Postmortem Radiology Research Articles

Postmortem radiology studies in global and national healthcare: literature analysis and perspectives of Russian specialists

Despite the significant importance of autopsies for determining the cause of death and the evaluating the effectiveness of treatments, there is a progressive decrease in their number across all countries. At the same time, there is an active introduction of postmortem radiological studies to analyze the bodies of deceased patients.
 The article presents literature analysis summarizing the results of surveys from foreign specialists, as well as the opinions of Russian specialists, regarding the possibilities and features of postmortem radiological studies, mainly focusing on deceased newborns and infants. It is noted that postmortem radiological studies are carried out as part of both pathoanatomical autopsy and forensic medical examination. Postmortem computed tomography in cases of violent death and postmortem magnetic resonance imaging in cases of death from diseases were performed more often. General clinical equipment located in clinical radiology departments was more frequently used than those located in the mortuary, pathology department, or forensic facility. The analysis of the results of postmortem radiological examinations was predominantly carried out by radiologists, with a joint analysis involving a radiologist and a pathologist being less common. It is emphasized that in the Russian Federation, postmortem radiological studies are mostly of a single nature. According to Russian researchers, in the current era of advancing personalized medicine, radiation techniques, and information technologies, there arises a need to use postmortem radiological studies to objectify and improve the accuracy of traditional autopsies. Postmortem radiological studies, which are objective operator-independent methods of examining the bodies of dead people, should be considered as a highly effective stage of pathology and, especially, forensic autopsy.

Crushed, uncooked egg in the oropharynx: a café coronary?

BackgroundObstruction of the upper respiratory airway can terminate in fatal asphyxia. Autopsy findings in asphyxial deaths as described in literature are not necessarily pathognomonic. A complete autopsy with ancillary studies is necessary to establish the cause, time, and manner of death.Case presentationThe authors present a 44-year-old male who was found dead in his car. He had been remanded in prison for drug trafficking 1 year prior to his death. No other history or death scene findings were provided by the police. Autopsy revealed a crushed, uncooked egg in his oropharynx. Postmortem radiology and toxicology were not done due to nonavailability of the required facilities. Death was ascribed to asphyxia due to a crushed, uncooked egg in the oropharynx.The manner of death could not be ascertained because pertinent information regarding the deceased’s medical records, locus report, and other ancillary investigations was not available.ConclusionsThis report presents an unusual cause of mechanical upper airway obstruction that has never been documented and discusses some of the deficiencies of autopsy practice in resource-limited countries.

Multidisciplinary approach to postmortem diagnostics

BACKGROUND: The technique that allows detecting various pathologies and clearly identifying the cause of death and other associated diseases without disturbing the integrity of the skin refers to postmortem radiological diagnostics and is called virtopsy. The number of autopsies decreases worldwide, which creates the need to use alternative non-invasive methods, including virtopsy. The main method of postmortem radiology is multislice computed tomography (CT), with its advantages including high sensitivity to bone pathology. Postmortem radiological diagnostics allow supplementing the classical autopsy. This multidisciplinary approach helps visualize a wide variety of pathologies and assist the pathologist in the diagnostic search.
 AIM: To assess the possibility of applying radiological diagnostic methods in the pathological anatomical practice and features of non-invasive autopsy (virtopsy) and its differences from the classical autopsy.
 METHODS: The archival material including macro preparations of two lower limbs with tumor-like masses of unclear genesis (the upper third of the femur and the calcaneal tuber) was used. The biomaterial was previously encased in a specially treated gelatin medium, which ensured its preservation and left parts of the CT scanner intact. Multislice CT was used for radiological assessment of the preparations. From the primary CT sequences obtained, scans with the best visualization in the bone and soft tissue windows were selected, and three-dimensional (3D) reconstruction was applied. Scans and 3D reconstructions of images of tumor-like masses of the heel and thigh bones were obtained. Interpretation of the borders of the mass, characteristics of morphology and possible source of growth of the neoplasm allowed assuming a malignant nature of the tumor, suggesting its bone origin. Further histologic examination in both cases confirmed the neoplasm (osteogenic sarcoma).
 RESULTS: CT scans and 3D reconstructions of images of tumour-like masses in the heel and femur were obtained. The interpretation of the boundaries of the mass, the morphological characteristics and the possible source of growth of the neoplasm suggested a malignant nature of the tumour, suggesting a bony origin. Further histological evaluation in both cases confirmed the nature of the neoplasm (osteogenic sarcoma).
 CONCLUSIONS: The use of postmortem radiological diagnostic elements provides a sufficiently accurate verification of the nature of some pathologies. However, the absence of tissue damage and disturbances of intact topographic characteristics play not the least role in the postmortem diagnosis. In contrast to autopsy, this technique allows to return to the original appearance of the structures examined and, if necessary, start the diagnostic search anew. Moreover, specialists from other regions can be remotely involved by sending the data of CT scanning.

