Postmortem Whole-Body CT Angiography: Evaluation of Two Contrast Media Solutions
Steffen Ross1,
Danny Spendlove1,
Stephan Bolliger1,
Andreas Christe2,
Lars Oesterhelweg1,
Silke Grabherr3,
Michael J. Thali1 and
Erich Gygax4
1 Centre for Forensic Imaging and Virtopsy, Institute of Forensic Medicine,
University of Bern, Buehlstrasse 20, CH-3012 Bern, Switzerland.
2 Department of Radiology, Inselspital Bern, University of Bern, Bern,
Switzerland.
3 Institute of Forensic Medicine, University of Lausanne, Lausanne,
Switzerland.
4 Clinic for Cardiovascular Surgery, Inselspital Bern, University of Bern, Bern,
Switzerland.
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Fig. 1 —Photograph shows minimally invasive access to vascular system
through right femoral incision and cannulation of femoral artery (red
arrow) and vein (blue arrow). Removable ligatures ensure
fixation of cannulas and ligation of vessels opened during preparation
process.
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Fig. 3A —Cadaver after osteoclastic craniotomy at right side and
clipping of M1 segment of right medial cerebral artery. (case 1; iodized oil
[Lipiodol, Guerbet] and paraffin oil solution) Maximum-intensity-projection
(MIP) images of cerebral vasculature in axial (A) and coronal
(B) reconstructions show even peripheral vessels are displayed exactly.
Note asymmetric enhancement of vessels in area of craniotomy and
asymmetrically contrasted lentigostriatic branches in coronal reconstruction
(B). Cerebral cortex shows no enhancement. Fetal origin of left
posterior artery is anatomic variant.
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Fig. 3B —Cadaver after osteoclastic craniotomy at right side and
clipping of M1 segment of right medial cerebral artery. (case 1; iodized oil
[Lipiodol, Guerbet] and paraffin oil solution) Maximum-intensity-projection
(MIP) images of cerebral vasculature in axial (A) and coronal
(B) reconstructions show even peripheral vessels are displayed exactly.
Note asymmetric enhancement of vessels in area of craniotomy and
asymmetrically contrasted lentigostriatic branches in coronal reconstruction
(B). Cerebral cortex shows no enhancement. Fetal origin of left
posterior artery is anatomic variant.
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Fig. 4A —Cadaver with subdural hematoma. (case 10; iopentol
[Imagopaque, GE Healthcare] and polyethylene glycol) Axial reconstruction
image (A) shows large, right subdural hematoma (asterisks)
with active extravasation of contrast media solution in anterior parts
(closed arrow). Asymmetric enhancement of cortex and basal ganglia
with depiction of massive midline shift to left can be seen in A and
subfalcial and infratentorial herniation of brain tissue to left (open
arrows) in coronal view (B). Absent cortical enhancement in
supplying area of right anterior cerebral artery and posterior branches of
left medial cerebral arteries suggests antemortem infarction. Note hypodensity
of subdural hematoma due to adaptation of window level and width on enhancing
cortex.
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Fig. 4A —Cadaver with subdural hematoma. (case 10; iopentol
[Imagopaque, GE Healthcare] and polyethylene glycol) Axial reconstruction
image (A) shows large, right subdural hematoma (asterisks)
with active extravasation of contrast media solution in anterior parts
(closed arrow). Asymmetric enhancement of cortex and basal ganglia
with depiction of massive midline shift to left can be seen in A and
subfalcial and infratentorial herniation of brain tissue to left (open
arrows) in coronal view (B). Absent cortical enhancement in
supplying area of right anterior cerebral artery and posterior branches of
left medial cerebral arteries suggests antemortem infarction. Note hypodensity
of subdural hematoma due to adaptation of window level and width on enhancing
cortex.
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Fig. 5 —Axial CT image of neck shows partly necrotic laryngeal
carcinoma with enhancing part on left side (dashed circle).
Enhancement of musculature of neck is most likely due to reanimation attempts.
