15283-B-Blokker

100 Chapter 6 ABSTRACT Aims: To determine the diagnostic accuracy of postmortem MRI (PMMR), CT (PMCT) and CT-guided biopsy for the detection of acute and chronic myocardial ischemia. Background: The autopsy rate worldwide is alarmingly low (0-15%). Mortality statistics are important and it is therefore essential to performautopsies in a sufficient proportion of deaths. The imaging autopsy, noninvasive or minimally invasive autopsy (MIA), can be used as an alternative to the conventional autopsy (CA) in an attempt to improve autopsy rates. Methods: We included 100 consecutive adult patients who died in hospital, and for whom next-of-kin gave permission to perform both CA and MIA. The MIA consists of unenhanced total-body PMMR and PMCT followed by CT-guided biopsies. CA was used as reference standard. We calculated sensitivity and specificity and receiver operating characteristics (ROC) curves for PMCT and PMMR as stand-alone test or combined with biopsy for detection of acute and chronic myocardial infarction . Results: Sensitivity and specificity of PMMR with biopsies for acute myocardial infarction was 0.97 and 0.95 respectively and 0.90 and 0.75 respectively for chronic myocardial infarction. PMMR without biopsies showed a high specificity (acute: 0.92; chronic: 1.00), but low sensitivity (acute: 0.50;chronic: 0.35). PMCT (Total Agatston calcium score) had a good diagnostic value for chronic myocardial infarction (AUC: 0.74, CI: 0.64-0.84), but not for acute myocardial infarction (AUC:0.60, CI: 0.48-0.72). Conclusion: We found that the combination of PMMR with biopsies had high sensitivity and specificity for the detection of acute and chronic MI.