Table 1.
Postmortem MRI protocol.
Table 2.
Postmortem CT protocol.
Fig 1.
Logistical flow-chart of minimally invasive autopsy.
Fig 2.
Case inclusion flow-chart.
Fig 3.
Diagnostic yield of postmortem CT and MRI.
Red–Imaging confidence score 0: diagnosis not detected; Orange–score 1: diagnosis detected on imaging, but unclear; biopsy required; Yellow–score 2: diagnosis seen on imaging and likely, biopsy required for confirmation; Green—score 3: diagnosis certain, no biopsy required.
Fig 4.
77-year-old woman with a history of hypertension and cerebral ischemia. She was resuscitated unsuccessfully after she was found gasping and unresponsive in bed. Postmortem MRI found T2 hypointensity in the septal, anterior and lateral myocardium (A, D, E: arrows) indicative of acute myocardial infarction in the area supplied by the left anterior descending (LAD) artery. CT-guided biopsies (B and C) from the myocardium were taken and histology showed contraction band necrosis (arrows) confirming acute myocardial infarction (F).
Fig 5.
A and B: 45-year-old woman with metastasized melanoma. Postmortem T1w MRI shows extensive metastases in brain (A), liver (circle) and spleen (arrows) (B). Tissue was sampled for histologic examination and genetic testing. C through G: 87-year-old man with a known aneurysm of the abdominal aorta, for which he underwent endovascular aortic repair (C: circle). The clinician wanted to exclude aortic rupture or acute myocardial infarction. Minimally invasive autopsy found prostate cancer (E: arrow) with multiple osseous metastases (D and E: arrowheads, F: arrow, G: circle) as unexpected findings. Focal signal abnormalities in the myocardium and histology confirmed acute myocardial infarction as the cause of death (not shown in this image).
Fig 6.
Rib fractures with soft-tissue hematoma.
89-year-old woman who underwent an elective coronary angiography for mitral valve insufficiency and complaints of angina. During the procedure she developed cardiac arrest and required cardiopulmonary resuscitation. She was transported to the intensive care, where she showed symptoms of hypovolemic shock and she died shortly afterwards. Postmortem CT showed multiple rib fractures (A and B: arrows) and on postmortem MRI a large soft-tissue hematoma was seen in the left flank (C: ellipse).
Table 3.
Case table.
Table 4.
Clinical utility of postmortem CT and postmortem MRI for specific clinical questions.
Table 5.
Costs of minimally invasive autopsy.
Table 6.
Costs of conventional autopsy.