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Head and Brain Postmortem Computed Tomography-Autopsy Correlation in Hospital Deaths
Serenella Serinelli1, Timothy E Richardson1, Sylvie Destian2
1From the Department of Pathology.
Abstract:
The use of postmortem computed tomography (PMCT) to support autopsy pathology has increased in recent decades. To some extent, PMCT has also been contemplated as a potential alternative to conventional postmortem examination. The purpose of this study was to investigate the ability of PMCT to detect specific pathologic findings in the head and brain in natural hospital deaths.We examined postmortem CT images and autopsy data from 31 subjects who died at SUNY (State University of New York) Upstate University Hospital between 2013 and 2018. Each subject underwent a noncontrast PMCT and a traditional autopsy. A neuroradiologist analyzed PMCT images for head and brain abnormalities. The autopsies were performed by pathologists who were aware of the radiology results.In our series, PMCT was able to detect the majority of the significant space-occupying lesions, although it was not always reliable in ascertaining their nature. Postmortem computed tomography revealed findings usually challenging to detect at autopsy. Unfortunately, there were also situations in which PMCT was misleading, showing changes that were difficult to interpret, or that could be related to postmortem events. Therefore, we conclude PMCT should be used as an adjunct rather than a substitute to autopsy.
Insights
Postmortem CT (PMCT) can detect many head and brain abnormalities found during autopsy, but it is not always reliable for determining their exact nature. PMCT is best used as a supplementary tool alongside traditional autopsy, not as a replacement.
Area of Science:
- Forensic Pathology
- Radiology
- Neuropathology
Background:
- Postmortem computed tomography (PMCT) use has grown, with considerations for its role as an alternative to conventional autopsy.
- The diagnostic capabilities of PMCT in examining head and brain pathologies require further investigation.
Purpose of the Study:
- To evaluate the effectiveness of PMCT in identifying specific pathological findings in the head and brain of individuals who died from natural causes in a hospital setting.
Main Methods:
- A retrospective analysis of noncontrast PMCT scans and autopsy data from 31 deceased individuals.
- Independent review of PMCT images by a neuroradiologist and autopsy by pathologists, with awareness of radiology findings.
Main Results:
- PMCT successfully detected most significant space-occupying lesions in the head and brain.
- The technology revealed findings often difficult to discern during autopsy but sometimes provided misleading or difficult-to-interpret results.
- PMCT identified changes potentially attributable to postmortem processes.
Conclusions:
- Postmortem CT is a valuable adjunct to traditional autopsy for detecting head and brain pathologies.
- PMCT should not be considered a substitute for conventional postmortem examination due to interpretation challenges and potential for misleading findings.
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