Key result
Post-mortem MRI identifies the cause of spontaneous hemopericardium with ~83% sensitivity vs. autopsy.
Why the study?
Spontaneous hemopericardium is rapidly fatal and imaging differentiation of its cause remains challenging, with PMCT less accurate in determining etiology.
Does post-mortem MRI (PMMRI) accurately detect the etiology of spontaneous hemopericardium in decedents?
Observational (n=34)
Does post-mortem MRI (PMMRI) accurately detect the etiology of spontaneous hemopericardium in decedents?
Answers are grounded in this paper and cite their sources.
Post-mortem MRI can accurately detect ruptured infarcts and aortic intimal flaps as causes of spontaneous hemopericardium, potentially reducing the need for autopsy.
Background Spontaneous hemopericardium is rapidly fatal and usually caused by cardiac rupture following myocardial infarction (RMI) or aortic rupture secondary to dissection (AD). Two patterns of hemopericardium are described on imaging i.e. crescentic clot or “hammered heart” (HH) and layered liquid blood or “hematocrit” (Hem). PMCT is accurate in detection of hemopericardium and differentiation of spontaneous from artefactual etiology (CPR) but less so in determining cause. Methods Following installation of a mortuary-based MRI scanner we have routinely imaged all decedents with hemopericardium detected on preliminary PMCT. PMMRI findings of blood pattern in the pericardial sac and likely etiology have been compared with PMCT findings and autopsy Results All 34 cases had PMCT and PMMRI with autopsy correlation in 12. PMMRI detected HH pattern of hemopericardium in 32 and Hem in 2. 11 of the 32 (34%) HH cases on PMMRI had a mixture of clotted blood and hematocrit. Of these 11, 9 (82%) had perimortem external cardiac massage. RMI was detected on PMMRI as an area of altered T2 signal in the myocardium with full thickness wall defect in 14 cases (41%) and AD in 20 (59%). Of the 20 AD cases, an intimal flap in the descending aorta on axial T1w and/or T2w sequences was detected in 15 (75%). PMMRI confirmation of autopsy findings in RMI was 5/5 (100%) and AD in 5/7 (71%) producing an overall sensitivity for PMMRI of 83% and PPV of 100%. AD cases not seen on PMMRI involved only the ascending aorta without intimal flap in the descending thoracic aorta. Conclusion PMMRI can accurately detect ruptured infarcts in the left ventricular wall and aortic intimal flaps in spontaneous hemopericardium. In our practice now, autopsy is only contemplated in cases of AD in younger persons where tissue sampling would be necessary for detection of underlying collagen disorders
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Chris O’Donnell (2026) conducted an observational in Spontaneous hemopericardium (n=34). Post-mortem MRI (PMMRI) vs. Autopsy was evaluated on Confirmation of autopsy findings for ruptured myocardial infarction and aortic dissection (Sensitivity 83%, PPV 100%). Post-mortem MRI (PMMRI) demonstrated an overall sensitivity of 83% and a positive predictive value of 100% for detecting the cause of spontaneous hemopericardium compared to autopsy.
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