Noninvasive postmortem investigation of cases refusing autopsy using computed tomography

Jitladda Wasinrat; Pakorn Wasinrat

doi:10.46475/asean-jr.v24i3.194

Authors

Jitladda Wasinrat, M.D. Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Thailand.
Pakorn Wasinrat, M.D.

DOI:

https://doi.org/10.46475/asean-jr.v24i3.194

Keywords:

Postmortem CT, Cause of death, Refusing autopsy case, Virtual autopsy

Abstract

Background: CT is a well-known tool to assess several conditions in living patients. The post-mortem CT (PMCT) has been introduced to determine the cause of death in dead subjects. CT is also the imaging modality of choice for the analysis of autopsy findings including fracture, hematoma, gas collection and gross tumor injury. The rate of standard autopsy is continuing to decline and there are several reasons for refusing autopsy.

Objective: The current research endeavor is investigate the usefulness of computed tomography (CT) in cases refusing autopsy.

Materials and Methods: In this study, the PMCT were evaluated in 150 subjects in different contexts of death. The causes of death were classified into four categories which include a definite cause of death, a possible cause of death, a minor pathological finding and no fatal findings. For the definite cause of death and the possible cause of death, the specific lesions are described in detail.

Results: The definite cause of death was detected in 48 (32%) of the subjects. The possible cause of death was detected in 18 (12%) of the subjects. The remaining 84 subjects were classified into minor pathological findings and no fatal findings in 46 (30.7%) and 38 (25.3%) of the patients, respectively. The fatal lesions of PMCT were found in 93 lesions(48 subjects) that were demonstrated by anatomical locations into the traumatic bone, intracranial, spine, thoracic, heart leak and abdominal lesions. We found definite causes of death in 6 subjects, which had no history of trauma and malignancy and were mentioned about a cardiopulmonary failure as a cause of death at first.

Conclusion: The PMCT is a useful tool for identifying the cause of death in many cases that have limitations for conventional autopsy. The morphological change such as intracranial hemorrhage is easily diagnosed with PMCT. The PMCT appears to be an alternative tool to assess the cause of death in any reason of objections.

Downloads

Download data is not yet available.

Metrics

Metrics Loading ...

References

Burton JL, Underwood J. Clinical, educational, and epidemiological value of autopsy. Lancet 2007;369:1471-80. doi: 10.1016/S0140-6736(07)60376-6.

Roberts IS, Benamore RE, Benbow EW, Lee SH, Harris JN, Jackson A, et al. Post-mortem imaging as an alternative to autopsy in the diagnosis of adult deaths: a validation study. Lancet 2012;379:136-42. doi: 10.1016/S0140-6736(11)61483-9.

Takahashi N, Higuchi T, Shiotani M, Hirose Y, Shibuya H, Yamanouchi H, et al. The effectiveness of postmortem multidetector computed tomography in the detection of fatal findings related to cause of non-traumatic death in the emergency department. Eur Radiol 2012;22:152-60. doi: 10.1007/s00330-011-2248-6.

Le Blanc-Louvry I, Thureau S, Duval C, Papin-Lefebvre F, Thiebot J, Dacher JN, et al. Post-mortem computed tomography compared to forensic autopsy findings: a French experience. Eur Radiol 2013;23:1829-35. doi: 10.1007/s00330-013-2779-0.

Wichmann D, Obbelode F, Vogel H, Hoepker WW, Nierhaus A, Braune S, et al.Virtual autopsy as an alternative to traditional medical autopsy in the intensive care unit: a prospective cohort study. Ann Intern Med 2012;156:123-30. doi: 10.7326/0003-4819-156-2-201201170-00008.

Burton JL, Kitsanta P. Daily application of post-mortem computed tomography digital autopsy in a public mortuary. Diagn Histopathol 2020;26:358-67.

Elkhateeb SA, Mohammed EB, Meleka HA, Ismail AAE. Postmortem computed tomography and autopsy for detection of lesions and causes of death in gunshot injury cases: a comparative study. Egypt J Forensic Sci 2018;8:50. doi:10.1186/s41935-018-0078-2.

Mentink MG, Latten BGH, Bakers FCH, Mihl C, Rennenberg RJMW, Kubat B, et al. Clinical relevance of unexpected findings of post-mortem computed tomography in hospitalized patients: an observational study. Int J Environ Res Public Health 2020;17:7572. doi: 10.3390/ijerph17207572.

Dirnhofer R, Jackowski C, Vock P, Potter K, Thali MJ. VIRTOPSY: minimally invasive, imaging-guided virtual autopsy. Radiographics 2006;26:1305-33. doi: 10.1148/rg.265065001.

Badam RK, Sownetha T, Babu DBG, Waghray S, Reddy L, Garlapati K, et al. Virtopsy: touch-free autopsy. J Forensic Dent Sci 2017;9:42-. doi: 10.4103/jfo.jfds_7_16.