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Original Research
Special Article
November 23, 2012

Postmortem Imaging-Guided Biopsy as an Adjuvant to Minimally Invasive Autopsy With CT and Postmortem Angiography: A Feasibility Study

Abstract

OBJECTIVE. Although postmortem CT suffices for diagnosing most forms of traumatic death, the examination of natural death is, to date, very difficult and error prone. The introduction of postmortem angiography has led to improved radiologic diagnoses of natural deaths. Nevertheless, histologic changes to tissues, an important aspect in traditional examination procedures, remain obscure even with CT and CT angiography. For this reason, we examined the accuracy of a minimally invasive procedure (i.e., CT angiography combined with biopsy) in diagnosing major findings and the cause of death in natural deaths.
MATERIALS AND METHODS. We examined 20 bodies in a minimally invasive fashion—namely, native CT, CT angiography, and biopsy—and compared the results to those obtained at subsequent autopsy and histologic analysis.
RESULTS. Regarding the major findings and the cause of death, the minimally invasive examination showed almost identical results in 18 of 20 cases. In one case, the severity of a cardiac ischemia was underestimated; in another case, the iliopsoas muscles were not biopsied, thus missing the diagnosis of discoid muscle necrosis and therefore a death due to hypothermia.
CONCLUSION. In light of increasing objections of the next of kin toward an autopsy and the necessity for medical examiners to assess the manner and cause of death, we think that the minimally invasive procedure described here may present a viable compromise in selected cases.

Introduction

In the last decade, postmortem imaging, especially that using CT, has gained increasing acceptance in the forensic field. Many groups in various countries have started to implement such procedures successfully [18].
By virtue of its capability in detecting and imaging osseous lesions, foreign bodies, and gas accumulations, postmortem CT has proved to be a useful tool in the examination of traumatic deaths. However, CT has certain limitations in the assessment of natural death. Vascular and organ pathologic abnormalities, for example, generally cannot be visualized accurately using native CT scans.
To address the problem of vascular pathologic abnormalities, postmortem angiography has been implemented with great success [913]. However, although the vascular bed could be visualized in detail and the results often surpassed those obtained by conventional autopsy, postmortem angiography does have certain limitations when addressing the cause of death (COD).
For example, postmortem angiography can show injuries to blood vessels in great detail and suffices to show an occlusion in a coronary or pulmonary artery, but it cannot deliver information regarding the cause of the occlusion. Atherosclerotic occlusions can be readily recognized with CT, but potentially lethal thrombotic occlusions cannot be differentiated from forensically irrelevant postmortem blood clots. Furthermore, atherosclerotic coronary occlusion, a finding that is frequently encountered at autopsy, may be irrelevant to the COD, because it can have existed for at least several weeks, months, or even years before the individual's death. Therefore, to assess the effect on an organ, for example the heart, one must also examine the structure of the tissue itself. At conventional autopsy, this is done macroscopically and very often also histologically.
Another problem in postmortem imaging is the vitality of an injury—that is, whether a lesion occurred during life or after death. The most common so-called vital reactions are hemorrhages, aspiration (e.g., blood, water, and gastric contents), inhalation of gases (e.g., carbon monoxide), embolism (e.g., fat, gas, and thrombi), or inflammatory responses. Although gas embolism and hemorrhages can be diagnosed with CT [14, 15], aspirated material can only be suspected, and inflammatory responses and fat embolisms are not detectable with CT. Traditional macromorphologic examination can usually discern between different aspirated materials, whereas microscopic findings of inflammation and diagnosis of fat embolism belong to the field of histology.
The accuracy of biopsy sampling has been shown before [16, 17]. However, to our knowledge, the possibility of diagnosing the COD by postmortem biopsy in combination with CT and postmortem angiography has not been examined to date.
To assess the diagnostic accuracy regarding the main findings and the COD, we compared the results of a minimally invasive approach (i.e., native CT, postmortem CT angiography, and biopsy) with those obtained in a conventional manner with autopsy and histologic analysis.

