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Sudden Cardiac Death and Ex-Situ Post-Mortem Cardiac Magnetic Resonance Imaging: A Morphological Study Based on
Giuseppe Bertozzi1, Francesco Pio Cafarelli1, Michela Ferrara2
1Department of Clinical and Experimental Medicine, University of Foggia, 71100 Foggia, Italy.
Insights
Post-mortem cardiac MRI effectively identifies heart abnormalities in sudden cardiac death (SCD) cases. This imaging technique aids forensic pathology by improving the accuracy of subsequent histological sampling and diagnosis.
Area of Science:
- Forensic Pathology
- Cardiovascular Imaging
- Medical Imaging
Background:
- Post-mortem imaging, including conventional radiography and Post Mortem Computed Tomography (PMCT), is increasingly used in forensic pathology.
- Post Mortem Magnetic Resonance Imaging (PMMRI) is emerging as a valuable tool for cardiovascular investigations.
Purpose of the Study:
- To confirm the efficacy of a Post Mortem Cardiac Resonance Imaging (PMCRI) protocol for studying human hearts ex-situ.
- To apply the PMCRI protocol to hearts from sudden cardiac death (SCD) victims to identify characteristic alterations.
Main Methods:
- A standardized PMCRI protocol was applied to human hearts obtained during autopsy and after 30-day formalin fixation.
- Exams were performed on a 1.5 T scanner, with images analyzed blindly and randomized by two readers.
- Comparison of imaging data with macroscopic and histological findings.
Main Results:
- The study confirmed the effectiveness of the PMMRI protocol for ex-situ heart analysis.
- Specific imaging features were correlated with pathological findings in SCD cases: hyperintense areas (STIR) indicated edema/pathological fibers, and hypointense areas (T2-FFE) suggested fibrosis.
- PMMRI demonstrated a valuable benefit in guiding subsequent histological sampling.
Conclusions:
- PMMRI is an effective method for examining human hearts post-mortem.
- The identified imaging semeiology aids in diagnosing SCD by highlighting edema and fibrosis.
- PMMRI enhances the diagnostic yield of post-mortem investigations in cases of sudden cardiac death.
Abstract:
During the last years, post-mortem imaging has gradually been assumed within research in the field of forensic pathology. This role appears to be clearly and simply applied in the trauma field with the use of conventional radiography or Post Mortem Computed Tomography (PMCT). Recently, particular attention was paid to cardiovascular imaging using Post Mortem Magnetic Resonance Imaging (PMMRI). The present experimental study aims to: (i) confirm the efficacy of a Post Mortem Cardiac Resonance Imaging (PMCRI) study protocol for the study of human hearts collected during the autopsy; (ii) apply the defined protocol on subjects who died of "SCD (sudden cardiac death)", to identify alterations that could guide subsequent sampling. Two hearts of healthy subjects (A: male 22 years; B: female 26 years), who died from causes other than SCD were collected and compared to hearts that belonged to SCD individuals (C: male, 47 years old; D: female, 44 years old; E: male; 72 years old). The exams were performed on a 1.5 T scanner (Philips Intera Achieva, Best, the Netherlands) on hearts collected during autopsy and after a 30-day formalin fixation. Two readers analyzed the obtained images blindly and after randomization. From the comparison between the data from imaging and the macroscopic and histological investigations carried out, the present study proved the effectiveness of a PMMRI protocol to study ex-situ hearts. Moreover, it suggested the following semeiology in post-mortem SCD cases: the hyperintense area with indistinct margins in the Short Tau Inversion Recovery (STIR) sequence was linked to edema or area of pathological fibers, whereas the hypointense area in the T2-FFE sequences was linked to fibrosis. PMMRI can provide a valuable benefit to post-mortem investigations, helping to distinctly improve the success rate of histological sampling and investigations, which remains the gold standard in the diagnosis of sudden death.
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