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Sudden death after chest pain: feasibility of virtual autopsy with postmortem CT angiography and biopsy
Steffen G Ross1, Michael J Thali, Stephan Bolliger
1Centre for Forensic Imaging and Virtopsy, Institute of Forensic Medicine, University of Berne, Bern, Switzerland.
Insights
Minimally invasive postmortem CT angiography with image-guided biopsy accurately detects the cause of death in acute chest disease cases. This advanced imaging and biopsy technique shows high potential for forensic pathology and determining mortality after chest pain.
Area of Science:
- Forensic Pathology
- Medical Imaging
- Cardiovascular Medicine
Background:
- Acute chest disease is a common cause of sudden death.
- Conventional autopsy, while definitive, is invasive.
- Minimally invasive techniques are sought to complement or replace traditional autopsy for determining cause of death.
Purpose of the Study:
- To evaluate the efficacy of postmortem CT angiography combined with image-guided biopsy in identifying the cause of death in decedents with suspected acute chest disease.
- To compare the diagnostic accuracy of this minimally invasive approach against conventional autopsy.
Main Methods:
- Twenty corpses with a history of acute chest pain underwent whole-body postmortem CT angiography and image-guided biopsies of the myocardium and lungs.
- Biopsies were performed for pulmonary clots to differentiate embolism from thrombus.
- Findings were compared with subsequent traditional autopsy and histology.
Main Results:
- Postmortem CT angiography and biopsy accurately determined the cause of death in 19 out of 20 cases, aligning with traditional autopsy findings.
- A high Cohen κ coefficient of 0.94 indicated strong agreement between methods.
- Specific causes identified included pulmonary embolism, aortic dissection, myocardial infarction, and coronary artery disease. CT-guided biopsy provided additional crucial histopathologic information in 7 cases.
Conclusions:
- Postmortem CT angiography with image-guided biopsy is a minimally invasive technique with significant potential for diagnosing the cause of death in cases of acute chest pain.
- This method offers a valuable alternative or adjunct to conventional autopsy, improving diagnostic yield and reducing invasiveness.
Purpose:
To determine the potential of minimally invasive postmortem computed tomographic (CT) angiography combined with image-guided tissue biopsy of the myocardium and lungs in decedents who were thought to have died of acute chest disease and to compare this method with conventional autopsy as the reference standard.
Materials And Methods:
The responsible justice department and ethics committee approved this study. Twenty corpses (four female corpses and 16 male corpses; age range, 15-80 years), all of whom were reported to have had antemortem acute chest pain, were imaged with postmortem whole-body CT angiography and underwent standardized image-guided biopsy. The standard included three biopsies of the myocardium and a single biopsy of bilateral central lung tissue. Additional biopsies of pulmonary clots for differentiation of pulmonary embolism and postmortem organized thrombus were performed after initial analysis of the cross-sectional images. Subsequent traditional autopsy with sampling of histologic specimens was performed in all cases. Thereafter, conventional histologic and autopsy reports were compared with postmortem CT angiography and CT-guided biopsy findings. A Cohen κ coefficient analysis was performed to explore the effect of the clustered nature of the data.
Results:
In 19 of the 20 cadavers, findings at postmortem CT angiography in combination with CT-guided biopsy validated the cause of death found at traditional autopsy. In one cadaver, early myocardial infarction of the papillary muscles had been missed. The Cohen κ coefficient was 0.94. There were four instances of pulmonary embolism, three aortic dissections (Stanford type A), three myocardial infarctions, three instances of fresh coronary thrombosis, three cases of obstructive coronary artery disease, one ruptured ulcer of the ascending aorta, one ruptured aneurysm of the right subclavian artery, one case of myocarditis, and one pulmonary malignancy with pulmonary artery erosion. In seven of 20 cadavers, CT-guided biopsy provided additional histopathologic information that substantiated the final diagnosis of the cause of death.
Conclusion:
Postmortem CT angiography combined with image-guided biopsy, because of their minimally invasive nature, have a potential role in the detection of the cause of death after acute chest pain.
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