Materials and Methods

Inclusion Criteria

Of all the cases of extraordinary death (accidents, suicides, homicides, and cases of unknown cause and manner of death) delivered to our institute for forensic autopsy, we included 20 consecutive cases of unclear COD (i.e., no known medical history explaining the death) that displayed no signs of mechanical trauma and for which the case circumstances were indicative of a natural death. The mean age of the studied group was 56.4 years; the male-to-female ratio was 14:6 (Table 1). Ten of the cases were found dead at home, five died in a clinical institution, two died in vehicles without a crash, one died during sports (jogging), one died on a mountain, and one died at the workplace.
TABLE 1: Overview of Cases and Findings Detected by Different Methods
Case No.Age (y)Circumstances of DeathResults of Histologic AnalysisCause of Death
SexAutopsy FindingsRadiology FindingsBiopsy FindingsConventionalMinimally Invasive
168MaleDied at homeCardiac hypertrophy, occluded stents, arteriosclerotic coronary stenosis, indurated lungsCardiac fibrosis, chronic blood aspiration, chronic interstitial pneumoniaCardiac hypertrophy, stent occlusions in right circumflex artery and right coronary artery, atypic pneumoniaCardiac fibrosis, chronic blood aspiration, chronic interstitial pneumoniaCardiac arrestCardiac arrest
260FemaleDied at homeAtherosclerotic coronary occlusion, acute myocardial infarction, pulmonary congestionExtensive contraction band necrosis, lungs congestedOcclusion of left anterior descending, pulmonary congestion, pleural effusionsExtensive contraction band necrosis, pulmonary edemaMyocardial infarctionMyocardial infarction
363MaleDied on busCardiac hypertrophy, sclerotic coronaries, stenosis proximal to left coronary artery, pulmonary edemaSingle contraction band necrosis and slight fibrosis, pulmonary congestion and edemaCardiac hypertrophy, sclerotic coronaries, stenosis proximal to left coronary artery, pulmonary edemaSlight myocardial fibrosis, pulmonary edema and congestionCardiac arrestCardiac arrest
481MaleDied at homeGastric content aspirationMyocardial fibrosis, aspiration pneumoniaAspiration pneumonia, pulmonary fibrosis positiveSlight myocardial fibrosis, slight pneumoniaCardiac arrest due to pneumoniaCardiac arrest
578MaleDied in hospitalCardiac hypertrophy, three-stem coronary artery disease, myocardial infarction scar, congested lungsMyocardial fibrosis, single contraction band necrosis, pulmonary congestionThree-stem coronary artery disease, cardiac hypertrophy, pulmonary congestionMyocardial fibrosis, single contraction band necrosis, pulmonary emphysemaCardiac arrestCardiac arrest
658MaleDied in practiceCardiac hypertrophy, occlusion of left anterior descending and circumflex arteries, pulmonary edemaMyocardial fibrosis, pulmonary edemaCardiac hypertrophy, occlusion of left anterior descending and right circumflex arteries, pulmonary edemaMyocardial fibrosisCardiac arrestCardiac arrest
752MaleDied at homeSmall-cell carcinoma in lungs and locoregional lymph node, tumor erosion of pulmonary arteryExtensive small-cell carcinoma in lungs and regional lymph nodesSmall-cell carcinoma, tumor erosion of pulmonary artery, mediastinal lymphangitisExtensive small-cell carcinoma in lungsExsanguinationExsanguination
833FemaleDied at homePulmonary edema, reactive spleenLymphocytic myocarditisPulmonary edema, splenomegalyLymphocytic myocarditisCardiac arrestCardiac arrest
