Abstract
Background: With the advancement of technology, Computed Tomography (CT) scan imaging can be used to gain deeper insight into the cause of death.
Aims: The purpose of this study was to perform a systematic review of the efficacy of Post- Mortem Computed Tomography (PMCT) scan compared with the conventional autopsies gleaned from literature published in English between the year 2009 and 2016.
Methodology: A literature search was conducted on three databases, namely PubMed, MEDLINE, and Scopus. A total of 387 articles were retrieved, but only 21 studies were accepted after meeting the review criteria. Data, such as the number of victims, the number of radiologists and forensic pathologists involved, causes of death, and additional and missed diagnoses in PMCT scans were tabulated and analysed by two independent reviewers.
Results: Compared with the conventional autopsy, the accuracy of PMCT scans in detecting injuries and causes of death was observed to range between 20% and 80%. The analysis also showed that PMCT had more advantages in detecting fractures, fluid in airways, gas in internal organs, major hemorrhages, fatty liver, stones, and bullet fragments. Despite its benefits, PMCT could also miss certain important lesions in a certain region such as cardiovascular injuries and minor vascular injuries.
Conclusion: This systematic review suggests that PMCT can replace most of the conventional autopsies in specific cases and is also a good complementary tool in most cases.
Keywords: Post-mortem computed tomography, CT scan, autopsy, human, virtual autopsy, cardiovascular.
Graphical Abstract
[1]
Ebert LC, Ruder TD, Martinez RM, et al. Computer-assisted virtual autopsy using surgical navigation techniques. AJR Am J Roentgenol 2015; 204(1) W58-62
[http://dx.doi.org/10.2214/AJR.13.11957] [PMID: 25539276]
[http://dx.doi.org/10.2214/AJR.13.11957] [PMID: 25539276]
[2]
Atanda A, Umar A, Yusuf I, et al. Autopsy and religion: a review of the literature. Sahel Med J 2016; 19(3): 119.
[3]
Thayyil S, Sebire NJ, Chitty LS, et al. MARIAS collaborative
group. Post-mortem MRI versus conventional autopsy in fetuses and children: a prospective validation study Lancet. 2013; 382(9888): 223-33.
[http://dx.doi.org/10.1016/S0140-6736(13)60134-8] [PMID: 23683720]
[http://dx.doi.org/10.1016/S0140-6736(13)60134-8] [PMID: 23683720]
[4]
Flach PM, Gascho D, Schweitzer W, et al. Imaging in forensic radiology: an illustrated guide for postmortem computed tomography technique and protocols. Forensic Sci Med Pathol 2014; 10(4): 583-606.
[http://dx.doi.org/10.1007/s12024-014-9555-6] [PMID: 24723662]
[http://dx.doi.org/10.1007/s12024-014-9555-6] [PMID: 24723662]
[5]
Westphal SE, Apitzsch J, Penzkofer T, Mahnken AH, Knüchel R. Virtual CT autopsy in clinical pathology: feasibility in clinical autopsies. Virchows Arch 2012; 461(2): 211-9.
[http://dx.doi.org/10.1007/s00428-012-1257-4] [PMID: 22729140]
[http://dx.doi.org/10.1007/s00428-012-1257-4] [PMID: 22729140]
[6]
Wichmann D, Obbelode F, Vogel H, et al. Virtual autopsy as an alternative to traditional medical autopsy in the intensive care unit: a prospective cohort study. Ann Intern Med 2012; 156(2): 123-30.
[http://dx.doi.org/10.7326/0003-4819-156-2-201201170-00008] [PMID: 22250143]
[http://dx.doi.org/10.7326/0003-4819-156-2-201201170-00008] [PMID: 22250143]
[7]
Roberts ISD, Benamore RE, Benbow EW, et al. Post-mortem imaging as an alternative to autopsy in the diagnosis of adult deaths: a validation study. Lancet 2012; 379(9811): 136-42.
[http://dx.doi.org/10.1016/S0140-6736(11)61483-9] [PMID: 22112684]
[http://dx.doi.org/10.1016/S0140-6736(11)61483-9] [PMID: 22112684]
[8]
Le Blanc-Louvry I, Thureau S, Duval C, et al. Post-mortem computed tomography compared to forensic autopsy findings: a French experience. Eur Radiol 2013; 23(7): 1829-35.
