Post-Mortem Cardiac 3T Magnetic Resonance Imaging. Visualization of Sudden Cardiac Death?

Jackowski, Christian; Schwendener, Nicole; Grabherr, Silke; Persson, Anders (2013). Post-Mortem Cardiac 3T Magnetic Resonance Imaging. Visualization of Sudden Cardiac Death? Journal of the American College of Cardiology, 62(7), pp. 617-629. Elsevier 10.1016/j.jacc.2013.01.089

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OBJECTIVES: This study aimed to investigate post-mortem magnetic resonance
imaging (pmMRI) for the assessment of myocardial infarction and hypointensities on post-mortem T2-weighted images as a possible method for visualizing the myocardial origin of arrhythmic sudden cardiac death.

BACKGROUND: Sudden cardiac death has challenged clinical and forensic
pathologists for decades because verification on post-mortem autopsy is not
possible. pmMRI as an autopsy-supporting examination technique has been shown to visualize different stages of myocardial infarction.

METHODS: In 136 human forensic corpses, a post-mortem cardiac MR examination was carried out prior to forensic autopsy. Short-axis and horizontal long-axis Images were acquired in situ on a 3-T system.

RESULTS: In 76 cases, myocardial findings could be documented and correlated to the autopsy findings. Within these 76 study cases, a total of 124 myocardial lesions were detected on pmMRI (chronic: 25; subacute: 16; acute: 30; and peracute: 53). Chronic, subacute, and acute infarction cases correlated excellently to the myocardial findings on autopsy. Peracute infarctions (age range: minutes to approximately 1 h) were not visible on macroscopic autopsy or histological examination. Peracute infarction areas detected on pmMRI could be verified in targeted histological investigations in 62.3% of cases and could be related to a matching coronary finding in 84.9%. A total of 15.1% of peracute lesions on pmMRI lacked a matching coronary finding but presented with severe myocardial hypertrophy or cocaine intoxication facilitating a cardiac death without verifiable coronary stenosis.

CONCLUSIONS: 3-T pmMRI visualizes chronic, subacute, and acute myocardial
infarction in situ. In peracute infarction as a possible cause of sudden cardiac
death, it demonstrates affected myocardial areas not visible on autopsy. pmMRI should be considered as a feasible post-mortem investigation technique for the deceased patient if no consent for a clinical autopsy is obtained.

Item Type:	Journal Article (Original Article)
Division/Institute:	04 Faculty of Medicine > Service Sector > Institute of Legal Medicine > Forensic Medicine 04 Faculty of Medicine > Service Sector > Institute of Legal Medicine > Management
UniBE Contributor:	Jackowski, Christian, Schwendener, Nicole
Subjects:	600 Technology > 610 Medicine & health
ISSN:	0735-1097
Publisher:	Elsevier
Language:	English
Submitter:	Katrin Renfer
Date Deposited:	24 Apr 2014 14:48
Last Modified:	05 Dec 2022 14:29
Publisher DOI:	10.1016/j.jacc.2013.01.089
URI:	https://boris.unibe.ch/id/eprint/44506