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Published on: June 11, 2019
Pulmonary thrombembolism as cause of death on unenhanced postmortem 3T MRI
Christian Jackowski1, Silke Grabherr, Nicole Schwendener
1Forensic Imaging Center Bern, Institute of Forensic Medicine, University of Bern, Buehlstr. 20, 3012 Bern, Switzerland. christian.jackowski@irm.unibe.ch
Objectives:
To investigate unenhanced postmortem 3-T MR imaging (pmMRI) for the detection of pulmonary thrombembolism (PTE) as cause of death.
Methods:
In eight forensic cases dying from a possible cardiac cause but with homogeneous myocardium at cardiac pmMRI, additional T2w imaging of the pulmonary artery was performed before forensic autopsy. Imaging was carried out on a 3-T MR system in the axial and main pulmonary artery adapted oblique orientation in situ. In three cases axial T2w pmMRI of the lower legs was added. Validation of imaging findings was performed during forensic autopsy.
Results:
All eight cases showed homogeneous material of intermediate signal intensity within the main pulmonary artery and/or pulmonary artery branches. Autopsy confirmed the MR findings as pulmonary artery thrombembolism. At lower leg imaging unilateral dilated veins and subcutaneous oedema with or without homogeneous material of intermediate signal intensity within the popliteal vein were found.
Conclusions:
Unenhanced pmMRI demonstrates pulmonary thrombembolism in situ. PmMR may serve as an alternative to clinical autopsy, especially when consent cannot be obtained.
Key Points:
• Postmortem MRI (pmMRI) provides an alternative to clinical autopsy • Fatal pulmonary thrombembolism (PTE) can now be diagnosed using postmortem MRI (pmMRI). • Special attention has to be drawn to the differentiation of postmortem clots.
Insights
Unenhanced postmortem MRI (pmMRI) effectively detects pulmonary thrombembolism (PTE) as a cause of death. This imaging technique can serve as a valuable alternative to traditional autopsy, especially when consent is an issue.
Area of Science:
- Forensic Radiology
- Cardiovascular Pathology
- Medical Imaging
Background:
- Pulmonary thrombembolism (PTE) is a significant cause of sudden death.
- Clinical autopsy is the standard for diagnosing PTE.
- Limitations exist in obtaining consent for autopsy in certain forensic cases.
Purpose of the Study:
- To evaluate the efficacy of unenhanced 3-Tesla postmortem MRI (pmMRI) in detecting pulmonary thrombembolism.
- To assess pmMRI as a potential alternative to clinical autopsy for diagnosing PTE.
Main Methods:
- Eight forensic cases with suspected cardiac death underwent T2-weighted pmMRI of the pulmonary artery.
- Imaging was performed in situ using a 3-T MR system.
- Lower leg imaging was added in three cases; all findings were validated by autopsy.
Main Results:
- All eight cases revealed homogeneous material consistent with pulmonary artery thrombembolism on pmMRI.
- Autopsy confirmed the presence of PTE in all cases.
- Lower leg imaging showed findings suggestive of deep vein thrombosis in some cases.
Conclusions:
- Unenhanced pmMRI is capable of diagnosing in situ pulmonary thrombembolism.
- Postmortem MRI offers a viable alternative to clinical autopsy, particularly when consent is not obtainable.
- Distinguishing postmortem clots requires careful attention during pmMRI interpretation.
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