Mokrane Fatima-Zohra, Savall Frederic, Dercle Laurent, Crubezy Eric, Telmon Norbert, Rousseau Hervé, Dedouit Fabrice
Service de Radiologie, CHU Toulouse-Rangueil, 1 avenue du Professeur Jean Poulhès, TSA 50032, 31059 Toulouse Cedex 9, France; Laboratoire AMIS-anthropologie moléculaire et imagerie de synthèse, UMR 2855, Faculté de Médecine Purpan, 37 Allées Jules Guesde, 31073 Toulouse cedex 7, France.
Service de Médecine Légale, CHU Toulouse-Rangueil, 1 avenue du Professeur Jean Poulhès, TSA 50032, 31059 Toulouse Cedex 9, France; Laboratoire AMIS-anthropologie moléculaire et imagerie de synthèse, UMR 2855, Faculté de Médecine Purpan, 37 Allées Jules Guesde, 31073 Toulouse cedex 7, France.
Forensic Sci Int. 2017 Feb;271:23-32. doi: 10.1016/j.forsciint.2016.12.008. Epub 2016 Dec 19.
Multi-phase post-mortem computed tomography angiography (MPMCTA) is a new diagnostic tool, used in forensic pathology. On the one hand, this technique allows a better and direct visualization of vascular and solid organ lesions. On the other hand, the invasiveness of the procedure-which requires surgical denudation (inguinal and/or cervical) and the insertion of surgical cannulas-leads to many relatives refusing scientific autopsies. Our hypothesis states that a minimally-invasive procedure combining interventional radiological techniques with MPMCTA (replacement of surgical cannulas by radiological catheters) will improve the approval rate of scientific autopsies by families. The aim of this study was to evaluate the feasibility of the minimally-invasive MPMCTA approach and to compare its performance to the current reference-standard (the conventional approach).
We included consecutively 16 corpses divided in two groups according to the contrast enhancement approach: radiological catheters (n=8), and surgical cannulas (n=8). Corpses were chosen and assigned randomly from our local data. The quality of the imaging procedure was compared according to four items: global vascular opacification, cerebral venous opacification, and lower limbs opacification (arterial and venous).
A minimally-invasive approach for scientific autopsies is feasible through a radiological catheter. Vascular opacification was optimal in 8 out of 8 cases and was no less effective than the control reference group using surgical cannula incision associated with their non-occlusive aspects.
多期尸检计算机断层血管造影(MPMCTA)是法医病理学中一种新的诊断工具。一方面,该技术能更好且直接地显示血管和实体器官病变。另一方面,该检查具有侵入性,需要手术剥离(腹股沟和/或颈部)并插入手术套管,这导致许多家属拒绝进行科学尸检。我们的假设是,将介入放射技术与MPMCTA相结合的微创方法(用放射导管取代手术套管)将提高家属对科学尸检的接受率。本研究的目的是评估微创MPMCTA方法的可行性,并将其性能与当前参考标准(传统方法)进行比较。
我们连续纳入了16具尸体,根据对比增强方法分为两组:放射导管组(n = 8)和手术套管组(n = 8)。尸体从我们当地的数据中随机选择并分配。根据四项指标比较成像检查的质量:整体血管显影、脑静脉显影以及下肢显影(动脉和静脉)。
通过放射导管进行科学尸检的微创方法是可行的。8例中有8例血管显影最佳,且与使用手术套管切口的对照参考组相比,在非闭塞方面效果不差。