Magnetic resonance imaging is useful in postmortem examination of neonates.1 As an alternative to invasive autopsy, the Jewish community asked for magnetic resonance imaging to be used in postmortem examinations in the general population. This service was established with the cooperation of the local coroner, and started in March 1997. Three private magnetic resonance imaging facilities take work for six coroners. Though funded, for religious reasons, by the local Jewish community, the service has also examined Muslim and Christian bodies. We describe the first fully operational service of its kind.
Methods and results
Since the inception of the service, the bodies of 53 people (28 women and 25 men), with an average age of 76 (range 54-96) years, have been examined. All were non-suspicious deaths referred to the coroner because the general practitioner or hospital doctor could not issue a death certificate or there had been recent surgery or other condition needing automatic referral to the coroner.
The cause of death was determined from magnetic resonance imaging and the clinical history. Bodies of people with metabolic disease, or other pathology unlikely to cause macroscopic changes in anatomy, were excluded from examination.
A confident diagnosis of the cause of death was made in 47 cases (87%). In six cases the clinical history and magnetic resonance imaging findings were inconclusive: invasive autopsy was necessary. The scan and autopsy results are given in the table. A full clinical history was obtained in all cases, but in one case further clinical information became available later, casting doubt over our diagnosis with magnetic resonance imaging.
Comment
In cases of non-suspicious death, magnetic resonance imaging is a credible alternative to invasive autopsy. General practitioners and hospital doctors accurately certify only 31-75% of deaths; the six cases examined by both magnetic resonance imaging and autopsy suggest that imaging is at least as accurate.2–5
Knowing the clinical history is important for evaluating images, particularly when a specific clinical question has been raised. After the clinical history was discussed with the coroner, however, nearly half the cases referred by hospital doctors were accepted by the coroner without any postmortem examination.
Many cases from general practice were referred to the coroner because the doctor had not seen the patient for several weeks, even though the patient had a proved history of disease. The doctors were either too busy or unavailable to visit the mortuary to review the body after death. In cases such as these, where specific diseases could be evaluated, magnetic resonance imaging was most valuable.
Magnetic resonance imaging is a useful examination technique. The hard copy images are suited to audit and quality control, which are noticeably absent from the present system. Imaging is expensive, however, as we scan the head, thorax, and upper abdomen. The availability of scanners and radiologists' time also limit its use.
Table.
Cause of death identified by magnetic resonance imaging and autopsy in 53 cases
| Magnetic resonance and clinical history
|
No
|
Autopsy
|
|---|---|---|
| Cardiac ischaemia or cardiac death | 31 | — |
| Pneumonia | 6 | — |
| Aortic aneurysm | 3 | — |
| Disseminated malignancy (one renal in origin) | 2 | — |
| Cerebral infarction | 2 | — |
| Cerebral haemorrhage | 1 | — |
| Adult respiratory distress syndrome (after surgery) | 1 | — |
| Pulmonary embolus (after surgery) | 1 | — |
| Pulmonary oedema, pleural effusions, abnormal left ventricular wall signal | 1 | Ischaemic heart disease, pulmonary oedema |
| Normal brain and lungs, left ventricular hypertrophy, pericardial fluid | 1 | Ischaemic heart disease |
| Old brain ischaemia, thorax and upper abdomen normal, history of ischaemic heart disease | 1 | Ischaemic heart disease |
| Fractured neck of femur, pulmonary consolidation, and oedema | 1 | Ischaemic heart disease, pneumonia, gastric erosions, pseudomembranous colitis fractured neck of femur |
| Pulmonary oedema, empyema pericardial fluid, septicaemia | 1 | Pulmonary oedema, pneumonia, pericarditis, septicaemia, empyema |
| Cardiomegaly, pulmonary oedema | 1 | Ischaemic heart disease |
Footnotes
Funding: No additional funding.
Competing interests: We performed the scans on private units, and we received private reporting fees (negligible compared to our usual private practice—that is, 53 cases over four years between four radiologists).
References
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