Department of Radiology, Erasmus University Medical Center, 's Gravendijkwal 230, 3015 CD, Rotterdam, The Netherlands.
Department of Pathology, Erasmus University Medical Center, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands.
Eur Heart J Cardiovasc Imaging. 2018 Jul 1;19(7):739-748. doi: 10.1093/ehjci/jey015.
The autopsy rate worldwide is alarmingly low (0-15%). Mortality statistics are important, and it is, therefore, essential to perform autopsies in a sufficient proportion of deaths. The imaging autopsy, non-invasive, or minimally invasive autopsy (MIA) can be used as an alternative to the conventional autopsy in an attempt to improve postmortem diagnostics by increasing the number of postmortem procedures. The aim of this study was to determine the diagnostic accuracy of postmortem magnetic resonance imaging (MRI), computed tomography (CT), and CT-guided biopsy for the detection of acute and chronic myocardial ischaemia.
We included 100 consecutive adult patients who died in hospital, and for whom next-of-kin gave permission to perform both conventional autopsy and MIA. The MIA consists of unenhanced total-body MRI and CT followed by CT-guided biopsies. Conventional autopsy was used as reference standard. We calculated sensitivity and specificity and receiver operating characteristics curves for CT and MRI as the stand-alone test or combined with biopsy for detection of acute and chronic myocardial infarction (MI). Sensitivity and specificity of MRI with biopsies for acute MI was 0.97 and 0.95, respectively and 0.90 and 0.75, respectively for chronic MI. MRI without biopsies showed a high specificity (acute: 0.92; chronic: 1.00), but low sensitivity (acute: 0.50; chronic: 0.35). CT (total Agatston calcium score) had a good diagnostic value for chronic MI [area under curve (AUC) 0.74, 95% confidence interval (CI) 0.64-0.84], but not for acute MI (AUC 0.60, 95% CI 0.48-0.72).
We found that the combination of MRI with biopsies had high sensitivity and specificity for the detection of acute and chronic myocardial ischaemia.
全球的尸检率低得惊人（0-15%）。死亡率统计数据很重要，因此，在一定比例的死亡病例中进行尸检至关重要。成像尸检、非侵入性或微创尸检（MIA）可作为常规尸检的替代方法，通过增加尸检程序的数量来提高死后诊断的准确性。本研究旨在确定死后磁共振成像（MRI）、计算机断层扫描（CT）和 CT 引导下活检对急性和慢性心肌缺血的检测的诊断准确性。
我们纳入了 100 例连续住院死亡的成年患者，其家属同意进行常规尸检和 MIA。MIA 包括未增强的全身 MRI 和 CT，然后进行 CT 引导下活检。常规尸检作为参考标准。我们计算了 CT 和 MRI 作为单独检查或与活检联合检测急性和慢性心肌梗死（MI）的敏感性和特异性以及受试者工作特征曲线。对于急性 MI，MRI 联合活检的敏感性和特异性分别为 0.97 和 0.95，对于慢性 MI，分别为 0.90 和 0.75。无活检的 MRI 显示出高特异性（急性：0.92；慢性：1.00），但敏感性较低（急性：0.50；慢性：0.35）。CT（总 Agatston 钙评分）对慢性 MI 具有良好的诊断价值[曲线下面积（AUC）0.74，95%置信区间（CI）0.64-0.84]，但对急性 MI 无诊断价值（AUC 0.60，95%CI 0.48-0.72）。
我们发现 MRI 联合活检对检测急性和慢性心肌缺血具有较高的敏感性和特异性。
