Minimally Invasive Autopsy Employing Post-Mortem CT and Targeted Coronary Angiography: Evaluation of Its Application to a Routine Coronial Service
Ian SD Roberts, Zoe C Traill. John Radcliffe Hospital, Oxford, United Kingdom; Churchill Hospital, Oxford, United Kingdom
Background: In the UK, post-mortem imaging is increasingly used as an alternative to traditional invasive medicolegal autopsy. We have developed a method of targeted CT coronary angiography in order to overcome a major weakness of cross-sectional imaging, that is diagnosis of coronary occlusion. In this study, we investigate the potential reduction in number of invasive autopsies by the application of post-mortem CT, with and without angiography, in a series of 120 adult deaths referred to HM Coroner.
Design: Coronial referrals were investigated by external examination and CT, with invasive autopsy performed only if there was no definite cause of death identified on imaging. The study was divided into two halves, with coronary angiography employed only in the second batch of 60 cases, in order to determine the added value of angiography. All were sudden adult deaths; case selection was performed by a single pathologist after review of the clinical history and circumstances of the death. Post-mortem imaging was interpreted by a single radiologist, and a cause of death, or requirement for invasive autopsy, determined by both pathologist and radiologist. The confidence of imaging cause of death was classified as definite (no autopsy), probable, possible or unascertained.
Results: Autopsy was not required in 38% of cases without coronary angiography and 70% of cases with angiography. The commonest final cause of death was ischemic heart disease (IHD), diagnosed in 48/120 (40%) cases. A definite radiological cause of death was provided in 3/20 (15%) IHD deaths without angiography and 23/28 (82%) with angiography. For all 120 cases, the confidence in imaging cause of death was definite in 65, probable in 13, possible in 37, and unascertained in 5. There was complete agreement between autopsy and imaging causes of death in the 13 cases with a “probable” cause of death on imaging, indicating that those cases for which imaging can provide an accurate cause of death without autopsy were correctly identified. Imaging identified unsuspected injuries, including 2 cases of femoral neck fracture that were missed at autopsy.
Conclusions: We conclude that in sudden adult deaths, a two-thirds reduction in the number of invasive Coronial autopsies can be achieved by use of post-mortem CT with targeted coronary angiography. At the same time, inclusion of post mortem CT into an autopsy service may improve accuracy of diagnosis, particularly for traumatic deaths.
Monday, March 4, 2013 8:00 AM
Proffered Papers: Section H1, Monday Morning