Post-mortem MRI may detect cause of sudden cardiac death

Researchers were able to identify chronic, subacute, acute and peracute MI using post-mortem cardiac MRI on human forensic corpses of patients who experienced sudden cardiac death. The imaging technique, they wrote, may offer a viable alternative to clinical autopsy.

The researchers performed post-mortem MRIs with a 3-T system on the corpses of 136 patients who likely died of cardiac causes before forensic autopsy.

Post-mortem MRI detected at least one ischemic lesion in 76 of the 136 cases. The causes of death in these cases were determined to be cardiac-related in the final forensic case assessment. In these patients, the researchers identified 124 myocardial lesions, 25 of which were chronic, 16 subacute, 30 acute and 53 peracute. Confirmation of chronic, subacute and acute lesions could be made histologically and macroscopically, with 100% agreement between autopsy and post-mortem MRI findings.

The researchers were unable to observe peracute lesions macroscopically on autopsy but were able to verify peracute lesions found on post-mortem MRI in targeted histological evaluations in 62.3% of cases. Peracute lesions could be linked to a matching coronary finding in 84.9% of cases. The remaining 15.1% did not have a matching coronary finding but presented with severe myocardial hypertrophy or cocaine intoxication.

“Post-mortem imaging is a new tool to explore [sudden cardiac death]. As in popular television series, the careful collection and analysis of data from different sources, including clinical information and advanced post-mortem imaging, lead to the identification of the cause of death,” André Schmidt, MD, PhD, of the Medical School of Ribeirao Preto, University of São Paulo in Brazil, wrote in an editorial comment. “From an epidemiological point of view, it will probably reduce the number of cases of unknown origin and may contribute to the establishment of a cost-effective diagnostic protocol.”

For more information:

Jackowski C. J Am Coll Cardiol. 2013;62:617-629.

Schmidt A. J Am Coll Cardiol. 2013;62:630-631.

Disclosure: This work was supported in part by a grant from Philips AG Healthcare, Zürich, Switzerland. The researchers report that they have no other relevant financial disclosures. Schmidt reports no relevant financial disclosures.