Early studies have suggested a role for high-resolution multi-detector CT (MDCT) imaging autopsy in the forensic investigation of death. Our study evaluated the sensitivity and potential role of MDCT as a replacement for or adjunct to conventional autopsy in the investigation of traumatic accidental or non-accidental death within a U.S. state medical examiner (ME) system.

20 decedents were prospectively investigated with whole body 40-detector row 2D and 3D MDCT (~4,500 images/study) within 24 hours of death following blunt (n=14) or penetrating (n=6; 5 ballistic) trauma. MDCT was interpreted by consensus by 2 radiologists and compared with ME autopsy results for major findings and cause of death. The authors (radiologists and forensic medical examiners) also evaluated the imaging findings as (a) comparable to; (b) a helpful adjunct to; or (c) of no additive value to conventional autopsy.

Imaging correctly identified 92 major findings (sensitivity 95.5%) and all 14 causes of death in cases of blunt trauma. These respective figures were 36 (sensitivity 94.7%) and 5 in cases of penetrating trauma. Six major false-negative CT findings included 2 nondisplaced atlanto-occipital subluxations, and lacerations of the bronchus, right heart, ascending aorta, and liver. All 26 major ballistic fragments recovered at autopsy were accurately localized, but 13 known pathways were incompletely or not identified, especially where no fragments remained. MDCT identified 7 major findings (3 cases of air embolism, 3 major fractures, 1 lung laceration) not detected at conventional autopsy. The authors evaluated MDCT findings as (a) comparable to autopsy in 13 cases (all blunt); (b) a helpful adjunct in 6 cases (5 penetrating); and (c) of no additive value in one case.

Early experience suggests that MDCT imaging autopsy shows promise as a sensitive tool for the detection of major injuries and cause of death after accidental blunt trauma. In non-accidental traumatic death, MDCT can be a valuable adjunct to mandatory autopsy for detection of injuries and ballistics.

MDCT autopsy has potential to replace conventional or enable limited, focused autopsy following fatal accidental blunt trauma.