Whole-body post mortem CT angiography (PMCTA) is an innovative and experimental imaging technique that relies heavily on interdisciplinary collaboration, access to skilled personnel, advanced technical equipment and the financial possibilities of the workplace. Native CT examinations (PMCT) prior to autopsy are already a standard procedure in certain forensic departments in the Czech Republic (e.g., murders, suicides, deaths of children, traffic accidents etc.). Nonetheless, the progression of forensic sciences all over the world shows the necessity to integrate other advanced imaging modalities in routine forensic practice. Incorporating PMCTA into standard forensic workflows enhances the precision of forensic diagnostics, supplements traditional autopsy findings, and elevates the objectivity of forensic outputs. This paper presents technical notes on the development of PMCTA in forensic practice in a department that since 2015 until now has routinely performed native CT examinations. Institutional support was crucial in enabling the adoption of the imaging technique, which has so far been applied to more than thirty cases. The department is currently conducting a comparative study focused on the application of three different types of perfusion media - polyethylene glycol (PEG), saline, paraffin oil - and assessing the diagnostic efficacy of PMCTA relative to conventional autopsy. Based on our experience, PMCTA is suitable for all corpses except those with advanced post-mortem decomposition or extensive open injuries. The highest diagnostic yield is achieved in cases involving suspected gastrointestinal bleeding or vascular pathologies and lesions especially of large vessels (e.g., dissection/rupture of the aorta). The protocol for whole-body PMCTA can be adapted to meet the specific needs and conditions of individual forensic departments, providing a flexible yet robust framework for enhancing forensic medical investigations.

• Klíčová slova
• : post mortem computed tomography angiography (PMCTA), Autopsy, forensic pathology, post mortem computed tomography (PMCT), research, virtopsy,
• MeSH
• celotělové zobrazování * metody   MeSH
• CT angiografie * metody   MeSH
• lidé MeSH
• pitva metody   MeSH
• posmrtné zobrazování MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

Post mortem magnetic resonance imaging is demonstrated as a supplementary method to classic pathological-anatomical autopsy in determining anomalies of the foetus. Frequently it plays a key role; primarily where the possibilities of performing autopsy are somehow limited (autolysis, ventricular dilatation). Specification of the final diagnosis subsequently enables us to improve prenatal diagnostics, both by means of magnetic resonance imaging and primarily by correlation with the prenatal ultrasound scan; this feedback improves the later method. This case report demonstrated that post mortem magnetic resonance imaging, in contrast with prenatal ultrasound examination, showed extensive haemorrhage in the germinal matrix, and also illustrated indirect symptoms testifying to agenesis of the corpus callosum. Prenatal ultrasound examination showed only hydrocephalus and absence of septum pellucidum. Pathological-anatomical autopsy of the brain was insufficient with regard to advanced autolysis and brain haemorrhage.

• MeSH
• blastodisk diagnostické zobrazování   patologie   MeSH
• cerebrální krvácení diagnostické zobrazování   patologie   MeSH
• diagnóza MeSH
• dospělí MeSH
• lidé MeSH
• magnetická rezonanční tomografie metody   MeSH
• mnohočetné abnormality diagnostické zobrazování   MeSH
• pitva MeSH
• potracený plod diagnostické zobrazování   MeSH
• prediktivní hodnota testů MeSH
• radiografie MeSH
• syndrom corpus callosum diagnostické zobrazování   patologie   MeSH
• těhotenství MeSH
• ultrasonografie MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• hodnotící studie MeSH
• kazuistiky MeSH
• práce podpořená grantem MeSH

OBJECTIVE: To improve prenatal diagnostic with a feedback of autopsy, complemented by post mortem magnetic resonance imaging (MRI). MRI is important for malformations of CNS, where autopsy can be insufficient. SUBJECT: Case report. SETTING: MR unit of the Department of radiology, Department of obstetrics and gynaecology and Department of pathology, 1st medical school, Charles University in Prague, General Teaching Hospital. SUBJECT AND METHOD: To compare prenatal ultrasound, post mortem MRI and autopsy. CONCLUSION: Case report documented complementarity of all three method; full agreement in brain malformation type was found.

