Post-Mortem Imaging

Post mortem imaging (PMI) utilizing cross-sectional modalities is a rapidly emerging field. The value of PMI is well established in adult imaging and is finding growing acceptance in the pediatric and perinatal domains.  Parents who are reluctant to allow conventional autopsy of their deceased child are more willing to permit post mortem imaging alone (“virtual autopsy”) or as imaging guided, limited conventional autopsy. PMI encompasses several different diagnostic areas beginning with perinatal/neonatal evaluation of known or suspected genetic abnormalities (e.g. skeletal dysplasia) and determination of live vs. stillbirth. In medicolegal cases PMI is used to evaluate cause/manner of death in infants and children, including suspected non-accidental trauma. Our goals for this committee/task force include informing SPR members, other radiology colleagues, and referring clinicians about the advantages and limitations of PMI by providing references and Pub Med links, guiding standardization of imaging protocols, and contributing to the PMI knowledge base.  We hope to provide assistance to radiologists in our community hospitals who are unfamiliar with pediatric PMI and to our local Medical Examiners and the State Departments of Justice in their death investigations. In addition PMI data on emergency medical intervention can be use to assess procedures used by local/regional Emergency Medical Response teams.

CT & MRI Protocols

Reference Articles

Post-Mortem Imaging Compared to Conventional Autopsy

  1. Thayyil S et al. Post-mortem MRI versus conventional autopsy in fetuses and children: a prospective validation study. Lancet 2013;382:223-33. PMID: 23683720. *Free article
    https://www.ncbi.nlm.nih.gov/pubmed/23683720

  2. Thayyil S et al. Post-mortem magnetic resonance imaging in the fetus, infant and child: A comparative study with conventional autopsy (MaRIAS Protocol). BMC Pediatr 2011;11:120. PMID: 22192497. *Free article

    https://www.ncbi.nlm.nih.gov/pubmed/22192497

Techniques

  1. Sieswerda-Hoogendoorn T, van Rijn RR. Current techniques in postmortem imaging with specific attention to paediatric applications. Pediatr Radiol 2010;40:141-142.  PMID: 20013258. *Free article
    https://www.ncbi.nlm.nih.gov/pubmed/20013258

  1. Arthurs OJ et al. Indications, advantages and limitations of perinatal postmortem imaging in clinical practice. Pediatr Radiol 2015;45:491-500. PMID: 25274468. *Free article

    https://www.ncbi.nlm.nih.gov/pubmed/25274468

     

  2. Postmortem Radiology and Imaging, Medscape, Angela D. Levy, MD. Updated July 16, 2012. http://emedicine.medscape.com/article/1785023-overview

Normal Appearances

  1. Klein WM et al. Normal pediatric postmortem CT appearances. Pediatr Radiol 2015;45:517-526. PMID: 25828355.

    https://www.ncbi.nlm.nih.gov/pubmed/25828355

     

  2. Arthurs OJ et al. Normal perinatal and paediatric postmortem magnetic resonance imaging appearances. Pediatr Radiol 2015;45:527-535. PMID: 25828356. *Free article
    https://www.ncbi.nlm.nih.gov/pubmed/25828356

3. Ishida M et al. Common postmortem computed tomography findings following atraumatic death: Differentiation between normal postmortem changes and pathologic lesions. Korean J Radiol 2015;16(4):798-809.  PMID: 26175579. *Free article
https://www.ncbi.nlm.nih.gov/pubmed/26175579

Pathologic Appearances

      1. Calder AD, Offiah AC. Foetal radiography for suspected skeletal dysplasia: technique, normal appearances, diagnostic approach. Pediatr Radiol 2015;45:536-548. PMID: 25173408.

https://www.ncbi.nlm.nih.gov/pubmed/25173408

2. Taylor AM et al. Postmortem cardiac imaging in fetuses and children. Pediatr Radiol 2015;45:549-555. PMID: 25828357. *Free article
https://www.ncbi.nlm.nih.gov/pubmed/25828357

3. Arthurs OJ et al. Postmortem magnetic resonance appearances of congenital high airway obstruction syndrome. Pediatr Radiol 2015;45:556-561. PMID: 25190454. *Free article
https://www.ncbi.nlm.nih.gov/pubmed/25190454

4. Pluchinotta FR et al. Postmortem imaging in congenital heart disease: preliminary experience. Acta Radiol 2015;56(10):1264-1272. PMID: 25392155.
https://www.ncbi.nlm.nih.gov/pubmed/25392155

