Dominic Wichmann, MD, DTM (*); Axel Heinemann, MD (*); Clemens Weinberg, MSc; Hermann Vogel, MD, PhD; Wilhelm Wolfgang Hoepker, MD, PhD; Silke Grabherr, MD, PhD; Klaus Pueschel, MD, PhD; Stefan Kluge, MD
Acknowledgment: The authors thank the medical staff of the Department of Intensive Care Medicine for their unfailing commitment to quality control when asking relatives for informed consent to do this study. Furthermore, they thank the technicians of the Department of Legal Medicine for their help in doing the CT scans.
Financial Support: By the University Medical Center Hamburg–Eppendorf. Dr. Grabherr had personal academic funding from the Fondation Leenaards. Fumedica provided consumables for multiphase PMCT angiography.
Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M13-2211.
Reproducible Research Statement: Study protocol, statistical code, and data set: Available from Dr. Wichmann (e-mail, firstname.lastname@example.org).
Requests for Single Reprints: Dominic Wichmann, MD, DTM, Department of Intensive Care Medicine, University Medical Center Hamburg–Eppendorf, Martinistrasse 52, D-20246 Hamburg, Germany.
Current Author Addresses: Drs. Wichmann and Kluge and Mr. Weinberg: Department of Intensive Care Medicine, University Medical Center Hamburg–Eppendorf, Martinistrasse 52, D-20246 Hamburg, Germany.
Drs. Heinemann, Vogel, and Pueschel: Department of Legal Medicine, University Medical Center Hamburg–Eppendorf, Martinistrasse 52, D-20246 Hamburg, Germany.
Dr. Hoepker: Department of Pathology, University Medical Center Hamburg–Eppendorf, Martinistrasse 52, D-20246 Hamburg, Germany.
Dr. Grabherr: Centre Universitaire Romand de Médecine Légale, Centre Hospital Universitaire Vaudois, Rue du Burgnon 21, CH-1011 Lausanne, Switzerland.
Author Contributions: Conception and design: D. Wichmann, A. Heinemann, W.W. Hoepker, K. Pueschel, S. Kluge.
Analysis and interpretation of the data: D. Wichmann, A. Heinemann, H. Vogel, K. Pueschel, S. Kluge.
Drafting of the article: D. Wichmann, S. Grabherr, S. Kluge.
Critical revision of the article for important intellectual content: D. Wichmann, A. Heinemann, H. Vogel, W.W. Hoepker, S. Grabherr, K. Pueschel, S. Kluge.
Final approval of the article: D. Wichmann, A. Heinemann, H. Vogel, W.W. Hoepker, K. Pueschel, S. Kluge.
Provision of study materials or patients: D. Wichmann, A. Heinemann, C. Weinberg, H. Vogel, W.W. Hoepker, K. Pueschel.
Statistical expertise: D. Wichmann, S. Kluge.
Obtaining of funding: A. Heinemann, S. Grabherr.
Administrative, technical, or logistic support: D. Wichmann, A. Heinemann, W.W. Hoepker, S. Grabherr, K. Pueschel, S. Kluge.
Collection and assembly of data: D. Wichmann, A. Heinemann, C. Weinberg, H. Vogel, W.W. Hoepker, K. Pueschel
Wichmann D, Heinemann A, Weinberg C, Vogel H, Hoepker WW, Grabherr S, et al. Virtual Autopsy With Multiphase Postmortem Computed Tomographic Angiography Versus Traditional Medical Autopsy to Investigate Unexpected Deaths of Hospitalized Patients: A Cohort Study. Ann Intern Med. 2014;160:534-541. doi: 10.7326/M13-2211
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Published: Ann Intern Med. 2014;160(8):534-541.
“Virtual” autopsy by postmortem computed tomography (PMCT) can replace medical autopsy to a certain extent but has limitations for cardiovascular diseases. These limitations might be overcome by adding multiphase PMCT angiography.
To compare virtual autopsy by multiphase PMCT angiography with medical autopsy.
Prospective cohort study. (ClinicalTrials.gov: NCT01541995)
Single-center study at the University Medical Center Hamburg–Eppendorf, Hamburg, Germany, between 1 April 2012 and 31 March 2013.
Hospitalized patients who died unexpectedly or within 48 hours of an event necessitating cardiopulmonary resuscitation.
Diagnoses from clinical records were compared with findings from both types of autopsy. New diagnoses identified by autopsy were classified as major or minor, depending on whether they would have altered clinical management.
Of 143 eligible patients, 50 (35%) had virtual and medical autopsy. Virtual autopsy confirmed 93% of all 336 diagnoses identified from antemortem medical records, and medical autopsy confirmed 80%. In addition, virtual and medical autopsy identified 16 new major and 238 new minor diagnoses. Seventy-three of the virtual autopsy diagnoses, including 32 cases of coronary artery stenosis, were identified solely by multiphase PMCT angiography. Of the 114 clinical diagnoses classified as cardiovascular, 110 were confirmed by virtual autopsy and 107 by medical autopsy. In 11 cases, multiphase PMCT angiography showed “unspecific filling defects,” which were not reported by medical autopsy.
These results come from a single center with concerted interest and expertise in postmortem imaging; further studies are thus needed for generalization.
In cases of unexpected death, the addition of multiphase PMCT angiography increases the value of virtual autopsy, making it a feasible alternative for quality control and identification of diagnoses traditionally made by medical autopsy.
University Medical Center Hamburg–Eppendorf.
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Cardiology, Emergency Medicine, Hospital Medicine.
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