Letters

Magnetic resonance imaging may be alternative to necropsy

EDITORCertification of the cause of death is a valuable source of information about illness in the community. When a death is unexplained the case is referred to the coroner in England and Wales and the procurator fiscal in Scotland. Although Scottish law does not demand explanation of a non-suspicious death, in England a cause of death (or mode of death under certain circumstances) must be determined, which often requires a necropsy.

Necropsy is not allowed by many religions, particularly Islam and Judaism, unless demanded by law. Over the past 18 months we have used magnetic resonance imaging to examine 15 patients whose deaths were unexplained. The patients were from areas in the North West region covered by five coroners. Examination of the brain, thorax, and upper abdomen showed that 10 of the patients had disease that was so severe that, had the patients been alive, they would have been at risk of death. In these cases the coroners accepted the magnetic resonance diagnoses as the cause of death. In the other five cases disease was found but was not deemed to be sufficiently severe to be the definite cause of death. As there was uncertainty about the cause a necropsy was done. In four of the five cases necropsy confirmed that the disease shown by magnetic resonance imaging was the cause of death.

Necropsy will always be the standard for determining cause of death, particularly as magnetic resonance imaging cannot show small vessel coronary artery disease. However, for patients whose religious beliefs make necropsy unwelcome magnetic resonance imaging may offer a reasonable alternative. The cost and availability of magnetic resonance imaging will prevent its widespread use. There is also a good chance that imaging will fail to show the cause of death and a necropsy will be required. Despite these drawbacks radiological investigations may be as valuable in death as they are in life.

Rob Bisset, Consultant radiologist.  .
X Ray Department, North Manchester General Hospital, Manchester M8 6RB