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Postmortem imaging of sudden cardiac death

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Abstract

Postmortem imaging is increasingly used in forensic practice in cases of natural deaths related to cardiovascular diseases, which represent the most common causes of death in developed countries. While radiological examination is generally considered to be a good complement for conventional autopsy, it was thought to have limited application in cardiovascular pathology. At present, multidetector computed tomography (MDCT), CT angiography, and cardiac magnetic resonance imaging (MRI) are used in postmortem radiological investigation of cardiovascular pathologies. This review presents the actual state of postmortem imaging for cardiovascular pathologies in cases of sudden cardiac death (SCD), taking into consideration both the advantages and limitations. The radiological evaluation of ischemic heart disease (IHD), the most frequent cause of SCD in the general population of industrialized countries, includes the examination of the coronary arteries and myocardium. Postmortem CT angiography (PMCTA) is very useful for the detection of stenoses and occlusions of coronary arteries but less so for the identification of ischemic myocardium. MRI is the method of choice for the radiological investigation of the myocardium in clinical practice, but its accessibility and application are still limited in postmortem practice. There are very few reports implicating postmortem radiology in the investigation of other causes of SCD, such as cardiomyopathies, coronary artery abnormalities, and valvular pathologies. Cardiomyopathies representing the most frequent cause of SCD in young athletes cannot be diagnosed by echocardiography, the most widely available technique in clinical practice for the functional evaluation of the heart and the detection of cardiomyopathies. PMCTA and MRI have the potential to detect advanced stages of diseases when morphological substrate is present, but these methods have yet to be sufficiently validated for postmortem cases. Genetically determined channelopathies cannot be detected radiologically. This review underlines the need to establish the role of postmortem radiology in the diagnosis of SCD.

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Authors and Affiliations

  1. University Center of Legal Medicine, Lausanne and Geneva, Rue du Bugnon 21, 1011, Lausanne, Switzerland

    Katarzyna Michaud, Silke Grabherr, Marc Daniel Bollmann & Patrice Mangin

  2. Center for Forensic Imaging, Institute of Forensic Medicine, University of Bern, Buehlstrasse 20, 3012, Bern, Switzerland

    Christian Jackowski

  3. Department of Diagnostic and Interventional Radiology, University Hospital of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland

    Franceso Doenz

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  1. Katarzyna Michaud
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Michaud, K., Grabherr, S., Jackowski, C. et al. Postmortem imaging of sudden cardiac death. Int J Legal Med 128, 127–137 (2014). https://doi.org/10.1007/s00414-013-0819-6

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