Post-mortem CT angiography illuminates causes of death

CT angiography is a useful adjunct to autopsy that is likely to increase the quality of post-mortem diagnosis, according to a study appearing online in the journal Radiology.

Researchers, including a team from Leicester, said the findings could have important implications for criminal investigations and hospital quality control efforts.

High-quality post-mortem investigations are vital for a number of reasons; most notably, as evidence in criminal investigations for which the body represents the main proof of a crime, and as a quality control measure for surgical interventions and medical treatment at hospitals.

Modern imaging techniques like CT and MRI are often used in forensic pathology. However, post-mortem CT is limited by relatively low soft tissue contrast and poor visualization of the vascular system. A technique known as post-mortem CT angiography, or PMCTA, was developed to address those limitations by introducing contrast agent into the body.

Professor Guy Rutty MBE, Chief Forensic Pathologist from the East Midlands Forensic Pathology Unit at the University of Leicester, said: "This study is important as not only does it yet again expose that the traditional invasive autopsy on its own should no longer be considered the gold standard for death investigation but that PMCTA, in which ever form is used, which is case specific, is a powerful investigative tool and, in the right circumstances, not only now for natural disease, but also for unnatural disease can, in the right circumstances, be considered a potential replacement for the invasive autopsy.”

PMCTA was significantly superior to autopsy at identifying skeletal and vascular lesions, or areas of damage in the bones and blood vessels. PMCTA identified 96 percent of skeletal lesions and 94 percent of vascular lesions, compared with 65 percent for autopsy. These lesions can provide important information in post-mortem examinations, Dr. Grabherr said.

Professor Bruno Morgan, Professor of Cancer Imaging and Radiology at the University of Leicester, said: "The team of Leicester were very grateful to be involved in this project. We thank the Leicestershire families who gave their consent for these research scans to be performed on their loved ones. The results have further strengthened our local research evidence, and have benefitted our local population by underpinning the increasing use of imaging to avoid invasive autopsy in cases where imaging provides sufficient accuracy."

In the future, the research group plans to study the combination of post-mortem angiography with MRI in order to increase the sensitivity of findings related to organs like the brain and liver.

 A video highlighting one technique of PMCTA (targeted coronary PMCTA) is available here: