Normal cranial postmortem CT findings in children.

INTRODUCTION: Postmortem imaging (both CT and MRI) has become a widely used tool the last few years, both for adults and children. If it would be known which findings are normal postmortem changes, interpretation of abnormal findings becomes less ambiguous. Our aim was to describe postmortem intracranial radiological findings on postmortem CT (PMCT) in children, which did not have a relationship with the cause of death, and to determine whether these findings have a relationship with the postmortem interval or with medical interventions.

MATERIALS AND METHODS: We selected all consecutive pediatric autopsies that were performed at the Netherlands Forensic Institute in the period 1-1-2008 to 31-12-2011, whereby the subject underwent total body PMCT. We collected data on age at death, gender, cause of death determined by forensic autopsy and time between death and PMCT. Normal findings that were scored were: gray-white differentiation of the brain, collapse of the ventricles, air in the orbit, fluid accumulation in the frontal and maxillary sinuses, and air in vessels of head and neck.

RESULTS: One-hundred-fifty-nine forensic pediatric autopsies were performed in the 4 year study period at the NFI; 77 underwent a total body PMCT, of which 68 were included in the analyses. Fluid accumulation in the sinuses was present 30-40% of the cases in which the sinuses were developed. In 22% of all children intravascular intracranial air, either arterial or venous, was detected. We did not find a relationship between the duration of the postmortem interval and the appearance of any of the findings. Intravenous infusion is not significantly associated with the presence of intravascular air, except for air in the left and right common carotid artery (B=2.9, P=0.05).

CONCLUSIONS: By demonstrating the intracranial abnormalities that appear postmortem, we have tried to provide more insight in the range of findings that can be seen with pediatric PMCT. As these findings resemble antemortem pathology, it is important that the radiologist who interprets PMCT has knowledge of these normal postmortem findings.