Utility of Postmortem Autopsy via Whole- Body Imaging: Initial Observations Comparing MDCT and 3.0T MRI Findings with Autopsy Findings Jang Gyu Cha, MD1 Dong Hun Kim, MD1 Objective: We prospectively compared whole-body multidetector computed Dae Ho Kim, MD2 tomography (MDCT) and 3.0T magnetic resonance (MR) images with autopsy Sang Hyun Paik, MD1 findings. Jai Soung Park, MD1 Materials and Methods: Five cadavers were subjected to whole-body, 16- Seong Jin Park, MD1 channel MDCT and 3.0T MR imaging within two hours before an autopsy. A radi- Hae Kyung Lee, MD1 ologist classified the MDCT and 3.0T MRI findings into major and minor findings, Hyun Sook Hong, MD1 which were compared with autopsy findings. 3 Duek Lin Choi, MD Results: Most of the imaging findings, pertaining to head and neck, heart and 4 Kyung Moo Yang, MD vascular, chest, abdomen, spine, and musculoskeletal lesions, corresponded to 4 Nak Eun Chung, MD autopsy findings. The causes of death that were determined on the bases of 4 Bong Woo Lee, MD MDCT and 3.0T MRI findings were consistent with the autopsy findings in four of 4 Joong Seok Seo, MD five cases. CT was useful in diagnosing fatal hemorrhage and pneumothorax, as well as determining the shapes and characteristics of the fractures and the direc- Index terms: tion of external force. MRI was effective in evaluating and tracing the route of a Computed tomography (CT) metallic object, soft tissue lesions, chronicity of hemorrhage, and bone bruises. Magnetic resonance (MR) Whole-body imaging Conclusion: A postmortem MDCT combined with MRI is a potentially powerful Forensic autopsy tool, providing noninvasive and objective measurements for forensic investiga- DOI:10.3348/kjr.2010.11.4.395 tions. Korean J Radiol 2010;11:395-406 Received January 19, 2010; accepted after revision April 5, 2010. orensic science has advanced in several fields, including genetics, crime 1Department of Radiology, scene investigation methods, and toxicology (1). In contrast, autopsies Soonchunhyang University Bucheon still use traditional methods, including the dissection of the corpse, oral Hospital, Gyunggi-do 420-020, Korea; F 2Department of Radiology, Konyang description, photography of the body, and written documentation of the findings (2). University Hospital, Daejeon 302-718, Korea; 3Department of Radiology, However, a conventional autopsy has many limitations including subjectivity, lack of Soonchunhyang University Hospital, Seoul reproducibility, restrictions on investigating the entire body and for the inability of a 140-743, Korea; 4Department of Forensic Medicine, National Institute of Scientific layman to understand the complex autopsy results (3). Investigation, Seoul 158-707, Korea Due to the rapid development of magnetic resonance (MR) imaging and computed This research was supported by the tomography (CT) over the course of recent decades, the territory of radiology has Research & Development Program for new technology of Forensic Pathology been extending from the brain, chest, and abdominal imaging to the heart and articu- through the National Institute of Scientific lar imaging. In contrast to the rapid development of clinical radiology, the application Investigation (NISI) funded by the Ministry of Public Administration and Security of imaging methods in forensic radiology has lagged far behind the technical develop- (1315000226, NISI-NG-2010-1). ments in imaging devices (1). An effort to document the body by objective and Address reprint requests to: noninvasive means began in the 1990s at the Institute of Forensic Medicine, Kyung Moo Yang, MD, Department of Forensic Medicine, National Institute of Diagnostic Radiology, and Neuroradiology of the University of Bern. This effort Scientific Investigation, 331-1 Sinwol resulted in the ‘Virtopsy’ project, which aimed to detect forensic findings in corpses 7-dong, Yangcheon-gu, Seoul 158-707, Korea. using multidetector CT (MDCT) and MR imaging, as well as comparing these results Tel. (822) 2600-4612 with traditional autopsy findings (4). Fax. (822) 2600-4829 e-mail: [email protected] Furthermore, with the advent of higher channel MDCT and 3.0T whole-body MRI, Korean J Radiol 11(4), Jul/Aug 2010 395 Cha et al. the potential of forensic radiology has increased. Many imaged in the supine position with arms up from the vertex studies have been performed to evaluate the utility of to the toe in two spiral acquisitions. All images were whole-body postmortem MRI in non-forensic cases for acquired using 1.5-mm detectors with a table feed of 36 detecting gross cranial, thoracic, and abdominal disease (4- mm per rotation (pitch 1.5). The protocol for all scan 9). Other groups have already performed whole-body acquisitions involved the use of a helical pitch of 0.532:1, postmortem imaging with MDCT (10, 11). 