Non-surgical autopsy using CT angiography
15 March 2011
A new non-surgical post-mortem technique that has the
potential to revolutionise the way autopsies are conducted has been
pioneered by forensic pathologists and radiologists at the University of
Leicester in collaboration with the University Hospitals of Leicester
NHS Trust.
The technique, called, minimally invasive targeted coronary
angiography, involves injecting a contrast agent into the body of a
deceased person through a small incision in the neck and then
performing a full-body CT scan.
The technique developed by a team in the East Midlands Forensic
Pathology Unit, at the University of Leicester, has been published
in the International Journal of Legal Medicine. This paper
presents the development of the methodology and protocol for this
technique from independent research commissioned by the National
Institute for Health Research (NIHR).
The study has taken another step towards a minimally invasive
autopsy for natural and unnatural deaths, for either single cases or
mass fatalities. It could also potentially allay qualms from certain
faith groups that object to autopsies.
Professor Guy Rutty, Chief Forensic Pathologist to the East
Midlands Forensic Pathology Unit, which is part of the Department of
Cancer Studies and Molecular Medicine, University of Leicester, said
the pilot study had demonstrated the potential of the technique to
change the future of post-mortem procedures.
He said: "Autopsies are not popular with the general public and
are viewed with great distaste. There are a number of faith groups
who voice objections to the autopsy. The development of a minimally
invasive autopsy technique would reduce the overall number of
invasive autopsies performed in the UK but would still provide a
service to the Coroner and determine the cause of a person’s death.
Currently, without the use of angiography, cardiac related death
cannot be reliably diagnosed using a post mortem CT (Computed
Tomography) scan so we needed to develop a system that could do
this."
“In collaboration with the radiology team, lead by Professor
Bruno Morgan, we have successfully developed a quick and simple
technique of ‘minimally invasive targeted coronary angiography’
where we inject contrast into the body of a deceased person through
a small incision in the neck and then perform a full body CT scan.
Using this method we are able to determine the cause of death in up
to 80% of cases (in the series analysed to date).
“Basically, the technique is used to highlight and examine the
vessels of the heart in people who have died. The technique is
inexpensive, easy to use and applicable to natural and unnatural
death, both single and mass fatalities.”
Professor Rutty explained the technique was novel because it uses
catheterisation, contrast and imaging techniques that have not been
reported previously. “Developing a new catheterisation system and
using two different types of contrast to highlight the coronary
vessels (air and standard coronary radio-opaque contrast media) sets
us apart from other research groups,” he said.
Professor Rutty added: “We were the first Unit in the world to
our knowledge to propose targeted angiography as the way forward,
and are now the first to describe the development, methodology and
protocols involved for cadaver cardiac CT angiography. Other groups
have done whole body angiography which is time consuming and
expensive and is unlikely to be implemented in the UK for everyday
autopsies.
“We are incredibly excited about the potential of this new
research. This technique could see the beginning of a permanent
change in autopsy practice in the UK, with fewer autopsies being
performed. This technique could be used in other centres across the
world.”
The research paper presents the results from an initial pilot of
24 cases. The University team will now complete a further 200 cases
this year to further evaluate the technique and build a bigger
evidence base.
Reference
Sarah L. Saunders, Bruno Morgan, Vimal Raj, Claire E. Robinson
and Guy N. Rutty. Targeted post-mortem computed tomography cardiac
angiography: proof of concept. International Journal of Legal
Medicine
DOI: 10.1007/s00414-011-0559-4