Postmortem computed tomography-angiography (PMCTA) in decomposed bodies – A feasibility study

• PMCTA has thus far been used on only recently deceased bodies.
• This study evaluates the feasibility of PMCTA in decomposed bodies.
• It describes the artifacts of PMCTA and compares different contrast media mixtures.
• PMCTA in decomposed bodies is feasible, even for heavily decomposed cases.
• Limiting factors are tissue destruction due to maggots and autolytic changes.

ObjectivePostmortem computed tomography angiography (PMCTA) has thus far been used on only recently deceased bodies. Therefore, it is crucial to evaluate the potential of PMCTA in decomposed bodies. The aims of this study were (I) to evaluate the feasibility of PMCTA, (II) to describe the artifacts of PMCTA and (III) to compare different contrast media mixtures for PMCTA in decomposed bodies.Materials and methodsPostmortem computed tomography (PMCT) was performed on ten decomposed bodies, and for PMCTA, lipophilic and hydrophilic contrast media mixtures were used.ResultsThe predominant areas, “hotspots”, for extravasation were located intra-cerebrally, peri-pancreatic and peri-splenic and were deemed to be artifacts due to decomposition. Complete opacification of all cerebral vessels was not achieved. By contrast, the coronaries had complete contrast in 6/10 of the cases. All cases had distinct enhancement of stomach mucosa, the kidneys, pancreas and spleen parenchyma that could be attributed to putrefaction. The comparison of both contrast agent mixtures revealed more distinct enhancement of the stomach mucosa for the lipophilic contrast mixture. Assessment of the large vascular structures in the torso as well as the coronary arteries was diagnostic for both contrast agent mixtures. The diagnostic value of PMCTA was affected by the stage of decomposition.ConclusionsPMCTA in decomposed bodies is feasible, even for heavily decomposed cases. The main limiting factors for the diagnostic accessibility of the vascular system are tissue destruction due to maggot infestation and autolytic changes, which are mainly in the upper abdominal organs.