Postmortem Computed Tomography Versus Conventional Autopsy for Cause of Death Determination

Abstract

Introduction: Conventional autopsy is the gold standard but is increasingly declined by families. Postmortem computed tomography (PMCT) is a noninvasive alternative. Its agreement with autopsy for major causes of death (trauma, hemorrhage, cardiac) needs systematic evaluation.
Methods: Systematic review of 21 studies (n=4,892) comparing PMCT (with or without angiography) versus conventional autopsy. Reference: autopsy as gold standard. Outcomes: sensitivity for detecting cause of death (COD) categorized as traumatic, hemorrhagic, cardiac, pulmonary, infectious. Secondary: major missed diagnoses (could alter legal outcome).
Results: PMCT sensitivity for traumatic COD (e.g., fractures, organ laceration) was 91% (95% CI 87–94%). For hemorrhagic COD (e.g., ruptured aneurysm), 84% (78–89%). For cardiac causes (myocardial infarction, coronary thrombosis), sensitivity was only 52% (42–62%) – most missed. Pulmonary embolism: sensitivity 67%. Missed diagnoses with legal significance occurred in 12% of PMCT-only cases, mostly cardiac arrhythmias without structural lesion. PMCT angiography improved vascular cause detection to 73%.
Discussion: PMCT is excellent for trauma but poor for cardiac and infectious deaths. It cannot replace autopsy when these are suspected.
Conclusion: Postmortem CT is a complementary tool but not equivalent to conventional autopsy for natural disease causes of death.