Virtual autopsies beat real ones

Nick Carne

Nick Carne

Dutch pathologists believe a less invasive approach to autopsies may be more acceptable to families and actually produce better outcomes.

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Autopsy images of a 60-year old man who underwent bilateral lung transplant two months before death. Credit: Radiological Society of North America

That’s not great news if you can’t imagine TV hospital dramas or police procedurals without some reality that makes you squirm, but new research suggests a high-tech but less visual alternative is well worth considering.

In a paper published in the journal Radiology, a team from Erasmus University Medical Centre in Rotterdam reports that computed tomography (CT) and magnetic resonance imaging (MRI) perform as well as conventional autopsy in detecting cause of death and yield more diagnoses.

“With minimally invasive autopsy the body is investigated from top to toe and with regular autopsy usually only the torso and, if consented by next of kin, the brain,” explains senior author Wolter Oosterhuis.

“Moreover, post-mortem CT and MRI demonstrate pathology, in particular of the skeleton and soft tissues, that is easily missed by the regular autopsy.”

It must be said that not all previous research has been as fulsome in its praise of minimally invasive approaches, sometimes suggesting they may be useful adjuncts or alternatives when a conventional autopsy is refused, but are not the whole answer.

Some specific studies have pointed to limitations, such as failing to demonstrate cardiac disease as an underlying cause of death or frequently missing causes of sudden death.

However, Oosterhuis and colleagues recorded impressive results when they compared combined post-mortem MRI, CT and CT-guided biopsies of main organs and lesions with conventional autopsies performed on 99 patients who had died in hospital.

The primary outcome measure was performance of minimally invasive autopsy and conventional autopsy in establishing immediate cause of death, compared to consensus cause of death.

They found agreement for cause of death in 92% of the cases. There was agreement with the consensus cause of death in 96 of 99 of the cases of minimally invasive autopsy, compared with 94 of 99 for conventional autopsy.

The 99 deceased had a total of 288 major diagnoses related to the consensus cause of death. Minimally invasive autopsy diagnosed 90% of them, compared with 78% for conventional autopsy.

The researchers also point to two other arguments they say favour a minimally invasive approach.

The first is that it provides a potentially more desirable option for next of kin, who may be reluctant to approve a conventional procedure on religious grounds. This is seen as one reason why rates of autopsy are declining, despite their value.

The second is that the information gathered can be stored for long-term use.

“It’s very important to note that conventional autopsy cannot be redone and items that were overlooked or misinterpreted cannot be corrected,” Oosterhuis says.

“Minimally invasive autopsy, on the other hand, provides a permanent record of the entire body that can be revisited and reanalysed by pathologists, radiologists, clinicians and next of kin.  For scientists, this dependable database has great potential for future research.”

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