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J Pathol Inform. 2018 Jul 19;9:28. doi: 10.4103/jpi.jpi_23_18. eCollection 2018.

Virtual Autopsy as a Screening Test Before Traditional Autopsy: The Verona Experience on 25 Cases.

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Department of Diagnostics and Public Health, Forensic Pathology Unit, University and Hospital Trust of Verona, Italy.
Department of Diagnostics and Public Health, Anatomic Pathology Unit, University and Hospital Trust of Verona, Italy.
Department of Forensic Medicine, Queen Elizabeth Hospital, Kota Kinabalu, Sabah, Malaysia.
Department of Neurological, Biomedical and Movement Sciences, University of Verona, Italy.
Center Research and Innovation for Digital Health, Veneto, Italy.
Department of Diagnostics and Public Health, Radiology Unit, University and Hospital Trust of Verona, Italy.
Department of Clinical Pharmacology, Cameron Forensic Medical Sciences, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, London, United Kingdom.
Institute of Pharmacy and Translational Medicine, Sechenov First Moscow State Medical University, Russian Federation, Russia.



Interest has grown into the use of multidetector computed tomography (CT) and magnetic resonance imaging as an adjunct or alternative to the invasive autopsy. We sought to investigate these possibilities in postmortem CT scan using an innovative virtual autopsy approach.


Twenty-five postmortem cases were scanned with the Philips Brilliance CT-64 and then underwent traditional autopsy. The images were interpreted by two blinded forensic pathologists assisted by a radiologist with the INFOPSY® Digital Autopsy Software System which provides three-dimensional images in Digital Imaging and Communications in Medicine format. Diagnostic validity of virtual autopsy (accuracy rate, sensitivity, specificity, and predictive values) and concordance between the two forensic pathologists (kappa intraobserver coefficients) were determined.


The causes of death at traditional autopsies were hemorrhage due to traumatic injuries (n = 8), respiratory failure (5), asphyxia due to drowning (4), asphyxia due to hanging or strangulation (2), heart failure (2), nontraumatic hemorrhage (1), and severe burns (1). In two cases, the cause of death could not be ascertained. In 15/23 (65%) cases, the cause of death diagnosed after virtual autopsy matched the diagnosis reported after traditional autopsy. In 8/23 cases (35%), traditional autopsy was necessary to establish the cause of death. Digital data provided relevant information for inferring both cause and manner of death in nine traumatic cases. The validity of virtual autopsy as a diagnostic tool was higher for traumatic deaths than other causes of death (accuracy 84%, sensitivity 82%, and specificity 86%). The concordance between the two forensic pathologists was almost perfect (>0.80).


Our experience supports the use of virtual autopsy in postmortem investigations as an alternative diagnostic practice and does suggest a potential role as a screening test among traumatic deaths.


Computed tomography; computed tomography scan; forensic sciences; postmortem investigation; traumatic deaths; virtual autopsies

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