem time interval, post-resuscitation status and intensive care unit (ICU) admittance.ResultsIntravascular air, pleural effusion, periportal edema, and distended intestines occurred more frequently in patients who were resuscitated compared to those who were not. Postmortem clotting was seen less often in resuscitated patients (p = 0.002). Distended intestines and loss of grey-white matter differentiation in the brain showed a significant correlation with postmortem time interval (p = 0.001, p<0.001). Hyperdense cerebral vessels, intravenous clotting, subcutaneous edema, fluid in the abdomen and internal livores of the liver were seen more in ICU patients. Longer postmortem time interval led to a significant increase in decomposition related changes (p = 0.026).ConclusionsThere is a wide variety of imaging features of postmortem change in in-hospital deaths. These imaging features vary among clinical conditions, increase with longer postmortem time interval and must be distinguished from pathologic changes.
Highlights
Hospital autopsy rates today are as low as 0–5%, having decreased from a rate of 30% or higher in the 1990s. [1,2,3] This low rate is alarming, since one in five autopsies show major discrepancies between antemortem and postmortem diagnoses despite improved diagnostic testing. [4] A possible cause for this decline may be the invasiveness of the conventional autopsy procedure. [5] To provide a less invasive alternative to conventional autopsy, imaging based autopsy methods were developed, primarily in forensic medicine
There is a wide variety of imaging features of postmortem change in in-hospital deaths
These imaging features vary among clinical conditions, increase with longer postmortem time interval and must be distinguished from pathologic changes
Summary
Hospital autopsy rates today are as low as 0–5%, having decreased from a rate of 30% or higher in the 1990s. [1,2,3] This low rate is alarming, since one in five autopsies show major discrepancies between antemortem and postmortem diagnoses despite improved diagnostic testing. [4] A possible cause for this decline may be the invasiveness of the conventional autopsy procedure. [5] To provide a less invasive alternative to conventional autopsy, imaging based autopsy methods were developed, primarily in forensic medicine. [5] To provide a less invasive alternative to conventional autopsy, imaging based autopsy methods were developed, primarily in forensic medicine. These modern autopsies include total-body postmortem CT (PMCT) and MR (PMMR), sometimes combined with CT angiography (PMCTA) and image-guided biopsies. [9,10,11] Combined PMCT, PMCTA and image-guided biopsies appear most sensitive in diagnosing cause of death, more clinical studies are needed to accurately determine the diagnostic value of the imaging autopsy. After death various chemical and physical processes affect the body in ways that can change PMCT and PMMR features of organs and soft-tissues. These processes can generally be divided into gravity dependent changes (including sedimentation of blood and livor mortis; known as lividity or hypostasis), decomposition (including putrefaction), rigor mortis (muscle stiffness) and algor mortis (cooling of the body)
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