Autopsy showed no evidence of metastatic disease. Note enhancement of right
submandibular gland (arrow). (case 7; iopentol [Imagopaque, GE
Healthcare] and polyethylene glycol)
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Fig. 6 —Large intramuscular extravasation in left sternocleidomastoid
muscle, identified at autopsy as intramuscular hematoma. (case 3; iodized oil
[Lipiodol, Guerbet] and paraffin oil solution)
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Fig. 7 —On volume-rendering technique image of coronaries, no
relevant stenoses were diagnosed. Complete depiction of both coronary arteries
was achieved by second scanning in prone position for better filling of more
ventrally situated right coronary ostium. (case 8; iopentol [Imagopaque, GE
Healthcare] and polyethylene glycol)
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Fig. 8A —Gunshot victim. (case 9; iopentol [Imagopaque, GE Healthcare]
and polyethylene glycol Axial CT image (A) and photograph of autopsy
specimen (B) show gunshot to chest with perforation of inferior right
cardiac ventricle (arrow, B) and massive hemorrhagic
pericardial tamponade (asterisks, A). Note extravasation of
contrast media solution in pericardial space. Scale (B) = cm.
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Fig. 8B —Gunshot victim. (case 9; iopentol [Imagopaque, GE Healthcare]
and polyethylene glycol Axial CT image (A) and photograph of autopsy
specimen (B) show gunshot to chest with perforation of inferior right
cardiac ventricle (arrow, B) and massive hemorrhagic
pericardial tamponade (asterisks, A). Note extravasation of
contrast media solution in pericardial space. Scale (B) = cm.
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Fig. 9A —Pulmonary embolism. (case 8; iopentol [Imagopaque, GE
Healthcare] and polyethylene glycol) Axial CT image (A) and photograph
of autopsy specimen (B) with frontal view of opened pulmonary trunk
after removal of heart show massive central and peripheral pulmonary embolism
(arrows) with filling defects in pulmonary trunk and lobe arteries of
both lungs. Thrombotic genesis of material was confirmed at autopsy.
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Fig. 9B —Pulmonary embolism. (case 8; iopentol [Imagopaque, GE
Healthcare] and polyethylene glycol) Axial CT image (A) and photograph
of autopsy specimen (B) with frontal view of opened pulmonary trunk
after removal of heart show massive central and peripheral pulmonary embolism
(arrows) with filling defects in pulmonary trunk and lobe arteries of
both lungs. Thrombotic genesis of material was confirmed at autopsy.
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Fig. 10A —Gunshot to chest. (case 9; iopentol [Imagopaque, GE
Healthcare] and polyethylene glycol) Sagittal multiplanar reconstruction image
(A) and photograph of autopsy specimen (B) show bullet track
(dashed line, A) through inferior sternum, with final position
of projectile in intervertebral space L1–L2. Penetration of left lobe of
liver with parenchymal extravasation of contrast media solution along
intrahepatic bullet track (arrow, A) and in omental bursa can
also be seen. Note retrosternal gas bubbles. Because of postmortem decreased
lung volume and cadaver lying on back, heart and liver have been shifted
cranially from original bullet track.
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Fig. 10B —Gunshot to chest. (case 9; iopentol [Imagopaque, GE
Healthcare] and polyethylene glycol) Sagittal multiplanar reconstruction image
(A) and photograph of autopsy specimen (B) show bullet track
(dashed line, A) through inferior sternum, with final position
of projectile in intervertebral space L1–L2. Penetration of left lobe of
liver with parenchymal extravasation of contrast media solution along
intrahepatic bullet track (arrow, A) and in omental bursa can
also be seen. Note retrosternal gas bubbles. Because of postmortem decreased
lung volume and cadaver lying on back, heart and liver have been shifted
cranially from original bullet track.
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Fig. 11A —Gunshot to chest. (case 9, iopentol [Imagopaque, GE
Healthcare] and polyethylene glycol) Axial CT image after arterial perfusion
(A), photograph of gross autopsy specimen (B), and histologic
specimen (elastic Van Gieson stain) (C) show laceration of right
lateral wall of abdominal aorta (arrows) with local aortic dissection
and intraperitoneal extravasation (asterisk, A). Note
enhancement of renal cortex. Scale (B) = cm. Magnification (C) =
x 20.
