Whole-body post mortem computed tomography angiography: technical notes

Whole-body post mortem CT angiography (PMCTA) is an innovative and experimental imaging technique that relies heavily on interdisciplinary collaboration, access to skilled personnel, advanced technical equipment and the financial possibilities of the workplace. Native CT examinations (PMCT) prior to autopsy are already a standard procedure in certain forensic departments in the Czech Republic (e.g., murders, suicides, deaths of children, traffic accidents etc.). Nonetheless, the progression of forensic sciences all over the world shows the necessity to integrate other advanced imaging modalities in routine forensic practice. Incorporating PMCTA into standard forensic workflows enhances the precision of forensic diagnostics, supplements traditional autopsy findings, and elevates the objectivity of forensic outputs. This paper presents technical notes on the development of PMCTA in forensic practice in a department that since 2015 until now has routinely performed native CT examinations. Institutional support was crucial in enabling the adoption of the imaging technique, which has so far been applied to more than thirty cases. The department is currently conducting a comparative study focused on the application of three different types of perfusion media - polyethylene glycol (PEG), saline, paraffin oil - and assessing the diagnostic efficacy of PMCTA relative to conventional autopsy. Based on our experience, PMCTA is suitable for all corpses except those with advanced post-mortem decomposition or extensive open injuries. The highest diagnostic yield is achieved in cases involving suspected gastrointestinal bleeding or vascular pathologies and lesions especially of large vessels (e.g., dissection/rupture of the aorta). The protocol for whole-body PMCTA can be adapted to meet the specific needs and conditions of individual forensic departments, providing a flexible yet robust framework for enhancing forensic medical investigations.