Ishida Masanori, Gonoi Wataru, Shirota Go, Abe Hiroyuki, Shintani-Domoto Yukako, Ikemura Masako, Ushiku Tetsuo, Abe Osamu
Department of Radiology.
Department of Pathology, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan.
Medicine (Baltimore). 2020 May;99(19):e20130. doi: 10.1097/MD.0000000000020130.
To evaluate the utility of unenhanced postmortem computed tomography (PMCT) for the investigation of in-hospital nontraumatic death in children up to 3 years of age.This study included the cadavers of children who died from intrinsic diseases before 3 years of age. The major underlying disease and the main organ-disease systems associated with the immediate causes of death were determined by clinical evaluation, PMCT, and autopsy, which were used as a reference standard. The rates of concordance between the former two methods and autopsy were calculated for all cases.In total, 22 cadavers (12 male and 10 female; mean age, 6.1 ± 8.2 months) were included. The rates of concordance between clinical evaluation/PMCT and autopsy for diagnosis of the major underlying disease and main organ-disease systems associated with the immediate causes of death were 100%/36% (P = .0015) and 59%/41% (P = .37), respectively. In cases where the respiratory system was associated with the immediate cause of death, PMCT showed greater diagnostic sensitivity (90%) than did clinical evaluation (20%). In contrast, the diagnostic sensitivity of PMCT was lower than that of clinical evaluation in cases involving disorders of the cardiac system and multiple organ systems (0% vs 100% for both).The findings of this study suggest that the use of unenhanced PMCT with clinical evaluation can result in improved detection of the immediate cause of death in select cases of in-hospital nontraumatic death before 3 years of age.
评估非增强型尸检计算机断层扫描（PMCT）在调查3岁以下儿童院内非创伤性死亡中的应用价值。本研究纳入了3岁前因内在疾病死亡的儿童尸体。通过临床评估、PMCT和作为参考标准的尸检来确定主要潜在疾病以及与直接死因相关的主要器官疾病系统。计算前两种方法与尸检在所有病例中的一致性率。总共纳入了22具尸体（12例男性和10例女性；平均年龄6.1±8.2个月）。临床评估/PMCT与尸检在诊断主要潜在疾病以及与直接死因相关的主要器官疾病系统方面的一致性率分别为100%/36%（P = 0.0015）和59%/41%（P = 0.37）。在呼吸系统与直接死因相关的病例中，PMCT显示出比临床评估更高的诊断敏感性（90%对20%）。相比之下，在涉及心脏系统和多器官系统疾病的病例中，PMCT的诊断敏感性低于临床评估（两者均为0%对100%）。本研究结果表明，在3岁以下儿童院内非创伤性死亡的特定病例中，结合临床评估使用非增强型PMCT可提高对直接死因的检测。
