EU Radiology: CT of value in postmortem trauma exams

Postmortem CT is a good alternative for a refused autopsy, as well as a valuable adjunct for a standard autopsy, because it detects injuries that may be overlooked during the examination, according to a review in this month’s issue of European Radiology.

Mark Scholing, MD, from the trauma unit and department of surgery at the Academic Medical Center in Amsterdam, and colleagues sought to assess the role of postmortem CT as an alternative for autopsy in determining the cause of death and the identification of specific injuries in trauma victims.

The researchers systematically reviewed the EMBASE and MEDLINE databases. They included 15 studies, describing 244 victims. The median sample size was 13. According to protocols, the patients were scanned from the skull to the pelvis. For neuroimaging studies, they were scanned from the skull to the first thoracic vertebral body.

The percentage agreement on the cause of death among postmortem CT and autopsy varied between 46 and 100 percent, according to the authors. Also, they found the overall amount of injuries detected on CT ranged from 53 to 100 percent, compared with autopsy.

“Several studies suggested that postmortem CT was capable of identifying injuries not detected during normal autopsy,” Scholing and colleagues wrote.

More than half of the studies reported significant false positive findings with postmortem CT, the researchers reported. They found that some injuries--such as facial fractures, gas embolisms, small pneumothoraces, pneumopericardium and pneumomediastinum--are difficult to detect during conventional autopsy but can be determined more easily with postmortem CT.

As a consequence of the difficulty in diagnosing some injuries with autopsy, “standard autopsy appears not to be a valid reference standard to test the performance of the postmortem CT in some cases. To circumvent this problem some authors used the combined findings of postmortem CT and autopsy as a reference standard, resulting in a relatively better performance for postmortem CT,” the investigators wrote.

According to the authors, their systematic review provides “inconsistent evidence” as to whether postmortem CT is a reliable alternative for autopsy in trauma victims.

Postmortem CT is a good alternative for a refused autopsy, as well as a valuable adjunct for a standard autopsy, because it detects injuries that may be overlooked during the examination, according to a review in this month’s issue of European Radiology.