Can computed tomography replace or supplement autopsy?

Area of Science:

• Forensic Pathology
• Radiology
• Medical Imaging

Background:

• Postmortem computed tomography (PMCT) is increasingly used in forensic pathology.
• The utility of PMCT in comparison to traditional medicolegal autopsy requires further evaluation.

Purpose of the Study:

• To prospectively compare the diagnostic accuracy of PMCT with medicolegal autopsy.
• To assess the ability of each method to identify abnormal findings and determine the cause of death (COD).

Main Methods:

• A prospective, double-blind study comparing autopsy findings with radiologist interpretations of PMCT scans.
• 890 cases were reviewed, including blunt force injury, pediatric trauma, firearm injuries, and drug poisoning deaths.
• Findings were coded using the Abbreviated Injury Scale and compared for congruence.

Main Results:

• Overall sensitivity for detecting abnormal findings was 71% for PMCT and 74.6% for autopsy.
• Sensitivities varied by injury type, with PMCT performing comparably or slightly lower than autopsy across categories.
• Both methods were sufficient to establish COD in most blunt force injury, pediatric trauma, firearm, and drug poisoning cases.

Conclusions:

• Both autopsy and PMCT have limitations but are effective in identifying critical findings and establishing COD.
• Integrating PMCT with autopsy provides a flexible approach, enhancing diagnostic capabilities in forensic investigations.
• Access to CT scanners and consulting radiologists is recommended for comprehensive forensic evaluations.