15283-B-Blokker

103 Accuracy of MIA for the detection of ischemic heart disease 6 Minimally Invasive Autopsy procedure MRI and CT scans were made according to standardized protocols (Table 1-A and 1-B respectively). Total acquisition time was one hour for MRI and around 5 minutes for CT. One radiologist (ACW) with expertise in postmortem radiology, performed the initial read of the MRI and CT scans, compared these to the available premortem imaging, and marked suspected pathological lesions on CT and MRI key images that were used to plan the biopsies. MRI was performed on a 1.5T scanner (Discovery MR450, GE Medical systems, Milwaukee, Wisconsin USA) and consisted of scans of the brain, neck, thorax, abdomen and pelvis. The MRI total-body protocol consisted of axially-acquired STIR FSE T2w and FLAIR FSE T1w from the cranium to the pelvis. An additional 2D STIR FSE T2w scan and 3D Fatsat FSPGR T1w scan with higher resolution than the total-body scans were acquired of the thorax, using an 8-channel torso array coil. All MRI scans were made in the axial orientation. After MRI was completed CT scans were acquired from head to feet (Somatom Definition, Siemens Healthcare, Forchheim, Germany). CT data sets of the head, thorax and abdomen were reconstructed with section thickness of 1.0 mm and 5.0 mm in the axial plane and 3.0 mm in the coronal and sagittal planes, by using medium-to-smooth (H31/B31) and very sharp (H70/B70) convolution kernels. CT-guided biopsies (12 Gauge) were taken from heart, lungs, liver, kidneys, spleen, and radiologically suspected pathology as indicated. In the heart, standard biopsies (5- 10 samples) were taken from the lateral wall (mid and basal parts) and apex of the left ventricle. Additional biopsies were taken from MRI signal abnormalities within the myocardium. In those cases where there was a clinical suspicion of myocardial infarction and the MRI showed no signal abnormalities additional biopsies were taken from the septum, anterior and posterior wall. The MIA pathologist (JWO) and researcher (BMB) examined the microscopic slides of the biopsies; when in doubt, they consulted pathologists with specific expertise, not involved in the matching conventional autopsy, to reach a conclusion. Cardiac imaging evaluation CT For each case, CT calcium score was calculated by one observer (IMW) using dedicated software (Syngo.via 3.0 Calcium Scoring ® , Siemens Healthcare, Forchheim, Germany) and expressed as total Agatston scores.