• MeSH
• dospělí MeSH
• indukovaný potrat MeSH
• lidé MeSH
• magnetická rezonanční tomografie * MeSH
• malformace mozkové kůry diagnóza   diagnostické zobrazování   patologie   MeSH
• pitva MeSH
• těhotenství MeSH
• ultrasonografie prenatální * MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• srovnávací studie MeSH

Post-mortem magnetic resonance appears to be a method supplementary to classic pathological-anatomical autopsy in determining foetal abnormalities. Frequently, it plays a key role, primarily where autopsy options are in some way limited (developed autolysis, dilatation of the ventricular system). This case report demonstrates that post-mortem magnetic resonance imaging can precisely determine the type of congenital malformation (hydranencephaly), by contrast to ultrasound, with which alobar holoprosencephaly has been described, often presenting a differential diagnosis problem. Pathological-anatomical autopsy was significantly limited due to this diagnosis and this methodology was incapable of unequivocally determining the type of malformation. We would like to demonstrate by this case report the necessity of performing post-mortem magnetic resonance imaging so that we may precisely determine the diagnosis as requested by the parents and also be able to answer the question posed by risks for future pregnancies.

• MeSH
• dospělí MeSH
• gestační stáří MeSH
• hydranencefalie diagnóza   genetika   patologie   MeSH
• lidé MeSH
• magnetická rezonanční tomografie metody   MeSH
• pitva * MeSH
• těhotenství MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH
• práce podpořená grantem MeSH

PURPOSE: The quality and precision of post-mortem MRI microscopy may vary depending on the embedding medium used. To investigate this, our study evaluated the impact of 5 widely used media on: (1) image quality, (2) contrast of high spatial resolution gradient-echo (T1 and T2* -weighted) MR images, (3) effective transverse relaxation rate (R2* ), and (4) quantitative susceptibility measurements (QSM) of post-mortem brain specimens. METHODS: Five formaldehyde-fixed brain slices were scanned using 7.0T MRI in: (1) formaldehyde solution (formalin), (2) phosphate-buffered saline (PBS), (3) deuterium oxide (D2 O), (4) perfluoropolyether (Galden), and (5) agarose gel. SNR and contrast-to-noise ratii (SNR/CNR) were calculated for cortex/white matter (WM) and basal ganglia/WM regions. In addition, median R2* and QSM values were extracted from caudate nucleus, putamen, globus pallidus, WM, and cortical regions. RESULTS: PBS, Galden, and agarose returned higher SNR/CNR compared to formalin and D2 O. Formalin fixation, and its use as embedding medium for scanning, increased tissue R2* . Imaging with agarose, D2 O, and Galden returned lower R2* values than PBS (and formalin). No major QSM offsets were observed, although spatial variance was increased (with respect to R2* behaviors) for formalin and agarose. CONCLUSIONS: Embedding media affect gradient-echo image quality, R2* , and QSM in differing ways. In this study, PBS embedding was identified as the most stable experimental setup, although by a small margin. Agarose and Galden were preferred to formalin or D2 O embedding. Formalin significantly increased R2* causing noisier data and increased QSM variance.

• Klíčová slova
• ex vivo imaging, formaldehyde fixation, post-mortem imaging, quantitative susceptibility mapping, ultra-high field MRI,
• MeSH
• ethery MeSH
• fluorokarbony MeSH
• formaldehyd MeSH
• fosfáty MeSH
• kontrastní látky MeSH
• lidé středního věku MeSH
• lidé MeSH
• magnetická rezonanční tomografie přístrojové vybavení   metody   MeSH
• mapování mozku metody   MeSH
• mozek diagnostické zobrazování   patologie   MeSH
• odběr biologického vzorku MeSH
• oxid deuteria MeSH
• pitva přístrojové vybavení   metody   MeSH
• počítačové zpracování obrazu MeSH
• poměr signál - šum MeSH
• sefarosa chemie   MeSH
• senioři MeSH
• zalévání tkání přístrojové vybavení   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Názvy látek
• ethery MeSH
• fluorokarbony MeSH
• formaldehyd MeSH
• fosfáty MeSH
• kontrastní látky MeSH
• oxid deuteria MeSH
• perfluoropolyether MeSH Prohlížeč
• sefarosa MeSH

