AJR:190, February 2008 345 this issue [4–13]. But until recently there has existed no practicable method for investigat- ing the entire vascular system in situ. Meth- ods such as vascular casting have been ap- plied only to isolated organs and are not practicable for the entire body [5]. Water- soluble contrast agents rapidly penetrate the surrounding tissue, causing edema and de- forming artifacts [5]. In the context of the Virtopsy project, a new technique for postmortem visualization of the vascular system has been developed. The technique entails injection of a lipophilic contrast agent after vascular perfusion with diesel oil [6]. With this two-step method, high-quality angiograms can be obtained. The initial perfusion with an oily medium flushes out the postmortem clots and remain- ing blood. Increasing the viscosity of the ap- plied oil selectively excludes the capillary system from the circulation because of the process of microembolization [6, 14, 15]. The possibility of inducing this event can be of great advantage in postmortem angiography. Two-Step Postmortem Angiography with a Modified Heart–Lung Machine: Preliminary Results Silke Grabherr 1,2 Erich Gygax 3 Barbara Sollberger 3 Steffen Ross 1 Lars Oesterhelweg 1 Stephan Bolliger 1 Andreas Christe 1,4 Valentin Djonov 5 Michael J. Thali 1 Richard Dirnhofer 1 Grabherr S, Gygax E, Sollberger B, et al. 1 Center of Forensic Imaging and Virtopsy, Institute of Forensic Medicine, University of Bern, Bern, Switzerland. 2 Institute of Forensic Medicine, University of Lausanne, Rue du Bugnon 21, CH-1005 Lausanne, Switzerland. Address correspondence to S. Grabherr (silke.grabherr@chuv.ch). 3 Department of Cardiovascular Surgery, University of Bern, Inselspital, Bern, Switzerland. 4 Institute of Diagnostic Radiology, University of Bern, Inselspital, Bern, Switzerland. 5 Institute of Anatomy, University of Bern, Bern, Switzerland. Forensic Radiology • Original Research AJR 2008; 190:345–351 0361–803X/08/1902–345 © American Roentgen Ray Society I mplementation of radiologic im- aging methods in postmortem examinations has become a field of intensive research activity [1]. Research groups such as Virtopsy [2, 3] are engaged in developing minimally invasive autopsy techniques. Visualization of the vas- cular system with postmortem angiography is one of the most challenging issues in fo- rensic medicine and pathologic anatomy [4]. Vascular diagnosis is difficult with conven- tional autopsy techniques, which reveal only the main vessels. If defects in smaller vessels lead to blood loss, the exact origin of the bleeding can be detected, but rarely. In fo- rensic cases, careful mapping of vascular in- juries can be important for legal reasons. Development of a minimally invasive post- mortem angiographic technique would be a landmark in the field. Since the beginning of the 16th century, the importance of postmortem vascular in- vestigation has been evidenced by the regu- lar appearance of publications dealing with Keywords: minimally invasive autopsy, iodized oil, noninvasive autopsy, postmortem angiography, virtual autopsy DOI:10.2214/AJR.07.2261 Received March 16, 2007; accepted after revision September 19, 2007. This study was financially supported by the Virtopsy Foundation. The method described is patent pending. OBJECTIVE. The purpose of this study was to adapt and improve a minimally invasive two-step postmortem angiographic technique for use on human cadavers. Detailed mapping of the entire vascular system is almost impossible with conventional autopsy tools. The tech- nique described should be valuable in the diagnosis of vascular abnormalities. MATERIALS AND METHODS. Postmortem perfusion with an oily liquid is estab- lished with a circulation machine. An oily contrast agent is introduced as a bolus injection, and radiographic imaging is performed. In this pilot study, the upper or lower extremities of four human cadavers were perfused. In two cases, the vascular system of a lower extremity was visualized with anterograde perfusion of the arteries. In the other two cases, in which the suspected cause of death was drug intoxication, the veins of an upper extremity were visual- ized with retrograde perfusion of the venous system. RESULTS. In each case, the vascular system was visualized up to the level of the small supplying and draining vessels. In three of the four cases, vascular abnormalities were found. In one instance, a venous injection mark engendered by the self-administration of drugs was rendered visible by exudation of the contrast agent. In the other two cases, occlusion of the arteries and veins was apparent. CONCLUSION. The method described is readily applicable to human cadavers. After establishment of postmortem perfusion with paraffin oil and injection of the oily contrast agent, the vascular system can be investigated in detail and vascular abnormalities rendered visible. Grabherr et al. Postmortem Angiography Forensic Radiology Original Research Downloaded from www.ajronline.org by 52.73.204.196 on 05/16/22 from IP address 52.73.204.196. Copyright ARRS. For personal use only; all rights reserved