Postmortem chest computed tomography in COVID-19: A minimally invasive autopsy method

Area of Science:

• Medical Imaging
• Pathology
• COVID-19 Research

Background:

• Performing autopsies during pandemics presents challenges due to contamination risks.
• Minimally invasive autopsy (MIA) offers a potential solution to balance understanding pathophysiology with safety.
• Integrating radiology and pathology is crucial for comprehensive postmortem analysis.

Purpose of the Study:

• To evaluate postmortem CT lung findings and their correlation with histopathology in fatal COVID-19 cases.
• To validate a minimally invasive autopsy model combining imaging and tissue analysis.
• To determine the relationship between radiological patterns and histopathological features of lung injury.

Main Methods:

• Twenty-nine patients with fatal COVID-19 underwent postmortem chest CT scans.
• Lung tissue samples were collected and examined for histopathological analysis, including diffuse alveolar damage (DAD).
• CT findings and histopathological features were quantified and correlated using statistical analysis.

Main Results:

• A significant positive correlation was found between overall CT severity scores and histopathological severity scores (R=0.66, p=0.0078).
• Positive correlations existed between normal lung percentages on CT and histopathology (R=0.65, p=0.0082).
• Negative correlations were observed between ground-glass opacities on CT and exudative DAD in histopathology (R=-0.68, p=0.005), with a trend for increased consolidations on CT correlating with decreased normal lung tissue histologically.

Conclusions:

• Minimally invasive autopsy is a valid approach for postmortem examination in pandemic scenarios.
• Increasing severity of lung involvement on CT correlates with more advanced histopathological disease.
• Radiological findings like ground-glass opacities require careful interpretation due to potential overestimation of disease in postmortem lungs.