title: Post-mortem imaging as an alternative to autopsy in the diagnosis of adult deaths: a validation study.
abstract: BACKGROUND
  Public objection to autopsy has led to a search for minimally invasive alternatives. Imaging has potential, but its accuracy is unknown. We aimed to identify the accuracy of post-mortem CT and MRI compared with full autopsy in a large series of adult deaths.
  
  
  METHODS
  This study was undertaken at two UK centres in Manchester and Oxford between April, 2006, and November, 2008. We used whole-body CT and MRI followed by full autopsy to investigate a series of adult deaths that were reported to the coroner. CT and MRI scans were reported independently, each by two radiologists who were masked to the autopsy findings. All four radiologists then produced a consensus report based on both techniques, recorded their confidence in cause of death, and identified whether autopsy was needed.
  
  
  RESULTS
  We assessed 182 unselected cases. The major discrepancy rate between cause of death identified by radiology and autopsy was 32% (95% CI 26-40) for CT, 43% (36-50) for MRI, and 30% (24-37) for the consensus radiology report; 10% (3-17) lower for CT than for MRI. Radiologists indicated that autopsy was not needed in 62 (34%; 95% CI 28-41) of 182 cases for CT reports, 76 (42%; 35-49) of 182 cases for MRI reports, and 88 (48%; 41-56) of 182 cases for consensus reports. Of these cases, the major discrepancy rate compared with autopsy was 16% (95% CI 9-27), 21% (13-32), and 16% (10-25), respectively, which is significantly lower (p<0·0001) than for cases with no definite cause of death. The most common imaging errors in identification of cause of death were ischaemic heart disease (n=27), pulmonary embolism (11), pneumonia (13), and intra-abdominal lesions (16).
  
  
  CONCLUSIONS
  We found that, compared with traditional autopsy, CT was a more accurate imaging technique than MRI for providing a cause of death. The error rate when radiologists provided a confident cause of death was similar to that for clinical death certificates, and could therefore be acceptable for medicolegal purposes. However, common causes of sudden death are frequently missed on CT and MRI, and, unless these weaknesses are addressed, systematic errors in mortality statistics would result if imaging were to replace conventional autopsy.
  
  
  BACKGROUND
  Policy Research Programme, Department of Health, UK.
authors: Department of Cellular Pathology, John Radcliffe Hospital, Oxford, UK. ian.roberts@ouh.nhs.uk
authors: Ian S D
authors: IS
authors: Roberts
authors: Rachel E
authors: RE
authors: Benamore
authors: Emyr W
authors: EW
authors: Benbow
authors: Stephen H
authors: SH
authors: Lee
authors: Jonathan N
authors: JN
authors: Harris
authors: Alan
authors: A
authors: Jackson
authors: Susan
authors: S
authors: Mallett
authors: Tufail
authors: T
authors: Patankar
authors: Charles
authors: C
authors: Peebles
authors: Carl
authors: C
authors: Roobottom
authors: Zoe C
authors: ZC
authors: Traill
mesh_terms: D000328:Adult; D001344:Autopsy / Q000379:methods*; D002423:Cause of Death; D006801:Humans; D008279:Magnetic Resonance Imaging; D017202:Myocardial Ischemia / Q000175:diagnosis; D011014:Pneumonia / Q000175:diagnosis; D011655:Pulmonary Embolism / Q000175:diagnosis; D014057:Tomography, X-Ray Computed