Postmortem enhancement of coronary arteries by multiphase whole body CT angiography. Comparison with antemortem coronary angiography

Background. Dissection and assessment of the coronary arteries are indispensible components of every autopsy. In cases of sudden death, particularly of elderly persons with pre-existing coronary heart disease and lack of correlates of long-term ischemia of cardiac muscle, stenosis, obliteration and thrombosis in the coronary arteries are often the decisive factors to explain the death on the basis of conventional autopsy diagnostics. Imaging techniques can be a supplemental aid for the diagnostics. Aim. The aim of this study was to evaluate the diagnostics of sudden cardiac death using imaging techniques. Material and methods. The perfusion quality of 38 defined coronary artery main stem flow areas as depicted by multiphase postmortem computed tomography angiography (MPMCTA) in 10 human corpses was compared with the digital film documentation of coronary angiography (CA), sometimes in combination with percutaneous transluminal angioplasty (PCTA), taken shortly before death. Results. Of the defined vascular areas with no pathological findings in CA, 96% also had no significant findings in postmortem angiography, resulting in a high specificity for the detection of free vascular perfusion by MPMCTA. Postmortem coagulation as a possible artifact only played a minor role. Coronary stenoses were sometimes overestimated in the postmortem angiography as compared to the CA. Post-stenotic areas in five current flow areas in the arterial as well as in the dynamic phase of MPMCTA partially showed repetitive perfusion gaps suggestive of fluid dynamic limitations of the oily contrast agent used. Conclusion. The significance of this small series is restricted by the limitations in comparing the CA film projection plane with the multiplanar CT reconstruction. Nevertheless, the inclusion of the functional aspects which are reflected by the antemortem imaging has proven to be a valuable tool in the interpretation of primary static postmortem coronary diagnostics by PMCTA or dissection.