Postmortem imaging as a complementary tool for the investigation of cardiac death

In the past 2 decades,modern radiological methods,such as multiple detector computed tomography (MDCT),MDCT-angiography,and cardiac magnetic resonance imaging (MRI)were introduced into postmortem practice for investigation of sudden death (SD),including cases of sudden cardiac death (SCD).In forensic cases,the underlying cause of SD is most frequently cardiovascular with coronary atherosclerotic disease as the leading cause.There are many controversies about the role of postmortem imaging in establishing the cause of death and especially the value of minimally invasive autopsy techniques.This paper discusses the state of the art for postmortem radiological evaluation of the heart compared to classical postmortem examination,especially in cases of SCD.In SCD cases,postmortem CT is helpful to estimate the heart size and to visualize haemopericardium and calcified plaques and valves,as well as to identify and locate cardiovascular devices.Angiographic methods are useful to provide a detailed view of the coronary arteries and to analyse them,especially regarding the extent and location of stenosis and obstruction.In postsurgical cases,it allows verification and documentation of the patency of stents and bypass grafts before opening the body.Postmortem MRI is used to investigate soft tissues such as the myocardium,but images are susceptible to postmortem changes and further work is necessary to increase the understanding of these radiological aspects,especially of the ischemic myocardium.In postsurgery cases,the value of postmortem imaging of the heart is reportedly for the diagnostic and documentation purposes.The implementation of new imaging methods into routine postmortem practice is challenging,as it requires not only an investment in equipment but,more importantly,investment in the expertise of interpreting the images.Once those requirements are implemented,however,they bring great advantages in investigating cases of SCD,as they allow documentation of the body,orientation of sampling for further analyses and gathering of other information that cannot be obtained by conventional autopsy such as a complete visualization of the vascular system using postmortem angiography.

Neck-MRI experience for investigation of survived strangulation victims

For the medicolegal evaluation of victims of survived strangulation,a neck-magnetic resonance imaging(MRI)can be performed for assessing lesions in the inner soft tissues(fat,muscles or lymph nodes,for example).In our institute,such MRI examinations have been performed for a test period of 4 years with the aim of evaluating the use of this tool by forensic pathologists and identifying medicolegal indicators for the performance of neck-MRI in surviving victims of strangulation.We retrospectively reviewed medicolegal reports from all victims examined during the test period.We extracted objective lesions(e.g.petechiae,bruising and abrasions)and reported clinical symptoms(e.g.vision disorder,dysphasia)from the reports.These findings were compared to those reported from the neck-MRI.In total,112 victims were clinically examined after suspected strangulation.Eleven of these victims underwent an MRI examination of the neck.Eighty-four of the victims presented objective lesions during the clinical examination,with eight showing signs of both petechiae and bruising.Neck-MRI was performed in four of these eight victims and three of them showed lesions visible in MRI.Of 76 victims with bruising as the only objective finding,66 victims described clinical symptoms.Of those 66 victims,seven were examined by MRI and two demonstrated lesions in MRI.When MRI was performed,relevant findings were detected in 45%of the cases.This leads to the suspicion that many more findings could have been detected in the other victims,if an MRI had been performed in those cases.Our results lead us to the conclusion that an MRI examination of victims of suspected strangulation is useful,and strict indications for its application should be established.