915MaleDied at homeCentral pulmonary thromboembolus, colitis ulcerosaColitis ulcerosa, fresh thromboembolus in pulmonary trunkCentral pulmonary thromboembolus, colitis ulcerosaColitis ulcerosa, fresh thromboembolus in pulmonary trunkRight heart failure due to pulmonary thromboembolusRight heart failure due to pulmonary thromboembolus
1078FemaleDied in hospitalIntrathoracic hemorrhage, thrombotic occlusion of right coronary artery, pulmonary edemaFibrosing alveolitis, proliferative state, pleuritis, pneumonic residuesThrombotic occlusion of right coronary artery, intrathoracic hemorrhage, pulmonary edema, pneumoniaFibrosing alveolitis, proliferative stateCardiac arrest due to hemorrhage and coronary occlusionCardiac arrest due to hemorrhage and coronary occlusion
1182MaleDied in carThrombotic occlusion of right coronary artery, 90% stenosis of left anterior descending, pulmonary edemaFresh thrombosis in coronary, pulmonary congestionThrombotic occlusion of right coronary artery, 90% stenosis of left anterior descending, pulmonary edemaPulmonary congestionCardiac arrest due to coronary occlusionCardiac arrest
1255MaleDied at homeCardiac hypertrophyPulmonary congestionCardiac hypertrophy, pulmonary congestionPulmonary congestionCardiac arrestCardiac arrest
1380MaleDied in hospitalCardiac hypertrophy, coronary occlusion, free coronary bypassesMyocardial fibrosis, pulmonary congestionCardiac hypertrophy, pulmonary congestion, coronary occlusion, free coronary bypassesMyocardial fibrosisCardiac arrestCardiac arrest
1454MaleDied during sportsThrombosis of right circumflex artery and right coronary artery, 90% stenosis of left anterior descending, pulmonary congestionFibrosis, single contraction band necrosis, pulmonary congestionThrombosis of right circumflex artery and right coronary artery, 90% stenosis of left anterior descending, pulmonary congestion positiveFibrosis, single contraction band necrosis, pulmonary congestionCardiac arrestCardiac arrest
1557MaleDied at workplaceCardiac hypertrophy, coronary stenoses, pulmonary congestionMultiple contraction band necroses, fibrosisCardiac hypertrophy, coronary stenoses, pulmonary congestionFibrosisMyocardial infarctionCardiac arrest
1652FemaleDied at homePulmonary thromboembolusFresh pulmonary thromboembolusPulmonary thromboembolus, coronaries normalFresh pulmonary thromboembolusRight heart failure due to pulmonary thromboembolusRight heart failure due to pulmonary thromboembolus
1749MaleDied at homeCardiac hypertrophy, aortic dissection reaching left coronary ostiumPulmonary congestionCardiac hypertrophy, aortic dissection reaching left coronary ostiumPulmonary congestionCardiac arrestCardiac arrest
1846FemaleDied at homeLarge intracranial tumor, cerebral edemaMeningiomaLarge intracranial tumor, cerebral edemaMeningiomaCentral respiratory paralysisCentral respiratory paralysis
1931MaleDied on mountainCachexia, gastric erosions, extensive tuberculosis of lungs and spleenDiscoid necrosis of iliopsoas muscle; tuberculosis in lungs, spleen, liver, colon, trunk lymph nodesTuberculosis of lungsTuberculosis of lungs and spleenHypothermiaCardiac arrest due to tuberculosis-associated cachexia
20
36
Female
Died during labor
Cerebral hemorrhages, pulmonary congestion
Massive embolism of amniotic fluid and fat
Cerebral hemorrhages, pulmonary congestion
Massive embolism of amniotic fluid and fat
Right heart failure
Cardiac arrest

