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J C Goslings – One of the best experts on this subject based on the ideXlab platform.
the value of postmortem computed tomography as an alternative for Autopsy in trauma victims a systematic reviewEuropean Radiology, 2009Co-Authors: M Scholing, T P Saltzherr, P Fung Kon H P Jin, Kees J Ponsen, J B Reitsma, J S Lameris, J C GoslingsAbstract:
The aim of this study was to assess the role of postmortem computed tomography (PMCT) as an alternative for Autopsy in determining the cause of death and the identification of specific injuries in trauma victims. A systematic review was performed by searching the EMBASE and MEDLINE databases. Articles were eligible if they reported both PMCT as well as Autopsy findings and included more than one trauma victim. Two reviewers independently assessed the eligibility and quality of the articles. The outcomes were described in terms of the percentage agreement on causes of death and amount of injuries detected. The data extraction and analysis were performed together. Fifteen studies were included describing 244 victims. The median sample size was 13 (range 5–52). The percentage agreement on the cause of death between PMCT and Autopsy varied between 46 and 100%. The overall amount of injuries detected on CT ranged from 53 to 100% compared with Autopsy. Several studies suggested that PMCT was capable of identifying injuries not detected during normal Autopsy. This systematic review provides inconsistent evidence as to whether PMCT is a reliable alternative for Autopsy in trauma victims. PMCT has promising features in postmortem examination suggesting PMCT is a good alternative for a refused Autopsy or a good adjunct to Autopsy because it detects extra injuries overseen during autopsies. To examine the value of PMCT in trauma victims there is a need for well-designed and larger prospective studies.
Neil J. Sebire – One of the best experts on this subject based on the ideXlab platform.
Feasibility of Postmortem Imaging Assessment of Brain: Liver Volume Ratios with Pathological Validation.Fetal Diagnosis and Therapy, 2019Co-Authors: Susan C. Shelmerdine, Kimberly L. Chung, J C Hutchinson, Claire L. Elliott, Neil J. Sebire, Owen J. ArthursAbstract:
INTRODUCTION: Organ volumes at postmortem magnetic resonance imaging (PMMR) should reflect Autopsy organ weights, and thus brain:liver volume ratios on imaging could be a surrogate for weight volume ratios at Autopsy to indicate fetal growth restriction (FGR). This study aims to determine whether imaging-based organ volume ratios can replace Autopsy organ weight ratios. Materials and Meth ods: An unselected cohort of perinatal deaths underwent PMMR prior to Autopsy. Semiautomated brain and liver volumes were compared to Autopsy organ weights and ratios. Ratios were compared using Bland-Altman plots, and intra- and interobserver variability was assessed. RESULTS: A total 49 fetuses (25 male, 51%) at 17-42 weeks gestation were -assessed. There was a reasonable correlation between Autopsy-derived brain:liver weight ratios (AB:LwR) and imaging-derived brain:liver volume ratios (IB:LvR; r = 0.8). The mean difference between AB:LwR and IB:LvR was +0.7 (95% limits of agreement range -1.5 to +2.9). In a small subset where FGR was present, the optimal IB:LvR ≥5.5 gave 83.3% sensitivity and 86.0% specificity for diagnosis. There was acceptable agreement within readers (mean difference in IB:LvRs 0.77 ± 2.21) and between readers -0.36 ± 0.68. CONCLUSION: IB:LvR provides a surrogate evaluation of AB:LwRs, and may be used as a marker of FGR where Autopsy is declined.
quantification of maceration changes using post mortem mri in fetusesBMC Medical Imaging, 2016Co-Authors: Paolo Montaldo, Owen J. Arthurs, Neil J. Sebire, S Addison, Vânia Oliveira, Peter J Lally, Andrew M Taylor, Sudhin ThayyilAbstract:
Post mortem imaging is playing an increasingly important role in perinatal Autopsy, and correct interpretation of imaging changes is paramount. This is particularly important following intra-uterine fetal death, where there may be fetal maceration. The aim of this study was to investigate whether any changes seen on a whole body fetal post mortem magnetic resonance imaging (PMMR) correspond to maceration at conventional Autopsy. We performed pre-Autopsy PMMR in 75 fetuses using a 1.5 Tesla Siemens Avanto MR scanner (Erlangen, Germany). PMMR images were reported blinded to the clinical history and Autopsy data using a numerical severity scale (0 = no maceration changes to 2 = severe maceration changes) for 6 different visceral organs (total 12). The degree of maceration at Autopsy was categorized according to severity on a numerical scale (1 = no maceration to 4 = severe maceration). We also generated quantitative maps to measure the liver and lung T2. The mean PMMR maceration score correlated well with the Autopsy maceration score (R2 = 0.93). A PMMR score of ≥4.5 had a sensitivity of 91 %, specificity of 64 %, for detecting moderate or severe maceration at Autopsy. Liver and lung T2 were increased in fetuses with maceration scores of 3–4 in comparison to those with 1–2 (liver p = 0.03, lung p = 0.02). There was a good correlation between PMMR maceration score and the extent of maceration seen at conventional Autopsy. This score may be useful in interpretation of fetal PMMR.
