• Stephan A Bolliger, Laura Filograna, Danny Spendlove, Michael J Thali, Stephan Dirnhofer, and Steffen Ross.
• Institute of Forensic Medicine, Centre for Forensic Imaging and Virtopsy, University of Bern, Switzerland. stephan.bolliger@irm.unibe.ch
• AJR Am J Roentgenol. 2010 Nov 1; 195 (5): 1051-6.

ObjectiveAlthough postmortem CT suffices for diagnosing most forms of traumatic death, the examination of natural death is, to date, very difficult and error prone. The introduction of postmortem angiography has led to improved radiologic diagnoses of natural deaths. Nevertheless, histologic changes to tissues, an important aspect in traditional examination procedures, remain obscure even with CT and CT angiography. For this reason, we examined the accuracy of a minimally invasive procedure (i.e., CT angiography combined with biopsy) in diagnosing major findings and the cause of death in natural deaths.Materials And MethodsWe examined 20 bodies in a minimally invasive fashion-namely, native CT, CT angiography, and biopsy-and compared the results to those obtained at subsequent autopsy and histologic analysis.ResultsRegarding the major findings and the cause of death, the minimally invasive examination showed almost identical results in 18 of 20 cases. In one case, the severity of a cardiac ischemia was underestimated; in another case, the iliopsoas muscles were not biopsied, thus missing the diagnosis of discoid muscle necrosis and therefore a death due to hypothermia.ConclusionIn light of increasing objections of the next of kin toward an autopsy and the necessity for medical examiners to assess the manner and cause of death, we think that the minimally invasive procedure described here may present a viable compromise in selected cases.

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