title: Differentiation of hemopericardium due to ruptured myocardial infarction or aortic dissection on unenhanced postmortem computed tomography.
abstract: The aim of the study was to evaluate unenhanced postmortem computed tomography (PMCT) in cases of non-traumatic hemopericardium by establishing the sensitivity, specificity and accuracy of diagnostic criteria for the differentiation between aortic dissection and myocardial wall rupture due to infarction. Twenty six cases were identified as suitable for evaluation, of which ruptured aortic dissection could be identified as the underlying cause of hemopericardium in 50% of the cases, and myocardial wall rupture also in 50% of the cases. All cases underwent a PMCT and 24 of the cases also underwent one or more additional examinations: a subsequent autopsy, or a postmortem magnetic resonance (PMMR), or a PMCT angiography (PMCTA), or combinations of the above. Two radiologists evaluated the PMCT images and classified each case as "aortic dissection", "myocardial wall rupture" or "undetermined". Quantification of the pericardial blood was carried out using segmentation techniques. 17 of 26 cases were correctly identified, either as aortic dissections or myocardial ruptures, by both readers. 7 of 13 myocardial wall ruptures were identified by both readers, whereas both readers identified correctly 10 of 13 aortic dissection cases. Taking into account the responses of both readers, specificity was 100% for both causes of hemopericardium and sensitivity as well as accuracy was higher for aortic dissections than myocardial wall ruptures (72.7% and 87.5% vs 53.8% and 75% respectively). Pericardial blood volumes were constantly higher in the aortic dissection group, but a statistical significance of these differences could not be proven, since the small count of cases did not allow for statistical tests. This study showed that diagnostic criteria for the differentiation between ruptured aortic dissection and myocardial wall rupture due to infarction are highly specific and accurate.
authors.affiliation: Institute of Forensic Medicine, Department of Forensic Medicine and Imaging, University of Zurich, Winterthurerstrasse 190/52, CH-8057, Zurich, Switzerland. garyfalia.ampanozi@irm.uzh.ch.
authors.forename: Garyfalia
authors.initials: G
authors.lastname: Ampanozi
authors.affiliation: Institute of Forensic Medicine, Department of Forensic Medicine and Imaging, University of Zurich, Winterthurerstrasse 190/52, CH-8057, Zurich, Switzerland.
authors.forename: Patricia M
authors.initials: PM
authors.lastname: Flach
authors.affiliation: Institute of Forensic Medicine, Department of Forensic Medicine and Imaging, University of Zurich, Winterthurerstrasse 190/52, CH-8057, Zurich, Switzerland.|Institute of Diagnostic, Interventional, and Pediatric Radiology, University Hospital Bern, University of Bern, CH-3010, Bern, Switzerland.
authors.forename: Thomas D
authors.initials: TD
authors.lastname: Ruder
authors.affiliation: Department of Diagnostic and Interventional Radiology, Molecular Imaging and Radiotherapy, PTV Foundation, "Tor Vergata" University of Rome, Viale Oxford 81, 00133, Rome, Italy.|Department of Radiological Sciences, PhD training program in Oncological Sciences, Catholic University of Rome, School of Medicine, University Hospital "A. Gemelli", Largo A. Gemelli 8, 00168, Rome, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Filograna
authors.affiliation: Institute of Forensic Medicine, Department of Forensic Medicine and Imaging, University of Zurich, Winterthurerstrasse 190/52, CH-8057, Zurich, Switzerland.
authors.forename: Wolf
authors.initials: W
authors.lastname: Schweitzer
authors.affiliation: Institute of Forensic Medicine, Department of Forensic Medicine and Imaging, University of Zurich, Winterthurerstrasse 190/52, CH-8057, Zurich, Switzerland.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Thali
authors.affiliation: Institute of Forensic Medicine, Department of Forensic Medicine and Imaging, University of Zurich, Winterthurerstrasse 190/52, CH-8057, Zurich, Switzerland.
authors.forename: Lars C
authors.initials: LC
authors.lastname: Ebert
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000000981:diagnostic imaging*; D001014:Aortic Aneurysm / Q000000981:diagnostic imaging*; D001810:Blood Volume; D000072226:Computed Tomography Angiography; D005260:Female; D049429:Forensic Pathology; D006341:Heart Rupture / Q000000981:diagnostic imaging*; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging*; D010490:Pericardial Effusion / Q000209:etiology*; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
keywords: Aortic dissection; Forensic radiology; Hemopericardium; Myocardial infarction; Postmortem computed tomography (PMCT); Virtopsy