Fukuda Haruki, Tokue Hiroyuki, Shiraishi Miyuki, Hayakawa Akira, Sano Rie
Department of Legal Medicine, Graduate School of Medicine, Gunma University, Maebashi, JPN.
Department of Diagnostic Radiology and Nuclear Medicine, Graduate School of Medicine, Gunma University, Maebashi, JPN.
Cureus. 2024 Jul 15;16(7):e64565. doi: 10.7759/cureus.64565. eCollection 2024 Jul.
Postmortem computed tomography angiography (PMCTA) is a valuable tool for diagnosing vascular conditions, such as hemorrhages, in trauma cases. This case report demonstrates the use of the Voronoi algorithm to assess myocardial ischemia using coronary PMCTA. A male in his 70s was found unconscious in a car after colliding with a traffic light pole. Despite medical interventions, including pericardial drainage and cardiopulmonary resuscitation, the patient died two hours later. PMCTA revealed significant filling defects in the left anterior descending artery (LAD), consistent with plaque rupture and narrowing observed during autopsy. The cause of death in this case was likely cardiac tamponade due to cardiac rupture secondary to myocardial infarction resulting from LAD stenosis. Cardiac perfusion areas were analyzed using the Voronoi algorithm, demonstrating a total myocardial volume of 151.9 mL in the left ventricle. Perfusion volumes were calculated as 92.9 mL (61.2%) for the LAD, 34.2 mL (22.5%) for the left circumflex artery, and 24.9 mL (16.4%) for the right coronary artery. The predicted ischemic volume distal to the LAD stenosis was estimated to be 49.8 mL (32.8%). Furthermore, the ischemic areas observed during autopsy macroscopically corresponded well with the predicted ischemic regions. This case highlights that combining PMCTA with the Voronoi algorithm provides an accurate method for assessing myocardial ischemic areas, offering a non-invasive approach to visualize and quantify perfusion and ischemic regions.
尸检计算机断层血管造影（PMCTA）是诊断创伤病例中血管疾病（如出血）的一种有价值的工具。本病例报告展示了使用Voronoi算法通过冠状动脉PMCTA评估心肌缺血情况。一名70多岁男性在与交通灯杆碰撞后被发现昏迷在车内。尽管进行了包括心包引流和心肺复苏在内的医疗干预，患者仍在两小时后死亡。PMCTA显示左前降支（LAD）存在明显充盈缺损，与尸检时观察到的斑块破裂和狭窄情况一致。该病例的死亡原因可能是由于LAD狭窄导致心肌梗死继发心脏破裂引起的心包填塞。使用Voronoi算法分析心脏灌注区域，结果显示左心室心肌总体积为151.9 mL。LAD的灌注体积计算为92.9 mL（61.2%），左旋支动脉为34.2 mL（22.5%），右冠状动脉为24.9 mL（16.4%）。LAD狭窄远端的预测缺血体积估计为49.8 mL（32.8%）。此外，尸检时宏观观察到的缺血区域与预测的缺血区域吻合良好。该病例突出表明，将PMCTA与Voronoi算法相结合为评估心肌缺血区域提供了一种准确方法，提供了一种可视化和量化灌注及缺血区域的非侵入性途径。