In forensic medicine, fatal hypothermia diagnosis is not always easy because findings are not specific, especially if traumatized. Post-mortem computed tomography (PMCT) is a useful adjunct to the cause-of-death diagnosis and some qualitative image character analysis, such as diffuse hyperaeration with decreased vascularity or pulmonary emphysema, have also been utilized for fatal hypothermia. However, it is challenging for inexperienced forensic pathologists to recognize the subtle differences of fatal hypothermia in PMCT images. In this study, we developed a deep learning-based diagnosis system for fatal hypothermia and explored the possibility of being an alternative diagnostic for forensic pathologists. An in-house dataset of forensic autopsy proven samples was used for the development and performance evaluation of the deep learning system. We used the area under the receiver operating characteristic curve (AUC) of the system for evaluation, and a human-expert comparable AUC value of 0.905, sensitivity of 0.948, and specificity of 0.741 were achieved. The experimental results clearly demonstrated the usefulness and feasibility of the deep learning system for fatal hypothermia diagnosis.

• Klíčová slova
• artificial intelligence, autopsy, deep learning, fatal hypothermia, post-mortem computed tomography,
• MeSH
• deep learning * MeSH
• hypotermie * diagnostické zobrazování   MeSH
• lidé MeSH
• pitva metody   MeSH
• počítačová rentgenová tomografie metody   MeSH
• příčina smrti MeSH
• soudní patologie metody   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

Pathological-anatomical autopsy is the gold standard for determining of foetal abnormalities, but in some cases its role is limited (pathology of central nervous system, in particular, in case of ventricular dilatation or developed autolysis). In pathology of central nervous system, where insufficiency of autopsy can occur, additional post mortem magnetic resonance imaging (MRI) is performed to determine type of malformation. In this case report, we would like to point out the fact that although all investigating methods including post mortem magnetic resonance and autopsy (incl. imunohistochemical tests) are used, this need not necessarily result in a clear diagnostic conclusion of the aborted foetus. Post mortem MRI visualized pathology: dilatation of both lateral ventricals, more in the left and, above all, a pathological focus parasagittaly on the right with haemorrhage and cystic component; it raised a suspicion on ependymoma. However imunohistochemical test did not give an unambiguous conclusion; therefore diagnosis based on MRI could not be uniquely verified.

• MeSH
• cerebrální krvácení diagnostické zobrazování   patologie   MeSH
• diferenciální diagnóza MeSH
• dospělí MeSH
• ependymom diagnóza   diagnostické zobrazování   patologie   MeSH
• gestační stáří MeSH
• lidé MeSH
• magnetická rezonanční tomografie * MeSH
• malformace nervového systému diagnóza   diagnostické zobrazování   patologie   MeSH
• mozek abnormality   patologie   MeSH
• nádory mozku diagnóza   diagnostické zobrazování   patologie   MeSH
• pitva metody   MeSH
• potracený plod abnormality   patologie   MeSH
• těhotenství MeSH
• ultrasonografie prenatální * MeSH
• ventriculi laterales abnormality   patologie   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

This case report describes a finding of vascular malformation of an aborted foetus of gestational age of the 22nd week. This concerns meningocerebral angiodysplasia, located in the posterior fossa and around the thalami. This disease is rare and is often accompanied by renal agenesis. The finding was complicated by hydrocephalus. Our report compares all three diagnostic methods (prenatal ultrasonography, post-mortem MR and autopsy). Prenatal ultrasonography described only hydrocephalus and reduction of cerebral parenchyma. MR displayed the extent of the malformation, the exact diagnosis was however determined by histological examination. MR described agenesis of structures of midbrain, which was confirmed by autopsy.

