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Can postmortem computed tomography detect antemortem hypoxic–ischemic encephalopathy?

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Abstract

The purpose of this study was to evaluate the usefulness of brain postmortem computed tomography (PMCT) findings for the detection of global hypoxia or hypoperfusion leading to hypoxic–ischemic encephalopathy (HIE) prior to death. Cadavers of individuals who died from non-traumatic causes were subjected to PMCT and pathological autopsy. Cases with an episode of cardiopulmonary arrest, hypoxia, or hypoperfusion that required intensive respiratory management at least 24 h before death and exhibited findings of HIE in conventional autopsy (HIE group, n = 6) were compared with those without such episodes prior to death (control group; overall, n = 37; age-matched, n = 8) with regard to four parameters: (1) width of the central sulcus (CS), (2) attenuation difference at the basal ganglia (BG) level, (3) attenuation difference between cerebral gray matter (GM) and cerebral white matter (WM), and (4) attenuation difference between cerebellar GM and cerebral GM. The results revealed significant differences in the width of the CS (P < 0.001), attenuation difference at the BG level (P < 0.001), and attenuation difference between cerebral GM and cerebral WM (P = 0.009) between the HIE group and the overall control group. When the age-matched control group and the HIE group were compared, there was a significant difference in the width of the CS (P = 0.026) and attenuation difference at the BG level (P < 0.001). Our results suggest that effacement of the sulcus of the cerebral hemisphere and the loss of contrast at the BG level on brain PMCT indicate the existence of HIE prior to death.

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Acknowledgments

This work was supported by a grant from the Japanese Ministry of Health, Labor and Welfare, for research into “Usefulness of Postmortem Images as an Ancillary Method for Autopsy in Evaluation of Death Associated with Medical Practice (2008–2009)”. The authors wish to acknowledge Dr Kuni Ohtomo, President, International University of Health and Welfare, for his for his intellectual contribution and proofreading and Dr Hidemi Okuma, Department of Radiology, Graduate School of Medicine, The University of Tokyo, for her help in PMCT data acquisition and analysis.

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Authors and Affiliations

  1. Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan

    Go Shirota, Masanori Ishida & Wataru Gonoi

  2. Department of Radiology, Mutual Aid Association for Tokyo Metropolitan Teachers and Officials, Sanraku Hospital, 2-5 Kandasurugadai, Chiyoda-ku, Tokyo, 101-8326, Japan

    Masanori Ishida

  3. Department of Pathology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan

    Yukako Shintani, Hiroyuki Abe, Masako Ikemura & Masashi Fukayama

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  1. Go Shirota
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  2. Masanori Ishida
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  3. Yukako Shintani
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  4. Hiroyuki Abe
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  5. Masako Ikemura
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  6. Masashi Fukayama
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  7. Wataru Gonoi
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Correspondence to Wataru Gonoi.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Written informed consent for using all corresponding clinical and radiographic data for our study was obtained from the next of kin of the decedents.

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Shirota, G., Ishida, M., Shintani, Y. et al. Can postmortem computed tomography detect antemortem hypoxic–ischemic encephalopathy?. Forensic Sci Med Pathol 12, 267–275 (2016). https://doi.org/10.1007/s12024-016-9787-8

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  • DOI: https://doi.org/10.1007/s12024-016-9787-8

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