Investigations Applied

After thorough external inspection by a board-certified forensic pathologist, the corpses underwent CT. Scans were obtained with a Somatom Emotion 6 scanner (Siemens Healthcare) with 4 × 1.25 mm collimation. The reconstruction interval was 0.7 mm. We calculated 2D and 3D reconstructions using a Leonardo workstation with Syngo CT software (both from Siemens Healthcare).
Minimally invasive postmortem CT angiography was performed via unilateral access to the femoral blood vessels (femoral artery and vein). A modified heart–lung machine was used as injection pump for a close simulation of the intravital pressure conditions. A mixture of polyethylene glycol (PEG 200) and water-soluble contrast medium (iohexol, Omnipaque, GE Healthcare) was injected separately into the arterial and the venous system. CT scans were then obtained with the CT unit described in the previous paragraph.
Before the actual biopsy procedure, a 13-gauge introducer needle was placed under CT fluoroscopic control into the area of interest. Biopsy specimens were obtained with a Bard Magnum biopsy gun and a 14-gauge UltraCORE biopsy needle (all biopsy equipment was from Bard Biopsy Systems) (Fig. 1A, 1B). In every case, at least the heart and lungs were biopsied (two or more specimens of the left ventricle and four specimens of both lungs were analyzed). In addition, suspicious regions as identified by CT were also biopsied. The CT took only a few minutes to perform, and the entire CT-based angiography procedure (including access to the femoral vessels) required almost 1 hour. Depending on the extent of the biopsies (i.e., heart and lungs only or additional radiologically suspicious regions), the biopsy procedure took between a few minutes to almost half an hour.
After CT scanning and acquisition of biopsies, all corpses underwent full forensic autopsy. In addition, histologic examinations were performed on all vital organs (at least brain, heart, lungs, liver, and kidneys) and on case-relevant tissues identified by macromorphological findings. Formalin-fixed histology and biopsy samples were routinely stained with H and E and, in heart specimens, also with chrome aniline blue and were evaluated by a board-certified forensic pathologist. Ziehl-Neelsen staining was performed on one case in which tuberculosis-suspicious lesions were seen macro- and microscopically. Native lung specimens were stained with Sudan red III to detect a possible fat embolism.

Evaluation Process

The main results of autopsy and histologic analyses were compared with the main results obtained by radiology (native CT and angiography) and biopsy. The causes of death, as diagnosed by the conventional autopsy in combination with histologic analysis, were then compared with those deduced using the minimally invasive approach with radiology and biopsy. If relevant preexisting cardiac pathologic abnormalities could be found (e.g., significant cardiac hypertrophy or coronary stenoses or occlusions), but no findings pertaining to an immediately lethal condition (such as an acute myocardial infarction) were noted, the COD was deemed “cardiac arrest.”

Results

The results of the conventional approach with autopsy and histologic analysis were remarkably similar to those obtained using postmortem radiology augmented by biopsy (Table 1).

Main Findings

The aspiration pneumonia of case 4 was noted as being a “slight pneumonia” by biopsy. However, CT of this case correctly diagnosed aspiration pneumonia, thus equalizing the conventional results (as in the cases with pulmonary congestion or edema).
Another shortcoming of biopsy was the failure to detect pneumonic residues in case 10. The patient was admitted to hospital with pneumonia and treated accordingly. A diagnostic transthoracic biopsy was performed a few days before death. The major findings, an intrathoracic hemorrhage caused by the biopsy during hospitalization and a thrombotic coronary occlusion, were found in both the conventional and the minimally invasive examination procedures. However, histologic analysis showed pneumonic residues, whereas CT revealed pneumonia, and the biopsy missed such residues.
Biopsy missed a pulmonary congestion or edema noted by histologic analysis in two of nine cases. However, this finding was registered at CT examination, so the combination of both radiology and biopsy delivered the same results as autopsy and biopsy.
Contraction band necrosis proved to be more difficult to find with biopsy specimens. In case 3, biopsy missed the histologically found single contraction band necrosis; in case 15, biopsy only showed single instead of multiple contraction band necroses, as seen at histologic analysis.

