Postmortem chest computed tomography in COVID-19: A minimally invasive autopsy method
Objectives: Performing autopsies in a pandemic scenario is challenging, as the need to understand pathophysiology must be balanced with the contamination risk. A minimally invasive autopsy might be a solution. We present a model that combines radiology and pathology to evaluate postmortem CT lung fi...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2024-06-01
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| Series: | European Journal of Radiology Open |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2352047724000017 |
| _version_ | 1797356071501692928 |
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| author | Paulo Savoia Marcio Valente Yamada Sawamura Renata Aparecida de Almeida Monteiro Amaro Nunes Duarte-Neto Maria da Graça Morais Martin Marisa Dolhnikoff Thais Mauad Paulo Hilário Nascimento Saldiva Claudia da Costa Leite Luiz Fernando Ferraz da Silva Ellison Fernando Cardoso |
| author_facet | Paulo Savoia Marcio Valente Yamada Sawamura Renata Aparecida de Almeida Monteiro Amaro Nunes Duarte-Neto Maria da Graça Morais Martin Marisa Dolhnikoff Thais Mauad Paulo Hilário Nascimento Saldiva Claudia da Costa Leite Luiz Fernando Ferraz da Silva Ellison Fernando Cardoso |
| author_sort | Paulo Savoia |
| collection | DOAJ |
| description | Objectives: Performing autopsies in a pandemic scenario is challenging, as the need to understand pathophysiology must be balanced with the contamination risk. A minimally invasive autopsy might be a solution. We present a model that combines radiology and pathology to evaluate postmortem CT lung findings and their correlation with histopathology. Methods: Twenty-nine patients with fatal COVID-19 underwent postmortem chest CT, and multiple lung tissue samples were collected. The chest CT scans were analyzed and quantified according to lung involvement in five categories: normal, ground-glass opacities, crazy-paving, small consolidations, and large or lobar consolidations. The lung tissue samples were examined and quantified in three categories: normal lung, exudative diffuse alveolar damage (DAD), and fibroproliferative DAD. A linear index was used to estimate the global severity of involvement by CT and histopathological analysis. Results: There was a positive correlation between patient mean CT and histopathological severity score indexes - Pearson correlation coefficient (R) = 0.66 (p = 0.0078). When analyzing the mean lung involvement percentage of each finding, positive correlations were found between the normal lung percentage between postmortem CT and histopathology (R=0.65, p = 0.0082), as well as between ground-glass opacities in postmortem CT and normal lungs in histopathology (R=0.65, p = 0.0086), but negative correlations were observed between ground-glass opacities extension and exudative diffuse alveolar damage in histological slides (R=−0.68, p = 0.005). Additionally, it was found is a trend toward a decrease in the percentage of normal lung tissue on the histological slides as the percentage of consolidations in postmortem CT scans increased (R =−0.51, p = 0.055). The analysis of the other correlations between the percentage of each finding did not show any significant correlation or correlation trends (p ≥ 0.10). Conclusions: A minimally invasive autopsy is valid. As the severity of involvement is increased in CT, more advanced disease is seen on histopathology. However, we cannot state that one specific radiological category represents a specific pathological correspondent. Ground-glass opacities, in the postmortem stage, must be interpreted with caution, as expiratory lungs may overestimate disease. |
| first_indexed | 2024-03-08T14:21:22Z |
| format | Article |
| id | doaj.art-93af04a3734946c6af3becb9424758b6 |
| institution | Directory Open Access Journal |
| issn | 2352-0477 |
| language | English |
| last_indexed | 2024-03-08T14:21:22Z |
| publishDate | 2024-06-01 |
| publisher | Elsevier |
| record_format | Article |
| series | European Journal of Radiology Open |
| spelling | doaj.art-93af04a3734946c6af3becb9424758b62024-01-14T05:39:02ZengElsevierEuropean Journal of Radiology Open2352-04772024-06-0112100546Postmortem chest computed tomography in COVID-19: A minimally invasive autopsy methodPaulo Savoia0Marcio Valente Yamada Sawamura1Renata Aparecida de Almeida Monteiro2Amaro Nunes Duarte-Neto3Maria da Graça Morais Martin4Marisa Dolhnikoff5Thais Mauad6Paulo Hilário Nascimento Saldiva7Claudia da Costa Leite8Luiz Fernando Ferraz da Silva9Ellison Fernando Cardoso10Department of Radiology, University of Sao Paulo School of Medicine, Institute of Radiology, Rua Doutor Ovidio Pires de Campos, 75, 05403-010, Cerqueira Cesar, São Paulo, SP, Brazil; Corresponding author.Department of Radiology, University of Sao Paulo School of Medicine, Institute of Radiology, Rua Doutor Ovidio Pires de Campos, 75, 05403-010, Cerqueira Cesar, São Paulo, SP, BrazilDepartment of Pathology, University of Sao Paulo School of Medicine, Av. Dr. Arnaldo, 455, sala 1155, 01246-903, Cerqueira Cesar, São