Non-invasive assessment of coronary inflammation improves the diagnostic accuracy of coronary death in post-mortem CT angiography

BACKGROUND: Post-mortem computed tomography (PMCT) is becoming the preferred method to diagnose the cause of death over autopsy. There are areas improvements for the technique. This study investigates the use of a minimally invasive procedure under imaging guidance to perform PMCT Angiography (PMCTA), and coronary inflammation assessment to identify coronary death to aid the radiologists' diagnosis against autopsy (ground truth). METHODS: Adults with unknown cause of death referred for Coroner's autopsy within 48 ​h from death were included. Three independent radiologists performed the analysis - cardiac radiologist performed the Fat Attenuation Index (FAI) score and AI-Risk, two radiologists with 2 years' and >10 years' PMCT experience blinded to autopsy results reported the cause of death without and with coronary inflammatory findings. RESULTS: PMCTA included 37 participants (15 by radiologist using imaging guided minimally invasive technique; 22 carotid cut down technique). FAI score and AI-Risk produced high sensitivity (84%) and specificity (94%) for the diagnosis of coronary death. The technique could be applied in both the contrast and non-contrast studies to differentiate coronary death versus non-coronary causes. Both radiologists showed high sensitivity (94%), but low specificity (72% and 56% respectively) in the diagnoses of coronary deaths. With the aid of the FAI score and AI-Risk, radiologists were able to identify all the true coronary deaths, and no false negative. CONCLUSIONS: PMCTA can be performed by radiologists using imaging guided minimally invasive technique. The FAI Score and AI-Risk can aid in the diagnosis of coronary death in routine PMCT.