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Fig. 11B —Gunshot to chest. (case 9, iopentol [Imagopaque, GE
Healthcare] and polyethylene glycol) Axial CT image after arterial perfusion
(A), photograph of gross autopsy specimen (B), and histologic
specimen (elastic Van Gieson stain) (C) show laceration of right
lateral wall of abdominal aorta (arrows) with local aortic dissection
and intraperitoneal extravasation (asterisk, A). Note
enhancement of renal cortex. Scale (B) = cm. Magnification (C) =
x 20.
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Fig. 11C —Gunshot to chest. (case 9, iopentol [Imagopaque, GE
Healthcare] and polyethylene glycol) Axial CT image after arterial perfusion
(A), photograph of gross autopsy specimen (B), and histologic
specimen (elastic Van Gieson stain) (C) show laceration of right
lateral wall of abdominal aorta (arrows) with local aortic dissection
and intraperitoneal extravasation (asterisk, A). Note
enhancement of renal cortex. Scale (B) = cm. Magnification (C) =
x 20.
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Fig. 12A —Gunshot to chest. (case 9, iopentol [Imagopaque, GE
Healthcare] and polyethylene glycol) Axial CT image (A) and photograph
of autopsy specimen (B) show laceration of left lateral wall of
inferior vena cava (arrows). Note local and
perihepatic–perisplenic (asterisk, A) extravasation of
contrast media solution.
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Fig. 12B —Gunshot to chest. (case 9, iopentol [Imagopaque, GE
Healthcare] and polyethylene glycol) Axial CT image (A) and photograph
of autopsy specimen (B) show laceration of left lateral wall of
inferior vena cava (arrows). Note local and
perihepatic–perisplenic (asterisk, A) extravasation of
contrast media solution.
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Fig. 13 —Coronal maximum-intensity-projection reconstruction of
superior mesenteric artery shows extravasation around left proximal branch of
vessel. Rupture was caused by massive compression of thorax and upper abdomen.
Note enhancement of pancreatic parenchyma and walls of gastrointestinal tract.
(case 6; iopentol [Imagopaque, GE Healthcare] and polyethylene glycol)
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Fig. 14A —Same case after contrast injection. (case 6; iopentol
[Imagopaque, GE Healthcare] and polyethylene glycol)
Maximum-intensity-projection reconstruction images after arterial (A)
and venous (B) injection of contrast media solution provide detailed
depiction of thoracoabdominal vasculature. Note decreasing arterial
enhancement during interval (15 minutes) between injections, allowing almost
separate imaging of arteries and veins.
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Fig. 14B —Same case after contrast injection. (case 6; iopentol
[Imagopaque, GE Healthcare] and polyethylene glycol)
Maximum-intensity-projection reconstruction images after arterial (A)
and venous (B) injection of contrast media solution provide detailed
depiction of thoracoabdominal vasculature. Note decreasing arterial
enhancement during interval (15 minutes) between injections, allowing almost
separate imaging of arteries and veins.
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Fig. 15A —Imaging of arm and hand. (case 7; iopentol [Imagopaque, GE
Healthcare] and polyethylene glycol) Volume-rendered technique image of right
brachial arteries after arterial filling provides complete visualization of
radial and ulnar arteries. Osseous structures have been removed by volume
editing.
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Fig. 15B —Imaging of arm and hand. (case 7; iopentol [Imagopaque, GE
Healthcare] and polyethylene glycol) Volume-rendered technique image of right
hand, palmar view, provides visualization of even small phalangeal
arteries.
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Fig. 16A —Imaging of leg and foot. Volume-rendered technique image
shows trifurcation of right popliteal artery, with signs of peripheral
arterial occlusive disease of right leg, mainly seen as lumen irregularities
in right peroneal artery (arrows). (case 7; iopentol [Imagopaque, GE
Healthcare] and polyethylene glycol)
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