Post-mortem changes of the vascular system—a thanatological study using multidetector computed tomography

Forensic pathologists have to deal with post-mortem changes of the human body. Those post-mortem phenomena are familiar and largely described in thanatology. However, knowledge about the influence of post-mortem phenomena on the vascular system is more limited, except for the apparition and development of cadaveric lividity. The introduction of multidetector computed tomography (MDCT) and magnetic resonance imaging (MRI) in the forensic field and the expansion of their usage in medico-legal routine, allow for exploring the inside of corpses differently and may play a part in the understanding of thanatological processes. This study aimed to describe post-mortem changes in the vascular system by investigating the presence of gas and collapsed vessels.We investigated post-mortem MDCT data of 118 human bodies. Cases with internal/external bleeding or corporal lesion allowing contamination with external air were excluded. Major vessels and heart cavities were systematically explored and a trained radiologist semi-quantitatively assessed the presence of gas.Collapsed veins were observed in 61.9% of cases (CI95% 52.5 to 70.6) and arteries in 33.1% (CI95% 24.7 to 42.3). Vessels most often affected were for arteries: common iliac (16.1%), abdominal aorta (15.3%), external iliac (13.6%), and for veins: infra-renal vena cava (45.8%), common iliac (22.0%), renal (16.9%), external iliac (16.1%), and supra-renal vena cava (13.6%). Cerebral arteries and veins, coronary arteries, and subclavian vein were unaffected. The presence of collapsed vessels was associated with a minor degree of cadaveric alteration. We observed that arteries and veins follow the same pattern of gas apparition for both the quantity and the location.In post-mortem radiology, collapsed vessels and intravascular gas are frequently visualized and as a result of all post-mortem changes, the assessment of the distribution of blood can be confusing. Therefore, knowledge of thanatological phenomena is crucial to prevent post-mortem radiological misapprehensions and possible false diagnoses.

Application of postmortem imaging modalities in cases of sudden death due to cardiovascular diseases–current achievements and limitations from a pathology perspective

Postmortem imaging (PMI) is increasingly used in postmortem practice and is considered a potential alternative to a conventional autopsy, particularly in case of sudden cardiac deaths (SCD). In 2017, the Association for European Cardiovascular Pathology (AECVP) published guidelines on how to perform an autopsy in such cases, which is still considered the gold standard, but the diagnostic value of PMI herein was not analyzed in detail. At present, significant progress has been made in the PMI diagnosis of acute ischemic heart disease, the most important cause of SCD, while the introduction of postmortem CT angiography (PMCTA) has improved the visualization of several parameters of coronary artery pathology that can support a diagnosis of SCD. Postmortem magnetic resonance (PMMR) allows the detection of acute myocardial injury-related edema. However, PMI has limitations when compared to clinical imaging, which severely impacts the postmortem diagnosis of myocardial injuries (ischemic versus non-ischemic), the age-dating of coronary occlusion (acute versus old), other potentially SCD-related cardiac lesions (e.g., the distinctive morphologies of cardiomyopathies), aortic diseases underlying dissection or rupture, or pulmonary embolism. In these instances, PMI cannot replace a histopathological examination for a final diagnosis. Emerging minimally invasive techniques at PMI such as image-guided biopsies of the myocardium or the aorta, provide promising results that warrant further investigations. The rapid developments in the field of postmortem imaging imply that the diagnosis of sudden death due to cardiovascular diseases will soon require detailed knowledge of both postmortem radiology and of pathology.

Mapping astrogliosis in the individual human brain using multidimensional MRI.