120 kVp, 160 mA, a 512 × 512 matrix, and a 0.5-s However, none of these studies included systematic rotation time, with a 50-cm field of view (FOV). The whole-body examinations using a combination of multide- images were reconstructed into 1-mm detector widths with tector CT and MRI (4-9) for forensic purposes. The present both bony and soft tissue algorithms. Using a Leonardo study was designed to compare whole-body MRI findings workstation (Syngo CT software; Siemens), two- at 3.0T and 16-channel MDCT for determining the cause dimensional sagittal and coronal reformations, as well as of death, with autopsy findings as the reference standard. three-dimensional (3-D) reconstructions were calculated. Multi-planar reformatted images were reviewed by using MATERIALS AND METHODS window widths of 1,500-8,000 and window levels of 500- 2,000. Subjects The reconstructed images were sent to an intradepart- Five cadavers were selected among the autopsy cases mental PACS (Star PACS; Infinite, Seoul, Korea) using the between February and March 2008. The imaging study Digital Imaging and Communications in Medicine protocol. was performed as a pre-evaluation process before the The duration of the MDCT scan in our cases was approxi- autopsy. The research proposal was approved by the mately 2-3 min. Institutional Review Board and inclusion criteria required the cadavers to have been from individuals aged 18 years MRI Scanning or older and who were suspected to die of unnatural Whole-body MRI examinations were performed on a 3T causes. Exclusion criteria were lack of informed consent MR system (Signa HDx; GE Healthcare, Milwaukee, WI) from the family, extreme injury, or putrefaction of the using a body coil. Detailed parameters for imaging body. The study subjects included four men and one sequences are provided in Table 1. The corpses were woman. Their ages ranged from 23 to 71 years (mean, placed in the supine position, with arms beside the body 47.8 years). CT and MRI were performed within 6-24 and examined from head to toe. hours after death. The corpses were draped with a vinyl Coronal and sagittal images were obtained using a cloth wrapper to prevent contamination of the machines maximum FOV of 45-50 cm and a turbo short tau due to any secretions or hemorrhage from the body. inversion recovery (STIR) through five stations in the coronal orientation: head/neck, thorax/abdomen, pelvis, CT Scanning thighs, and calves. Subsequently, the whole body was CT was performed on a 16-detector MDCT (Sensation scanned with coronal and sagittal T1-weighted fast spoiled 16; Siemens, Erlangen, Germany). The subjects were gradient-echo (FSPGR) sequences. Whole-body STIR Table 1. MRI Parameters Parameter Pulse TE TR TI BW FOV Thickness/ Scan FA Matrix NEX Station Sequence (ms) (ms) (ms) (kHz) (cm) Spacing (mm) Time 1 FSPGR 2.1 180 80 62.5 48 8/2 256×192 1 0:36 STIR 27 4,000 180 90 62.5 48 8/2 256×224 1 3:37 2 FSPGR 2.1 180 80 62.5 48 8/2 256×192 1 0:37 STIR 27 4,000 180 90 62.5 48 8/2 256×224 1 3:37 3 FSPGR 2.1 180 80 62.5 48 8/2 256×192 1 0:37 STIR 27 4,000 180 90 62.5 48 8/2 256×224 1 3:37 4 FSPGR 2.1 180 80 62.5 48 8/2 256×192 1 0:41 STIR 27 4,000 180 90 62.5 48 8/2 256×224 1 3:37 5 FSPGR 2.1 180 80 62.5 48 8/2 256×192 1 0:41 STIR 27 4,000 180 90 62.5 48 8/2 256×224 1 3:37 Note.─ BW = bandwidth, FA = flip angle, FOV = field of view, FSPGR = fast spoiled gradient-recalled turbo, NEX = number of excitations, STIR = short tau inversion recovery, TE = echo time, TI = inversion time, TR = repetition time 396 Korean J Radiol 11(4), Jul/Aug 2010 Postmortem Autopsy via Whole Body Imaging imaging was possible within 12-28 min and T1-weighted to a cardioradiologist, chest radiologists, abdominal radiol- imaging within 10-16 min at a 1.3 × 1.1 mm and 1.8 × ogists, a neuroradiologist, and a head and neck radiologist, 1.3 mm in-plane resolution, respectively. Total imaging and proceeded to analyze the radiological data with a time for whole-body imaging was less than 40 min in all focus on their subspecialties. They each performed their cases. If major findings were detected on whole-body evaluations blinded to the autopsy findings and the images or an external wound was found on a part of the photographic documentation. However, a forensic patholo- body, closer investigations were performed with dedicated gist participated in CT and MR image acquisition and local coils (head coil, surface coil, shoulder coil) (Table 2). described each corpse’s identity and the scenes of the After the examination, the images were electronically accidents to radiologists.