Postmortem quantitative 1.5-T MRI for the differentiation and characterization of serous fluids, blood, CSF, and putrefied CSF

The purpose of the present study was to investigate whether serous fluids, blood, cerebrospinal fluid (CSF), and putrefied CSF can be characterized and differentiated in synthetically calculated magnetic resonance (MR) images based on their quantitative T1, T2, and proton density (PD) values. Images from 55 postmortem short axis cardiac and 31 axial brain 1.5-T MR examinations were quantified using a quantification sequence. Serous fluids, fluid blood, sedimented blood, blood clots, CSF, and putrefied CSF were analyzed for their mean T1, T2, and PD values. Body core temperature was measured during the MRI scans. The fluid-specific quantitative values were related to the body core temperature. Equations to correct for temperature differences were generated. In a 3D plot as well as in statistical analysis, the quantitative T1, T2 and PD values of serous fluids, fluid blood, sedimented blood, blood clots, CSF, and putrefied CSF could be well differentiated from each other. The quantitative T1 and T2 values were temperature-dependent. Correction of quantitative values to a temperature of 37 °C resulted in significantly better discrimination between all investigated fluid mediums. We conclude that postmortem 1.5-T MR quantification is feasible to discriminate between blood, serous fluids, CSF, and putrefied CSF. This finding provides a basis for the computer-aided diagnosis and detection of fluids and hemorrhages.

[1]  Mirmohamad Miri,et al.  Approach to undiagnosed exudative pleural effusion: the diagnostic yield of blind pleural biopsy. , 2011, Caspian journal of internal medicine.

[2]  E. Böhm,et al.  Zur ultrastruktur vitaler, postmortaler und autolysierter gerinnsel , 1983 .

[3]  A. V. van Geel,et al.  The composition of serous fluid after axillary dissection. , 1999, The European journal of surgery = Acta chirurgica.

[4]  P. Adhikari,et al.  Profile of ascites patient admitted in Nepal Medical College Teaching Hospital. , 2012, Nepal Medical College journal : NMCJ.

[5]  Keith L Ligon,et al.  Diffusion-weighted imaging of fungal cerebral infection. , 2005, AJNR. American journal of neuroradiology.

[6]  N. Jagannathan,et al.  High‐resolution NMR spectroscopy of human body fluids and tissues in relation to prostate cancer , 2014, NMR in biomedicine.

[7]  C. Lam,et al.  Pleural effusion lipoproteins measured by NMR spectroscopy for diagnosis of exudative pleural effusions: a novel tool for pore-size estimation. , 2014, Journal of proteome research.

[8]  A. Algeciras-Schimnich,et al.  Body fluid analysis: Clinical utility and applicability of published studies to guide interpretation of today’s laboratory testing in serous fluids , 2013, Critical reviews in clinical laboratory sciences.

[9]  D L Parker,et al.  Temperature distribution measurements in two-dimensional NMR imaging. , 1983, Medical physics.

[10]  P. Lundberg,et al.  Rapid magnetic resonance quantification on the brain: Optimization for clinical usage , 2008, Magnetic resonance in medicine.

[11]  In vivo T1 values from guinea pig brain depend on body temperature , 1992, Magnetic resonance in medicine.

[12]  A. Persson,et al.  Post-mortem cardiac 3-T magnetic resonance imaging: visualization of sudden cardiac death? , 2013, Journal of the American College of Cardiology.

[13]  F. Schleyer.  [Postmortem blood viscosity, blood cell volume, osmotic erythrocyte resistance and blood sedimentation in relation to cadaver age and cause of death]. , 1958, Virchows Archiv fur pathologische Anatomie und Physiologie und fur klinische Medizin.

[14]  John O. Prior,et al.  Diagnostic accuracy of 18F-FDG-PET and PET/CT in the differential diagnosis between malignant and benign pleural lesions: a systematic review and meta-analysis. , 2014, Academic radiology.

[15]  P. Ljung,et al.  State‐of‐the‐art of visualization in post‐mortem imaging , 2012, APMIS : acta pathologica, microbiologica, et immunologica Scandinavica.

[16]  Anders Ynnerman,et al.  Full Body Virtual Autopsies using a State-of-the-art Volume Rendering Pipeline , 2006, IEEE Transactions on Visualization and Computer Graphics.

[17]  Sanjay Behari,et al.  Comparison of the magnetization transfer ratio and fluid‐attenuated inversion recovery imaging signal intensity in differentiation of various cystic intracranial mass lesions and its correlation with biological parameters , 2006, Journal of magnetic resonance imaging : JMRI.

[18]  A. S. Hall,et al.  Measurement of changes in tissue temperature using MR imaging. , 1986, Journal of computer assisted tomography.

[19]  Johan Kihlberg,et al.  Quantitative MRI in Isotropic Spatial Resolution for Forensic Soft Tissue Documentation. Why and How? * , 2011, Journal of forensic sciences.

[20]  M. Knopp,et al.  Quantitative assessment of mobile protein levels in human knee synovial fluid: feasibility of chemical exchange saturation transfer (proteinCEST) MRI of osteoarthritis. , 2011, Magnetic resonance imaging.

