title: Ventilated postmortem computed tomography in children: feasibility and initial experience.
abstract: OBJECTIVE
  Ventilated postmortem computed tomography (vPMCT) is associated with improved pulmonary imaging compared to standard PMCT in adults. We aimed to evaluate the feasibility of performing ventilated PMCT in children.
  
  
  METHODS
  Postmortem thoracic CT was performed before (PMCT) and after ventilation (vPMCT). We used a range of mouthpieces, including endotracheal tubes, bag and mask and laryngeal mask airway (LMA). Hounsfield units of the lungs at PMCT were measured for normal and abnormal lung areas, before and after ventilation. All patients underwent full conventional autopsy and histology.
  
  
  RESULTS
  Twelve patients underwent ventilated PMCT, median age 52 days (range 3-304 days). Ventilated PMCT provided diagnostic lung images in all 12 cases, compared to only three unventilated PMCT examinations (p < 0.005). In all cases, ventilated PMCT improved the image quality of aerated lungs irrespective of the method used. Average lung Hounsfield units decreased significantly with ventilation from pre-vPMCT values (-134.1 ± 215.1 vs post-vPMCT -531.8 ± 190.1; p < 0.001). LMA with continuous positive pressure ventilation subjectively provided the best results.
  
  
  CONCLUSIONS
  Ventilated PMCT significantly improves lung aeration in children and can aid recognition of areas of abnormality in paediatric lungs. Such advances will improve accuracy and uptake of imaging-assisted autopsies in children.
authors.affiliation: Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK, owen.arthurs@gosh.nhs.uk.
authors.forename: Owen J
authors.initials: OJ
authors.lastname: Arthurs
authors.forename: Anna
authors.initials: A
authors.lastname: Guy
authors.forename: Liina
authors.initials: L
authors.lastname: Kiho
authors.forename: Neil J
authors.initials: NJ
authors.lastname: Sebire
mesh_terms: D005240:Feasibility Studies; D005260:Female; D005554:Forensic Medicine; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008168:Lung / Q000000981:diagnostic imaging*; D008297:Male; D061330:Multidetector Computed Tomography / Q000379:methods*; D011175:Positive-Pressure Respiration; D011237:Predictive Value of Tests; D012151:Resuscitation / Q000295:instrumentation; D012680:Sensitivity and Specificity