15283-B-Blokker

63 Alternatives to conventional autopsy: a systematic review 4 Advantages and disadvantages of the non-invasive and minimally invasive autopsy methods When comparing radiological techniques for non-invasive and minimally invasive autopsy methods, CT and MRI are likely to be preferred over ultrasound. Both have their strengths and shortcomings, and may ideally complement each other. Table 4 gives an overview of the advantages and disadvantages of the radiologic techniques. 80,97,103,105,106,119,120,125-128 Both radiologic techniques and scopic techniques are generally used in medical practice for the living. Hence, they are not available for autopsy cases during busy working hours. If a technique were to be purchased for post-mortem investigations only, the costs may not outweigh the benefits. The more advanced an alternative autopsy technique is, the higher is it’s price, but, in general, the better are it’s diagnostic capabilities (if the reviewed studies had used all available techniques, their results would inevitably have been better). Yet, those capabilities are not always required for each individual autopsy case. For example, MRI should preferably be used to examine congenital abnormalities or neurologic pathology in neonates, infants and children, whereas CT is required to examine lung pathology in adults. Without reliable criteria for selecting those techniques or protocols required based on individual case characteristics, it is impossible tominimize cost and enable investigators to identify or rule out specific pathologies. In order to determine an adequate strategy, that is not unduly expensive, more studies should be performed on large study groups that represent patients with all causes of death. According to the articles reviewed difficulties remain, even with the advancedminimally invasive autopsy techniques The main difficulties are in detecting small metastases 80 ; in diagnosing cardiovascular disease, such as (localized or massive) acute myocardial infarction and endocarditis 57,59,108,109 ; and in distinguishing post-mortem clotting from true thromboembolic material, especially in the pulmonary arteries. 59,108 On the other hand, in certain cases post-mortem imaging has a diagnostic advantage, since some death related findings are better depicted on imaging than with conventional autopsy. For example, a pneumothorax was diagnosed on imaging only and missed at autopsy. 57,129 To achieve the highest diagnostic accuracy we think an alternative autopsy method should at least be minimally invasive. Even though the minimally invasive autopsy method is not yet as accurate as conventional autopsy, some of its other features favour this alternative method.