Abstract Archives of the RSNA, 2007


SSC04-05

Utility of Whole Body CT Imaging Autopsy in a US State Chief Medical Examinerís Investigation of Traumatic Death: Initial Experience

Scientific Papers

Presented on November 26, 2007
Presented as part of SSC04: Emergency Radiology (Penetrating Injuries, Emergency Care )

Participants

Barry David Daly MD, Presenter: Nothing to Disclose
Clint W. Sliker MD, Abstract Co-Author: Nothing to Disclose
Dawn Zulauf, Abstract Co-Author: Nothing to Disclose
Jack L. Titus MD, Abstract Co-Author: Nothing to Disclose
Priti Anilkumar Shah MD, Abstract Co-Author: Nothing to Disclose
Mary Ripple, Abstract Co-Author: Nothing to Disclose
Zubiallah Ali, Abstract Co-Author: Nothing to Disclose
David Fowler MD, Abstract Co-Author: Nothing to Disclose
et al, Abstract Co-Author: Nothing to Disclose
et al, Abstract Co-Author: Nothing to Disclose

PURPOSE

Early studies have suggested a role for high-resolution multi-detector CT (MDCT) imaging autopsy in the forensic investigation of death. Our study evaluated the sensitivity and potential role of MDCT as a replacement for or adjunct to conventional autopsy in the investigation of traumatic accidental or non-accidental death within a U.S. state medical examiner (ME) system.

METHOD AND MATERIALS

20 decedents were prospectively investigated with whole body 40-detector row 2D and 3D MDCT (~4,500 images/study) within 24 hours of death following blunt (n=14) or penetrating (n=6; 5 ballistic) trauma. MDCT was interpreted by consensus by 2 radiologists and compared with ME autopsy results for major findings and cause of death. The authors (radiologists and forensic medical examiners) also evaluated the imaging findings as (a) comparable to; (b) a helpful adjunct to; or (c) of no additive value to conventional autopsy.

RESULTS

Imaging correctly identified 92 major findings (sensitivity 95.5%) and all 14 causes of death in cases of blunt trauma. These respective figures were 36 (sensitivity 94.7%) and 5 in cases of penetrating trauma. Six major false-negative CT findings included 2 nondisplaced atlanto-occipital subluxations, and lacerations of the bronchus, right heart, ascending aorta, and liver. All 26 major ballistic fragments recovered at autopsy were accurately localized, but 13 known pathways were incompletely or not identified, especially where no fragments remained. MDCT identified 7 major findings (3 cases of air embolism, 3 major fractures, 1 lung laceration) not detected at conventional autopsy. The authors evaluated MDCT findings as (a) comparable to autopsy in 13 cases (all blunt); (b) a helpful adjunct in 6 cases (5 penetrating); and (c) of no additive value in one case.

CONCLUSION

Early experience suggests that MDCT imaging autopsy shows promise as a sensitive tool for the detection of major injuries and cause of death after accidental blunt trauma. In non-accidental traumatic death, MDCT can be a valuable adjunct to mandatory autopsy for detection of injuries and ballistics.

CLINICAL RELEVANCE/APPLICATION

MDCT autopsy has potential to replace conventional or enable limited, focused autopsy following fatal accidental blunt trauma.

Cite This Abstract

Daly, B, Sliker, C, Zulauf, D, Titus, J, Shah, P, Ripple, M, Ali, Z, Fowler, D, et al, , et al, , Utility of Whole Body CT Imaging Autopsy in a US State Chief Medical Examinerís Investigation of Traumatic Death: Initial Experience.  Radiological Society of North America 2007 Scientific Assembly and Annual Meeting, November 25 - November 30, 2007 ,Chicago IL. http://archive.rsna.org/2007/5000817.html