15283-B-Blokker

61 Alternatives to conventional autopsy: a systematic review 4 Several studies have shown that post-mortem whole-body CT-angiography visualizes pathological changes in blood vessels, such as stenosis, occlusion and injuries, and improves the accuracy of a minimally invasive autopsy method. 48,80,108,109,118 As these whole-body angiographies tend to be expensive, for heart-lung machines and large volumes of special contrast agents are required, either out-dated and therefore LQH[SHQVLYH HTXLSPHQW RU QHZO\ GHYHORSHG ORZ FRVW WDUJHWHG DQJLRJUDSK\ PHWKRGV are being used. For instance, a post-mortem coronary CT-angiography was designed to improve the accuracy of a minimally invasive autopsy method in sudden natural death cases. 119,120 For findings in the coronary arteries, Roberts et al. achieved a correlation of 80% between autopsy and CT-angiography. Moreover, Saunders et al. were able to reduce the time for whole-body CT-scanning and a coronary CT-angiography to an average of 48 minutes. Another interesting technique, which was not performed in any of the reviewed studies, is post-mortem ventilation. In clinical practice, the detection of small lung lesions is improved by having patients hold their breath when the scan is made. To achieve a similar effect in post-mortem imaging, forensic examiners simulated expiration and inspiration scans by ventilating the lungs. 121-123 When searching for validation studies of alternatives to autopsies, we also found articles about verbal autopsy. This is a WHO-method used in populations lacking vital registration and medical certification, to determine the probable cause of death based on questionnaires and/ or narratives fromnext-of-kin or other reliable informants (such as caregivers). The method is not based on any post-mortem physical examination of the body, and not accurate for attributing cause of death at the individual level. Therefore, verbal autopsy was excluded from this review. Limitations We found very few validation studies on non-invasive and minimally invasive autopsy methods performed on adults with a non-suspicious and supposedly natural cause of death. We therefore chose not to exclude studies that did not provide sufficient data for composing complete 2x2 tables. As a result, the agreement on cause of death could not always be calculated, as it should be based on the combined true positives and true negatives whereas the latter was frequently missing. As we could neither extract true negatives nor false positives, we calculated only sensitivity percentages, even though the results had originally been reported as being agreement percentages.