• Publikační typ
• časopisecké články MeSH

AIMS: In Wilson disease (WD), T2/T2*-weighted (T2*w) MRI frequently shows hypointensity in the basal ganglia that is suggestive of paramagnetic deposits. It is currently unknown whether this hypointensity is related to copper or iron deposition. We examined the neuropathological correlates of this MRI pattern, particularly in relation to iron and copper concentrations. METHODS: Brain slices from nine WD and six control cases were investigated using a 7T-MRI system. High-resolution T2*w images were acquired and R2* parametric maps were reconstructed using a multigradient recalled echo sequence. R2* was measured in the globus pallidus (GP) and the putamen. Corresponding histopathological sections containing the lentiform nucleus were examined using Turnbull iron staining, and double staining combining Turnbull with immunohistochemistry for macrophages or astrocytes. Quantitative densitometry of the iron staining as well as copper and iron concentrations were measured in the GP and putamen and correlated with R2* values. RESULTS: T2*w hypointensity in the GP and/or putamen was apparent in WD cases and R2* values correlated with quantitative densitometry of iron staining. In WD, iron and copper concentrations were increased in the putamen compared to controls. R2* was correlated with the iron concentration in the GP and putamen, whereas no correlation was observed for the copper concentration. Patients with more pronounced pathological severity in the putamen displayed increased iron concentration, which correlated with an elevated number of iron-containing macrophages. CONCLUSIONS: T2/T2*w hypointensity observed in vivo in the basal ganglia of WD patients is related to iron rather than copper deposits.

• Klíčová slova
• Wilson disease, brain, iron accumulation, pathology, post mortem 7T MRI,
• MeSH
• astrocyty MeSH
• bazální ganglia diagnostické zobrazování   metabolismus   patologie   MeSH
• corpus striatum metabolismus   patologie   MeSH
• dospělí MeSH
• hepatolentikulární degenerace diagnostické zobrazování   metabolismus   patologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• magnetická rezonanční tomografie MeSH
• makrofágy MeSH
• měď metabolismus   MeSH
• mladý dospělý MeSH
• železo metabolismus   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• měď MeSH
• železo MeSH

Drowning diagnosis is a complicated process in the autopsy, even with the assistance of autopsy imaging and the on-site information from where the body was found. Previous studies have developed well-performed deep learning (DL) models for drowning diagnosis. However, the validity of the DL models was not assessed, raising doubts about whether the learned features accurately represented the medical findings observed by human experts. In this paper, we assessed the medical validity of DL models that had achieved high classification performance for drowning diagnosis. This retrospective study included autopsy cases aged 8-91 years who underwent postmortem computed tomography between 2012 and 2021 (153 drowning and 160 non-drowning cases). We first trained three deep learning models from a previous work and generated saliency maps that highlight important features in the input. To assess the validity of models, pixel-level annotations were created by four radiological technologists and further quantitatively compared with the saliency maps. All the three models demonstrated high classification performance with areas under the receiver operating characteristic curves of 0.94, 0.97, and 0.98, respectively. On the other hand, the assessment results revealed unexpected inconsistency between annotations and models' saliency maps. In fact, each model had, respectively, around 30%, 40%, and 80% of irrelevant areas in the saliency maps, suggesting the predictions of the DL models might be unreliable. The result alerts us in the careful assessment of DL tools, even those with high classification performance.

• Klíčová slova
• Computer-aided diagnosis, Deep learning, Drowning, Postmortem computed tomography, Validity assessment,
• MeSH
• deep learning * MeSH
• dítě MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• pitva * metody   MeSH
• počítačová rentgenová tomografie * metody   MeSH
• posmrtné zobrazování MeSH
• reprodukovatelnost výsledků MeSH
• retrospektivní studie MeSH
• ROC křivka MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• utonutí * diagnóza   MeSH
• Check Tag
• dítě MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH