Institute of Forensic Medicine, University Basel, Health Department Basel-Stadt, Pestalozzistrasse 22, 4056 Basel, Switzerland.
Forensic Sci Int. 2020 Oct;315:110427. doi: 10.1016/j.forsciint.2020.110427. Epub 2020 Jul 24.
The current literature about histological alterations and artefacts associated with postmortem computed tomography angiography (PMCTA) is scarce and limited to qualitative research. The aim of this study was to describe and quantify histological alterations and artefacts in histologic specimens of the inner organs. The spleen, the liver, the kidneys and the pancreas were eviscerated in the course of standard forensic autopsy, followed by manual arterial and venous perfusion of the organs with the lipophilic contrast agent Angiofil®. Computed tomography (CT) of the organ packages was executed to evaluate if the perfusion with Angiofil® was sufficient. The CT scans revealed a good delineation of the vessel trees up to the organ periphery, suggesting a sufficient perfusion. Tissue samples were taken before and after perfusion, stained with hematoxylin-eosin (H&E) and examined by using microscopy. Native and perfused specimens were assessed on the basis of a qualitative rating scale in regard to the integrity of the cells, the tissue architecture and induced alterations. Subsequently the observed differences before and after perfusion with Angiofil® were analyzed quantitatively. While the liver, spleen and kidneys could be evaluated, further microscopic examinations of the pancreatic tissue were not possible due to vast autolytic changes. On the cellular level no changes in the liver, spleen and kidneys were observed after administering Angiofil®. While the tissue architecture of these organs remained intact, a significant blood volume displacement occurred. As a consequence, tissue with hypoemic or normal blood state demonstrated congestion. Further, optically empty spaces emerged regularly in the vessels and the parenchyma of each organ as a surrogate for the lipophilic contrast agent. With a few exceptions an adequate perfusion up to the microscopic level was observed. Following the results of this investigation, CT-controlled manual injection of Angiofil® into isolated organs may be an alternative to the generalized in situ application of contrast agents in the course of PMCTA. It is of eminent importance to know the artefacts induced by an Angiofil® injection in order to avoid a misinterpretation or a masking of findings. Thus, a collection of native tissue specimens has to be done before contrast agent application.
目前关于死后 CT 血管造影 (PMCTA) 相关组织学改变和伪影的文献很少，且仅限于定性研究。本研究旨在描述和量化内脏组织学标本的组织学改变和伪影。在标准法医解剖过程中，切除脾脏、肝脏、肾脏和胰腺，然后用亲脂性对比剂 Angiofil®手动动脉和静脉灌注器官。对器官包进行 CT 扫描，以评估 Angiofil®灌注是否充足。CT 扫描显示血管树在器官周围清晰可见，提示灌注充足。在灌注前后采集组织样本，用苏木精-伊红 (H&E) 染色，然后用显微镜检查。根据细胞完整性、组织结构和诱导改变的定性评分标准评估未灌注和灌注的标本。随后分析 Angiofil®灌注前后观察到的差异。可以评估肝脏、脾脏和肾脏，但是由于广泛的自溶改变，无法进一步对胰腺组织进行显微镜检查。在给予 Angiofil®后，在细胞水平上观察到肝、脾和肾没有变化。尽管这些器官的组织结构保持完整，但发生了显著的血容量置换。因此，组织处于低灌注或正常血供状态表现为充血。此外，在每个器官的血管和实质中经常出现光学上的空空间，作为亲脂性对比剂的替代物。除了少数例外，在微观水平上观察到了足够的灌注。根据这项研究的结果，CT 控制下的 Angiofil®对孤立器官的手动注射可能是 PMCTA 中对比剂普遍原位应用的替代方法。了解 Angiofil®注射引起的伪影对于避免错误解释或掩盖发现至关重要。因此，在应用对比剂之前必须采集一组未处理的组织标本。
