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Postmortem computed tomography angiography (PMCTA) and traditional autopsy in cases of sudden cardiac death due to coronary artery disease: a systematic review and meta-analysis

  • ETHICS AND FORENSIC RADIOLOGY
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Abstract

Introduction

Several studies have been performed to assess the efficacy of postmortem computed tomography angiography (PMCTA) in solving cases of sudden cardiac death, even in comparison with the traditional autopsy. However, the results were often inconsistent and inconclusive. Therefore, a global discussion on the subject through a systematic review of the literature and a meta-analysis is necessary.

Methods

A systematic search of PubMed was performed up to April 23, 2018. Studies exploring the role of PMCTA in cases of sudden cardiac death and the accuracy of this method in diagnosing the cause of death compared to traditional autopsy were included.

Results

The overall sensitivity and specificity of the seven included studies, using conventional autopsy as a reference standard, were 92% and 95%, respectively. The positive and negative likelihood ratios were, respectively, 20.76 (95% CI 1.16–370.2) and 0.08 (95% CI 0.03–0.17), showing that PMCTA represents a strong indicator of the posttest probability of disease. The diagnostic odds ratio and the area under the curve were, respectively, 261.54 (95% CI 1.87–5760.53) and 0.93 (95% CI 0.90–0.95), indicating a high diagnostic power of the test.

Conclusion

PMCTA demonstrated a high accuracy in the diagnosis of parietal and luminal coronary changes but was less effective in detecting myocardial ischemia and necrosis. Therefore, the only radiological investigation is often insufficient to determine the cause of sudden death and the conventional autopsy remains the gold standard. However, PMCTA can improve the performance of the autopsy, serving as an aid and guide in the sampling phase for histopathological investigations.

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Authors and Affiliations

  1. Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161, Rome, Italy

    Raffaele La Russa, Mariantonia Di Sanzo, Matteo Scopetti, Vittorio Gatto, Alessandro Santurro, Rocco Valerio Viola, Paola Frati & Vittorio Fineschi

  2. IRCCS Neuromed, Via Atinense 18, Pozzilli, 86077, Italy

    Raffaele La Russa, Paola Frati & Vittorio Fineschi

  3. Department of Radiological Sciences, Oncology and Pathology, Sapienza University, Viale Regina Elena 324, 00161, Rome, Italy

    Carlo Catalano & Valeria Panebianco

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  1. Raffaele La Russa
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All authors contributed to manuscript drafting and critical discussion and approved the definitive version.

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Correspondence to Vittorio Fineschi.

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This article does not contain any studies with human participants or animals performed by any of the authors. All accepted principles of ethical and professional conduct have been followed.

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La Russa, R., Catalano, C., Di Sanzo, M. et al. Postmortem computed tomography angiography (PMCTA) and traditional autopsy in cases of sudden cardiac death due to coronary artery disease: a systematic review and meta-analysis. Radiol med 124, 109–117 (2019). https://doi.org/10.1007/s11547-018-0943-y

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