[21]  P. Lundberg,et al.  Novel method for rapid, simultaneous T1, T*2, and proton density quantification , 2007, Magnetic resonance in medicine.

[22]  D. Jondal,et al.  Brogdon’s Forensic Radiology, 2nd ed. , 2012 .

[23]  Johan Kihlberg,et al.  Rapid T1 quantification based on 3D phase sensitive inversion recovery , 2010, BMC Medical Imaging.

[24]  C. Boesch,et al.  Virtopsy, a new imaging horizon in forensic pathology: virtual autopsy by postmortem multislice computed tomography (MSCT) and magnetic resonance imaging (MRI)--a feasibility study. , 2003, Journal of forensic sciences.

[25]  S. Grabherr,et al.  Pulmonary thrombembolism as cause of death on unenhanced postmortem 3T MRI , 2013, European Radiology.

[26]  Christian Jackowski,et al.  Characterization and differentiation of body fluids, putrefaction fluid, and blood using Hounsfield unit in postmortem CT , 2014, International Journal of Legal Medicine.

[27]  Christian Jackowski,et al.  A state-of-the-art pipeline for postmortem CT and MRI visualization: from data acquisition to interactive image interpretation at autopsy , 2011, Acta radiologica.

[28]  A. Christe,et al.  Postmortem Imaging of Blunt Chest Trauma Using CT and MRI: Comparison With Autopsy , 2008, Journal of thoracic imaging.

[29]  Michael J. Thali,et al.  Brogdon's Forensic Radiology, Second Edition , 2010 .

[30]  Yu-Chung N. Cheng,et al.  Magnetic Resonance Imaging: Physical Principles and Sequence Design , 1999 .

[31]  K Messmer,et al.  Non-invasive temperature mapping using MRI: comparison of two methods based on chemical shift and T1-relaxation. , 1998, Magnetic resonance imaging.

[32]  P. Mangin,et al.  Advances in post-mortem CT-angiography. , 2014, The British journal of radiology.

[33]  O Smedby,et al.  Synthetic Mri of the Brain in a Clinical Setting , 2012, Acta radiologica.

[34]  M. Reiser,et al.  Hyperthermia induces T1 relaxation and blood flow changes in tumors. A MRI thermometry study in vivo. , 2003, Magnetic resonance imaging.

[35]  Postmortem Noninvasive Virtual Autopsy: Extrapleural Hemorrhage After Blunt Thoracic Trauma , 2007, The American journal of forensic medicine and pathology.

[36]  Michael O'Brien,et al.  Postmortem whole‐body magnetic resonance imaging as an adjunct to autopsy: Preliminary clinical experience , 2001, Journal of magnetic resonance imaging : JMRI.

[37]  O. Weber,et al.  The influence of body temperature on image contrast in post mortem MRI. , 2012, European journal of radiology.

[38]  E W Benbow,et al.  Accuracy of magnetic resonance imaging in determining cause of sudden death in adults: comparison with conventional autopsy , 2003, Histopathology.

[39]  M. Thali,et al.  Postmortem radiology of fatal hemorrhage: measurements of cross-sectional areas of major blood vessels and volumes of aorta and spleen on MDCT and volumes of heart chambers on MRI. , 2006, AJR. American journal of roentgenology.

[40]  A. Persson,et al.  Whole Body Postmortem Angiography with a High Viscosity Contrast Agent Solution Using Poly Ethylene Glycol as Contrast Agent Dissolver , 2008, Journal of forensic sciences.

[41]  N Hosten,et al.  Comparison of four magnetic resonance methods for mapping small temperature changes , 1999, Physics in medicine and biology.

[42]  F. Montravers,et al.  Diagnostic accuracy of [18F]DOPA PET and PET/CT in patients with neuroendocrine tumors: a meta-analysis , 2013, Clinical and Translational Imaging.

[43]  J. Huo,et al.  Intrapleural or intraperitoneal lobaplatin for treatment of patients with malignant pleural effusion or ascites. , 2013, Asian Pacific journal of cancer prevention : APJCP.

[44]  Michael J Thali,et al.  VIRTOPSY: minimally invasive, imaging-guided virtual autopsy. , 2006, Radiographics : a review publication of the Radiological Society of North America, Inc.

[45]  S. Grabherr,et al.  Development and validation of a postmortem radiological alteration index: the RA-Index , 2012, International Journal of Legal Medicine.

[46]  C A Beltrami,et al.  Analysis of cystic intracranial lesions performed with fluid-attenuated inversion recovery MR imaging. , 1999, AJNR. American journal of neuroradiology.

[47]  A. Montaño-Loza.  New concepts in liver cirrhosis: clinical significance of sarcopenia in cirrhotic patients. , 2013, Minerva gastroenterologica e dietologica.

[48]  G. Adam,et al.  Differenzierung seröser und putrider Flüssigkeiten in vitro und in vivo mit diffusionsgewichteter MRT , 2001 .

[49]  M. Thali,et al.  Postmortem imaging of blood and its characteristics using MSCT and MRI , 2006, International Journal of Legal Medicine.