Determination of cause of death with blinded coronal whole-body MRI compared to forensic examination

Abstract

Objective: Value of a simplified coronal whole-body magnetic resonance imaging (MRI) protocol in determining cause of death. Material and methods: A total of 30 cases were evaluated by post-mortem whole-body MRI. The radiologists did not receive any information concerning the medical history of the deceased or the circumstances of death. The study was carried out with a coronal whole-body protocol, without complementary axial sequences. The MRI was performed on a 1.5 Tesla magnetic resonance system. The blinded imaging outcomes were correlated with those of forensic examination (medical history, autopsy, histopathology) as the reference standard. Results: The mean age at the time of death was 54 years (range 1–86 years). The most common cause of death was cardiac disease in 15 cases, followed by the diagnosis of pneumonia (3 cases). In 3 cases, the cause of death after MRI and autopsy remained unclear. A cardiac cause of death was correctly diagnosed with MRI in 14 of the 15 cases and a non-cardiac cause of death in 11 of the 15 cases. The overall sensitivity of MRI was 83% with a specificity of 98%. With exact differentiation between acute myocardial infarction and other cardiac causes of death, the sensitivity of MRI decreased to 60% (specificity 97%). Conclusion: Despite the simplified coronal examination protocol, matches with the conventional autopsy are achievable, as previously described only for more elaborate protocols with minimally invasive methods and combinations of computed tomography (CT) and MRI. Therefore, a simplified MRI examination as used in this study seems to be feasible in the clinical routine of post-mortem diagnostics.