Hoppe Hanno, Arnold Isabel, Lange-Herr Nicolas, Klaus Jeremias, Schwendener Nicole, Brünig Julia, Dislich Bastian, Trippel Mafalda, Banz Yara, Zech Wolf-Dieter
Department of Diagnostic, Interventional, and Pediatric Radiology, Bern University Hospital, University of Bern, Inselspital Bern, Switzerland.
Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland.
Virchows Arch. 2025 Jun 5. doi: 10.1007/s00428-025-04130-5.
The last decades have seen a constant decline in non-forensic clinical autopsy rates worldwide. In this context, post-mortem computed tomography (PMCT) and post-mortem magnetic resonance imaging (PMMR) might offer an alternative to the clinical autopsy. So far, post-mortem imaging is used routinely only in forensic medicine, but it has not yet been implemented into routine clinical pathology casework. This study aimed to assess the diagnostic accuracy of unenhanced PMCT and PMMR for basic pathology groups and specific diagnoses compared to the clinical autopsy. Post-mortem imaging (PMCT and PMMR) was conducted before autopsy on n = 120 non-forensic patients deceased in hospitals in a prospective study. Imaging findings were compared to autopsy findings, and sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for causes of death and specific pathologic findings. Some of the diagnoses recorded showed high specificity and NPV of over 85% for both PMCT and PMMR. However, even the combined use of PMCT and PMMR could not visualize various relevant autopsy findings such as those related to sepsis, hematologic malignancies, chronic liver congestion, endomyocardial, myocardial, and liver fibrosis, acute tubular necrosis, aortic valve stenosis, duodenal ulceration, and small macroscopic findings in general. For specific findings, post-mortem imaging showed no significant differences to autopsy and high diagnostic accuracy with over 85% sensitivity. Examples for such findings included the diagnosis of acute myocardial infarction and pulmonary embolism in PMMR, pneumonia in PMCT, as well as pancreatitis, abscesses, metastases, and aortic dissection in both PMCT and PMMR.
在过去几十年里，全球非法医临床尸检率持续下降。在此背景下，尸检计算机断层扫描（PMCT）和尸检磁共振成像（PMMR）可能为临床尸检提供一种替代方法。到目前为止，尸检成像仅在法医学中常规使用，但尚未应用于常规临床病理工作。本研究旨在评估与临床尸检相比，未增强的PMCT和PMMR对基本病理组和特定诊断的诊断准确性。在一项前瞻性研究中，对n = 120例在医院死亡的非法医患者在尸检前进行了尸检成像（PMCT和PMMR）。将成像结果与尸检结果进行比较，并计算死因和特定病理结果的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）。记录的一些诊断显示，PMCT和PMMR的特异性和NPV均超过85%。然而，即使联合使用PMCT和PMMR，也无法显示各种相关的尸检结果，如与败血症、血液系统恶性肿瘤、慢性肝淤血、心内膜、心肌和肝纤维化、急性肾小管坏死、主动脉瓣狭窄、十二指肠溃疡以及一般微观检查结果相关的那些。对于特定结果，尸检成像与尸检相比无显著差异，且诊断准确性高，敏感性超过85%。这些结果的例子包括PMMR中急性心肌梗死和肺栓塞的诊断、PMCT中肺炎的诊断，以及PMCT和PMMR中胰腺炎、脓肿、转移瘤和主动脉夹层的诊断。
