Forensic Imaging Center Bern, Institute of Forensic Medicine, University of Bern, Bern, Switzerland.
J Am Coll Cardiol. 2013 Aug 13;62(7):617-29. doi: 10.1016/j.jacc.2013.01.089. Epub 2013 Apr 3.
This study aimed to investigate post-mortem magnetic resonance imaging (pmMRI) for the assessment of myocardial infarction and hypointensities on post-mortem T2-weighted images as a possible method for visualizing the myocardial origin of arrhythmic sudden cardiac death.
Sudden cardiac death has challenged clinical and forensic pathologists for decades because verification on post-mortem autopsy is not possible. pmMRI as an autopsy-supporting examination technique has been shown to visualize different stages of myocardial infarction.
In 136 human forensic corpses, a post-mortem cardiac MR examination was carried out prior to forensic autopsy. Short-axis and horizontal long-axis images were acquired in situ on a 3-T system.
In 76 cases, myocardial findings could be documented and correlated to the autopsy findings. Within these 76 study cases, a total of 124 myocardial lesions were detected on pmMRI (chronic: 25; subacute: 16; acute: 30; and peracute: 53). Chronic, subacute, and acute infarction cases correlated excellently to the myocardial findings on autopsy. Peracute infarctions (age range: minutes to approximately 1 h) were not visible on macroscopic autopsy or histological examination. Peracute infarction areas detected on pmMRI could be verified in targeted histological investigations in 62.3% of cases and could be related to a matching coronary finding in 84.9%. A total of 15.1% of peracute lesions on pmMRI lacked a matching coronary finding but presented with severe myocardial hypertrophy or cocaine intoxication facilitating a cardiac death without verifiable coronary stenosis.
3-T pmMRI visualizes chronic, subacute, and acute myocardial infarction in situ. In peracute infarction as a possible cause of sudden cardiac death, it demonstrates affected myocardial areas not visible on autopsy. pmMRI should be considered as a feasible post-mortem investigation technique for the deceased patient if no consent for a clinical autopsy is obtained.
本研究旨在探讨死后磁共振成像（pmMRI）在评估心肌梗死和死后 T2 加权图像上的低信号中的作用，作为可视化心律失常性心源性猝死心肌起源的一种可能方法。
心源性猝死几十年来一直困扰着临床和法医病理学家，因为死后尸检无法证实。pmMRI 作为一种支持尸检的检查技术，已被证明可以可视化不同阶段的心肌梗死。
在 136 例人体法医尸体中，在法医解剖前进行了死后心脏磁共振检查。在 3T 系统上原位采集短轴和水平长轴图像。
在 76 例病例中，可以记录到心肌发现，并与尸检发现相关。在这 76 例研究病例中，共在 pmMRI 上检测到 124 个心肌病变（慢性：25 个；亚急性：16 个；急性：30 个；和超急性：53 个）。慢性、亚急性和急性梗死病例与尸检的心肌发现相关性极好。肉眼尸检或组织学检查均无法检测到超急性梗死（发病时间：数分钟至约 1 小时）。pmMRI 上检测到的超急性梗死区域在 62.3%的情况下可以通过有针对性的组织学调查得到证实，在 84.9%的情况下可以与相应的冠状动脉发现相关。pmMRI 上的 15.1%的超急性病变缺乏相应的冠状动脉发现，但伴有严重的心肌肥厚或可卡因中毒，导致可证实的冠状动脉狭窄无明显狭窄的情况下发生心源性猝死。
3T pmMRI 可在原位可视化慢性、亚急性和急性心肌梗死。在可能导致心源性猝死的超急性梗死中，它显示了肉眼尸检无法显示的受影响的心肌区域。如果未获得临床尸检同意，pmMRI 应被视为一种可行的死后检查技术。
