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Diagnostic tips for multi-phase post-mortem computed tomography angiography interpretation in upper gastro-intestinal

Kim Wiskott1, Virginie Magnin2,3, Coraline Egger2

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Summary

Multi-phase Post-mortem Computed Tomography Angiography (MPMCTA) aids in diagnosing upper gastro-intestinal bleeding. This study establishes criteria to differentiate true bleeding from artifacts, improving postmortem diagnostic accuracy.

Keywords:
Gastro-intestinal hemorrhagesMPMCTAPost-mortem angiographyPost-mortem hemorrhagesUpper gastro-intestinal bleeding

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Area of Science:

  • Forensic Radiology
  • Vascular Imaging
  • Postmortem Diagnostics

Background:

  • Multi-phase Post-mortem Computed Tomography Angiography (MPMCTA) enhances postmortem diagnoses, especially for vascular issues.
  • Upper gastro-intestinal bleeding is a significant cause of death in forensic practice.
  • MPMCTA can produce artifacts mimicking true bleeding, necessitating differentiation criteria.

Purpose of the Study:

  • To compare the diagnostic accuracy of MPMCTA and autopsy in detecting upper GI bleeding.
  • To establish criteria for distinguishing true GI hemorrhage from artifacts on MPMCTA.
  • To improve the interpretation of upper GI contrast extravasation in postmortem angiography.

Main Methods:

  • Retrospective cross-sectional study analyzing MPMCTA and autopsy data.
  • Involved 326 human bodies with suspected upper GI bleeding.
  • Focused on identifying specific features of true bleeding versus artifacts.

Main Results:

  • Contrast extravasation in the GI tract on MPMCTA does not always indicate active bleeding.
  • True GI hemorrhage on MPMCTA shows specific features: hyperdense material on native CT and focal contrast leakage during arterial/venous phases.
  • Autopsy findings were used to validate MPMCTA interpretations.

Conclusions:

  • Radiologists and forensic pathologists need criteria to differentiate true upper GI bleeding from MPMCTA artifacts.
  • Specific MPMCTA findings can reliably indicate true GI hemorrhage.
  • Accurate interpretation of MPMCTA is crucial for precise postmortem diagnosis in cases of GI bleeding.