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J C Goslings - One of the best experts on this subject based on the ideXlab platform.
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the value of postmortem computed tomography as an alternative for Autopsy in trauma victims a systematic review
European 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.
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Feasibility of Postmortem Imaging Assessment of Brain: Liver Volume Ratios with Pathological Validation.
Fetal Diagnosis and Therapy, 2019Co-Authors: Susan C. Shelmerdine, J C Hutchinson, Kimberly L. Chung, 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.
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quantification of maceration changes using post mortem mri in fetuses
BMC Medical Imaging, 2016Co-Authors: Paolo Montaldo, S Addison, Vânia Oliveira, Peter J Lally, Andrew M Taylor, Neil J. Sebire, Sudhin Thayyil, Owen J. ArthursAbstract: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.
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post mortem mri versus conventional Autopsy in fetuses and children a prospective validation study
The 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.
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minimally invasive perinatal autopsies using magnetic resonance imaging and endoscopic postmortem examination keyhole Autopsy feasibility and initial experience
Journal of Maternal-fetal & Neonatal Medicine, 2012Co-Authors: Neil J. Sebire, Andrew M Taylor, Sudhin Thayyil, M A Weber, Imran Mushtaq, Lyn S ChittyAbstract:Objective: Perinatal Autopsy provides additional diagnostic information in a significant proportion of cases but parents and relatives frequently decline traditional postmortem (PM) examination, partly due to the unacceptability of the cosmetic effects of large incisions and concerns regarding organ retention. We present a novel minimally invasive Autopsy method for fetal and neonatal PMexaminations, which includes PM magnetic resonance imaging (MRI) for assessment of anatomy and endoscopic internal examination to allow direct organ visualization and targeted tissue biopsy. Methods: Descriptive retrospective feasibility report of the first 10 perinatal cases undergoing endoscopic minimally invasive Autopsy. Results: A minimally invasive Autopsy (MIA) approach based on postmortem MRI (PM MRI) and endoscopic Autopsy with tissue biopsy is feasible and effective with minimal cosmetic consequences compared to traditional PM examination. Endoscopic examination with tissue biopsy provided additional diagnostic i...
Dominic Gascho - One of the best experts on this subject based on the ideXlab platform.
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The added value of postmortem magnetic resonance imaging in cases of hanging compared to postmortem computed tomography and Autopsy
Forensic 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.
Michael J. Thali - One of the best experts on this subject based on the ideXlab platform.
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The added value of postmortem magnetic resonance imaging in cases of hanging compared to postmortem computed tomography and Autopsy
Forensic 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.
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Unexpected brain finding in pre-Autopsy postmortem CT
Forensic Science Medicine and Pathology, 2017Co-Authors: Vasiliki Chatzaraki, Stephan A Bolliger, Michael J. Thali, Sebastian Eggert, Thomas D RuderAbstract:A case is presented in which pre-Autopsy postmortem computed tomography (PMCT) revealed an unexpected brain abscess with a related frontal sinusitis and an erosion of the posterior wall of the frontal sinus. PMCT findings enabled the forensic pathologists to adapt protective measures during Autopsy and protect their health from infection. Pre-Autopsy PMCT has been also useful in the early differential diagnosis procedure. The complementary use of postmortem imaging and Autopsy can improve the quality of forensic death investigations.
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postmortem magnetic resonance imaging reproducing typical Autopsy heart measurements
Legal Medicine, 2015Co-Authors: Thomas D Ruder, Michael J. Thali, Garyfalia Ampanozi, Gary M Hatch, Patricia M FlachAbstract:Abstract Purpose The aim of this study was to evaluate the utility of cardiac postmortem magnetic resonance (PMMR) to perform routine measurements of the ventricular wall thicknesses and the heart valves and to assess if imaging measurements are consistent with traditional Autopsy measurements. Methods In this retrospective study, 25 cases with cardiac PMMR and subsequent Autopsy were included. The thicknesses of the myocardial walls as well as the circumferences of all heart valves were measured on cardiac PMMR and compared to Autopsy measurements. Paired samples T -test and the Wilcoxon-Signed rank test, were used to compare Autopsy and cardiac PMMR measurements. For exploring correlations, the Pearson's Correlation coefficient and the Spearman's Rho test were used. Results Cardiac PMMR measurements of the aortic and pulmonary valve circumferences showed no significant differences from Autopsy measurements. The mitral and tricuspid valves circumferences differed significantly from Autopsy measurements. Left myocardial and right myocardial wall thickness also differed significantly from Autopsy measurements. Left and right myocardial wall thickness, and tricuspid valve circumference measurements on cardiac PMMR and Autopsy, correlated strongly and significantly. Conclusion Several PMMR measurements of cardiac parameters differ significantly from corresponding Autopsy measurements. However, there is a strong correlation between cardiac PMMR measurements and Autopsy measurements in the majority of these parameters. It is important to note that myocardial walls are thicker when measured in situ on cardiac PMMR than when measured at Autopsy. Investigators using post-mortem MR should be aware of these differences in order to avoid false diagnoses of cardiac pathology based on cardiac PMMR.