[http://dx.doi.org/10.1007/s00330-013-2779-0] [PMID: 23479220]
[http://dx.doi.org/10.1007/s00330-013-2779-0] [PMID: 23479220]
[9]
Colard T, Delannoy Y, Bresson F, Marechal C, Raul JS, Hedouin V. 3D-MSCT imaging of bullet trajectory in 3D crime scene reconstruction: two case reports. Leg Med (Tokyo) 2013; 15(6): 318-22.
[http://dx.doi.org/10.1016/j.legalmed.2013.07.002] [PMID: 23931960]
[http://dx.doi.org/10.1016/j.legalmed.2013.07.002] [PMID: 23931960]
[10]
Tartaglione T, Filograna L, Roiati S, Guglielmi G, Colosimo C, Bonomo L. Importance of 3D-CT imaging in single-bullet cranioencephalic gunshot wounds. Radiol Med (Torino) 2012; 117(3): 461-70.
[http://dx.doi.org/10.1007/s11547-011-0784-4] [PMID: 22271006]
[http://dx.doi.org/10.1007/s11547-011-0784-4] [PMID: 22271006]
[11]
Kirchhoff SM, Scaparra EF, Grimm J, et al. Postmortem computed tomography (PMCT) and autopsy in deadly gunshot wounds--a comparative study. Int J Legal Med 2016; 130(3): 819-26.
[http://dx.doi.org/10.1007/s00414-015-1225-z] [PMID: 26156451]
[http://dx.doi.org/10.1007/s00414-015-1225-z] [PMID: 26156451]
[12]
Makhlouf F, Scolan V, Ferretti G, Stahl C, Paysant F. Gunshot fatalities: correlation between post-mortem multi-slice computed tomography and autopsy findings: a 30-months retrospective study. Leg Med (Tokyo) 2013; 15(3): 145-8.
[http://dx.doi.org/10.1016/j.legalmed.2012.11.002] [PMID: 23274151]
[http://dx.doi.org/10.1016/j.legalmed.2012.11.002] [PMID: 23274151]
[13]
Ruder TD, Thali Y, Bolliger SA, et al. Material differentiation in forensic radiology with single-source dual-energy computed tomography. Forensic Sci Med Pathol 2013; 9(2): 163-9.
[http://dx.doi.org/10.1007/s12024-012-9398-y] [PMID: 23264199]
[http://dx.doi.org/10.1007/s12024-012-9398-y] [PMID: 23264199]
[14]
Leth PM, Madsen BH. Drowning investigated by post mortem computed tomography and autopsy. J Forens Radiol Imaging 2017; 9(1): 28-30.
[http://dx.doi.org/10.1016/j.jofri.2017.02.002]
[http://dx.doi.org/10.1016/j.jofri.2017.02.002]
[15]
Daly B, Abboud S, Ali Z, Sliker C, Fowler D. Comparison of whole-body post mortem 3D CT and autopsy evaluation in accidental blunt force traumatic death using the abbreviated injury scale classification. Forensic Sci Int 2013; 225(1-3): 20-6.
[http://dx.doi.org/10.1016/j.forsciint.2012.08.006] [PMID: 22947431]
[http://dx.doi.org/10.1016/j.forsciint.2012.08.006] [PMID: 22947431]
[16]
Jacobsen C, Bech BH, Lynnerup N. A comparative study of cranial, blunt trauma fractures as seen at medicolegal autopsy and by computed tomography. BMC Med Imaging 2009; 9(1): 18.
[http://dx.doi.org/10.1186/1471-2342-9-18] [PMID: 19835570]
[http://dx.doi.org/10.1186/1471-2342-9-18] [PMID: 19835570]
[17]
Levy AD, Harcke HT, Getz JM, Mallak CT. Multidetector computed tomography findings in deaths with severe burns. Am J Forensic Med Pathol 2009; 30(2): 137-41.
[http://dx.doi.org/10.1097/PAF.0b013e3181879cc9] [PMID: 19465802]
[http://dx.doi.org/10.1097/PAF.0b013e3181879cc9] [PMID: 19465802]
[18]
Schulze C, Hoppe H, Schweitzer W, Schwendener N, Grabherr S, Jackowski C. Rib fractures at postmortem computed tomography (PMCT) validated against the autopsy. Forensic Sci Int 2013; 233(1-3): 90-8.
[http://dx.doi.org/10.1016/j.forsciint.2013.08.025] [PMID: 24314506]
[http://dx.doi.org/10.1016/j.forsciint.2013.08.025] [PMID: 24314506]
[19]
Sohail S, Mirza FH, Khan QS. Postmortem computed tomography for diagnosis of cause of death in male prisoners. J Pak Med Assoc 2010; 60(1): 4-8.