Cause of Death

The COD as postulated by conventional methods was in almost complete accordance with that determined by the minimally invasive procedure (Figs. 2, 3, 4). Indeed, in 18 of 20 cases, both methods delivered identical results. However, in one case (case 15), biopsy only showed single contraction band necrosis, thus rendering the COD found by the minimally invasive method as a “cardiac arrest,” whereas histologic analysis revealed extensive contraction band necroses, therefore permitting the diagnosis of the COD as a “myocardial infarction.”
Another case (case 19), displayed a totally different COD by the minimally invasive technique than by the conventional procedure. In this case, the fully clothed frozen body of a man was found lying in snow in the mountains. Although both methods revealed extensive tuberculosis infection, the minimally invasive technique failed to detect gastric erosions. These erosions indicate a long agonal phase, which is, taking the incident scene into account, indicative of a hypothermic death. Furthermore, the iliopsoas muscles were not biopsied, which is why the discoid necrosis of these muscle fibers, a finding typical for hypothermia, was missed. This led to the erroneous determination of the manner of death in the minimally invasive examination to be natural, whereas autopsy proved this to be an accidental death due to hypothermia.
Fig. 1A 46-year-old woman found dead in her bed after several week long history of headaches, nausea, and vomiting. Native coronal CT reconstruction of brain window shows large hyperdense (light) structure in frontal lobe.
Fig. 1B 46-year-old woman found dead in her bed after several week long history of headaches, nausea, and vomiting. Sagittal CT reconstruction shows biopsy needle being placed into hyperdense structure. Needle biopsy of hyperdense structure showed whorled cell clusters and psammoma bodies, thus proving that radiologically seen structure was meningioma.
Fig. 2 60-year-old woman found dead at home. Three-dimensional CT reconstruction of heart after postmortem angiography displays almost complete occlusion of right coronary artery (arrow). Biopsy of left ventricle showed contraction band necrosis.
Fig. 3 31-year-old man found fully clothed on mountain. CT coronal reformation (lung window) shows cavernous lesion (black arrow) of right pulmonary apex, nodular opacity of left lung (white arrow), and diffuse opacity of right lung. These findings are highly indicative of tuberculosis. Biopsy of lung showed caseating granuloma, indicating lesions to be possibly tuberculous. Histologic analysis also showed giant cells and epithelioid cells not visible in biopsy specimen. Ziehl-Neelsen staining proved presence of acid-fast bacteria.
Fig. 4 52-year-old man who died at home. CT axial reformation of lung window shows biopsy needle advancing into region highly suspicious for neoplasia. Biopsy of tumor showed extensive infiltrates of small-cell lung carcinoma.

