CT may be the new autopsy method for medical examiners

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CHICAGO, Nov. 27—CT autopsy has the potential to replace conventional autopsy in determining the cause of certain accidental deaths, for which all states in the U.S. are required by law to perform an autopsy, according to findings presented today at the 93rd annual meeting of the Radiological Society of North America (RSNA).

"CT is a sensitive imaging tool for detecting injuries and cause of death in victims of blunt trauma," said Barry Daly, MD, professor of radiology in the School of Medicine at the University of Maryland in Baltimore. "When there are major injuries, such as those resulting from a motor vehicle accident, CT may provide enough information to enable a conventional autopsy to be avoided altogether."

Daly said the purpose of the study evaluated the sensitivity and potential role of multidetector CT (MDCT) as a replacement for or adjunct to conventional autopsy in the investigation of traumatic accidental or non-accidental death within a U.S. state medical examiner system.

According to the results, 20 autopsies were performed using whole-body multi-detector CT at the University of Maryland Medical Center. Interpretations of the CT scans by two radiologists were compared with the results of a conventional autopsy performed on each body by state forensic medical examiners. Included were 14 victims of blunt trauma and six victims of a penetrating wound made either by a knife or ballistic weapon.

Daly said that in all 14 blunt trauma cases and five of the six penetrating wounds, CT accurately identified the cause of death. The radiologists and forensic medical examiners evaluated the CT findings as comparable to conventional autopsy in 13 of the 14 blunt trauma cases and as a helpful adjunct in five of the six penetrating wound cases. CT was able to localize rapidly all 26 major ballistic fragments recovered from the victims during conventional autopsy, he said.

The results show that “MDCT imaging autopsy shows promise as a sensitive tool for the detection of major injuries and cause of death after accidental blunt trauma. In non-accidental traumatic death, MDCT can be a valuable adjunct to mandatory autopsy for detection of injuries and ballistics.”

"Autopsy is mandatory in deaths involving gunshot wounds, but CT can serve as a powerful adjunct to the conventional exam," Daly said. "Performing CT imaging first may speed up a conventional autopsy, especially when it comes to locating ballistic fragments, which are so important to criminal investigations."

In addition, CT was more sensitive than conventional autopsy in identifying air embolism, an often undetected important contributing factor in fatal trauma.

According to Daly, the technology is only now generating strong interest within the nation's forensic community. "Although these preliminary results are promising, more research is needed to show that CT could be widely used within the U.S. medical examiners system," he said.