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The pseudo-SAH sign: an imaging pitfall in postmortem computed tomography.

Go Shirota1, Wataru Gonoi2, Masako Ikemura3

  • 1Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.

International Journal of Legal Medicine
|July 22, 2017
PubMed
Summary

Postmortem CT accurately detects subarachnoid hemorrhage (SAH), but pseudo-SAH can mislead. Differentiating true SAH from pseudo-SAH involves examining CT signs and clinical history to avoid misdiagnosis.

Keywords:
Postmortem computed tomographyPseudo-SAH, hypoxic-ischemic encephalopathySubarachnoid hemorrhage

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Area of Science:

  • Forensic Radiology
  • Neuropathology

Background:

  • Postmortem computed tomography (PMCT) is crucial for identifying subarachnoid hemorrhage (SAH), a condition with high mortality.
  • Distinguishing true SAH from pseudo-SAH on PMCT is challenging due to similar imaging findings.

Purpose of the Study:

  • To assess the diagnostic accuracy of brain PMCT for SAH detection.
  • To identify characteristic features differentiating true SAH from pseudo-SAH.

Main Methods:

  • Compared PMCT findings (sulcal effacement, asymmetry, SAH thickness, intraventricular/intraparenchymal hemorrhage) and clinical history (LVAD, anticoagulation, global ischemia) between true SAH and pseudo-SAH groups.
  • Correlated PMCT findings with autopsy results in 128 subjects.

Main Results:

  • PMCT showed 95.2% sensitivity and 94.6% specificity for SAH; 71.4% of positive PMCT findings were confirmed by autopsy.
  • True SAH cases exhibited significantly more asymmetry, greater SAH thickness, and more intraventricular/intraparenchymal hemorrhage than pseudo-SAH.
  • Global ischemia was more frequent in pseudo-SAH cases.

Conclusions:

  • Brain PMCT is highly sensitive and specific for SAH, but careful evaluation of specific CT signs and clinical history is essential to differentiate true SAH from pseudo-SAH.
  • Asymmetry, SAH thickness, and associated hemorrhages are key indicators of true SAH, while global ischemia suggests pseudo-SAH.