title: Post-mortem cardiac 3-T magnetic resonance imaging: visualization of sudden cardiac death?
abstract: OBJECTIVE
  This study aimed to investigate post-mortem magnetic resonance imaging (pmMRI) for the assessment of myocardial infarction and hypointensities on post-mortem T2-weighted images as a possible method for visualizing the myocardial origin of arrhythmic sudden cardiac death.
  
  
  BACKGROUND
  Sudden cardiac death has challenged clinical and forensic pathologists for decades because verification on post-mortem autopsy is not possible. pmMRI as an autopsy-supporting examination technique has been shown to visualize different stages of myocardial infarction.
  
  
  METHODS
  In 136 human forensic corpses, a post-mortem cardiac MR examination was carried out prior to forensic autopsy. Short-axis and horizontal long-axis images were acquired in situ on a 3-T system.
  
  
  RESULTS
  In 76 cases, myocardial findings could be documented and correlated to the autopsy findings. Within these 76 study cases, a total of 124 myocardial lesions were detected on pmMRI (chronic: 25; subacute: 16; acute: 30; and peracute: 53). Chronic, subacute, and acute infarction cases correlated excellently to the myocardial findings on autopsy. Peracute infarctions (age range: minutes to approximately 1 h) were not visible on macroscopic autopsy or histological examination. Peracute infarction areas detected on pmMRI could be verified in targeted histological investigations in 62.3% of cases and could be related to a matching coronary finding in 84.9%. A total of 15.1% of peracute lesions on pmMRI lacked a matching coronary finding but presented with severe myocardial hypertrophy or cocaine intoxication facilitating a cardiac death without verifiable coronary stenosis.
  
  
  CONCLUSIONS
  3-T pmMRI visualizes chronic, subacute, and acute myocardial infarction in situ. In peracute infarction as a possible cause of sudden cardiac death, it demonstrates affected myocardial areas not visible on autopsy. pmMRI should be considered as a feasible post-mortem investigation technique for the deceased patient if no consent for a clinical autopsy is obtained.
authors.affiliation: Forensic Imaging Center Bern, Institute of Forensic Medicine, University of Bern, Bern, Switzerland. christian.jackowski@irm.unibe.ch
authors.forename: Christian
authors.initials: C
authors.lastname: Jackowski
authors.forename: Nicole
authors.initials: N
authors.lastname: Schwendener
authors.forename: Silke
authors.initials: S
authors.lastname: Grabherr
authors.forename: Anders
authors.initials: A
authors.lastname: Persson
mesh_terms: D000328:Adult; D000368:Aged; D001344:Autopsy / Q000379:methods; D002423:Cause of Death; D016757:Death, Sudden, Cardiac / Q000209:etiology / Q000473:pathology*; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000401:mortality / Q000473:pathology*; D011446:Prospective Studies; D012494:Sampling Studies; D012680:Sensitivity and Specificity
keywords: LV; MRI; T(2)-weighted; T2w; left ventricular; magnetic resonance imaging; myocardial infarction; pmMRI; post-mortem cardiac imaging; post-mortem magnetic resonance imaging