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Postmortem Whole-Body CT Angiography: Evaluation of Two Contrast Media Solutions

¹ Centre for Forensic Imaging and Virtopsy, Institute of Forensic Medicine, University of Bern, Buehlstrasse 20, CH-3012 Bern, Switzerland.
² Department of Radiology, Inselspital Bern, University of Bern, Bern, Switzerland.
³ Institute of Forensic Medicine, University of Lausanne, Lausanne, Switzerland.
⁴ Clinic for Cardiovascular Surgery, Inselspital Bern, University of Bern, Bern, Switzerland.

OBJECTIVE. The objective of our study was to establish a standardized procedure for postmortem whole-body CT-based angiography with lipophilic and hydrophilic contrast media solutions and to compare the results of these two methods.

MATERIALS AND METHODS. Minimally invasive postmortem CT angiography was performed on 10 human cadavers via access to the femoral blood vessels. Separate perfusion of the arterial and venous systems was established with a modified heart–lung machine using a mixture of an oily contrast medium and paraffin (five cases) and a mixture of a water-soluble contrast medium with polyethylene glycol (PEG) 200 in the other five cases. Imaging was executed with an MDCT scanner.

RESULTS. The minimally invasive femoral approach to the vascular system provided a good depiction of lesions of the complete vascular system down to the level of the small supplying vessels. Because of the enhancement of well-vascularized tissues, angiography with the PEG-mixed contrast medium allowed the detection of tissue lesions and the depiction of vascular abnormalities such as pulmonary embolisms or ruptures of the vessel wall.

CONCLUSION. The angiographic method with a water-soluble contrast medium and PEG as a contrast-agent dissolver showed a clearly superior quality due to the lack of extravasation through the gastrointestinal vascular bed and the enhancement of soft tissues (cerebral cortex, myocardium, and parenchymal abdominal organs). The diagnostic possibilities of these findings in cases of antemortem ischemia of these tissues are not yet fully understood.

Keywords: angiography • contrast media • noninvasive autopsy • postmortem whole-body angiography • virtopsy • virtual autopsy

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