Postmortem cranial MRI and autopsy correlation in suspected child abuse

We investigated the correlation between postmortem magnetic resonance imaging (MRI) of the head and autopsy findings in suspected child abuse. Postmortem MRI was performed within 24 h of death and before autopsy in 11 children 2 years old or younger whose deaths were unexplained or suspected to be due to child abuse. MRI findings were available to the pathologist at the time of autopsy. In eight cases of death from non-accidental trauma, cerebral edema, contusion, shearing injury, ischemia, and infarction were well demonstrated on MRI. In the three deaths determined not to be due to trauma, there were no false-positive MRI findings. Autopsy was superior in detection of subarachnoid hemorrhage, suture separation, extracranial injuries, and very small subdural hematomas. MRI findings were useful in directing the autopsy and brain-cutting to focal areas of abnormality. Postmortem MRI and autopsy are complementary, and each may disclose abnormalities missed by the other. In half of the eight cases of child abuse examined, the combination of MRI and autopsy added valuable information compared with the results of autopsy alone. Postmortem MRI can be a valuable addition to autopsy findings in the investigation of fatalities potentially due to child abuse.