Delayed cerebral enhancement on post-mortem computed tomography due to residual contrast medium administered shortly before death.
Delayed cerebral enhancement on post-mortem computed tomography due to residual contrast medium administered shortly before death.
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DOI：
10.1016/j.radcr.2021.04.065
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发表时间：
2021-08
影响因子：
--
通讯作者：
Gonoi W
中科院分区：
文献类型：
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作者：
Okimoto N;Ishida M;Abe H;Ikemura M;Fujimoto K;Kanemaru N;Ushiku T;Abe O;Gonoi W
死后计算机断层扫描（CT）是目前一个众所周知的程序，并有助于死后调查。在这个病例报告中，我们报告了一个独特的死后CT发现：与死前灌注造影剂相关的延迟性脑增强。一名72岁的女性在一家餐馆失去知觉，被救护车送往医院。尽管进行了复苏努力，她还是死于心脏骤停引起的缺氧缺血性脑病。死亡前约6小时，她接受了头部的增强生前CT。脑实质未见异常强化。然后，在她死亡后11小时，她接受了非增强尸检CT，结果显示，由于残留的碘化造影剂，除了缺氧缺血性脑病的其他特征性发现外，还显示了双侧高密度尾状核和壳核。这种现象的机制可能是由于灰质的缺氧缺血性变化导致的血脑屏障的破坏和/或选择性脆弱性。由于死前输注碘化造影剂，死后CT上基底节增强可能提示缺氧缺血性脑病，这在死后CT解释中应注意。
Postmortem computed tomography (CT) is currently a well-known procedure and helps in postmortem investigations. In this case report, we report a unique postmortem CT finding: delayed cerebral enhancement associated with the antemortem infusion of contrast medium. A 72-year-old female lost consciousness at a restaurant and was taken to a hospital in an ambulance. Despite resuscitation efforts, she died of hypoxic–ischemic encephalopathy caused by cardiac arrest. About 6 h before her death, she underwent enhanced antemortem CT of the head. No abnormal enhancement was observed in the cerebral parenchyma. Then, 11 h after her death, she underwent unenhanced postmortem CT, which showed bilateral hyperdense caudate nucleus and putamina, due to residual iodinated contrast medium, in addition to other characteristic findings of hypoxic–ischemic encephalopathy. The mechanism underlying this phenomenon could be the destruction of the blood–brain barrier, and/or selective vulnerability, due to hypoxic–ischemic changes in the gray matter. Enhancement of basal ganglia on postmortem CT due to antemortem infusion of iodinated contrast medium might suggest hypoxic–ischemic encephalopathy, which should be noted in postmortem CT interpretations.