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Experts Say Virtual Autopsy Just Doesn’t Cut It

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About 23 percent of the time, an old-fashioned autopsy comes up with a new diagnosis that was missed by all of modern medicine’s amazing imaging tests and sophisticated laboratory procedures.

So why, ask two experts at The Johns Hopkins Hospital in Baltimore, should we think that the imaging-based virtual autopsy, or “virtopsy,” is ready to replace the traditional direct physical inspection of the body’s internal organs?

Pathologist Elizabeth Burton, MD, deputy director of the autopsy service at Johns Hopkins, said that despite the dazzling postmortem scans depicted on such TV series as Bones and the various CSI shows:

The traditional autopsy, though less and less frequently performed, is still the gold standard for determining why and how people really died.

Dr. Burton was quoted in a Johns Hopkins news release. She and Johns Hopkins clinical fellow Mahmud Mossa-Basha, MD, state their case in an editorial in today’s edition of Annals of Internal Medicine.

A German study in the same issue shows some of virtopsy’s strengths and limitations. Among 47 people who underwent both virtual and conventional autopsies, 102 new diagnoses were found. Virtual autopsy by CT scan missed 20.8 percent of the new diagnoses, particularly air pockets in collapsed lungs (which can impede breathing) and bone fractures. Conventional autopsy missed 13.4 percent, most commonly heart attack, pulmonary emboli, and cancer.

That suggests that the best approach would be a combination of traditional autopsy with scanning. Dr. Burton agreed. “It’s not a question of either traditional autopsy or virtopsy,” she said. “It’s a question of what methods work best in determining cause of death.”

For example, she said, imaging can pick up a spot on a lung. But it can’t tell whether that spot is cancer, a fungal infection, tuberculosis-related granuloma, or a benign mass. For that, you need a physical examination.

On the other hand, a conventional autopsy without scanning might have missed that spot altogether. “Steady progress in imaging technology is refining conventional autopsy,” said Dr. Mossa-Basha, “making it better and more accurate.”

Related seminar: Imaging Advances: Abdominal, Thoracic, Skeletal

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