title: Diagnostic accuracy of postmortem imaging vs autopsy-A systematic review.
abstract: Background Postmortem imaging has been used for more than a century as a complement to medico-legal autopsies. The technique has also emerged as a possible alternative to compensate for the continuous decline in the number of clinical autopsies. To evaluate the diagnostic accuracy of postmortem imaging for various types of findings, we performed this systematic literature review. Data sources The literature search was performed in the databases PubMed, Embase and Cochrane Library through January 7, 2015. Relevant publications were assessed for risk of bias using the QUADAS tool and were classified as low, moderate or high risk of bias according to pre-defined criteria. Autopsy and/or histopathology were used as reference standard. Findings The search generated 2600 abstracts, of which 340 were assessed as possibly relevant and read in full-text. After further evaluation 71 studies were finally included, of which 49 were assessed as having high risk of bias and 22 as moderate risk of bias. Due to considerable heterogeneity - in populations, techniques, analyses and reporting - of included studies it was impossible to combine data to get a summary estimate of the diagnostic accuracy of the various findings. Individual studies indicate, however, that imaging techniques might be useful for determining organ weights, and that the techniques seem superior to autopsy for detecting gas Conclusions and Implications In general, based on the current scientific literature, it was not possible to determine the diagnostic accuracy of postmortem imaging and its usefulness in conjunction with, or as an alternative to autopsy. To correctly determine the usefulness of postmortem imaging, future studies need improved planning, improved methodological quality and larger materials, preferentially obtained from multi-center studies.
authors.affiliation: Section of Forensic Medicine, Dept of Community Medicine and Rehabilitation, Umeå University, PO Box 7016, SE-907 12 Umeå, Sweden. Electronic address: anders.eriksson@rmv.se.
authors.forename: Anders
authors.initials: A
authors.lastname: Eriksson
authors.affiliation: Section of Forensic Medicine, Dept of Community Medicine and Rehabilitation, Umeå University, PO Box 7016, SE-907 12 Umeå, Sweden.
authors.forename: Torfinn
authors.initials: T
authors.lastname: Gustafsson
authors.affiliation: Swedish Agency for Health Technology Assessment and Assessment of Social Services, PO Box 3657, SE-103 59 Stockholm, Sweden; Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, SE-171 77 Stockholm.
authors.forename: Malin
authors.initials: M
authors.lastname: Höistad
authors.affiliation: Swedish Agency for Health Technology Assessment and Assessment of Social Services, PO Box 3657, SE-103 59 Stockholm, Sweden; Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, SE-171 77 Stockholm.
authors.forename: Monica
authors.initials: M
authors.lastname: Hultcrantz
authors.affiliation: Swedish Agency for Health Technology Assessment and Assessment of Social Services, PO Box 3657, SE-103 59 Stockholm, Sweden.
authors.forename: Stella
authors.initials: S
authors.lastname: Jacobson
authors.affiliation: Swedish Agency for Health Technology Assessment and Assessment of Social Services, PO Box 3657, SE-103 59 Stockholm, Sweden.
authors.forename: Ingegerd
authors.initials: I
authors.lastname: Mejare
authors.affiliation: Department of Medical and Health Sciences, Center for Medical Image Science and Visualization (CMIV), Linköping University, SE-581 85, Linköping Sweden.
authors.forename: Anders
authors.initials: A
authors.lastname: Persson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001344:Autopsy / Q000592:standards*; D002648:Child; D003952:Diagnostic Imaging / Q000592:standards*; D004812:Epidemiologic Methods; D049429:Forensic Pathology / Q000592:standards; D006801:Humans; D008875:Middle Aged; D055815:Young Adult
keywords: Autopsy; Diagnostic accuracy; Postmortem imaging; Systematic review