title: Normal cranial postmortem CT findings in children.
abstract: BACKGROUND
  Postmortem imaging (both CT and MRI) has become a widely used tool the last few years, both for adults and children. If it would be known which findings are normal postmortem changes, interpretation of abnormal findings becomes less ambiguous. Our aim was to describe postmortem intracranial radiological findings on postmortem CT (PMCT) in children, which did not have a relationship with the cause of death, and to determine whether these findings have a relationship with the postmortem interval or with medical interventions.
  
  
  METHODS
  We selected all consecutive pediatric autopsies that were performed at the Netherlands Forensic Institute in the period 1-1-2008 to 31-12-2011, whereby the subject underwent total body PMCT. We collected data on age at death, gender, cause of death determined by forensic autopsy and time between death and PMCT. Normal findings that were scored were: gray-white differentiation of the brain, collapse of the ventricles, air in the orbit, fluid accumulation in the frontal and maxillary sinuses, and air in vessels of head and neck.
  
  
  RESULTS
  One-hundred-fifty-nine forensic pediatric autopsies were performed in the 4 year study period at the NFI; 77 underwent a total body PMCT, of which 68 were included in the analyses. Fluid accumulation in the sinuses was present 30-40% of the cases in which the sinuses were developed. In 22% of all children intravascular intracranial air, either arterial or venous, was detected. We did not find a relationship between the duration of the postmortem interval and the appearance of any of the findings. Intravenous infusion is not significantly associated with the presence of intravascular air, except for air in the left and right common carotid artery (B=2.9, P=0.05).
  
  
  CONCLUSIONS
  By demonstrating the intracranial abnormalities that appear postmortem, we have tried to provide more insight in the range of findings that can be seen with pediatric PMCT. As these findings resemble antemortem pathology, it is important that the radiologist who interprets PMCT has knowledge of these normal postmortem findings.
authors.affiliation: Section Forensic Pediatrics, Department of Forensic Medicine, Netherlands Forensic Institute, The Hague, The Netherlands; Department of Radiology, Academic Medical Center/Emma Children's Hospital, Amsterdam, The Netherlands. Electronic address: t.sieswerda@amc.nl.
authors.forename: T
authors.initials: T
authors.lastname: Sieswerda-Hoogendoorn
authors.affiliation: Department of Radiology, Academic Medical Center/Emma Children's Hospital, Amsterdam, The Netherlands. Electronic address: l.f.beenen@amc.nl.
authors.forename: L F M
authors.initials: LF
authors.lastname: Beenen
authors.affiliation: Section Forensic Pediatrics, Department of Forensic Medicine, Netherlands Forensic Institute, The Hague, The Netherlands; Department of Radiology, Academic Medical Center/Emma Children's Hospital, Amsterdam, The Netherlands. Electronic address: r.r.vanrijn@amc.nl.
authors.forename: R R
authors.initials: RR
authors.lastname: van Rijn
mesh_terms: D000792:Angiography; D001921:Brain / Q000000981:diagnostic imaging*; D002648:Child; D002675:Child, Preschool; D004618:Embolism, Air / Q000000981:diagnostic imaging; D005260:Female; D049429:Forensic Pathology; D005626:Frontal Sinus / Q000000981:diagnostic imaging*; D006801:Humans; D007223:Infant; D007262:Infusions, Intravenous; D008297:Male; D008443:Maxillary Sinus / Q000000981:diagnostic imaging*; D009915:Orbit / Q000000981:diagnostic imaging*; D011180:Postmortem Changes; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed
keywords: Forensic sciences; Postmortem changes; Putrefaction; Tomography, X-ray computed