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141 CT and MR features of postmortem change in deaths 8 on because of MR scanner availability). Directly after PMMR, PMCT was performed on a dual-source CT scanner (SOMATOM Definition Flash, Siemens Healthcare Forchheim, Germany) and consisted of scans from head to feet. Standardized CT-guided biopsies (12 Gauge) were taken from heart, lungs, liver, kidneys, spleen, and additional biopsies were taken from radiologically suspected pathology. All biopsies were stained with hematoxylin and eosin (H&E) and when requested by the pathologist additional stains were performed. Scoring We composed a scoring list of PMCT and PMMR features of postmortem change (Table 3-5). The features that were included were based on our radiological expertise 56,57 and were supplemented with features from published postmortem imaging studies. 48,102,108,110,121,126,128,153,210,217-241 All cases were retrospectively and independently scored by a radiologist (ACW; board- certified with 10 years of clinical expertise in postmortem imaging) and a researcher (IMW with 3 years of expertise). When available, clinical information and antemortem scans were reviewed. Specific clinical conditions were scored; including intensive care unit (ICU) admittance and post-resuscitation status (PRS). PMCT and PMMR features were – if possible – categorized to a specific chemical and/ or physical process; 1. gravity dependent changes; 2. decomposition; 3. rigor mortis; 4. algor mortis. Features that could not be classified to any of these four processes were labeled to a miscellaneous category. Statistical analyses We recorded percentage of male/female cases, mean age at death, and mean postmortem time interval (PTI) including standard deviations. PTI was defined as the time fromdeath to the start of MR scanning. For each case, we calculated the frequency of PMCT and PMMR features. Fisher’s exact test was used for the association between specific clinical conditions (ICU and PRS) and frequencies of PMCT and PMMR features. Linear discriminant analysis was used to evaluate the correlation of PTI and PMCT and PMMR features. ANOVA was used to test the correlation of PTI and a combination score for all decomposition and all gravity dependent changes. The inter-observer agreement was calculated using kappa statistics (agreement <0.2: poor, 0.2-0.4: fair, 0.4-0.6: moderate, 0.6-0.8: good, and 0.8-1.0: very good). Furthermore we calculated inter-observer agreement for the group of pathological mimics (those postmortem changes that were most likely to be confused with real pathologic changes) and a group of postmortem changes that does not correspond to a pathologic process with similar radiological features.