There are currently no non-invasive imaging methods available for astrogliosis assessment or mapping in the central nervous system despite its essential role in the response to many disease states, such as infarcts, neurodegenerative conditions, traumatic brain injury and infection. Multidimensional MRI is an increasingly employed imaging modality that maximizes the amount of encoded chemical and microstructural information by probing relaxation (T1 and T2) and diffusion mechanisms simultaneously. Here, we harness the exquisite sensitivity of this imagining modality to derive a signature of astrogliosis and disentangle it from normative brain at the individual level using machine learning. We investigated ex vivo cerebral cortical tissue specimens derived from seven subjects who sustained blast-induced injuries, which resulted in scar-border forming astrogliosis without being accompanied by other types of neuropathological abnormality, and from seven control brain donors. By performing a combined post-mortem radiology and histopathology correlation study we found that astrogliosis induces microstructural and chemical changes that are robustly detected with multidimensional MRI, and which can be attributed to astrogliosis because no axonal damage, demyelination or tauopathy were histologically observed in any of the cases in the study. Importantly, we showed that no one-dimensional T1, T2 or diffusion MRI measurement can disentangle the microscopic alterations caused by this neuropathology. Based on these findings, we developed a within-subject anomaly detection procedure that generates MRI-based astrogliosis biomarker maps ex vivo, which were significantly and strongly correlated with co-registered histological images of increased glial fibrillary acidic protein deposition (r = 0.856, P < 0.0001; r = 0.789, P < 0.0001; r = 0.793, P < 0.0001, for diffusion-T2, diffusion-T1 and T1-T2 multidimensional data sets, respectively). Our findings elucidate the underpinning of MRI signal response from astrogliosis, and the demonstrated high spatial sensitivity and specificity in detecting reactive astrocytes at the individual level, and if reproduced in vivo, will significantly impact neuroimaging studies of injury, disease, repair and aging, in which astrogliosis has so far been an invisible process radiologically.

Prenatal ultrasonographic features in Blomstrand osteochondrodysplasia: Antenatal case series confirmed by postmortem radiology and molecular diagnosis.

Blomstrand osteochondrodysplasia (BOCD, MIM #215045) is an ultrarare lethal skeletal dysplasia (LSD) perinatally, characterized by extremely advanced bone maturation, generalized osteosclerosis, and severe tetramicromelia caused by biallelic loss-of-function mutations in the parathyroid hormone receptor-1 gene (PTHR1). We aim to describe prenatal ultrasonographic features in a retrospective fetal case series of BOCD and emphasize the importance of multidisciplinary antenatal evaluation of LSDs to improve the differential diagnosis. Prenatal ultrasound findings of five fetal cases diagnosed with BOCD between 2000 and 2019 in the Prenatal Diagnosis Unit and Medical Genetics were reviewed, along with postmortem examination results and confirmatory molecular results. All fetuses presented with severe sonographic findings of LSDs comprising tetramicromelia, thoracic hypoplasia, and retro-micrognathia. Marked cervical hyperextension was present in three fetuses. Flared metaphyses were prenatally identified in only one fetus. X-rays of four fetuses evaluated postmortem showed advanced bone maturation, generalized osteosclerosis, and dumbbell-like appearance of long bones due to metaphyseal enlargement. The presence of retro-micrognathia along with a protruding tongue and severe metaphyseal flaring can suggest a diagnosis of BOCD, when prenatal ultrasound findings are indicative for LSD. The diagnosis can be ascertained through postmortem clinical and radiological evaluation and/or molecular testing.

Postmortem Imaging of an Unusual Case of Fatal Heart and Lung Perforation Due to Self-Treatment.

Intentional or accidental cardiothoracic injuries caused by needles and pins are rare and commonly reported in individuals with psychiatric conditions or intravenous drug users. Although rare, these cases could result in serious injury during the performance of an autopsy and highlight the importance of post-mortem radiology. Therapeutic complications with cardiac perforation have been reported due to pericardiocentesis and acupuncture. The majority of reported cases were not fatal and some had a prolonged asymptomatic period of weeks or even years after insertion. Needles or other sharp objects can reach the cardiovascular system directly through the chest wall, indirectly from any segment of the gastrointestinal tract after swallowing needles, or through migration of broken needles from distant injection sites in intravenous drug users. We report a case of rapidly fatal cardiopulmonary injuries following "self-treatment" to "pop" a cyst with a piercing needle. The scene, autopsy, computed tomography, and digital x-ray findings of this unique case are discussed with a review of selective literature. In this case, the right lung and heart showed multiple perforations, possibly resulting from heartbeats or respirations pushing the organs against the needle. To our knowledge, perforations in this setting of "self-treatment" have not been previously reported in the literature.

