Two-Step Postmortem Angiography with a Modified Heart–Lung Machine: Preliminary Results

Center of Forensic Imaging and Virtopsy, Institute of Forensic Medicine, University of Bern, Bern, Switzerland.
American Journal of Roentgenology (Impact Factor: 2.73). 03/2008; 190(2):345-51. DOI: 10.2214/AJR.07.2261
Source: PubMed


The purpose of this study was to adapt and improve a minimally invasive two-step postmortem angiographic technique for use on human cadavers. Detailed mapping of the entire vascular system is almost impossible with conventional autopsy tools. The technique described should be valuable in the diagnosis of vascular abnormalities.
Postmortem perfusion with an oily liquid is established with a circulation machine. An oily contrast agent is introduced as a bolus injection, and radiographic imaging is performed. In this pilot study, the upper or lower extremities of four human cadavers were perfused. In two cases, the vascular system of a lower extremity was visualized with anterograde perfusion of the arteries. In the other two cases, in which the suspected cause of death was drug intoxication, the veins of an upper extremity were visualized with retrograde perfusion of the venous system.
In each case, the vascular system was visualized up to the level of the small supplying and draining vessels. In three of the four cases, vascular abnormalities were found. In one instance, a venous injection mark engendered by the self-administration of drugs was rendered visible by exudation of the contrast agent. In the other two cases, occlusion of the arteries and veins was apparent.
The method described is readily applicable to human cadavers. After establishment of postmortem perfusion with paraffin oil and injection of the oily contrast agent, the vascular system can be investigated in detail and vascular abnormalities rendered visible.

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    • "Parameters were: Tube voltage 120 kVp; automatic dose modulation software (CARE dose 4D ™ , Siemens, Forchheim, Germany) including a whole body scan with slice thickness 2.0 mm; a separate head scan with slice thickness 0.6 mm and a scan of the torso with elevated arms and a slice thickness of 1.0 mm. Additionally, a PMCT-angiography (PMCTA) was performed adapted from techniques described by Ross et al. [5] [6] and Grabherr et al. [7] [8]. A solution of 3 l of polyethylene glycol (PEG 200; Schaerer and Schlaepfer, Rothrist Switzerland) and Iopentol (Imagopaque 300; Amersham Health, Wädenswil, Switzerland), mixed at a ratio of 15:1, was first injected arterially by femoral cannulation on the left, using a pressurecontrolled pump (Virtangio s , Fumedica AG, Muri, Switzerland). "
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    ABSTRACT: We present a case of an incidentally found patent foramen ovale in an adult that died after being shot twice, which was identified at postmortem computed tomography angiography (PMCTA). PMCTA was performed to visualize the trajectory and injuries due to gunshot trauma. The patent foramen ovale was detected in the arterial contrast media application by extensive, unanticipated filling of the right atrium and the inferior cava vein with a small contrasted connection between both atria. The finding was confirmed by autopsy, but did not attribute to the cause of death.
    Journal of Forensic Radiology and Imaging 07/2014; 2(3). DOI:10.1016/j.jofri.2014.03.007
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    • "Because the contrast agent is an oily liquid, this disadvantage could be overcome by simply decreasing its viscosity. This is done, for example, to perform microangiography (Grabherr et al., 2008a, 2008b). Our experience also highlights the advantages of combining clinical and postmortem specialists. "
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    ABSTRACT: The development of new medical devices, such as aortic valves, requires numerous preliminary studies on animals and training of personnel on cadavers before the devices can be used in patients. Postmortem circulation, a technique used for postmortem angiography, allows the vascular system to be reperfused in a way similar to that in living persons. This technique is used for postmortem investigations to visualize the human vascular system and to make vascular diagnoses. Specific material for reperfusing a human body was developed recently. Our aim was to investigate whether postmortem circulation that imitates in vivo conditions allows for the testing of medical materials on cadavers. We did this by delivering an aortic valve using minimally invasive methods. Postmortem circulation was established in eight corpses to recreate an environment as close as possible to in vivo conditions. Mobile fluoroscopy and a percutaneous catheterization technique were used to deliver the material to the correct place. Once the valve was implanted, the heart and primary vessels were extracted to confirm its position. Postmortem circulation proved to be essential in several of the cadavers because it helped the clinicians to deliver the material and improve their implantation techniques. Due to the intravascular circulation, sites with substantial arteriosclerotic stenosis could be bypassed, which would have been impossible without perfusion. Although originally developed for postmortem investigations, this reperfusion technique could be useful for testing new medical devices intended for living patients. Clin. Anat., 2013. © 2013 Wiley Periodicals, Inc.
    Clinical Anatomy 05/2014; 27(4). DOI:10.1002/ca.22357 · 1.33 Impact Factor
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    • "Different approaches have been made in order to increase the diagnostic value of PMCT. One of these approaches has been the effort to inject different kinds of contrast agents into the vascular system in order to achieve a contrast enhanced scan [11], [15], [16]. Different methods and contrast agents have been tested in order to achieve a satisfying contrast as well as different kinetics of the applied agent. "
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    ABSTRACT: To evaluate the diagnostic value of contrast enhanced post mortem computed tomography (PMCT) in comparison to non-enhanced post mortem CT in the detection of cardiovascular causes of death (COD). As autopsy rates decline, new methods to determine CODs are necessary. So contrast enhanced PMCT shall be evaluated in comparison to established non-enhanced PMCT in order to further improve the method. In a prospective study, 20 corpses were examined using a 64-row multisclice CT (MSCT) before and after intraarterial perfusion with a newly developed, barium-bearing contrast agent and ventilation of the lungs. The cause of death was determined in enhanced and unenhanced scans and a level of confidence (LOC) was given by three experienced radiologists on a scale between 0 and 4. Results were compared to autopsy results as gold standard. Autopsy was performed blinded to PMCT-findings. The method allowed visualization of different types of cause of death. There was a significant improvement in LOC in enhanced scans compared to unenhanced scans as well as an improvement in the detection of COD. The cause of death could be determined in 19 out of 20 patients. PMCT is feasible and appears to be robust for diagnosing cardiovascular causes of death. When compared with unenhanced post-mortem CT intraarterial perfusion and pulmonary ventilation significantly improve visualization and diagnostic accuracy. These promising results warrant further studies.
    PLoS ONE 04/2014; 9(4):e93101. DOI:10.1371/journal.pone.0093101 · 3.23 Impact Factor
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