Major discrepancies in cause of death were found in 30% of cases.


Can advanced imaging serve as an alternative to full autopsy in determining the cause of unexpected death? Prompted by religious and other objections to autopsy and to an organ harvesting scandal in the 1990s, British investigators randomly selected 182 adult cases referred to coroners in two cities during a 2-year period. For each case, whole-body postmortem computed tomography (CT) and magnetic resonance imaging (MRI) studies were obtained prior to full autopsy. Two pairs of radiologists independently interpreted the CT and MRI studies, respectively. Each pair produced a consensus report based on a single imaging modality, and all four radiologists produced a final consensus report based on both modalities. Reports identified cause of death, the radiologists' confidence in their conclusions, and their recommendation as to whether autopsy was needed.

In 30% of cases, major discrepancies in cause of death (organ or pathology) occurred between the consensus report and autopsy. In 48% of cases, radiologists reported a "definite" consensus diagnosis not requiring autopsy; in one third of these, major discrepancies with autopsy findings occurred. CT consistently yielded fewer discrepancies with autopsy than did MRI. The most frequently over- and under-identified diagnoses were coronary heart disease, pulmonary embolism, bronchopneumonia, and intestinal infarction.


Citation(s):

Roberts ISD et al. Post-mortem imaging as an alternative to autopsy in the diagnosis of adult deaths: A validation study. Lancet 2011 Nov 22; [e-pub ahead of print].