title: Comparison of conventional autopsy and magnetic resonance imaging in determining the cause of sudden death in the young.
abstract: BACKGROUND
  Sudden death in the young is a tragic complication of a number of medical diseases. There is limited data regarding the utility of post-mortem Magnetic Resonance (MR) imaging and Computer Tomography (CT) scanning in determining the cause of sudden death. This study sought to compare the accuracy of post-mortem cross-sectional imaging (MR and CT) with the conventional autopsy in determining the cause of sudden death in the young.
  
  
  METHODS
  Consecutive patients from 2010 to 2012 (aged 1-35 years) who had sudden death were included. Patients were scanned by CT and 1.5 T MR imaging prior to the conventional autopsy being performed. The primary outcome was diagnostic congruence between imaging and conventional autopsy.
  
  
  RESULTS
  In 17 patients studied, the mean age at death was 23 ± 11 years, with a male predominance (n = 12; 71%). The most common cause of death was a primary cardiac pathology (n = 8; 47%), including ARVC (24%) and ischemic heart disease (12%). Non-cardiac causes identified included pulmonary embolism (6%), and aortic dissection (6%). MR imaging correctly identified the diagnosis in 12 patients who subsequently had positive findings at conventional autopsy, while the diagnosis in the remaining 5 cases remained unexplained. MR imaging was found to be highly sensitive (100%) with a high negative (100%) and positive (80%) predictive value.
  
  
  CONCLUSIONS
  Dedicated post-mortem MR imaging of the heart and brain is a useful modality in determining the cause of sudden death in children and young adults, particularly in situations where a conventional autopsy cannot be performed for logistic, cultural or personal reasons.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Puranik
authors.forename: Belinda
authors.initials: B
authors.lastname: Gray
authors.forename: Helen
authors.initials: H
authors.lastname: Lackey
authors.forename: Laura
authors.initials: L
authors.lastname: Yeates
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Parker
authors.forename: Johan
authors.initials: J
authors.lastname: Duflou
authors.affiliation: Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia. c.semsarian@centenary.org.au.
authors.forename: Christopher
authors.initials: C
authors.lastname: Semsarian
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D001344:Autopsy / Q000379:methods*; D001706:Biopsy; D001921:Brain / Q000473:pathology*; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D003645:Death, Sudden / Q000473:pathology*; D016757:Death, Sudden, Cardiac / Q000473:pathology; D005260:Female; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D009206:Myocardium / Q000473:pathology*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D055815:Young Adult