Whole-body post-mortem computed tomography compared with autopsy in the investigation of unexpected death in infants and children

Maïa Proisy 1, 2, 3 Antoine Jérôme Marchand 4 Philippe Loget 5 Renaud Bouvet 2 Michel Roussey 6 Fabienne Pelé 7 Céline Rozel 2, 1 Catherine Treguier 1 Pierre Darnault 3 Bertrand Bruneau 2
1 Service de radiologie et imagerie médicale [Rennes]
2 CHU Pontchaillou [Rennes]
3 VisAGeS - Vision, Action et Gestion d'informations en Santé
INSERM - Institut National de la Santé et de la Recherche Médicale : U746, Inria Rennes – Bretagne Atlantique , IRISA-D5 - SIGNAUX ET IMAGES NUMÉRIQUES, ROBOTIQUE
4 ARNA - Acides Nucléiques : Régulations Naturelle et Artificielle
5 Service d'anatomie et cytologie pathologiques [Rennes]
6 Département de médecine de l'enfant et de l'adolescent
7 Irset - Institut de recherche, santé, environnement et travail
Abstract : To investigate the contribution of whole-body post-mortem computed tomography (PMCT) in sudden unexpected death in infants and children. METHODS: Forty-seven cases of sudden unexpected death in children investigated with radiographic skeletal survey, whole-body PMCT and autopsy were enrolled. For imaging interpretation, non-specific post-mortem modifications and abnormal findings related to the presumed cause of death were considered separately. All findings were correlated with autopsy findings. RESULTS: There were 31 boys and 16 girls. Of these, 44 children (93.6 %) were younger than 2 years. The cause of death was found at autopsy in 18 cases (38.3 %), with 4 confirmed as child abuse, 12 as infectious diseases, 1 as metabolic disease and 1 as bowel volvulus. PMCT results were in accordance with autopsy in all but three of these 18 cases. Death remains unexplained in 29 cases (61.7 %) and was correlated with no abnormal findings on PMCT in 27 cases. Major discrepancies between PMCT and autopsy findings concerned pulmonary analysis. CONCLUSIONS: Whole-body PMCT may detect relevant findings that can help to explain sudden unexpected death and is essential for detecting non-accidental injuries. We found broad concordance between autopsy and PMCT, except in a few cases of pneumonia. It is a non-invasive technique acceptable to relatives. KEY POINTS: • Whole-body post-mortem computed tomography (PMCT) is an effective non-invasive method. • Whole-body PMCT is essential for detecting child abuse in unexpected death. • There is concordance on cause of death between PMCT and autopsy. • Whole-body PMCT could improve autopsy through dissection and sampling guidance. • PMCT shows findings that may be relevant when parents reject autopsy.
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Journal articles
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https://www.hal.inserm.fr/inserm-01576306
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Submitted on : Tuesday, August 22, 2017 - 6:43:49 PM
Last modification on : Thursday, July 11, 2019 - 1:01:53 AM

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Maïa Proisy, Antoine Jérôme Marchand, Philippe Loget, Renaud Bouvet, Michel Roussey, et al.. Whole-body post-mortem computed tomography compared with autopsy in the investigation of unexpected death in infants and children. European Radiology, Springer Verlag, 2013, 23 (6), pp.1711 - 1719. ⟨10.1007/s00330-012-2738-1⟩. ⟨inserm-01576306⟩

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