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Minimally invasive autopsy with MRI and CT improves Postmortem diagnosis

Minimally invasive autopsy with MRI and CT improves Postmortem diagnosis

Minimally invasive autopsy with MRI and CT has similar performance to that of conventional autopsy in the detection of death cause and also has a higher yield of diagnoses, according to a new study published in the journal Radiology.

J. Wolter Oosterhuis, Department of Pathology at Erasmus University Medical Center in Rotterdam, the Netherlands, and colleagues conducted the study to compare the diagnostic performance of minimally invasive autopsy with that of conventional autopsy.

Conventional autopsies are valuable tools that yield a wealth of information. Autopsies give insights into new diseases and the side effects of drugs while providing data for health statistics and epidemiologic studies and tissue for molecular studies. They are important for teaching pathology in medical school and training medical specialists. Perhaps most importantly, autopsies can answer central questions surrounding the cause of death, said Dr. Oosterhuis.

“Since in about 15 percent of cases autopsy reveals an unexpected cause of death, it provides important feedback to clinicians, to the benefit of future patients,” he said.

The rates of conventional autopsies have been rapidly declining despite the importance of conventional autopsies for a variety of reasons, said the study authors, including the reluctance of next-of-kin due to the invasiveness of the procedure. Due to this, non-invasive or minimally invasive alternative autopsy methods have emerged as potentially valuable options.

Postmortem CT and MRI enable visualization of the entire body, and image-guided tissue biopsies can be obtained for further examination.

The research team compared the performance of minimally invasive autopsy to that of conventional autopsy in 99 deceased humans. The minimally invasive autopsy procedure combined post-mortem MRI, CT and CT-guided biopsies of the main organs and pathological lesions–abnormalities caused by disease or trauma.

Key Findings:

  • The two methods showed similar performance in determining the immediate cause of death.
  • Cause of death determined with the minimally invasive autopsy and conventional autopsy agreed in 91 of the 99 cadavers (92%).
  • Agreement with consensus cause of death occurred in 96 of 99 cadavers (97%) with the minimally invasive autopsy and in 94 of 99 cadavers (95%) with the conventional autopsy.
  • All 288 grouped major diagnoses were related to consensus cause of death.
  • Minimally invasive autopsy enabled diagnosis of 259 of them (90%) and conventional autopsy 224 (78%); 200 (69%) were found with both methods.
  • At clinical examination, the cause of death was not suspected in 17 of the 99 cadavers (17%), and 124 of 288 grouped major diagnoses (43%) were not established.
  • There were 219 additional clinical questions; 189 (86%) were answered with the minimally invasive autopsy and 182 (83%) were answered with the conventional autopsy.

“With minimally invasive autopsy, the body is investigated from top to toe, and with regular autopsy usually only the torso and, if consented by next-of-kin, the brain,” Dr. Oosterhuis said. “Moreover, postmortem CT and MRI demonstrate pathology, in particular of the skeleton and soft tissues, that is easily missed by the regular autopsy.”

According to Dr. Oosterhuis, minimally invasive autopsy presents a potentially more desirable option for next-of-kin who may be reluctant to approve the conventional procedure on religious grounds.

The minimally invasive autopsy has the additional benefit of providing information that can be stored for long-term use.

“It’s very important to note that conventional autopsy cannot be redone, and items that were overlooked or misinterpreted cannot be corrected,” Dr. Oosterhuis said “Minimally invasive autopsy, on the other hand, provides a permanent record of the entire body that can be revisited, and reanalyzed by pathologists, radiologists, clinicians, and next-of-kin. For scientists, this dependable database has great potential for future research.”

Implications for Patient Care:

  • The minimally invasive autopsy is an alternative to conventional autopsy, with similar diagnostic performance.
  •  If a pathologic condition is suspected where the air is involved (eg, pneumothorax, air embolus), postmortem imaging is highly recommended as a replacement or an adjunct to conventional autopsy.
  • Minimally invasive autopsy and conventional autopsy each have strengths and weaknesses; therefore, optimal use of these two procedures or combinations of them may be established.

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Source: With inputs from Radiology

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