Post-mortem imaging as an alternative to autopsy in the diagnosis of adult deaths: A validation study

Background: Public objection to autopsy has led to a search for minimally invasive alternatives. Imaging has potential, but its accuracy is unknown. We aimed to identify the accuracy of post-mortem CT and MRI compared with full autopsy in a large series of adult deaths. Methods: This study was undertaken at two UK centres in Manchester and Oxford between April, 2006, and November, 2008. We used whole-body CT and MRI followed by full autopsy to investigate a series of adult deaths that were reported to the coroner. CT and MRI scans were reported independently, each by two radiologists who were masked to the autopsy findings. All four radiologists then produced a consensus report based on both techniques, recorded their confidence in cause of death, and identified whether autopsy was needed. Findings: We assessed 182 unselected cases. The major discrepancy rate between cause of death identified by radiology and autopsy was 32 (95 CI 26-40) for CT, 43 (36-50) for MRI, and 30 (24-37) for the consensus radiology report; 10 (3-17) lower for CT than for MRI. Radiologists indicated that autopsy was not needed in 62 (34; 95 CI 28-41) of 182 cases for CT reports, 76 (42; 35-49) of 182 cases for MRI reports, and 88 (48; 41-56) of 182 cases for consensus reports. Of these cases, the major discrepancy rate compared with autopsy was 16 (95 CI 9-27), 21 (13-32), and 16 (10-25), respectively, which is significantly lower (p