post mortem mri versus conventional Autopsy in fetuses and children a prospective validation studyThe Lancet, 2013Co-Authors: Sudhin Thayyil, Neil J. Sebire, Lyn S Chitty, Angie Wade, W K Chong, Oystein E Olsen, Roxana Gunny, Amaka C Offiah, Catherine M OwensAbstract:
Summary Background Post-mortem MRI is a potential diagnostic alternative to conventional Autopsy, but few large prospective studies have compared its accuracy with that of conventional Autopsy. We assessed the accuracy of whole-body, post-mortem MRI for detection of major pathological lesions associated with death in a prospective cohort of fetuses and children. Methods In this prospective validation study, we did pre-Autopsy, post-mortem, whole-body MRI at 1·5 T in an unselected population of fetuses (≤24 weeks’ or >24 weeks’ gestation) and children (aged Findings We analysed 400 cases, of which 277 (69%) were fetuses and 123 (31%) were children. Cause of death or major pathological lesion detected by minimally invasive Autopsy was concordant with conventional Autopsy in 357 (89·3%, 95% CI 85·8–91·9) cases: 175 (94·6%, 90·3–97·0) of 185 fetuses at 24 weeks’ gestation or less, 88 (95·7%, 89·3–98·3) of 92 fetuses at more than 24 weeks’ gestation, 34 (81·0%, 66·7–90·0) of 42 newborns aged 1 month or younger, 45 (84·9%, 72·9–92·1) of 53 infants aged older than 1 month to 1 year or younger, and 15 (53·6%, 35·8–70·5) of 28 children aged older than 1 year to 16 years or younger. The dedicated radiologist or pathologist review of the minimally invasive Autopsy showed that in 165 (41%) cases a full Autopsy might not have been needed; in these cases, concordance between Autopsy and minimally invasive Autopsy was 99·4% (96·6–99·9). Interpretation Minimally invasive Autopsy has accuracy similar to that of conventional Autopsy for detection of cause of death or major pathological abnormality after death in fetuses, newborns, and infants, but was less accurate in older children. If undertaken jointly by pathologists and radiologists, minimally invasive Autopsy could be an acceptable alternative to conventional Autopsy in selected cases. Funding Policy research Programme, Department of Health, UK.
Dominic Gascho – One of the best experts on this subject based on the ideXlab platform.
The added value of postmortem magnetic resonance imaging in cases of hanging compared to postmortem computed tomography and AutopsyForensic Science Medicine and Pathology, 2020Co-Authors: Eva Deininger-czermak, Michael J. Thali, Jakob Heimer, Carlo Tappero, Dominic GaschoAbstract:
The purpose of this study was to evaluate the added value of postmortem magnetic resonance imaging (MRI) compared to postmortem computed tomography (CT) and Autopsy in cases of fatal hanging. In addition, the study analyzed the strengths of each examination method regarding typical injuries in these cases. We investigated a cohort of 25 decedents who underwent CT, MRI and Autopsy. Two radiologists assessed all MR images of the head and neck as well as the corresponding CT images. The results were compared to Autopsy findings by retrospectively analyzing the Autopsy reports. Postmortem MRI revealed intramuscular hemorrhages in a large number of cases, however, Autopsy did not confirm all of the detected hemorrhages. CT and Autopsy detected fractures in several cases, whereas MRI showed a fracture in just one single case. Other previously described vital signs and relevant findings, such as fracture-related gas bubbles, soft tissue emphysema or pneumomediastinum, were observed in only a few individual cases. MRI provided added diagnostic value in the detection of soft tissue injuries and lymph node swelling in fatal hangings. As an adjunct to Autopsy, postmortem MRI may reveal additional hemorrhages, which might be missed at Autopsy. Since standard MRI demonstrated low sensitivity for the detection of fractures, an additional imaging modality or Autopsy is required to overcome this limitation.