Post-mortem imaging compared with autopsy in trauma victims--A systematic review.
BACKGROUND
Post-mortem imaging or virtual autopsy is a rapidly advancing field of post-mortem investigations of trauma victims. In this review we evaluate the feasibility of complementation or replacement of conventional autopsy by post-mortem imaging in trauma victims.


METHODS
A systematic review was performed in compliance with the PRISMA guidelines. MEDLINE, Embase and Cochrane databases were systematically searched for studies published between January 2008 and January 2014, in which post-mortem imaging was compared to conventional autopsy in trauma victims. Studies were included when two or more trauma victims were investigated.


RESULTS
Twenty-six studies were included, with a total number of 563 trauma victims. Post-mortem computer tomography (PMCT) was performed in 22 studies, post-mortem magnetic resonance imaging (PMMRI) in five studies and conventional radiography in two studies. PMCT and PMMRI both demonstrate moderate to high-grade injuries and cause of death accurately. PMCT is more sensitive than conventional autopsy or PMMRI in detecting skeletal injuries. For detecting minor organ and soft tissue injuries, autopsy remains superior to imaging. Aortic injuries are missed frequently by PMCT and PMMRI and form their main limitation.


CONCLUSIONS
PMCT should be considered as an essential supplement to conventional autopsy in trauma victims since it detects many additional injuries. Despite some major limitations, PMCT could be used as an alternative for conventional autopsy in situations where conventional autopsy is rejected or unavailable.
Department of Trauma Surgery, VU University Medical Centre, De Boelelaan 1117, 1081 HZ Amsterdam, The Netherlands; Department of General Surgery, Slotervaartziekenhuis, Louwesweg 6, 1066 EC Amsterdam, The Netherlands. Electronic address: hamid.jalalzadeh@gmail.com.
Hamid
H
Jalalzadeh
Department of Trauma Surgery, VU University Medical Centre, De Boelelaan 1117, 1081 HZ Amsterdam, The Netherlands; Department of General Surgery, Slotervaartziekenhuis, Louwesweg 6, 1066 EC Amsterdam, The Netherlands.
Georgios F
GF
Giannakopoulos
Department of Radiology and Nuclear Medicine, VU University Medical Centre, De Boelelaan 1117, 1081 HZ Amsterdam, The Netherlands.
Ferco H
FH
Berger
Department of Pathology, VU University Medical Centre, De Boelelaan 1117, 1081 HZ Amsterdam, The Netherlands; Department of Pathology, Symbiant, Medisch Centrum Alkmaar, Wilhelminalaan 12, 1815 JD Alkmaar, The Netherlands.
Judith
J
Fronczek
Department of Pathology, VU University Medical Centre, De Boelelaan 1117, 1081 HZ Amsterdam, The Netherlands; Department of Pathology, Symbiant, Medisch Centrum Alkmaar, Wilhelminalaan 12, 1815 JD Alkmaar, The Netherlands.
Frank R W
FRW
van de Goot
Department of Forensic Medicine, Public Health Service, P.O. Box 2200, 1000 CE Amsterdam, The Netherlands.
Udo J
UJ
Reijnders
Department of Trauma Surgery, VU University Medical Centre, De Boelelaan 1117, 1081 HZ Amsterdam, The Netherlands.
Wietse P
WP
Zuidema
D001344:Autopsy; D002423:Cause of Death; D005554:Forensic Medicine / Q000379:methods; D006801:Humans; D008279:Magnetic Resonance Imaging; D014057:Tomography, X-Ray Computed; D014947:Wounds and Injuries / Q000000981:diagnostic imaging* / Q000473:pathology*
Autopsy; Injury; PMCT; PMMRI; Post-mortem imaging; Trauma