Traumatic brain injury: Comparison between autopsy and ante-mortem CT. (November 2017)

• Record Type: Journal Article
• Authors: Panzer, Stephanie; Covaliov, Lidia; Augat, Peter; Peschel, Oliver
• Is Part Of: Journal of forensic and legal medicine. Volume 52(2017)
• Page Start: 62
• Page End: 69
• Publication Date: 2017-11
• Subjects: Autopsy -- Virtual autopsy -- Computed tomography -- Ante-mortem computed tomography -- Traumatic brain injury; Medical jurisprudence -- Periodicals; Forensic sciences -- Periodicals; Forensic Medicine -- Periodicals; Médecine légale -- Périodiques; Electronic journals; 614.1
• DOI: 10.1016/j.jflm.2017.08.007
• Languages: English
• ISSNs: 1752-928X

Abstract

Abstract: Purpose: The aim of this study was to compare pathological findings after traumatic brain injury between autopsy and ante-mortem computed tomography (CT). A second aim was to identify changes in these findings between the primary posttraumatic CT and the last follow-up CT before death. Methods: Through the collaboration between clinical radiology and forensic medicine, 45 patients with traumatic brain injury were investigated. These patients had undergone ante-mortem CT as well as autopsy. During autopsy, the brain was cut in fronto-parallel slices directly after removal without additional fixation or subsequent histology. Typical findings of traumatic brain injury were compared between autopsy and radiology. Additionally, these findings were compared between the primary CT and the last follow-up CT before death. Results: The comparison between autopsy and radiology revealed a high specificity (≥80%) in most of the findings. Sensitivity and positive predictive value were high (≥80%) in almost half of the findings. Sixteen patients had undergone craniotomy with subsequent follow-up CT. Thirteen conservatively treated patients had undergone a follow-up CT. Comparison between the primary CT and the last ante-mortem CT revealed marked changes in the presence and absence of findings, especially in patients with severe traumatic brain injury requiring decompression craniotomy. Conclusion: The main pathological findings of traumatic brain injury were comparable between clinical ante-mortem CT examinations and autopsy. Comparison between the primary CT after trauma and the last ante-mortem CT revealed marked changes in the findings, especially in patients with severe traumatic brain injury. Hence, clinically routine ante-mortem CT should be included in the process of autopsy interpretation. Highlights: The comparison revealed a high specificity in most of the findings. In severe traumatic brain injury findings clearly changed in the ante-mortem course. As first imaging modality following trauma ante-mortem CT has a high value. Ante-mortem CT is supposed to provide complementary information to autopsy.