Sudden and unexpected deaths due to non-traumatic abdominal disorders: A forensic perspective

Sudden and unexpected deaths due to non-traumatic abdominal disorders are a disregarded topic in the forensic field. These conditions are very heterogenous, accounting for 1–5% of sudden deaths. Specifically, acute gastrointestinal hemorrhages, bowel obstructions, liver cirrhosis, and necrotizing pancreatitis are frequently reported, whereas there are also unusual conditions which deserve careful analysis. Furthermore, the postmortem examinations of such disorders are not straightforward in the forensic setting since advanced putrefaction of the body, alleged medical malpractice, or the absence of any medical records could complicate autopsy procedures. Thus, the use of forensic histopathology, toxicology, microbiology, and postmortem radiology may help the pathologists to identify the abdominal cause of death. In this paper, the authors aim to discuss most of congenital and acquired abdominal conditions that have resulted in sudden and unexpected deaths. Hence, the discussion of the pathological features of each abdominal organ or system is prefaced with practical examples from caseworks of the Milan Institute of Legal Medicine. However, this paper also shows an extensive literature review with selected medicolegal articles to detailly describe the lethal mechanisms related to each condition, along with any associated risk factors or other diseases. Finally, each section shows a focus on either novel forensic approach (when available) or medicolegal implications, such as the use of postmortem radiology, peculiar histopathologic findings, or allegations in medical malpractices.

A 5-Year Retrospective Study on Infant Homicide Presenting as Cot Death: Are We Missing Infant Homicides?

Being found dead in cot or bed is the most common presentation encountered with infant deaths. These deaths are often associated with unsafe sleep environment. The postmortem examination in such cases is often negative, and along with family objections, cultural, and other factors, may lead to a coroner considering not authorizing a postmortem examination. However, not identifying a homicide is a potential risk if a postmortem examination is not performed. This 5-year retrospective study investigated the proportion of infant homicide death initially presenting as cot death. Of a total of 103 cases of infants initially presenting as being found dead in cot or bed, 3 (approximately 3%) were classified as homicides after postmortem examination. During the study period, a total of 9 infant homicides were reported, translating to 33% (3 of 9) of infant homicides presented as cot deaths. Postmortem radiology was a valuable adjunct, but was unable to recognize 2 of the homicide cases with traumatic head injuries (with subdural hemorrhage and brain injury only). We strongly advocate that all infant deaths presenting as cot death require a full postmortem examination.

Radiodense gastric contents in postmortem computed tomography

Background: Postmortem radiology often encounters foreign bodies in the stomach: food. Rarely, this intragastric content exhibits a high radiodensity, which can be confused with intragastric pills. We hypothesized that the radiodensity of this gastric content provided information about the interval between last meal and death. Methodology: The institutional database was searched for cases with high radiodense gastric contents seen on imaging. The postmortem interval was computed, and the interval between last meal and death was estimated. In addition, a simulation of postmortem gastric digestion was conducted. Samples of pasta, rice, lentils, chicken meat and broccoli were added to a gastric juice simulate. Computed tomography scans of the samples were repeatedly conducted for 4 h. Results: In total, 11 cases were included in the study. The gastric content was carbohydrates (rice, pasta, lentils) in six cases and meat in five cases. In both the cases and the experiment, maximum radiodensity of carbohydrates (>150 HU) was higher than of meat (100–150 HU) and vegetables (~50 HU, only experimental). Intragastric radiodensity did not correlate with the postmortem interval, and was stable in the experimental simulation apart from a decrease during the first 90 min for pasta and rice, which coincided with an increase of the radiodensity of the surrounding fluid. Conclusion: A differentiation of gastric content based on radiodensity and morphology is possible. All cases with high radiodensity had a short interval from last meal to death whenever computable. The radiodensity of intragastric food postmortem appears to be independent from the postmortem interval.

Died with or Died of? Development and Testing of a SARS CoV-2 Significance Score to Assess the Role of COVID-19 in the Deaths of Affected Patients.