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forensic relevance of post mortem ct imaging of the haemopericardium in determining the cause of death
Legal Medicine, 2014Co-Authors: Michael J. Thali, Laura Filograna, Daniela MarchettiAbstract:The post-mortem diagnosis of pericardial tamponade is associated with several medical legal problems. Thus, we explored whether post-mortem computed tomography might provide useful and reliable information for the diagnosis of this relevant disease in combination with Autopsy data. We retrospectively reviewed the post-mortem computed tomography and Autopsy reports of 15 Autopsy cases with haemopericardium detected at the Institute of Forensic Medicine in Berne from July 2005 to February 2010. Two computer tomography findings were examined in combination with Autopsy results. The first was the "hyperdense armoured heart," which has been previously described as post-mortem evidence of heart beating for a time after the initiation of intrapericardial bleeding. The second was the "flattening of the anterior surface" of the heart which has been previously observed in vivo as a sign of the compression effect of the haemopericardium on the heart. Our retrospective analysis showed the combined presence of both of these findings in all cases of Autopsy evidence of pericardial tamponade with the exception of one case. In contrast, the concomitance of both of them was never observed in cases of Autopsy death due to haemorrhage in which neither the flattening of the anterior surface of the heart was detected except for one case. In conclusion, these results should be considered a first step toward the potentially using post-mortem computed tomography in combination with Autopsy data in the diagnosis of pericardial tamponade especially considering the possibility to detect sign as the flattened heart signal which cannot be assessed after opening the pericardium at Autopsy.
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postmortem imaging of blunt chest trauma using ct and mri comparison with Autopsy
Journal of Thoracic Imaging, 2008Co-Authors: Emin Aghayev, Martin Sonnenschein, Andreas Christe, Michael J. Thali, Christian Jackowski, Richard Dirnhofer, Peter VockAbstract:OBJECTIVE: Postmortem examination of chest trauma is an important domain in forensic medicine, which is today performed using Autopsy. Since the implementation of cross-sectional imaging methods in forensic medicine such as computed tomography (CT) and magnetic resonance imaging (MRI), a number of advantages in comparison with Autopsy have been described. Within the scope of validation of cross-sectional radiology in forensic medicine, the comparison of findings of postmortem imaging and Autopsy in chest trauma was performed. METHODS: This retrospective study includes 24 cases with chest trauma that underwent postmortem CT, MRI, and Autopsy. Two board-certified radiologists, blind to the Autopsy findings, evaluated the radiologic data independently. Each radiologist interpreted postmortem CT and MRI data together for every case. The comparison of the results of the radiologic assessment with the Autopsy and a calculation of interobserver discrepancy was performed. RESULTS: Using combined CT and MRI, between 75% and 100% of the investigated findings, except for hemomediastinum (70%), diaphragmatic ruptures (50%; n=2) and heart injury (38%), were discovered. Although the sensitivity and specificity regarding pneumomediastinum, pneumopericardium, and pericardial effusion were not calculated, as these findings were not mentioned at the Autopsy, these findings were clearly seen radiologically. The averaged interobserver concordance was 90%. CONCLUSION: The sensitivity and specificity of our results demonstrate that postmortem CT and MRI are useful diagnostic methods for assessing chest trauma in forensic medicine as a supplement to Autopsy. Further radiologic-pathologic case studies are necessary to define the role of postmortem CT and MRI as a single examination modality.
Bertrand Bruneau - One of the best experts on this subject based on the ideXlab platform.
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Whole-body post-mortem computed tomography compared with Autopsy in the investigation of unexpected death in infants and children
European Radiology, 2013Co-Authors: Maïa Proisy, Antoine Jérôme Marchand, Philippe Loget, Renaud Bouvet, Michel Roussey, Fabienne Pelé, Céline Rozel, Catherine Treguier, Pierre Darnault, Bertrand BruneauAbstract:To investigate the contribution of whole-body post-mortem computed tomography (PMCT) in sudden unexpected death in infants and children. METHODS: Forty-seven cases of sudden unexpected death in children investigated with radiographic skeletal survey, whole-body PMCT and Autopsy were enrolled. For imaging interpretation, non-specific post-mortem modifications and abnormal findings related to the presumed cause of death were considered separately. All findings were correlated with Autopsy findings. RESULTS: There were 31 boys and 16 girls. Of these, 44 children (93.6 %) were younger than 2 years. The cause of death was found at Autopsy in 18 cases (38.3 %), with 4 confirmed as child abuse, 12 as infectious diseases, 1 as metabolic disease and 1 as bowel volvulus. PMCT results were in accordance with Autopsy in all but three of these 18 cases. Death remains unexplained in 29 cases (61.7 %) and was correlated with no abnormal findings on PMCT in 27 cases. Major discrepancies between PMCT and Autopsy findings concerned pulmonary analysis. CONCLUSIONS: Whole-body PMCT may detect relevant findings that can help to explain sudden unexpected death and is essential for detecting non-accidental injuries. We found broad concordance between Autopsy and PMCT, except in a few cases of pneumonia. It is a non-invasive technique acceptable to relatives. KEY POINTS: • Whole-body post-mortem computed tomography (PMCT) is an effective non-invasive method. • Whole-body PMCT is essential for detecting child abuse in unexpected death. • There is concordance on cause of death between PMCT and Autopsy. • Whole-body PMCT could improve Autopsy through dissection and sampling guidance. • PMCT shows findings that may be relevant when parents reject Autopsy.
