Virtual Autopsy as a Screening Test Before Traditional Autopsy: The Verona Experience on 25 Cases

Abstract

Background: Interest has grown into the use of multidetector computed tomography (CT) and magnetic resonance imaging as an adjunct or alternative to the invasive autopsy. We sought to investigate these possibilities in postmortem CT scan using an innovative virtual autopsy approach.

Methods: Twenty-five postmortem cases were scanned with the Philips Brilliance CT-64 and then underwent traditional autopsy. The images were interpreted by two blinded forensic pathologists assisted by a radiologist with the INFOPSY^® Digital Autopsy Software System which provides three-dimensional images in Digital Imaging and Communications in Medicine format. Diagnostic validity of virtual autopsy (accuracy rate, sensitivity, specificity, and predictive values) and concordance between the two forensic pathologists (kappa intraobserver coefficients) were determined.

Results: The causes of death at traditional autopsies were hemorrhage due to traumatic injuries (n = 8), respiratory failure (5), asphyxia due to drowning (4), asphyxia due to hanging or strangulation (2), heart failure (2), nontraumatic hemorrhage (1), and severe burns (1). In two cases, the cause of death could not be ascertained. In 15/23 (65%) cases, the cause of death diagnosed after virtual autopsy matched the diagnosis reported after traditional autopsy. In 8/23 cases (35%), traditional autopsy was necessary to establish the cause of death. Digital data provided relevant information for inferring both cause and manner of death in nine traumatic cases. The validity of virtual autopsy as a diagnostic tool was higher for traumatic deaths than other causes of death (accuracy 84%, sensitivity 82%, and specificity 86%). The concordance between the two forensic pathologists was almost perfect (>0.80).

Conclusions: Our experience supports the use of virtual autopsy in postmortem investigations as an alternative diagnostic practice and does suggest a potential role as a screening test among traumatic deaths.

Keywords: Computed tomography; computed tomography scan; forensic sciences; postmortem investigation; traumatic deaths; virtual autopsies.

Figure 1

Case number 15, homicide, gunshot head trauma (a-d). Stellate entry wound with three comminuted and one sutural fractures (a and b); digital localization of the bullets and their fragments (c); circular-shaped exit wound, three-dimensional reconstruction (d)

Figure 2

Case number 19, drowning: past fractures of right 4, 5, and 7 ribs and asymmetrical pelvis (a). Case number 1, road traffic collision: traumatic brain injury and jaw fracture (b) and skull fracture over the cranial base (c). Case number 22, homicide: blunt and abdominal stab wound trauma (d)

Figure 3

Summarized rate of cases with an identified cause of death solved with virtual autopsy and cases requiring a traditional autopsy