Multi-phase post-mortem CT-angiography: a pathologic correlation study on cardiovascular sudden death

Abstract

Multi-phase post-mortem CT-angiography (MPMCTA) has the great potential to increase the quality of the post-mortem investigation, especially in the area of sudden death; however, its role as routine complement to the pathology toolbox is still questioned as it needs to be further standardized. The aim of this study is to investigate the contribution of MPMCTA in cases of sudden unexplained death in adults and in particular in sudden cardiovascular death. Sixty-eight sudden unexpected deaths of adults were investigated at our institution between 2012 and 2013. Ten cases underwent MPMCTA and autopsy and were included in the study. Before the angiographic step by complete filling of the vascular system, prior to any manipulation of the body, a non-contrast CT-scan was carried out. Image reconstructions were performed on a CT workstation (Vitrea) and two radiologists experienced with post mortem imaging interpreted the MPMCTA findings. In all 10 cases, we could state a good correlation between combination of post-mortem CT and MPMCTA and autopsy procedures, confirming a high diagnostic sensitivity. With this case series we want to illustrate the advantages offered by performing MPMCTA when facing a sudden death, regardless of specific suspicion for acute coronary syndrome or other vascular or ischemic disease.

Keywords: Angiography; Imaging; Sudden death.

Figure 1.. Volume rendering (A) and maximum intensity projection (B) reconstructions showed the massive left hemothorax, also confirmed by the post-mortem examination (C).

Figure 2.. Maximum intensity projection reconstruction revealed the irregularity of aortic lumen, the leakage of contrast agent from the aortic wall tear.

Note the starting and end point of lumen irregularity.

Figure 3.. Volume rendering reconstruction revealed the irregular opacification of aortic lumen, and on the right we show the autopsy findings that confirmed the ruptured thoracic aortic wall.

Figure 4. The ascending aorta appeared dilated, over the valvular plane, with the diameter of 5 cm, and it showed also the descending thoracic aorta ectasia (with a maximum diameter of 8 cm).

The section of the thoracic aorta confirmed the aortic dissection of the wall with the false and the true lumen.

Figure 5.. MPMCTA results of case No. 6.

MIP reconstruction showed the calcified plaque at the left anterior descending coronary artery (A) and right coronary artery (B). Volume rendering reconstruction enabled a better visualization of the stenosis of the left anterior descending coronary artery and of the right coronary artery, respectively. MIP: maximum intensity projection; MPMCTA: multi-phase post-mortem CT-angiography.