Post-mortem Cardiac MRI in Sudden Cardiac Death: The Interesting Intertwining of Radiology and Histology to Diagnose...

Although the "conventional" autopsy is still considered the "gold standard" for the definition of the cause of death, an emerging interest in noninvasive cadaveric investigations is spreading. Among all these, the application of post-mortem magnetic resonance imaging of the heart is increasingly gaining ground in the study of sudden cardiac death.

Using the diffusion tensor imaging sequence, the present study aimed to demonstrate how through the fractional anisotropy value it is possible to qualitatively and quantitatively define sudden cardiac death, particularly in cases of sudden arrhythmic death syndrome. Four hearts were collected for the present pilot study: the first from a subject who died from a brain injury caused by a gunshot, and the other three hearts from subjects who died of sudden cardiac death. In all cases examined, the extracted hearts were hung inside a container containing 10% formalin solution and placed inside a 1.5T scanner with a 16-channel chest coil. Then, the cardiac diffusion tensor imaging sequence was performed and the quantitative maps of fractional anisotropy and apparent diffusion coefficient were obtained. After imaging analysis, the samples were processed, paraffin-embedded, and stained with hematoxylin and eosin and trichrome staining. Cases B, C, and D showed lower fractional anisotropy values than nonpathological one.

Histological investigation revealed extensive areas of fibrosis and foci of contraction band necrosis in heart B, myofiber disarray and interstitial fibrosis in heart C, and findings consistent with atonic death in heart D.

The study aimed to demonstrate that in cases of sudden cardiac death, lower fractional anisotropy values, as already observed in clinical trials, are associated with arrhythmic heart disease or myocardial infarction. Quantitative, appreciable, and reproducible data could support such diagnoses.