Discussion

Although CT alone did not suffice to diagnose all major findings detected by autopsy and histologic analysis, the combination of native CT, postmortem CT angiography, and biopsy, representing a minimally invasive approach, delivered remarkable results. Indeed, this minimally invasive approach led to the correct diagnosis of the COD in 18 (90%) of 20 cases. In one case, autopsy detected a myocardial infarction, a finding that was confirmed histologically. Although postmortem CT angiography displayed a thrombotic coronary occlusion, biopsy of the heart showed only a single contraction band necrosis, a finding that permitted only the vague diagnosis of the COD being a “cardiac arrest.” This underestimation of the severity of the ischemic damage may be overcome by selecting different areas of the heart, especially the papillary muscles, instead of the left ventricular wall, where, depending on the extent of the ischemia, no damage may be detected in the tiny biopsy sample. Targeted biopsy of such small structures is technically possible, as Aghayev et al. [17] showed when performing biopsy on peas in gelatin and corpses.
This sampling of regions of interest may increase the accuracy of histopathologic diagnosis. However, incidental findings not visible by CT or CT angiography, or macroscopic examination at autopsy, will be missed unless all (relevant) organs are examined histopathologically on a routine basis, as is standard procedure in clinical autopsies. Such an extensive microscopic examination is obviously hardly possible with postmortem biopsy, and incidental minor findings may therefore be missed in the minimally invasive examination.
In the remaining discrepant case regarding the COD, the man with tuberculosis who died due to hypothermia (case 19), the reason for the missed diagnosis is different. The autopsy was performed by an experienced forensic pathologist who knew which samples should be taken for confirmation of the suspected diagnosis. However, the biopsy was undertaken by a person with little forensic experience who omitted the biopsy of the iliopsoas muscles. The correct diagnosis, death due to hypothermia, was therefore not possible on the basis of minimally invasive examinations. This shortcoming highlights the necessity of a close collaboration between pathologists and radiologists in performing the proper examinations and thus arriving at the correct conclusions.
Such a close collaboration not only assists in making proper conclusions, but also may improve safety of the pathologists. For example, in case 19, the tuberculosis infection was unknown before the examinations. The surprise finding of a potentially lethal infection is not rare in forensic pathology, where, in contrast to clinical pathology, infections are frequent (i.e., in IV drug users) and a medical history is often unknown. Here, postmortem imaging in combination with biopsy may give important information as to the presence of certain contagious diseases such as tuberculosis, and thus help the pathologist to apply the necessary protection, such as special face masks, against such an infection.
Although this is an admittedly small study, we nevertheless believe that it highlights certain difficulties and advantages. The main advantage is that minimally invasive autopsy techniques are less objected to than conventional autopsies. The minimally invasive approach described here may serve as a compromise between this objection toward an autopsy and the physicians' need for information regarding pathologic conditions. Furthermore, minimally invasive postmortem examinations pose less risk of exposure of examiners to infectious agents than an autopsy.
However, certain drawbacks cannot be dismissed. For example, a discrete change in color or texture of an organ, an immensely important observation at autopsy, is obviously not visible in radiology. In these cases, the minimally invasive examiner will have to rely on blind chance biopsies of all important organs. Because of the small size of the biopsy specimen, tiny localized pathologic abnormalities not seen radiologically may be missed by chance sampling of organs.
Another problem is the time needed for a minimally invasive examination. An experienced pathologist will be able to perform a full autopsy in less time than with the minimally invasive technique. However, we believe that, with more experience and better equipment, these examinations will become more rapid and cheaper, very much like the development of laparoscopic surgical procedures.
We conclude from our study that the combination of CT, postmortem CT angiography, and biopsy is a valid tool to examine bodies in a minimally invasive fashion. A close collaboration between pathologists and radiologists is imperative for the correct sampling and diagnostic assessment and, therefore, for the success of such an undertaking.

Acknowledgments

We thank B. Nicolet for the staining of the biopsy and histology specimens and W. Bolliger for assistance in manuscript preparation.

Footnote

Address correspondence to S. A. Bolliger ([email protected]).

