15283-B-Blokker

72 Chapter 4 Table 4. Advantages and disadvantages of non-invasive and minimally invasive autopsy methods using radiological techniques Advantages Disadvantages Ultrasound 105,106 Logistics High availability. Operator friendly Image quality and diagnose Inferior to MRI and CT in image quality. Inferior to MRI and CT in biopsy guidance. Limited visualisation of the vascular system (no flow). Operator dependent Cost Inexpensive CT 103,125,132 Logistics High availability. Rapid whole-body examination. Repeated scanning possible. Possibility of biopsy guidance Logistics Limited availability during regular working hours (interferes with scanning of the living) Cost Relatively inexpensive (compared to MRI) Image quality and diagnose Limited visualisation of pathology in soft tissues and organ parenchyma. Limited differentiation of normal postmortem changes (e.g. clotting, sedimentation) and pathology (e.g. pulmonary thromboembolism). Limited ability to diagnose cardiac causes of death (e.g. patency of coronaries, acute myocardial infarction). Image artefacts (e.g. metal from dental filling, prosthetic valves) Image quality and diagnose Good visualization of bone (e.g. fractures), lung parenchyma disease, calcifications (stones, atherosclerosis), acute haemorrhage, air/ gas (e.g. pneumothorax, pneumatosis intestinalis, free air). High in-plane resolution (e.g. small lung nodules). Isovolumetric multi-planar and 3D reconstructions MRI 103,126,132 Logistics Possibility of biopsy guidance Logistics Limited availability during regular working hours (interferes with scanning of the living). Relatively time consuming examination (depending on scan protocol). Requires dedicated postmortem scan protocols (e.g. adjusting scan parameters for the body temperature). Requires MRI compatible body bags (e.g. no metal) Image quality and diagnose Good, detailed visualization of organ parenchyma (e.g. brain, heart and myocardial infarct age), soft tissue (e.g. muscle injury), fluids (e.g. pleural/ pericardial), nervous system (e.g. spinal canal disorders), bone marrow disorders, metabolic diseases (e.g. hemochromatosis), large vessels (e.g. aortic dissection). Good differentiation between postmortem changes and pathology Cost Relatively expensive. Requires dedicated training of technicians Image quality and diagnose Image artefacts (e.g. metal from dental filling) CT Angiography 80,97,125,128,132 Image quality and diagnose Good detection (of the origin) of haemorrhages (e.g. aortic rupture). Good detection of cardiovascular conditions (e.g. coronary stenosis) Logistics Limited availability of dedicated equipment and contrast agents. Time consuming and complicated examination (e.g. achieving optimal contrast timing and full enhancement is difficult) Cost Expensive (longer procedure time, contrast agents, dedicated equipment). Requires dedicated training Image quality and diagnose Differentiation between post-mortem clotting and embolus is difficult. Lack of circulation and insufficient mixing of blood and contrast Targeted CT (coronary) angiography 97,119,120 Cost Relatively inexpensive equipment (compared to whole-body angiography). Cannulation and scanning can be performed with minimal training Logistics Time consuming examination (e.g. positioning catheter, turning the corpse) Image quality and diagnose Less expensive than whole-body angiography Image quality and diagnose Images restricted to coronary arteries. Limited visualisation of internal mammary grafts, due to balloon position in the ascending aorta