Findings could represent breakthrough in how autopsy practice is conducted in UK and worldwide
A ground-breaking study by Leicester pathologists and radiologists could represent a breakthrough in how autopsy practice is conducted in the United Kingdom and around the world.
The research was led by Professors Guy Rutty and Bruno Morgan from our University and the East Midlands Forensic Pathology Unit. It was funded by the National Institute for Health Research (NIHR) and is published in the Lancet.
Professor Rutty explained: “Over the years there have been several attempts to develop alternative approaches to the invasive autopsy to limit the extent to which the cadaver is dissected. Although these techniques have been published, the invasive examination remains the standard adopted approach.”
A previous study of PMCT published in the Lancet in 2012 showed promise for using medical imaging to investigate the cause of natural death, but with a major weakness: the inability to diagnose coronary artery disease, the most common cause of natural death.
Professor Morgan explained: “In clinical CT scanning, a contrast agent is injected into a vein and circulation delivers it around the body. This allows the CT scan to show the state of blood vessels anywhere in the body. However, the lack of circulation in cadavers means these techniques cannot be used.”
This has been overcome by developing a novel minimally invasive coronary artery angiography technique. A variety of these techniques have been developed around the world over the last few years, but this is the first large-scale fully autopsy-controlled trial to demonstrate their efficacy in adult natural death.
Professor Rutty explained: “Here at the University of Leicester we developed a quick and minimally invasive approach to improve diagnostic accuracy. This uniquely uses a combination of standard contrast agent (positive) and air (negative) to show the coronary artery lumens and ventricular cavities.”
Professor Morgan explained: “By ‘minimally invasive’ we mean that we use a catheter inserted into an artery to perform the angiography. The insertion techniques are like those we use on patients every day in our clinics, with just the use of local anaesthetic to numb the skin.”
The Leicester team applied their PMCTA technique to a cohort of 240 deaths investigated by the HM coroner. They show that a cause of death could be given in 92% of cases, based on “the balance of probabilities”, the burden of proof required by the HM Coroner. Comparison with independently generated autopsy results showed that PMCTA had a similar accuracy to autopsy, did not miss autopsy-identifiable unnatural or “reportable” causes of death, and would also not significantly change population “cause of death” statistics.
Professor Morgan added: “We have shown that PMCT enhanced by targeted coronary angiography can diagnose the cause of death in up to 90% of HM Coronial investigations for suspected natural death. This is the most successful application of PMCT and PMCTA to-date in natural death, and shows that a significant number of deaths could be investigated without the need for an invasive autopsy.”
Professor Rutty recently conducted an interview with the BBC World Service about the new research (starts at 45 seconds).
- Press release
- A written feature about the study providing further information is available here
- A letter from HM Senior Coroner Catherine Mason lending her full support to the collaborative study is available on the University of Leicester website here
A video highlighting the new research is available here: