Department of Forensic Medicine, Jagiellonian University Medical College, Kraków, Poland.
IDietrich-Bonhoeffer Klinikum Neubrandenburg, Germany.
Arch Med Sadowej Kryminol. 2024;74(1):50-63. doi: 10.4467/16891716AMSIK.24.004.19649.
The aim of this study is to provide a retrospective assessment of the possibility of determining the severity of atherosclerosis based on postmortem computed tomography (PMCT), autopsy protocols and histopathological examination results. In the first stage of the study, 200 cases were evaluated of persons over 40 years of age in whom postmortem computed tomography and autopsy were performed. In the second stage, the cases were divided into a study group (cardiovascular deaths) and a control group, as well as divided by age and, in addition to autopsy protocols and PMCT results, histopathological findings were evaluated.
The results of stage I demonstrated that the best detection of atherosclerosis was in the advanced stage with a predominance of detection in PMCT. Atherosclerosis detection in autopsy was highest in the coronary arteries, aorta and cerebral arteries; while in PMCT it remained equal in all evaluated locations. Autopsy showed higher detection of advanced atherosclerotic lesions in the coronary arteries and aorta compared to PMCT. The results of stage II of the study revealed that attaching the results of the general histopathological examination to the retrospective evaluation does not provide an opportunity to increase the accuracy of the evaluation of atherosclerotic lesions. The results obtained indicate the need for prospective studies.
Autopsy allows macroscopic evaluation of a very broad spectrum of atherosclerotic lesions, but often without precise determination of their nature, and with limited localization; PMCT allows accurate and reproducible evaluation of calcified atherosclerotic lesions in large and medium-sized vessels, but is unsuitable for the evaluation of non-calcified lesions and small vessels; targeted histopathological examinations allow very accurate, but local assessment of atherosclerotic lesions.
本研究旨在通过死后计算机断层扫描（PMCT）、尸检协议和组织病理学检查结果，对基于死后 CT 确定动脉粥样硬化严重程度的可能性进行回顾性评估。在研究的第一阶段，评估了 200 例 40 岁以上行 PMCT 和尸检的患者。在第二阶段，将病例分为研究组（心血管死亡）和对照组，并按年龄分组，除了尸检协议和 PMCT 结果外，还评估了组织病理学发现。
第一阶段的结果表明，在晚期阶段，PMCT 对动脉粥样硬化的检测最佳，以检测为主。尸检对冠状动脉、主动脉和脑动脉的动脉粥样硬化检测最高；而 PMCT 在所有评估部位的检测率均相等。尸检显示，与 PMCT 相比，冠状动脉和主动脉的晚期动脉粥样硬化病变检测率更高。研究第二阶段的结果表明，将一般组织病理学检查结果附加到回顾性评估中，并没有提供增加动脉粥样硬化病变评估准确性的机会。研究结果表明需要进行前瞻性研究。
尸检可以对非常广泛的动脉粥样硬化病变进行宏观评估，但往往无法准确确定其性质和局限性；PMCT 可以准确、可重复地评估大中血管的钙化性动脉粥样硬化病变，但不适合评估非钙化性病变和小血管；靶向组织病理学检查可以对动脉粥样硬化病变进行非常准确但局部的评估。
