Comparison between postmortem computed tomography and autopsy in the detection of traumatic head injuries

L Legrand; T Delabarde; R Souillard-Scemama; I Sec; I Plu; J-M Laborie; Y Delannoy; L Hamza; M Taccoen; L de Jong; J Benzakoun; M Edjlali; J-F Méder; C Oppenheim; B Ludes

doi:10.1016/j.neurad.2019.03.008

Comparison between postmortem computed tomography and autopsy in the detection of traumatic head injuries

J Neuroradiol. 2020 Feb;47(1):5-12. doi: 10.1016/j.neurad.2019.03.008. Epub 2019 Apr 4.

Authors

L Legrand¹, T Delabarde², R Souillard-Scemama³, I Sec⁴, I Plu⁵, J-M Laborie⁴, Y Delannoy⁶, L Hamza⁷, M Taccoen⁸, L de Jong⁹, J Benzakoun⁹, M Edjlali⁹, J-F Méder⁹, C Oppenheim⁹, B Ludes²

Affiliations

¹ Service d'imagerie morphologique et fonctionnelle, centre hospitalier Sainte-Anne, 1 rue Cabanis, 75014 Paris, France; Pôle universitaire d'imagerie post-mortem, Université Paris Descartes, 12, rue de l'Ecole de Médecine, 75006 Paris, France; INSERM UMR 1266, Institut de Psychiatrie et Neurosciences de Paris, 102-108 rue de la Santé, 75014 Paris, France. Electronic address: l.legrand@ghu-paris.fr.
² Pôle universitaire d'imagerie post-mortem, Université Paris Descartes, 12, rue de l'Ecole de Médecine, 75006 Paris, France; Institut médico-légal de Paris, 2, place Mazas, 75012 Paris, France; CNRS UMR 5288 Institut National de la transfusion sanguine, 6, rue Cabanel, 75015 Paris, France.
³ Service d'imagerie morphologique et fonctionnelle, centre hospitalier Sainte-Anne, 1 rue Cabanis, 75014 Paris, France; Pôle universitaire d'imagerie post-mortem, Université Paris Descartes, 12, rue de l'Ecole de Médecine, 75006 Paris, France.
⁴ Pôle universitaire d'imagerie post-mortem, Université Paris Descartes, 12, rue de l'Ecole de Médecine, 75006 Paris, France; Institut médico-légal de Paris, 2, place Mazas, 75012 Paris, France; Unité médico-judiciaire, Hôtel-Dieu, 1, place du Parvis de Notre-Dame, 75004 Paris, France.
⁵ Pôle universitaire d'imagerie post-mortem, Université Paris Descartes, 12, rue de l'Ecole de Médecine, 75006 Paris, France; Institut médico-légal de Paris, 2, place Mazas, 75012 Paris, France; Sorbonne Université, 91, boulevard de l'Hôpital, 75013 Paris, France.
⁶ Pôle universitaire d'imagerie post-mortem, Université Paris Descartes, 12, rue de l'Ecole de Médecine, 75006 Paris, France; Institut médico-légal de Paris, 2, place Mazas, 75012 Paris, France; Institut médico-légal de Lille, rue André Verhaeghe, 59000 Lille, France.
⁷ Pôle universitaire d'imagerie post-mortem, Université Paris Descartes, 12, rue de l'Ecole de Médecine, 75006 Paris, France; Institut médico-légal de Paris, 2, place Mazas, 75012 Paris, France; Service d'accueil des urgences, hôpital Avicenne, 125, rue de Stalingrad, 93000 Bobigny, France.
⁸ Pôle universitaire d'imagerie post-mortem, Université Paris Descartes, 12, rue de l'Ecole de Médecine, 75006 Paris, France; Institut médico-légal de Paris, 2, place Mazas, 75012 Paris, France.
⁹ Service d'imagerie morphologique et fonctionnelle, centre hospitalier Sainte-Anne, 1 rue Cabanis, 75014 Paris, France; Pôle universitaire d'imagerie post-mortem, Université Paris Descartes, 12, rue de l'Ecole de Médecine, 75006 Paris, France; INSERM UMR 1266, Institut de Psychiatrie et Neurosciences de Paris, 102-108 rue de la Santé, 75014 Paris, France.

PMID: 30954548
DOI: 10.1016/j.neurad.2019.03.008

Abstract

Introduction: The aim of this study was to assess the agreement between postmortem computed tomography (PMCT) and autopsy in detecting traumatic head injuries.

Materials and methods: Consecutive cases of death that underwent both unenhanced PMCT and conventional autopsy were collected from our institution database during a period of 3 years and reviewed retrospectively. PMCT images were reviewed for the presence of fractures (cranial vault, skull base, facial bones and atlas/axis) and intracranial hemorrhage. Kappa values were calculated to determine the agreement between PMCT and autopsy reports.

Results: 73 cases were included, of which 44 (60%) had head trauma. Agreement between PMCT and autopsy was almost perfect (κ = 0.95) for fractures and substantial (κ = 0.75) for intracranial hemorrhage. PMCT was superior to autopsy in detecting facial bone and upper cervical spine fractures, and intraventricular hemorrhage. However, in some cases thin extra-axial blood collections were missed on PMCT.

Conclusions: The agreement between PMCT and autopsy in detecting traumatic head injuries was good. Using a combination of both techniques increases the quality of postmortem evaluation because more lesions are detected.

Keywords: Autopsy; Fracture; Hemorrhage; Postmortem computed tomography; Traumatic head injuries.

Publication types

Comparative Study

MeSH terms

Adolescent
Adult
Aged
Aged, 80 and over
Autopsy*
Brain Injuries, Traumatic / diagnosis*
Brain Injuries, Traumatic / pathology
Child
Child, Preschool
Craniocerebral Trauma / diagnosis*
Craniocerebral Trauma / pathology
Female
Humans
Infant
Infant, Newborn
Male
Middle Aged
Neuroradiography
Tomography, X-Ray Computed*
Young Adult