title: Quantification of interstitial fluid on whole body CT: comparison with whole body autopsy.
abstract: OBJECTIVE
  Interstitial fluid accumulation can occur in pleural, pericardial, and peritoneal spaces, and subcutaneous tissue planes. The purpose of the study was to assess if whole body CT examination in a postmortem setting could help determine the presence and severity of third space fluid accumulation in the body.
  
  
  METHODS
  Our study included 41 human cadavers (mean age 61 years, 25 males and 16 females) who had whole-body postmortem CT prior to autopsy. All bodies were maintained in the morgue in the time interval between death and autopsy. Two radiologists reviewed the whole-body CT examinations independently to grade third space fluid in the pleura, pericardium, peritoneum, and subcutaneous space using a 5-point grading system. Qualitative CT grading for third space fluid was correlated with the amount of fluid found on autopsy and the quantitative CT fluid volume, estimated using a dedicated software program (Volume, Syngo Explorer, Siemens Healthcare).
  
  
  RESULTS
  Moderate and severe peripheral edema was seen in 16/41 and 7/41 cadavers respectively. It is not possible to quantify anasarca at autopsy. Correlation between imaging data for third space fluid and the quantity of fluid found during autopsy was 0.83 for pleural effusion, 0.4 for pericardial effusion and 0.9 for ascites. The degree of anasarca was significantly correlated with the severity of ascites (p < 0.0001) but not with pleural or pericardial effusion. There was strong correlation between volumetric estimation and qualitative grading for anasarca (p < 0.0001) and pleural effusion (p < 0.0001).
  
  
  CONCLUSIONS
  Postmortem CT can help in accurate detection and quantification of third space fluid accumulation. The quantity of ascitic fluid on postmortem CT can predict the extent of anasarca.
authors.affiliation: Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA. robertologullo@yahoo.it.|Department of Radiology, School of Medicine, University of Milano, Milan, Italy. robertologullo@yahoo.it.
authors.forename: Roberto
authors.initials: R
authors.lastname: Lo Gullo
authors.affiliation: Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA.
authors.forename: Shelly
authors.initials: S
authors.lastname: Mishra
authors.affiliation: Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA.
authors.forename: Diego A
authors.initials: DA
authors.lastname: Lira
authors.affiliation: Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA.
authors.forename: Atul
authors.initials: A
authors.lastname: Padole
authors.affiliation: Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA.
authors.forename: Alexi
authors.initials: A
authors.lastname: Otrakji
authors.affiliation: Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA.
authors.forename: Ranish Deedar Ali
authors.initials: RD
authors.lastname: Khawaja
authors.affiliation: Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA.
authors.forename: Sarvenaz
authors.initials: S
authors.lastname: Pourjabbar
authors.affiliation: Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA.
authors.forename: Sarabjeet
authors.initials: S
authors.lastname: Singh
authors.affiliation: Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA.
authors.forename: Jo-Anne O
authors.initials: JA
authors.lastname: Shepard
authors.affiliation: Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA.
authors.forename: Subba R
authors.initials: SR
authors.lastname: Digumarthy
authors.affiliation: Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA.
authors.forename: Mannudeep K
authors.initials: MK
authors.lastname: Kalra
authors.affiliation: Department of Pathology and Center for Systems Biology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA.
authors.forename: James R
authors.initials: JR
authors.lastname: Stone
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001201:Ascites / Q000000981:diagnostic imaging / Q000473:pathology; D001344:Autopsy; D001663:Bilirubin / Q000032:analysis; D002102:Cadaver; D004487:Edema / Q000000981:diagnostic imaging / Q000473:pathology; D045604:Extracellular Fluid / Q000378:metabolism*; D005260:Female; D049429:Forensic Pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D010496:Pericardium / Q000000981:diagnostic imaging / Q000378:metabolism / Q000473:pathology; D010537:Peritoneum / Q000000981:diagnostic imaging / Q000378:metabolism / Q000473:pathology; D010994:Pleura / Q000000981:diagnostic imaging / Q000378:metabolism / Q000473:pathology; D010996:Pleural Effusion / Q000000981:diagnostic imaging / Q000473:pathology; D012709:Serum Albumin / Q000032:analysis; D012720:Severity of Illness Index; D040521:Subcutaneous Tissue / Q000000981:diagnostic imaging / Q000378:metabolism / Q000473:pathology; D051598:Whole Body Imaging
chemical_list: D012709:Serum Albumin; D001663:Bilirubin
keywords: Anasarca; Postmortem CT; Third space fluid overload; Virtual autopsy; Whole-body CT