Adult post-mortem imaging in traumatic and cardiorespiratory death and its relation to clinical radiological imaging

Abstract

The use of post-mortem imaging is expanding throughout the world with increasing use of advanced imaging techniques, such as contrast-enhanced CT and MRI. The questions asked of post-mortem imaging are complex and can be very different, for example for natural sudden death investigation will focus on the cause, whereas for trauma the cause of death is often clear, but injury patterns may be very revealing in investigating the background to the incident. Post-mortem imaging is different to clinical imaging regarding both the appearance of pathology and the information required, but there is much to learn from many years of clinical research in the use of these techniques. Furthermore, it is possible that post-mortem imaging research could be used not only for investigating the cause of death but also as a model to conduct clinically relevant research. This article reviews challenges to the development of post-mortem imaging for trauma, identification and cardiorespiratory death, and how they may be influenced by current clinical thinking and practice.

Figure 1.

An image from a fluoroscopic series showing a catheter inserted into the orifice of the right coronary artery (RCA) of a cadaver (white arrow) and a pressure wire inserted into the RCA (black arrows). Pressure changes in the RCA secondary to pump injection of air/contrast in the ascending aorta can then be measured.

Figure 2.

Cardiac images, in two different cases, of autopsy proven myocardial infarction, using (a) water-soluble contrast agent and (b) lipophilic contrast agent in paraffin oil. The water-soluble agent “enhanced” the normal myocardium showing perfusion deficits (*) relating to ischaemia, whereas the normal myocardium is not enhanced by the lipophilic agent, and at autopsy no oil was identifiable in the capillaries.

Figure 3.

Whole-body angiography using (a) lipophilic contrast in paraffin oil (case of ruptured aortic aneurism) and (b) air (no vascular abnormality).

Figure 4.

Images of the heart before (a) and after (b) lipophilic contrast in paraffin oil showing atypical myocardial enhancement in a case of death owing to hypertensive heart disease and obesity.

Figure 5.

Post-mortem CT studies in two cases: normal (a, b) and with pneumonia (c, d) documented during autopsy. The second image of each case (b, d) is after lung ventilation using a supralaryngeal airway and continuous ventilation pressure of 40 mBar and shows clearing of normal background lung changes (b) but not pneumonia changes (d).