CT angiography more accurate than autopsies in finding cause of death

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Post-mortem computed tomography CT angiography is better than just performing an autopsy or CT without angiography in determining how and why a person died, according to a new study in Radiology.

High quality post-mortem examinations are important not only in criminal investigations but also in the evaluation of the quality of clinical care and diagnosis a patient received. However, in many cases, there is concern that conventional autopsies are not as accurate as they should be.

Using CT to augment autopsies is promising because of its relatively low maintenance costs, short exam times and ease of operation. However, in the past, the lack of contrast in unenhanced CT limited its use in determining an individual’s cause of death.

The researchers, from the University Center of Legal Medicine Lausanne-Geneva in Switzerland studied whether using CT angiography would improve post-mortem examinations. CT angiography uses a specific perfusion device and an oil-based contrast agent. The researchers studied 500 human corpses where autopsies were ordered from nine European centers during February 2012 to August 2015. They used unenhanced CT and CT angiography, using standard IT algorithms for reconstruction, followed by conventional autopsy.

They found that CT angiography was “superior” to autopsy and CT without angiography in revealing essential findings; using both CT angiography and conventional autopsy in combination revealed the most findings.

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Specifically, autopsies helped identify 61.3 percent of the 18,654 findings, post-mortem CT helped identify 76 percent of them, and post-mortem CT angiography helped identify 89.9 percent. CT angiography was especially superior at identifying essential skeletal lesions and vascular lesions, both common in traumatic death. The only findings in which CT angiography was not superior to conventional autopsy involved soft tissue findings.

The best results were achieved when autopsy was combined with post-mortem CT and post-mortem CT angiography, especially in cases of natural death and malpractice.

If the autopsies had been performed without any post-mortem CT, 39 percent of all findings and 23 percent of essential findings would not have been reported. “In some cases, the interpretation of the autopsy results regarding the cause of death and events leading to death would have been incomplete or simply wrong if post-mortem CT and post-mortem CT angiography had not been performed,” The study authors wrote.

“By combining autopsy and CT angiography, the reported number of findings can be increased, leading to a better postmortem examination. If only imaging or autopsy can be applied, the choice depends on the investigated case and the suspected findings,” they said.

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