Since December 2019, a new form of coronavirus, SARS-CoV-2, has spread from China to the whole word, raising concerns regarding Coronavirus Disease 2019 (COVID-19) endangering public health and life. Over 1.5 million deaths related with COVID-19 have been recorded worldwide, with wide variations among countries affected by the pandemic and continuously growing numbers. The aim of this paper was to provide an overview of the literature cases of deaths involving COVID-19 and to evaluate the application of the COVID-19 Significance Score (CSS) in the classification of SARS CoV-2-related fatalities, comparing it with the Hamburg rating scale. The results obtained allowed us to highlight that CSS used after a complete accurate post-mortem examination, coupled to the retrieval of in vivo data, post-mortem radiology, histology and toxicology, as well as to additional required analyses (e.g., electronic microscopy) is a useful and concise tool in the assessment of the cause of death and the role played by this virus. A shared use of this scale might hopefully lower the inhomogeneities in forensic evaluation of SARS CoV-2-related fatalities.

Postmortem Computed Tomography Angiography of Newborns.

We propose an original method of postmortem computed tomography angiography of the body of a deceased newborn. The work is based on the analysis of the results of comprehensive postmortem computed tomography and pathological examination of 30 newborns, who died from congenital malformations. The key to a full-fledged postmortem radiation study using intravascular contrasting of deceased newborns and infants is the presence of vascular catheters established during life, as well as conducting it no earlier than 12 h and no later than 48 h after death. As a contrast agent, we recommend to use an iodine-containing water-soluble radiopaque drug containing at least 250 mg of iodine per 1 ml. The volume of contrast agent is calculated based on body weight, taking into account the general edema syndrome. The introduction of a contrast agent is carried out through vascular catheters in 3 stages in various positions of the body. The analysis of tomograms and 3D-reconstruction of blood vessels using their pseudocoloring allows accurate assessment of the topography of blood vessels with the possibility of separate study of the arterial and venous vessels, and to identify both congenital abnormalities of the heart and blood vessels, and their acquired pathology. CT angiography in some cases is superior to traditional autopsy in the diagnosis of blood vessel pathology. Postmortem CT angiography should be considered as an important stage of postmortem radiology in the structure of comprehensive pathological analysis of newborns and infants.

Postmortem Computed Tomography: An Overview for Forensic Nurses Involved in Death Investigation.

The traditional invasive autopsy has been considered the "gold standard" for death investigation worldwide. However, this has now been challenged by a new minimally invasive approach that utilizes cross-sectional radiological imaging to investigate the death. Globally, postmortem computed tomography is the most commonly used modality and is becoming increasingly available throughout the world. Forensic nurses working in association with coroners and medical examiners' offices, as well as mass fatality incidents, now need to update their knowledge base to understand these innovative techniques, the advantages and disadvantages to their use, and how they impact on medicolegal death investigation and the care of the deceased and bereaved. Using the example of the coroner system of England and Wales, this article provides a comparison between the traditional invasive autopsy and postmortem radiological alternatives and presents the impact postmortem radiology is now having on death investigation.

Remote post-mortem radiology reporting in disaster victim identification: experience gained in the 2017 Grenfell Tower disaster

On 14 June 2017 at 00:54 h, the worst residential fire since the conclusion of the Second World War broke out in Flat 16, 4th floor of the 24-storey residential Grenfell Tower Block of flats, North Kensington, West London, UK. Seventy-one adults and children died, including one stillbirth. All victims of the Grenfell Tower disaster who died at the scene underwent post-mortem computed tomography (PMCT) imaging using a mortuary-sited mobile computed tomography scanner. For the first time, to the authors’ knowledge, the disaster victim identification (DVI) radiology reporting was undertaken remote to the mortuary scanning. Over an 11-week period, 119 scans were undertaken on 16 days, with up to 18 scans a day. These were delivered to a remote reporting centre at Leicester on 13 days with between 2 and 20 scans arriving each day. Using a disaster-specific process pathway, a team of 4 reporters, with 3 support staff members, trialled a prototype INTERPOL DVI radiology reporting form and produced full radiology reports and supporting image datasets such that they were able to provide 96% of prototype DVI forms, 99% of image datasets and 86% of preliminary reports to the DVI teams in London within one working day of image receipt. This paper describes the first use of remote radiology reporting for DVI and exemplifies how remote PMCT reporting can be used to support a DVI process of this scale.

