Omer Berman, Abstract Co-Author: Nothing to Disclose

Margareta Vasserman, Abstract Co-Author: Nothing to Disclose

Konstantin Zaitsev, Abstract Co-Author: Nothing to Disclose

Sigal Tal MD, Presenter: Nothing to Disclose

To examine the feasibility of minimizing pediatric autopsies in forensic medicine by utilizing MRI and CT imaging in concert with focused local autopsy, due to public and religious opposition to conventional autopsies in Israel.

During 2011-2012, we performed imaging studies of 11 children aged 2 months to 9 years. 8 of these cases were followed by complete autopsies, in 1 case a partial autopsy, and in 2 cases only external examination was performed. Total body CT was done in all cases. In all but one case MRI of the head and neck was performed. Three of the deaths were due to trauma, and 8 were due to sudden death.

In cases of trauma a good correlation between radiographic and autopsy findings was found. CT was helpful in identifying skeletal injuries, which could have been missed in autopsy, such as posterior upper rib fractures, and was invaluable in reconstructing mechanisms of injury. MRI was superior to autopsy in detecting spinal cord and brain injury. In 5 of the sudden death cases, pulmonary consolidations were demonstrated in both modalities, suggesting pneumonia, which was confirmed by autopsy. In two cases, myocarditis and encephalitis were found in autopsy, but not radiographically. In 1 case, a diagnosis of hyperthermia was based on circumstances, though both imaging and autopsy findings were non-specific. In 2 cases in which no autopsy had been performed, pneumonia was suspected based on imaging alone.

Post-mortem imaging studies should be an inseparable and complementary part of the conventional autopsy in all infant/child death investigations. In sudden death, when traumatic or criminal involvement has been excluded, invasive autopsy can be limited to areas of positive findings on CT/MRI, or sometimes even abandoned.

MRI and CT imaging can help in determining the cause of death in children and could serve as a replacement or complementary examination to autopsy. 

Berman, O, Vasserman, M, Zaitsev, K, Tal, S, Correlation between Post-Mortem Computed Tomography and Magnetic Resonance Imaging and Autopsy Findings in Children.  Radiological Society of North America 2012 Scientific Assembly and Annual Meeting, November 25 - November 30, 2012 ,Chicago IL. http://archive.rsna.org/2012/12030464.html