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Can We Skip the Autopsy?AUTHOR: Tom Heston, MD

The postmortem autopsy is considered the gold standard in the determination of the cause of death. Newerimaging technologies, however, including high resolution computed tomography (CT) and magneticresonance imaging (MRI), may allow in some cases a virtual autopsy instead, that utilizes medical imagingalone. The benefits of a virtual, imaging autopsy include the potential for conducting more autopsies whichcould lead to more accurate mortality statistics, and reduced costs. The virtual autopsy may also be morewidely accepted by families and religions.

A study published in the January 14th, 2012 issue of the Lancet compared traditional autopsy results withvirtual autopsy by both CT and MRI. They randomly enrolled 182 cases that underwent both virtual and fullconventional autopsy. The CT and MRI scans were independently interpreted for cause of death, then acombined report was created from both imaging modalities. The radiologists also indicated how confidentthey were in their diagnosis, which was based entirely upon the scan images. The cases were then dividinginto two groups: those with a definite imaging diagnosis, and those without a definite imaging diagnosis. The researchers found that overall, about 1 in 3 virtual autopsies contained a major discrepancy whencompared with the full, traditional autopsy. Radiologists considered the imaging diagnosis for cause of deathto be definite in about half of the cases. In these cases where the imaging results were considered definite,the major discrepancy rate with full autopsy was about 1 in 6. The researchers also found that CT was moreaccurate than MRI when using a conventional autopsy as the gold standard. Major common sources of errorwere when the cause of death was coronary heart disease, pulmonary embolism, bronchopneumonia, andintestinal infarction. As the study progressed, the radiologists improved their interpretation accuracy,however, major discrepancies continued to exist.

The researchers concluded that when conducting a virtual autopsy, CT imaging was better than MRIscanning in providing an accurate cause of death. When the findings on virtual autopsy were considereddefinite, the major discrepancy rate with full autopsy was 16%.

COMMENT: This is a new, emerging application of medical imaging that has tremendous potential. Theauthors note that when the imaging diagnosis was considered definite, the error rate was comparable to theerror rate of a conventional, full autopsy. As physician experience with this relatively new application ofmedical imaging improves, it is likely that the accuracy will significantly rise. Because of the relatively low costand ease of conducting a virtual autopsy, it is likely to become fully integrated into and a routine part ofpostmortem investigation.

REFERENCE

Roberts IS, Benamore RE, Benbow EW et al. Post-mortem imaging as an alternative to autopsy in thediagnosis of adult deaths: a validation study. Lancet. 2012 Jan 14;379(9811):136-42

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