Classification based on the presence of skull fractures on curved maximum intensity skull projections by means of deep learning

Abstract Objectives Postmortem computed tomography (PMCT) usually includes the generation of great amounts of imaging data, and is often reviewed by forensic pathologists. To allow a more resource-efficient diagnosis, deep neural networks may act as a pre-scanning tool in postmortem radiology. In this study, a deep neural network to classify cases depending on the presence skull fractures on curved maximum intensity projections (CMIP). Methods Calvarial CMIPs of each 75 cases with and without documented skull fractures were retrospectively generated from our database. Then, half of the data were randomly assigned to either training or validation. In supervised training, fractures were manually marked. During validation, each image received a gradual score between 0 and 1 predicting the likelihood of showing one or more fractures. Results With a total number of 100 networks trained, the average area under the Receiver Operating Characteristic curve (AUC) was 0.895. The best performing network had an AUC of 0.965. At a classification threshold of 0.79, the network classified fracture cases correctly with a sensitivity of 91.4% and a specificity of 87.5%. Conclusion Classification based on the existence of skull fractures on CMIPs with deep learning is feasible. For the purpose of pre-scanning PMCT data, a classification threshold of 0.75 with a sensitivity of 100% can be applied. A higher number of images of validated skull fractures available will increase the performance of the network. In the future, Deep learning might enable a more resource-efficient assessment in postmortem radiology.

Medicolegal Death Investigation: Coroner and Forensic Pathology Functions and Processes in Victoria, Australia.

The medicolegal death investigation in Victoria, Australia is a traditional coroner system based on the model in England and Wales in the early 20th Century. In 1985, the first of a series of legislative amendments were made that proved the vanguard of reform of the coroners' jurisdictions in Australia. The Victorian Institute of Forensic Medicine (the Institute) was established by the Coroners Act 1985 (Vic.), now the Victorian Institute of Forensic Medicine Act 1985 (Vic.), to provide forensic pathology, medical, and related scientific services needed by the justice system. In addition to death investigation, other forensic and scientific services are performed by the Institute including: clinical medical examinations and support services for assault victims and perpetrators, forensic toxicology services and molecular biology, and anthropology and odontology services in relation to human identification. Medical and nursing staff provide medical information and support to families in a therapeutic setting, as well as direct referral to clinical medical specialists. This takes place where a medical death investigation procedure uncovers genetic or familial disease that may place other family members at risk of future illness. A donor tissue bank ensures that a death also provides the opportunity for families to donate organs and tissues from the deceased for transplantation. Today, the traditional autopsy is one of several modalities of death investigation with postmortem radiology and imaging playing a significant role. This paper describes the principles and new processes at the Institute that support the coroner in death investigation and prevention as well as the therapeutic services designed to relieve the burden of disease on the community.

Sudden death in a child caused by a giant cavernous hemangioma of the anterior mediastinum

A 4-year-old girl who had been treated for asthma since the age of 2 years had a severe coughing fit and died suddenly. The patient had a history of occasional severe coughing fits, and these fits had been worsening in severity during the week before her death. Prior to death, she was taken to a clinician, and thymic hypertrophy was suspected based on chest X-ray findings. The clinician recommended that she visit a general hospital at a later date; however, she died that night. Postmortem radiology and autopsy revealed a large mass in the anterior mediastinum compressing the heart and airway, and no other findings attributable to sudden death were observed. Therefore, we concluded that the patient's death was attributable to acute respiratory and cardiac circulatory failure secondary to the pressure induced by the mass. Microscopically, the mass showed a cavernous structure composed of cystically dilated, thin-walled large vessels filled with blood. The final diagnosis was a cavernous hemangioma. Hemangiomas are the most common benign vascular anomalies seen in young children; however, mediastinal hemangiomas are rare and can cause life-threatening complications because of their size and location. Therefore, forensic pathologists should include hemangioma as a differential diagnosis in children with anterior mediastinal masses.

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

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.

Normal pediatric postmortem CT appearances.

Postmortem radiology is a rapidly developing specialty that is increasingly used as an adjunct to or substitute for conventional autopsy. The goal is to find patterns of disease and possibly the cause of death. Postmortem CT images bring to light processes of decomposition most radiologists are unfamiliar with. These postmortem changes, such as the formation of gas and edema, should not be mistaken for pathological processes that occur in living persons. In this review we discuss the normal postmortem thoraco-abdominal changes and how these appear on CT images, as well as how to differentiate these findings from those of pathological processes.