15283-B-Blokker

146 Chapter 8 Autolysis occurs early after death. It leads to significant changes that can be noted at microscopic examination of tissues obtained at biopsy, in particular of the pancreas and adrenal glands. 210,251 However, in our cohort imaging features of these organs seem less affected by autolysis. Imaging features related to decomposition were seen more frequently. There was tendency to more extensive livores of the lungs with longer PTI and the livores can become so extensive as to completely consolidate the lung parenchyma. In such cases, accurate diagnosis of underlying parenchymal disease can be challenging. In such cases we highly recommend to biopsy both normal and suspected parts of parenchyma to reliably differ postmortem changes from infection (Fig 3A-I), hemorrhage, or tumor. 116,211,252,253 The distribution of putrefactive gas also differs with a different PTI, first occurring in the heart cavities and large vessels and with longer intervals in the smaller vessels, organ parenchyma and soft tissues. Putrefactive gas must be differentiated frompathological air collections, such as soft tissue emphysema, free air or gas in the intestinal wall. Putrefactive gas usually has an intestinal origin and travels through the mucosa to the portal veins in the early stage. It may mimic air embolism, however the latter will show a more equal distribution throughout the vascular system. 116 Intestinal bacteria continue to produce gas after death causing bowel distension. The amount of intestinal air significantly increases with longer PTI. This may look similar to a bowel obstruction or paralysis, and should be carefully evaluated. With longer PTI, putrefaction can also lead to formation of subcutaneous air. Our study had several limitations. We composed a scoring list of postmortem imaging features that may not be complete and some features may be missing. We did not measure body temperature during scanning. Ideally, body temperature should be monitored to allow adaption of MR scan parameters to temperature variations to achieve optimal tissue contrast. However all bodies were stored at the morgue at a constant temperature of 5 degrees Celsius prior to scanning and the transit time from the morgue to the MR scanner was equal for all cases. We optimized MR sequences for scanning of cold corpses. Furthermore the scan time was maintained approximately the same for all scanning sessions while the temperature in the scanning room was kept constant. CONCLUSION There is a wide variety of imaging features of postmortem change in in-hospital deaths. These imaging features vary among clinical conditions, increase with longer PTI and must be distinguished from pathologic changes.