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Will CT Scans and MRIs Kill the Autopsy?

The views expressed are those of the author and are not necessarily those of Scientific American.

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body with toe tag

courtesy of iStockphoto/MrPants

Instead of cutting into a dead body to determine the cause of death, some coroners are already calling in a radiologist. But can CT (computed tomography) and MRI (magnetic-resonance imaging) tests accurately assess the recently deceased?

Formal autopsies have been on the decline for decades, due in part to tightening budgets. In the U.S. less than a quarter of deaths are followed with an autopsy, and previous research has shown that about a third of deaths have an incorrect causes listed on the death certificate. To lower cost and to help families whose religions prohibit post-mortem dissection, non-invasive imaging technology has been gaining favor. Some evidence had suggested, however, that CTs and MRIs are not quite as reliable as a traditional autopsy.

A new U.K. study of 182 adult deaths shows that more than half the time, a radiologist could pinpoint the cause of death with just a scan. But in 42 percent of CT scans and 32 percent of MRIs (and 30 percent of cases that used both), the radiologists’ assessments differed from those from a full autopsy. The research was led by Ian Roberts, of the cellular pathology department at John Radcliffe Hospital in Oxford, and the results were published online Monday in The Lancet.

“Post-mortem imaging cannot yet be regarded as a universal substitute for autopsy,” James Underwood, of the University of Sheffield, wrote in an essay in the same issue of the journal.

Imaging analyses were particularly poor at picking up certain common causes of death, including artery blockage (pulmonary embolism) and pneumonia. But they surpassed autopsy in a few areas, such as collapsed lungs and some bone fractures. Another benefit would be their longevity, remaining available for re-analysis long after tissue samples would have been discarded.

Even with mixed reviews, imaging techniques could help determine when a full autopsy might not be needed. The researchers noted that the imaging approach could be used more for pre-autopsy screening, which could weed out the cases that don’t require further investigation—and for those that do, the information gleaned from CT scans or MRIs could help guide later dissections. CT scans can also be cheaper than a traditional autopsy, and by using machines that they already own, medical institutions could keep costs down, noted the research team.

Underwood concluded that for now, the best use of imaging might indeed be to  lessen the demand on coroners’ time by keeping traditional autopsies to “those cases in which the cause of death cannot be arrived at in any other way.”

Katherine Harmon Courage About the Author: Katherine Harmon Courage is a freelance writer and contributing editor for Scientific American. Her book Octopus! The Most Mysterious Creature In the Sea is out now from Penguin/Current. Follow on Twitter @KHCourage.

The views expressed are those of the author and are not necessarily those of Scientific American.

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  1. 1. rgcorrgk 2:13 am 11/22/2011

    First, let me say, the feet pictured above look to be attached to a live body. (Sometimes a person sent to the morgue doesn’t meet the prime requirement – rest assured that doesn’t happen often).
    Legal parameters engulf all medical examiner jurisdictions. In most there are certain types of death which require a full post-mortem; other deaths need only be reported and so on. There is a great deal of information that cannot be acquired by non-invasive means. For example, the color or even odor of a tissue or stomach contents can be important. Toxicological studies are often required and so on. As for the “longevity remaining available for re-analysis”, an imaging record can be discarded or corrupted, and samples from the post can and are often preserved and keep for possible further analysis, if proven necessary (or even for future medical research).
    Richard Carlson

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  2. 2. davedobbs 9:44 am 11/22/2011

    Nice piece — though I doubt scanning’s capacity to ‘rule out cases that don’t require further investigation.’ Countless post-mortem autopsy studies, including those of people who’d been scanned heavily during treatment, find causes of death that the scans missed. I wrote about this a few years ago in the Times Magazine. (Story here: Here’s the passage most relevant to scanning:

    “Perhaps the most troubling reason for the decline of the autopsy is the overconfidence that doctors — and patients — have in M.R.I.’s and other high-tech diagnostic technologies. Bill Pellan of the Pinellas County medical examiner’s office says: ”We get this all the time. The doctor will get our report and call and say: ‘But there can’t be a lacerated aorta. We did a whole set of scans.’ We have to remind him we held the heart in our hands.”

    In fact, advanced diagnostic tools do miss critical problems and actually produce more false-negative diagnoses than older methods, probably because doctors accept results too readily. One study of diagnostic errors made from 1959 to 1989 (the period that brought us CAT scans, M.R.I.’s and many other high-tech diagnostics) found that while false-positive diagnoses remained about 10 percent during that time, false-negative diagnoses — that is, when a condition is erroneously ruled out — rose from 24 percent to 34 percent. Another study found that errors occur at the same rate regardless of whether sophisticated diagnostic tools are used. Yet doctors routinely dismiss possible diagnoses because high-tech tools show negative results. One of my own family doctors told me that he rarely asks for an autopsy because ”with M.R.I.’s and CAT scans and everything else, we usually know why they died.”

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  3. 3. ASHIK 10:44 am 11/22/2011

    There can be slight modifications in the procedure of performing autopsy but i dont think CT scans and MRIs can replace traditional method of an autopsy.Doctors in the making must practise traditional methods.In trained hands its best to go for traditional method than using modern tehnology.CT scans and MRIs must be used as additional procedure in disecting the dead body along with traditional one.

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  4. 4. drjudymelinek 11:31 am 11/23/2011

    As a board-certified forensic pathologist I find that forensic pathology benefits greatly when multiple complimentary modalities are used. In the ideal setting, a death should be investigated with both radiology and autopsy. The CT or MRI would pick up findings that may require a difficult dissection; and they can also help direct the dissection. The autopsy can confirm or refute suspicious findings on CT/MRI. I have seen major findings (such as coronery artery blockage and subtle non-displaced skull fractures) missed on radiography. But I have also had cases where without a pre-autopsy radiographic study, I probably wouldn’t have suspected a neck or pelvic fracture, especially if there was minimal gross hemorrhage to guide me to the finding. Unfortunately, with the increased emphasis on cost containment, it is rare that a forensic institute (medical examiner’s or coroner’s office) has access to a CT or MRI. Most make do with routine X-rays, and only get these types of studies when the patients survive long enough to make it to the hospital.

    Judy Melinek, MD

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  5. 5. Quinn the Eskimo 2:42 am 11/25/2011

    Will CT and MRI tell you which 9 mm gun fired the bullet?
    Will CT and MRI tell you which poison was used?
    Will CT and MRI tell you why the pancreatic cancer started?


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