[PMID: 20055270]
[PMID: 20055270]
[20]
Kawasumi Y, Usui A, Hosokai Y, et al. PMCT findings of intervertebral separation. J Forens Radiol Imaging 2014; 2(4): 182-7.
[http://dx.doi.org/10.1016/j.jofri.2014.09.001]
[http://dx.doi.org/10.1016/j.jofri.2014.09.001]
[21]
Makino Y, Yokota H, Hayakawa M, et al. Spinal cord injuries with normal postmortem CT findings: a pitfall of virtual autopsy for detecting traumatic death. AJR Am J Roentgenol 2014; 203(2): 240-4.
[http://dx.doi.org/10.2214/AJR.13.11775] [PMID: 25055254]
[http://dx.doi.org/10.2214/AJR.13.11775] [PMID: 25055254]
[22]
Norzailin AB, Noor Azman S, Mohd Helmee MN, Khairul Anuar Z. The sensitivity, specificity and predictive values of post mortem computed tomography in detecting liver and splenic injury due to road traffic accident. Med J Malaysia 2016; 71(1): 1-7.
[PMID: 27130735]
[PMID: 27130735]
[23]
Malli N, Ehammer T, Yen K, Scheurer E. Detection and characterization of traumatic scalp injuries for forensic evaluation using computed tomography. Int J Legal Med 2013; 127(1): 195-200.
[http://dx.doi.org/10.1007/s00414-012-0690-x] [PMID: 22399104]
[http://dx.doi.org/10.1007/s00414-012-0690-x] [PMID: 22399104]
[24]
Leth PM, Struckmann H, Lauritsen J. Interobserver agreement of the injury diagnoses obtained by postmortem computed tomography of traffic fatality victims and a comparison with autopsy results. Forensic Sci Int 2013; 225(1-3): 15-9.
[http://dx.doi.org/10.1016/j.forsciint.2012.03.028] [PMID: 22541590]
[http://dx.doi.org/10.1016/j.forsciint.2012.03.028] [PMID: 22541590]
[25]
Leth PM, Thomsen J. Experience with post-mortem computed tomography in Southern Denmark 2006-11. J Forens Radiol Imaging 2013; 1(4): 161-6.
[http://dx.doi.org/10.1016/j.jofri.2013.07.006]
[http://dx.doi.org/10.1016/j.jofri.2013.07.006]
[26]
Karim MKA, Hashim S, Bradley DA, et al. Assessment of knowledge and awareness among radiology personnel regarding current computed tomography technology and radiation dose. J Phys Conf Ser 2016; 2016 694012031
[http://dx.doi.org/10.1088/1742-6596/694/1/012031]
[http://dx.doi.org/10.1088/1742-6596/694/1/012031]
[27]
Geiger GA, Kim MB, Xanthopoulos EP, et al. Stage migration in planning PET/CT scans in patients due to receive radiotherapy for non-small-cell lung cancer. Clin Lung Cancer 2014; 15(1): 79-85.
[http://dx.doi.org/10.1016/j.cllc.2013.08.004] [PMID: 24238934]
[http://dx.doi.org/10.1016/j.cllc.2013.08.004] [PMID: 24238934]
[28]
Zech W-D, Jackowski C, Schwendener N, Brencicova E, Schuster F, Lombardo P. Postmortem CT versus forensic autopsy: frequent discrepancies of tracheobronchial content findings. Int J Legal Med 2016; 130(1): 191-8.
[http://dx.doi.org/10.1007/s00414-015-1264-5] [PMID: 26400026]
[http://dx.doi.org/10.1007/s00414-015-1264-5] [PMID: 26400026]
[29]
Grabherr S, Doenz F, Steger B, et al. Multi-phase post-mortem CT angiography: development of a standardized protocol. Int J Legal Med 2011; 125(6): 791-802.
[http://dx.doi.org/10.1007/s00414-010-0526-5] [PMID: 21057803]
[http://dx.doi.org/10.1007/s00414-010-0526-5] [PMID: 21057803]
[30]
Ross SG, Bolliger SA, Ampanozi G, Oesterhelweg L, Thali MJ, Flach PM. Postmortem CT angiography: capabilities and limitations in traumatic and natural causes of death. Radiographics 2014; 34(3): 830-46.
[http://dx.doi.org/10.1148/rg.343115169] [PMID: 24819799]
[http://dx.doi.org/10.1148/rg.343115169] [PMID: 24819799]
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