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Multi-phase post-mortem CT-angiography: a pathologic correlation study on cardiovascular sudden death
Emanuela Turillazzi1, Paola Frati2, Natascha Pascale1
1Section of Forensic Pathology, Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy.
Insights
Multi-phase post-mortem CT-angiography (MPMCTA) enhances post-mortem investigations for sudden death cases. This study shows MPMCTA correlates well with autopsy, improving diagnostic sensitivity in sudden cardiovascular death investigations.
Area of Science:
- Forensic Radiology
- Cardiovascular Pathology
- Medical Imaging
Background:
- Multi-phase post-mortem CT-angiography (MPMCTA) shows potential for improving post-mortem investigations, particularly in sudden death cases.
- Standardization is needed to establish MPMCTA as a routine tool in forensic pathology.
Observation:
- A study included 10 adult sudden unexpected death cases investigated between 2012 and 2013.
- Non-contrast CT scans were performed before angiography, followed by MPMCTA.
- Experienced radiologists interpreted MPMCTA findings, comparing them with autopsy results.
Findings:
- MPMCTA demonstrated a strong correlation with autopsy findings in all 10 cases.
- The combined approach of post-mortem CT and MPMCTA showed high diagnostic sensitivity.
- MPMCTA proved advantageous in identifying causes of sudden death, irrespective of initial suspicion.
Implications:
- MPMCTA can significantly contribute to the diagnostic accuracy of sudden death investigations.
- This technique offers valuable insights into cardiovascular and ischemic events.
- Further standardization could integrate MPMCTA as a routine component of the forensic pathology toolkit.
Abstract:
Multi-phase post-mortem CT-angiography (MPMCTA) has the great potential to increase the quality of the post-mortem investigation, especially in the area of sudden death; however, its role as routine complement to the pathology toolbox is still questioned as it needs to be further standardized. The aim of this study is to investigate the contribution of MPMCTA in cases of sudden unexplained death in adults and in particular in sudden cardiovascular death. Sixty-eight sudden unexpected deaths of adults were investigated at our institution between 2012 and 2013. Ten cases underwent MPMCTA and autopsy and were included in the study. Before the angiographic step by complete filling of the vascular system, prior to any manipulation of the body, a non-contrast CT-scan was carried out. Image reconstructions were performed on a CT workstation (Vitrea) and two radiologists experienced with post mortem imaging interpreted the MPMCTA findings. In all 10 cases, we could state a good correlation between combination of post-mortem CT and MPMCTA and autopsy procedures, confirming a high diagnostic sensitivity. With this case series we want to illustrate the advantages offered by performing MPMCTA when facing a sudden death, regardless of specific suspicion for acute coronary syndrome or other vascular or ischemic disease.
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