5. Sarikouch S et al. Value of postmortem magnetic resonance imaging for fatal neonatal congenital heart disease: a case report. Pediatr Cardiol 2008;29:667-669. PMID: 18004614.
https://www.ncbi.nlm.nih.gov/pubmed/18004614

6. Okuma H et al. Heart wall is thicker on postmortem computed tomography than on antemortem computed tomography: the first longitudinal study. PloS One 2013;8(9):e76026. PMID: 24086680. *Free article
https://www.ncbi.nlm.nih.gov/pubmed/24086680

7. Okuma H et al. Comparison of attenuation of striated muscle between postmortem and antemortem computed tomography: results of a longitudinal study.  PloS One 2014;9(11):e111457. PMID: 25365255. *Free article
https://www.ncbi.nlm.nih.gov/pubmed/25365255

Forensic Imaging

  1. Hong TS et al. Value of postmortem thoracic CT over radiography in imaging of pediatric rib fractures. Pediatr Radiol 2011;41:736-748. PMID: 21264464.

    https://www.ncbi.nlm.nih.gov/pubmed/21264464

  2. Guddat SS et al. Proof of live birth using postmortem multislice computed tomography (pmMSCT) in cases of suspected neonaticide: advantages of diagnostic imaging compared to conventional autopsy. Forensic Sci Med Pathol 2013;9:3-12. PMID: 22760696.

    https://www.ncbi.nlm.nih.gov/pubmed/22760696

Opinions

  1. Arthurs OJ, van Rijn RR. Paediatric and perinatal postmortem imaging: mortui vivos docent. Pediatr Radiol 2015;45:476-477. PMID: 25238808. *Free article

    https://www.ncbi.nlm.nih.gov/pubmed/25238808

  2. Chapman S. What are the greatest challenges and/or barriers to applying postmortem imaging in paediatric radiology? Pediatr Radiol 2015;45:478. PMID: 24839143.
    https://www.ncbi.nlm.nih.gov/pubmed/24839143

  3. Ruder TD. What are the greatest challenges or barriers to applying post-mortem imaging in pediatric radiology? Pediatr Radiol 2015;45:479. PMID: 24894972.
    https://www.ncbi.nlm.nih.gov/pubmed/24894972

  4. Hatch GM. What are the greatest challenges or barriers to applying post-mortem imaging in pediatric radiology? Pediatr Radiol 2015;45:480. PMID: 25246095.
    https://www.ncbi.nlm.nih.gov/pubmed/25246095

  5. Cain TM. What are the greatest challenges or barriers to applying postmortem imaging in paediatric radiology? Pediatr Radiol 2015;45:481. PMID: 25149161.
    https://www.ncbi.nlm.nih.gov/pubmed/25149161

  6. Alison M. Postmortem imaging in paediatric radiology - the French perspective. Pediatr Radiol 2015;45:482. PMID: 25149160.
    https://www.ncbi.nlm.nih.gov/pubmed/25149160

  7. Arthurs OJ et al. Paediatric and perinatal postmortem imaging: the need for a subspecialty approach. Pediatr Radiol 2015;45:483-490. PMID: 25172007. *Free article
    https://www.ncbi.nlm.nih.gov/pubmed/25172007

  8. Cohen MC et al. Running a postmortem service - a business case and clinical experience. Pediatr Radiol 2015;45:501-508. PMID: 25828353.
    https://www.ncbi.nlm.nih.gov/pubmed/25828353

  9. Gorincour G et al. The future of pediatric and perinatal postmortem imaging. Pediatr Radiol 2015;45:509-516. PMID: 25828354.
    https://www.ncbi.nlm.nih.gov/pubmed/25828354

  10. Harcke HT. The case for postmortem imaging. Pediatr Radiol 2010;40:138-140. PMID: 20013259.
    https://www.ncbi.nlm.nih.gov/pubmed/20013259

Committee Members

Roster

Mary Patricia Harty, MD, Chair
Pierre Jean-Marie Schmit, MD, Vice Chair
Micheal A. Breen, MBBCh  
Sharon W. Gould, MD
Tatum S. Johnson, MD
Amy R. Mehollin-Ray, MD
Mark E. Sharafinski, MD

Survey Results

Coming Soon.

Educational Exhibits

     

Coming Soon.