Skip to main content
Log in

The effect of post-mortem computed tomography angiography (PMCTA) using water-soluble, iodine-based radiographic contrast on histological analysis of the liver, kidneys and left ventricle of the heart

  • Original Article
  • Published:
Forensic Science, Medicine and Pathology Aims and scope Submit manuscript

Abstract

The purpose of this study was to investigate the impact of post-mortem computed-tomography angiography (PMCTA) on the histology of the liver, kidneys and heart. Multiple tissue cores were collected from the liver, left and right kidneys and left ventricle utilizing CT-guided biopsy. Subsequent whole body PMCTA was performed using a solution of polyethylene glycol and iodinated radiographic contrast, and an embalming pump. Corresponding biopsy cores were collected at autopsy, and blinded histology analysis assessing for PMCTA-induced histology artefact was performed. The blinded analysis of pre-PMCTA and post-PMCTA biopsy samples demonstrated that whole body PMCTA had no effect on the histological analyses of the liver (0%, CI = 0–13.7%), left ventricle of the heart (0%, CI = 0–36.9%) and right kidney (0%, CI = 13.2%), however likely caused increased Bowman’s capsule spaces in the left kidney of one case (4%, CI = 0.01–20.4%). Other artefactual histological changes identified included eosinophilic material in the liver, whiter interstitium and dilated tubules in kidney samples, and autolysis-related changes, however these could not be categorically attributed to the PMCTA procedure. PMCTA causes zero or minimal effect to the histological examination of the liver, left kidney, right kidney and left ventricle, and as such performing PMCTA prior to autopsy is unlikely to impact autopsy histological results in these organs.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Jackowski C, Bolliger S, Aghayev E, Christe A, Kilchoer T, Aebi B, et al. Reduction of postmortem angiography-induced tissue edema by using polyethylene glycol as a contrast agent dissolver. J Forensic Sci. 2006;51(5):1134–7.

    Article  PubMed  Google Scholar 

  2. Capuani C, Guilbeau-Frugier C, Mokrane FZ, Delisle MB, Marcheix B, Rousseau H, et al. Tissue microscopic changes and artifacts in multi-phase post-mortem computed tomography angiography in a hospital setting: a fatal case of systemic vasculitis. Forensic Sci Int. 2014;242:e12–7.

    Article  PubMed  Google Scholar 

  3. Bancroft J. Theory and practice of histological techniques. 6th ed. Edinburgh: Churchill Livingstone; 2008.

    Google Scholar 

  4. Clopper C. The use of confidence or fiducial limits illustrated in the case of the binomial. Biometrika. 1934;26:404–13.

    Article  Google Scholar 

  5. Bowers D. Medical statistics from scratch - an introduction for health professionals. 2nd ed. John Wiley and Sons Ltd: Chichester, England, Hoboken; 2008.

    Google Scholar 

  6. Ross S, Spendlove D, Bolliger S, Christe A, Oesterhelweg L, Grabherr S, et al. Postmortem whole-body CT angiography: evaluation of two contrast media solutions. Am J Roentgen. 2008;190(5):1380–9.

    Article  Google Scholar 

  7. Grabherr S, Grimm J, Baumann P, Mangin P. Application of contrast media in post-mortem imaging (CT and MRI). Radiol Med. 2015;120(9):825–34.

    Article  Google Scholar 

  8. Jackowski C, Persson A, Thali M. Whole body postmortem angiography with a high viscosity contrast agent solution using poly ethylene glycol as contrast agent dissolver. J Forensic Sci. 2008;53(2):465–8.

    Article  PubMed  Google Scholar 

  9. Ross SG, Bolliger SA, Ampanozi G, Oesterhelweg L, Thali MJ, Flach PM. Postmortem CT angiography: capabilities and limitations in traumatic and natural causes of death. Radiographics. 2014;34(3):830–46.

    Article  PubMed  Google Scholar 

  10. Zhou C, Byard RW. Factors and processes causing accelerated decomposition in human cadavers - an overview. J Forensic Legal Med. 2011;18(1):6–9.

    Article  Google Scholar 

  11. Apitzsch JC, Westphal S, Penzkofer T, Kuhl CK, Knüchel R, Mahnken AH. The use of contrast-enhanced post mortem CT in the detection of cardiovascular deaths. PLoS One. 2014;9(4):e93101.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Shoukri M. Measures of interobserver agreement and reliability. 2nd ed. Boca Raton: CRC Press; 2008.

    Google Scholar 

  13. Mladinich C, Ackerman N, Berry CR, Buergelt CD, Longmate J. Evaluation and comparison of automated biopsy devices: work in progress. Radiology. 1992;184(3):845–7.

    Article  CAS  PubMed  Google Scholar 

  14. Sternberg S. Histology for pathologists. 2nd ed. Philadelphia: Lippencott-Raven; 1997.

    Google Scholar 

  15. Hopper K, Abendroth CS, Sturtz KW, Matthews YL, Stevens LA, Shirk SJ. Automated biopsy devices: a blinded evaluation. Radiology. 1993;187(3):653–60.

    Article  CAS  PubMed  Google Scholar 

  16. Rastogi V, Puri N, Arora S, Kaur G, Yadav L, Sharma R. Artefacts: a diagnostic dilemma - a review. J Clin Diagn Res. 2013;7(10):2408–13.

    PubMed  PubMed Central  Google Scholar 

  17. Ruder T, Schulze K, Ross S, Ampanozi G, Gascho D, Laberke P, et al. Into the decomposed body - feasibility of post-mortem CT angiography in a decomposed cadaver. J Forensic Radiol Imaging. 2014;2(3):149–52.

    Article  Google Scholar 

  18. Egger C, Bize P, Vaucher P, Mosimann P, Schneider B, Dominguez A, et al. Distribution of artifactual gas on post-mortem multidetector computed tomography (MDCT). Int J Legal Med. 2012;126(1):3–12.

    Article  PubMed  Google Scholar 

  19. Dettmeyer RB. The role of histopathology in forensic practice: an overview. Forensic Sci Med Pathol. 2014;10(3):401–12.

    Article  CAS  PubMed  Google Scholar 

  20. Bruguier C, Mosimann PJ, Vaucher P, Uské A, Doenz F, Jackowski C, et al. Multi-phase postmortem CT angiography: recognizing technique-related artefacts and pitfalls. Int J Legal Med. 2013;127(3):639–52.

    Article  CAS  PubMed  Google Scholar 

  21. Robinson C, Barber J, Amoroso J, Morgan B, Rutty G. Pump injector system applied to targeted post-mortem coronary artery angiography. Int J Legal Med. 2013;127(3):661–6.

    Article  PubMed  Google Scholar 

  22. Inokuchi G, Yajima D, Hayakawa M, Motomura A, Chiba F, Torimitsu S, et al. The utility of postmortem computed tomography selective coronary angiography in parallel with autopsy. Forensic Sci Med Pathol. 2013;9(4):506–14.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The VIFM Histology staff for histological support.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Samantha Higgins.

Ethics declarations

Ethics

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Ethics approval references numbers University of Melbourne Ethics ID 1238028 and VIFM 8/2012.

Conflicts of interest

None to declare.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Higgins, S., Parsons, S., Woodford, N. et al. The effect of post-mortem computed tomography angiography (PMCTA) using water-soluble, iodine-based radiographic contrast on histological analysis of the liver, kidneys and left ventricle of the heart. Forensic Sci Med Pathol 13, 317–327 (2017). https://doi.org/10.1007/s12024-017-9871-8

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12024-017-9871-8

Keywords

Navigation