Department of Diagnostic Radiology, Graduate School of Biomedical and Health Science, Hiroshima University, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8551, Japan.
Center for Cause of Death Investigation Research, Graduate School of Biomedical and Health Science, Hiroshima University, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8551, Japan.
Jpn J Radiol. 2024 Aug;42(8):825-831. doi: 10.1007/s11604-024-01559-7. Epub 2024 Apr 16.
Postmortem CT (PMCT) is used widely to identify the cause of death. However, its diagnostic performance in cases of natural death from out-of-hospital cardiac arrest (OHCA) may be unsatisfactory because the cause tends to be cardiogenic and cannot be detected on PMCT images. We retrospectively investigated the diagnostic performance of PMCT in the diagnosis of natural death from OHCA and compared it to that of unnatural death.
Our series included 450 cases; 336 were natural- and 114 were unnatural death cases. Between 2018 and 2022 all underwent non-contrast PMCT to identify the cause of death. Two radiologists reviewed the PMCT images and categorized them as diagnostic (PMCT alone sufficient to determine the cause of death), suggestive (the cause of death was suggested but additional information was needed), and non-diagnostic (the cause of death could not be determined on PMCT images). The diagnostic performance of PMCT was defined by the percentage of diagnosable and suggestive cases and compared between natural- and unnatural death cases. Interobserver agreement for the cause of death on PMCT images was also assessed with the Cohen kappa coefficient of concordance.
The diagnostic performance of PMCT for the cause of natural- and unnatural deaths from OHCA was 30.3% and 66.6%, respectively (p < 0.01). The interobserver agreement for the cause of natural- and unnatural deaths on PMCT images was very good with kappa value 0.92 and 0.96, respectively.
As PMCT identified the cause of natural death by OHCA in only 30% of cases, its diagnostic performance must be improved.
死后 CT（PMCT）被广泛用于确定死因。然而，在院外心脏骤停（OHCA）自然死亡的情况下，其诊断性能可能不理想，因为死因往往是心源性的，无法在 PMCT 图像上检测到。我们回顾性研究了 PMCT 在诊断 OHCA 自然死亡中的诊断性能，并将其与非自然死亡进行了比较。
我们的系列包括 450 例；336 例为自然死亡，114 例为非自然死亡。在 2018 年至 2022 年期间，所有患者均接受非对比 PMCT 以确定死因。两名放射科医生回顾了 PMCT 图像，并将其分为诊断（仅 PMCT 即可确定死因）、提示（提示死因，但需要更多信息）和非诊断（无法在 PMCT 图像上确定死因）。PMCT 的诊断性能定义为可诊断和提示病例的百分比，并在自然死亡和非自然死亡病例之间进行比较。还使用一致性κ系数评估了 PMCT 图像上死因的观察者间一致性。
PMCT 对 OHCA 自然死亡和非自然死亡原因的诊断性能分别为 30.3%和 66.6%（p<0.01）。PMCT 图像上自然死亡和非自然死亡原因的观察者间一致性非常好，κ 值分别为 0.92 和 0.96。
由于 PMCT 仅能确定 30%的 OHCA 自然死亡原因，因此其诊断性能必须提高。