Paulo, SP, BrazilDepartment of Pathology, University of Sao Paulo School of Medicine, Av. Dr. Arnaldo, 455, sala 1155, 01246-903, Cerqueira Cesar, São Paulo, SP, BrazilDepartment of Radiology, University of Sao Paulo School of Medicine, Institute of Radiology, Rua Doutor Ovidio Pires de Campos, 75, 05403-010, Cerqueira Cesar, São Paulo, SP, BrazilDepartment of Pathology, University of Sao Paulo School of Medicine, Av. Dr. Arnaldo, 455, sala 1155, 01246-903, Cerqueira Cesar, São Paulo, SP, BrazilDepartment of Pathology, University of Sao Paulo School of Medicine, Av. Dr. Arnaldo, 455, sala 1155, 01246-903, Cerqueira Cesar, São Paulo, SP, BrazilDepartment of Pathology, University of Sao Paulo School of Medicine, Av. Dr. Arnaldo, 455, sala 1155, 01246-903, Cerqueira Cesar, São Paulo, SP, BrazilDepartment of Radiology, University of Sao Paulo School of Medicine, Institute of Radiology, Rua Doutor Ovidio Pires de Campos, 75, 05403-010, Cerqueira Cesar, São Paulo, SP, BrazilDepartment of Pathology, University of Sao Paulo School of Medicine, Av. Dr. Arnaldo, 455, sala 1155, 01246-903, Cerqueira Cesar, São Paulo, SP, BrazilDepartment of Radiology, University of Sao Paulo School of Medicine, Institute of Radiology, Rua Doutor Ovidio Pires de Campos, 75, 05403-010, Cerqueira Cesar, São Paulo, SP, Brazil; Hospital Israelita Albert Einstein, Av. Albert Einstein, 627/701, 05652-900, Morumbi, São Paulo, SP, BrazilObjectives: Performing autopsies in a pandemic scenario is challenging, as the need to understand pathophysiology must be balanced with the contamination risk. A minimally invasive autopsy might be a solution. We present a model that combines radiology and pathology to evaluate postmortem CT lung findings and their correlation with histopathology. Methods: Twenty-nine patients with fatal COVID-19 underwent postmortem chest CT, and multiple lung tissue samples were collected. The chest CT scans were analyzed and quantified according to lung involvement in five categories: normal, ground-glass opacities, crazy-paving, small consolidations, and large or lobar consolidations. The lung tissue samples were examined and quantified in three categories: normal lung, exudative diffuse alveolar damage (DAD), and fibroproliferative DAD. A linear index was used to estimate the global severity of involvement by CT and histopathological analysis. Results: There was a positive correlation between patient mean CT and histopathological severity score indexes - Pearson correlation coefficient (R) = 0.66 (p = 0.0078). When analyzing the mean lung involvement percentage of each finding, positive correlations were found between the normal lung percentage between postmortem CT and histopathology (R=0.65, p = 0.0082), as well as between ground-glass opacities in postmortem CT and normal lungs in histopathology (R=0.65, p = 0.0086), but negative correlations were observed between ground-glass opacities extension and exudative diffuse alveolar damage in histological slides (R=−0.68, p = 0.005). Additionally, it was found is a trend toward a decrease in the percentage of normal lung tissue on the histological slides as the percentage of consolidations in postmortem CT scans increased (R =−0.51, p = 0.055). The analysis of the other correlations between the percentage of each finding did not show any significant correlation or correlation trends (p ≥ 0.10). Conclusions: A minimally invasive autopsy is valid. As the severity of involvement is increased in CT, more advanced disease is seen on histopathology. However, we cannot state that one specific radiological category represents a specific pathological correspondent. Ground-glass opacities, in the postmortem stage, must be interpreted with caution, as expiratory lungs may overestimate disease.http://www.sciencedirect.com/science/article/pii/S2352047724000017TomographyThoraxAutopsyPathology |
| spellingShingle | Paulo Savoia Marcio Valente Yamada Sawamura Renata Aparecida de Almeida Monteiro Amaro Nunes Duarte-Neto Maria da Graça Morais Martin Marisa Dolhnikoff Thais Mauad Paulo Hilário Nascimento Saldiva Claudia da Costa Leite Luiz Fernando Ferraz da Silva Ellison Fernando Cardoso Postmortem chest computed tomography in COVID-19: A minimally invasive autopsy method European Journal of Radiology Open Tomography Thorax Autopsy Pathology |
| title | Postmortem chest computed tomography in COVID-19: A minimally invasive autopsy method |
| title_full | Postmortem chest computed tomography in COVID-19: A minimally invasive autopsy method |
| title_fullStr | Postmortem chest computed tomography in COVID-19: A minimally invasive autopsy method |
| title_full_unstemmed | Postmortem chest computed tomography in COVID-19: A minimally invasive autopsy method |
| title_short | Postmortem chest computed tomography in COVID-19: A minimally invasive autopsy method |
| title_sort | postmortem chest computed tomography in covid 19 a minimally invasive autopsy method |
| topic | Tomography Thorax Autopsy Pathology |
| url | http://www.sciencedirect.com/science/article/pii/S2352047724000017 |
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