15283-B-Blokker

102 Chapter 6 In this study, we evaluate the minimally invasive autopsy (MIA) approach using both nonenhanced CT and MRI followed by CT-guided biopsies. The aim of this study was to determine the diagnostic accuracy of MRI, CT and CT-guided biopsy for the detection of acute and chronic MI, with conventional autopsy as the reference standard. METHODS Study design This study was undertaken as part of the Minimally Invasive Autopsy (MIA) study; this is a prospective single center cross-sectional study in a tertiary referral hospital comparing diagnostic performance of conventional autopsy and MIA. Conventional autopsy followed MIA on the same case. Pathologists involved with conventional autopsy were blinded to MIA findings as much as possible; however biopsy sites could potentially lead to increased suspicion of the biopsied organs and tissues by the autopsy pathologist. MIA personnel were blinded to autopsy findings. Patients From January 2012 through December 2014 all hospitalized patients aged 18 years and older who died at Erasmus University Medical Center were eligible, if written informed consent was obtained from next-of-kin for MIA and conventional autopsy of at least the torso. Exclusion criteria were (suspected) unnatural cause of death, body size exceeding height of 16 inches in supine position (limitation for MRI), known or suspected “high- risk” infected bodies (tuberculosis, hepatitis B and C, human immunodeficiency virus, methicillin-resistant Staphylococcus aureus, multi-drug resistant Acinetobacter), and open abdominal wounds that could not be completely closed or taped to prevent leakage of body fluids. Clinical information All relevant clinical information including medical history and suspected cause of death was recorded and available for both the MIA and the conventional autopsy team. The treating physician decided the most likely cause of death and a differential diagnosis based on the clinical presentation. For the analysis the population was divided into a group with and a group without clinical suspicion for ischemic heart disease.