University Center of Legal Medicine, Lausanne and Geneva, Rue du Bugnon 21, 1011, Lausanne, Switzerland,
Int J Legal Med. 2014 Jan;128(1):127-37. doi: 10.1007/s00414-013-0819-6. Epub 2013 Jan 16.
Postmortem imaging is increasingly used in forensic practice in cases of natural deaths related to cardiovascular diseases, which represent the most common causes of death in developed countries. While radiological examination is generally considered to be a good complement for conventional autopsy, it was thought to have limited application in cardiovascular pathology. At present, multidetector computed tomography (MDCT), CT angiography, and cardiac magnetic resonance imaging (MRI) are used in postmortem radiological investigation of cardiovascular pathologies. This review presents the actual state of postmortem imaging for cardiovascular pathologies in cases of sudden cardiac death (SCD), taking into consideration both the advantages and limitations. The radiological evaluation of ischemic heart disease (IHD), the most frequent cause of SCD in the general population of industrialized countries, includes the examination of the coronary arteries and myocardium. Postmortem CT angiography (PMCTA) is very useful for the detection of stenoses and occlusions of coronary arteries but less so for the identification of ischemic myocardium. MRI is the method of choice for the radiological investigation of the myocardium in clinical practice, but its accessibility and application are still limited in postmortem practice. There are very few reports implicating postmortem radiology in the investigation of other causes of SCD, such as cardiomyopathies, coronary artery abnormalities, and valvular pathologies. Cardiomyopathies representing the most frequent cause of SCD in young athletes cannot be diagnosed by echocardiography, the most widely available technique in clinical practice for the functional evaluation of the heart and the detection of cardiomyopathies. PMCTA and MRI have the potential to detect advanced stages of diseases when morphological substrate is present, but these methods have yet to be sufficiently validated for postmortem cases. Genetically determined channelopathies cannot be detected radiologically. This review underlines the need to establish the role of postmortem radiology in the diagnosis of SCD.
死后影像学在与心血管疾病相关的自然死亡的法医学实践中越来越多地被应用，这些疾病是发达国家最常见的死亡原因。虽然放射学检查通常被认为是常规尸检的良好补充，但它在心血管病理学中的应用被认为是有限的。目前，多排螺旋 CT（MDCT）、CT 血管造影和心脏磁共振成像（MRI）被用于心血管病理学的死后放射学研究。本综述考虑到优势和局限性，介绍了在心脏性猝死（SCD）病例中，心血管病理学死后影像学的现状。放射学评估缺血性心脏病（IHD），这是工业化国家普通人群中 SCD 的最常见原因，包括冠状动脉和心肌的检查。死后 CT 血管造影（PMCTA）非常有助于检测冠状动脉狭窄和闭塞，但对识别缺血性心肌的作用较小。MRI 是临床实践中心肌放射学研究的首选方法，但在死后实践中，其可及性和应用仍然有限。很少有报道表明死后放射学在其他原因的 SCD 调查中起作用，例如心肌病、冠状动脉异常和瓣膜病变。在年轻运动员中最常见的 SCD 原因的心肌病不能通过超声心动图诊断，超声心动图是临床实践中最广泛使用的用于评估心脏功能和检测心肌病的技术。PMCTA 和 MRI 有可能在存在形态学底物时检测到疾病的晚期，但这些方法尚未在死后病例中得到充分验证。遗传性通道病不能通过放射学检测。本综述强调了需要确定死后放射学在 SCD 诊断中的作用。
