| frelryHor | Дата: Суббота, 14.09.2013, 09:23 | Сообщение # 1 |
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According to radiologists, an autopsy was unnecessary in 34% of cases for CT as well as in both 48% of cases for MRI- and consensus-reports. When these cases were compared with autopsy, the major discrepancies occurred in 16% of cases for CT, 21% cases for MRI and 16% in consensus-reports, which was substantially less in those cases where radiologists showed less confidence regarding the cause of death. The researchers discovered that the most prevalent imaging errors in identifying cause of death amongst all 182 cases consisted of 27 cases of ischemic heart disease, which were either missed or over attributed, in 11 cases of pulmonary embolism as well as in 13 cases of pneumonia and 16 cases of intra-abdominal lesions. According to the authors: When radiologists are confident that the cause of death on imaging is definite, the discrepancy rate between the radiological and autopsy diagnoses is lower and might be acceptable from a medicolegal point of view. The radiologists' ability to accurately identify cases for which their diagnosis is correct is essential for the safe introduction of a minimally invasive autopsy service. If used as a pre-autopsy screen, imaging might avoid unnecessary autopsies (e. for ruptured aortic aneurysm), identify lesions difficult to diagnose by dissection, and help to guide dissection by identification of pathologies needing further investigation. Therefore, imaging could reduce the number of invasive autopsies at the same time as improving their quality.
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They continue saying: Practical and clinical governance considerations remain. Where will imaging be done? If clinical facilities are used, providers should ensure that services for living patients are not disrupted. Service providers will need training and assessment in the interpretation of post-mortem imaging. Cost implications are also a concern; MRI in particular is more expensive than is traditional autopsy. Further development of postmortem imaging is needed and this development must be based on careful consideration of comparisons between radiology and autopsy. Professor James Underwood, University of Sheffield, UK, says in a linked comment: Post-mortem imaging cannot yet be regarded as a universal substitute for autopsy; it is one of several methods available for determining the cause of death.
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