Wiskott Kim, Magnin Virginie, Egger Coraline, Soto Ruben, Grabherr Silke, Fracasso Tony
University Center of Legal Medicine Lausanne-Geneva, University of Geneva, Geneva University Hospitals, Rue Michel-Servet 1, 1211, Geneva 4, Switzerland.
University Center of Legal Medicine Lausanne-Geneva, University of Lausanne, Lausanne University Hospital, Chemin de La Vuillette 4, 1000, Lausanne, Switzerland.
Int J Legal Med. 2025 Sep 8. doi: 10.1007/s00414-025-03593-0.
In the past 10 years, the Multi-phase Post-mortem Computed Tomography Angiography (MPMCTA) has considerably improved the quality and precision of postmortem diagnoses, particularly in cases with vascular implication. MPMCTA is known to have higher sensitivity for detecting the source of a hemorrhage than autopsy. Death by upper gastro-intestinal (GI) bleeding is not so uncommon in forensic practice. MPMCTA, like any other diagnostic test, can produce artifacts that must be recognized. Radiologists at our center have previously encountered images suggestive of upper GI bleeding that were ultimately identified as artifacts during autopsy. This is why we believe it is essential to establish criteria to differentiate true bleeding from artifacts. The aim of our study was to compare the diagnostic value of MPMCTA and autopsy in detecting and localizing sources of upper GI bleeding, and to establish diagnostic criteria to aid in the interpretation of upper GI contrast extravasation on angiography. We conducted a retrospective cross-sectional study, analyzing MPMCTA and autopsy data from 326 human bodies. In the GI tract, contrast extravasation should not be immediately interpreted as a sign of active bleeding. In cases of true GI hemorrhage, MPMCTA reveals specific features suggestive of bleeding, such as hyperdense material within the GI tract on native CT, and a focal contrast leakage during the arterial or venous phase. This article offers tips that may help radiologists and forensic pathologists distinguish true bleeding from artifacts when interpreting MPMCTA findings in the upper GI tract.
在过去10年中，多期尸检计算机断层血管造影（MPMCTA）显著提高了尸检诊断的质量和准确性，尤其是在涉及血管的病例中。众所周知，MPMCTA在检测出血源方面比尸检具有更高的敏感性。上消化道（GI）出血导致的死亡在法医实践中并不罕见。与任何其他诊断测试一样，MPMCTA也可能产生必须识别的伪影。我们中心的放射科医生此前曾遇到过提示上消化道出血的图像，这些图像在尸检时最终被确定为伪影。这就是为什么我们认为有必要建立区分真正出血和伪影的标准。我们研究的目的是比较MPMCTA和尸检在检测和定位上消化道出血源方面的诊断价值，并建立有助于解释血管造影中上消化道对比剂外渗的诊断标准。我们进行了一项回顾性横断面研究，分析了326具尸体的MPMCTA和尸检数据。在胃肠道中，对比剂外渗不应立即被解释为活动性出血的迹象。在真正的胃肠道出血病例中，MPMCTA显示出提示出血的特定特征，如在平扫CT上胃肠道内的高密度物质，以及在动脉期或静脉期的局灶性对比剂渗漏。本文提供了一些提示，可能有助于放射科医生和法医病理学家在解释上消化道MPMCTA结果时区分真正的出血和伪影。