References

1.
O'Donnell C, Woodford N. Post-mortem radiology: a new sub-specialty? Clin Radiol 2008; 63:1189 –1194
2.
Hayakawa M, Yamamoto S, Motani H, Yajima D, Sato Y, Iwase H. Does imaging technology overcome problems of conventional postmortem examination? A trial of computed tomography imaging for postmortem examination. Int J Legal Med 2006; 120:24–26
3.
Christe A, Ross S, Oesterhelweg L, et al. Abdominal trauma: sensitivity and specificity of postmortem noncontrast imaging findings compared with autopsy findings. J Trauma 2009; 66:1302 –1307
4.
Schnider J, Thali MJ, Ross S, Oesterhelweg L, Spendlove D, Bolliger SA. Injuries due to sharp trauma detected by post-mortem multislice computed tomography (MSCT): a feasibility study. Leg Med (Tokyo) 2009; 11:4 –9
5.
Andenmatten MA, Thali MJ, Kneubuehl BP, et al. Gunshot injuries detected by post-mortem multislice computed tomography (MSCT): a feasibility study. Leg Med (Tokyo) 2008; 10:287–292
6.
Harcke HT, Levy AD, Getz JM, Robinson SR. MDCT analysis of projectile injury in forensic investigation. AJR 2008; 190:352; [web]W106–W111
7.
Aghayev E, Christe A, Sonnenschein M, et al. Postmortem imaging of blunt chest trauma using CT and MRI: comparison with autopsy. J Thorac Imaging 2008; 23:20 –27
8.
Ljung P, Winskog C, Persson A, Lundström C, Ynnerman A. Full body virtual autopsies using a state-of-the-art volume rendering pipeline. IEEE Trans Vis Comput Graph 2006; 12:869–876
9.
Ross S, Spendlove D, Bolliger S, et al. Postmortem whole-body CT angiography: evaluation of two contrast media solutions. AJR 2008; 190:1380 –1389
10.
Jackowski C, Persson A, Thali MJ. Whole body postmortem angiography with a high viscosity contrast agent solution using poly ethylene glycol as contrast agent dissolver. J Forensic Sci 2008; 53:465 –468
11.
Ehrlich E, Farr T, Maxeiner H. Detection of arterial bleeding points in basilar subarachnoid hemorrhage by postmortem angiography. Leg Med (Tokyo) 2008; 10:171–176
12.
Grabherr S, Gygax E, Sollberger B, et al. Two-step postmortem angiography with a modified heart-lung machine: preliminary results. AJR 2008; 190:345 –351
13.
Jackowski C, Bolliger S, Aghayev E, et al. Reduction of postmortem angiography-induced tissue edema by using polyethylene glycol as a contrast agent dissolver. J Forensic Sci 2006; 51:1134– 1137
14.
Aghayev E, Sonnenschein M, Jackowski C, et al. Postmortem radiology of fatal hemorrhage: measurements of cross-sectional areas of major blood vessels and volumes of aorta and spleen on MDCT and volumes of heart chambers on MRI. AJR 2006; 187:209–215
15.
Jackowski C, Thali M, Sonnenschein M, et al. Visualization and quantification of air embolism structure by processing postmortem MSCT data. J Forensic Sci 2004; 49:1339 –1342
16.
Aghayev E, Thali MJ, Sonnenschein M, Jackowski C, Dirnhofer R, Vock P. Post-mortem tissue sampling using computed tomography guidance. Forensic Sci Int 2007; 166:199–203
17.
Aghayev E, Ebert LC, Christe A, et al. CT databased navigation for post-mortem biopsy: feasibility study. J Forensic Leg Med 2008; 15:382 –387

Information & Authors

Information

Published In

American Journal of Roentgenology
Pages: 1051 - 1056
PubMed: 20966306

History

Submitted: March 12, 2010
Accepted: April 12, 2010
First published: November 23, 2012

Keywords

  1. postmortem angiography
  2. postmortem biopsy
  3. postmortem CT
  4. virtopsy

Authors

Affiliations

Stephan A. Bolliger
Institute of Forensic Medicine, Centre for Forensic Imaging and Virtopsy, University of Bern, Buehlstrasse 20, Bern CH-3012, Switzerland.
Laura Filograna
Institute of Forensic Medicine, Centre for Forensic Imaging and Virtopsy, University of Bern, Buehlstrasse 20, Bern CH-3012, Switzerland.
Danny Spendlove
Institute of Forensic Medicine, Centre for Forensic Imaging and Virtopsy, University of Bern, Buehlstrasse 20, Bern CH-3012, Switzerland.
Michael J. Thali
Institute of Forensic Medicine, Centre for Forensic Imaging and Virtopsy, University of Bern, Buehlstrasse 20, Bern CH-3012, Switzerland.
Stephan Dirnhofer
Institute of Pathology, University of Basel, Basel, Switzerland.
Steffen Ross
Institute of Forensic Medicine, Centre for Forensic Imaging and Virtopsy, University of Bern, Buehlstrasse 20, Bern CH-3012, Switzerland.

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