Head And Brain Postmortem Computed Tomography (PMCT) - Autopsy Correlation In Hospital Deaths.

The frequency of postmortem computed tomography (PMCT) imaging as support to autopsy has increased in the past decade. The purpose of this study was to compare the head and brain findings from PMCT with the autopsy results, to determine the diagnostic reliability of PMCT in deaths of hospitalized patients. We examined postmortem CT images and autopsy data from 31 subjects who died at SUNY Upstate University Hospital between 2013-2018. Each subject underwent a full-body noncontrast PMCT and then a traditional autopsy. A neuroradiologist analyzed PMCT images for head and brain abnormalities. The autopsies were performed by pathologists who were aware of the radiology results. A data extraction sheet was developed to record age, sex, race, cause of death, PMCT and autopsy findings. Gross and histology findings from the autopsy were compared to the results from the PMCT. The mean age of our population was 63 years (range: 5-85 years). Thirteen subjects were females and 18 males. Noncontrast PMCT was able to detect specific intracranial findings that were subsequently observed at the autopsy, such as brain atrophy, atherosclerosis, intracranial hemorrhages, edema, shifts, and herniations. On the other hand, small intracranial hemorrhages/tumors and skin findings could be established only at autopsy. Although not all of the pathologic findings were detected on imaging, the most important pathologies that can cause severe disability or death (such as hemorrhages, shifts, herniations), were correctly identified. In a few cases, the findings of the PMCT were essential to help to perform a more focused brain autopsy: for example, in case of subdural/epidural hemorrhage, the calvarium was removed more carefully, in order not to alter the position and volume of the hemorrhage. Also, in case of localized edema detected at the PMCT, a more focused histology sampling was performed. In conclusion, although not all the pathologic findings were detected on the radiological images, the most important ones that can cause disability or death were correctly identified. Moreover, the PMCT findings helped to perform a more focused gross and histology brain autopsy.