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Assessing the use of magnetic resonance imaging virtopsy as an alternative to autopsy: a systematic review and meta-analysis
  1. Mohammad Usman Ahmad1,2,
  2. Kamal Ali Sharif3,
  3. Haisum Qayyum1,2,
  4. Bushra Ehsanullah4,
  5. Svetlana Balyasnikova5,6,
  6. Anita Wale5,6,
  7. Arun Shanmuganandan7,
  8. Muhammed Rafay Sameem Siddiqui7,
  9. Thanos Athanasiou8,
  10. Graham John Kemp9
  1. 1 School of Medicine, University of Liverpool, Liverpool, UK
  2. 2 Institute of Translational Medicine, University of Liverpool, Liverpool, UK
  3. 3 Tameside General Hospital, Ashton-Under-Lyne, UK
  4. 4 Warwick Hospital, Warwick, UK
  5. 5 Imperial College London, London, UK
  6. 6 Department of Radiology, The Royal Marsden NHS Foundation Trust, London, UK
  7. 7 Department of Colorectal Surgery, Croydon University Hospital, Croydon, UK
  8. 8 Department of Surgery and Cancer, Imperial College London, London, UK
  9. 9 Magnetic Resonance and Image Analysis Research Centre, University of Liverpool, Liverpool, UK
  1. Correspondence to Professor Graham John Kemp, Liverpool Magnetic Resonance Imaging Centre (LiMRIC), University of Liverpool, Liverpool, UK; G.J.Kemp{at}


Background The post mortem examination or autopsy is a trusted method of identifying the cause of death. Patients and their families may oppose an autopsy for a variety of reasons, including fear of mutilation or owing to religious and personal beliefs. Imaging alternatives to autopsy have been explored, which may provide a viable alternative.

Objective To explore the possibility of using MRI virtopsy to establish the cause of death as an alternative to the traditional post mortem examination or autopsy.

Methods Systematic review was carried out of all studies, without language restriction, identified from Medline, Cochrane (1960–2016) and Embase (1991–2016) up to December 2016. Further searches were performed using the bibliographies of articles and abstracts. All studies reporting the diagnosis of the cause of death by both MRI virtopsy and traditional autopsy were included.

Results Five studies with 107 patients, contributed to a summative quantitative outcome in adults. The combined sensitivity of MRI virtopsy was 0.82 (95% CI 0.56 to 0.94) with a diagnostic odds ratio (DOR) of 11.1 (95% CI 2.2 to 57.0). There was no significant heterogeneity between studies (Q=1.96, df=4, p=0.75, I2=0). Eight studies, with 953 patients contributed to a summative quantitative outcome in children. The combined sensitivity of MRI virtopsy was 0.73 (95% CI 0.59 to 0.84) with a DOR of 6.44 (95% CI 1.36 to 30.51). There was significant heterogeneity between studies (Q=34.95, df=7, p<0.01, I2=80).

Conclusion MRI virtopsy may offer a viable alternative to traditional autopsy. By using MRI virtopsy, a potential cost reduction of at least 33% is feasible, and therefore ought to be considered in eligible patients.

  • virtopsy
  • autopsy
  • imaging
  • MRI

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  • Contributors MUA and MRSS planned, supervised and carried out the study. KAS and HQ carried out the literature and data search. All authors contributed to the writing of the manuscript.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Correction notice This paper has been amended since it was published Online First. Owing to a scripting error, some of the publisher names in the references were replaced with ’BMJ Publishing Group'. This only affected the full text version, not the PDF. We have since corrected these errors and the correct publishers have been inserted into the references.