Correlation of post mortem LODOX digital radiological images with histopathological findings at autopsy : a prospective autopsy study at the Tygerberg Forensic Pathology Service Facility

[摘要] ENGLISH ABSTRACT: Background: The LODOX Statscan is a whole-body digital X-ray scanning device which wasadapted for medical usage. The LODOX has an established role in the field of Forensic Pathologywhere it shows high sensitivity and specificity for the detection of skeletal pathology and foreignbodies. The role of the scanner in the detection of soft tissue pathology in the lungs of adults has notbeen reported and this study aims to review the radio-pathological correlation and the applicability ofLODOX as a viable screening tool in the detection of lung pathology in post mortem cases.Methods: We prospectively reviewed cases which were referred for medico-legal autopsy betweenNovember 2012 and March 2013 to the Tygerberg Forensic Pathology Service mortuary, Cape Town,South Africa. All cases meeting the prescribed inclusion criteria underwent LODOX scanning as wellas macroscopic and microscopic evaluation of the lungs as permitted by the Inquests Act 58 of 1959.The macroscopic and microscopic variables were considered the 'gold standard when compared withthe results of the LODOX. The sensitivity, specificity, positive and negative predictive values wereassessed.Results: One hundred and fifty nine cases (159) were included in the study. The most commonradiographic patterns reported were the presence of ground glass opacities and consolidation. Overall,low to moderate sensitivity of these LODOX patterns in the prediction of pneumonic microscopicpathology (oedema, acute and chronic inflammation and features of diffuse alveolar damage) wasnoted. These values were lower than that reported for pneumonia using conventional X-rays.Additionally, these LODOX patterns have a high probability of representing oedema orautolytic/decomposition change. Pneumothorax was the most common pleural pathology detected onLODOX, but autopsy correlation could not be performed. Poor to no correlation was noted with thevariables of cavity, malignant tumour, and bronchiectasis, but the prevalence of these conditions inour cohort was low. In general, LODOX predictions were better at excluding pathology which wasnot present rather than confirming pathology which was present.Conclusions: The LODOX offers excellent evidentiary value in the demonstration of a pneumothoraxbut currently has limited value as a 'stand alone test in the field of Forensic Pathology. However thecontinued use of the LODOX as an adjunct examination, as well as prospective study of itsapplicability, is advised.

[发布机构] Stellenbosch University