This thesis, entitled “Postmortem CT Angiography in Fetuses and Children: Development, Systematic Review, and Forensic Insights from Pediatric Cases,” explores the application of postmortem imaging techniques, with a particular focus on Postmortem CT Angiography (PMCTA), in the investigation of fetal and pediatric deaths. While cross-sectional imaging has progressively emerged as a complement, and in some contexts an alternative, to conventional autopsy in forensic pathology, its use in fetuses and young children remains an evolving field, facing both technical and interpretative challenges. The objective of this work was to develop and optimize PMCTA protocols tailored to the anatomical and physiological specificities of these vulnerable populations, while taking into account the ethical considerations inherent to postmortem imaging in minors.
The thesis is structured around three original articles that respectively introduce, synthesize and evaluate dedicated PMCTA methods. Language editing assistance was provided using ChatGPT (OpenAI, 2024–2025); however, the author remains solely responsible for the scientific content and conclusions.
The first article, “Development of a technique for postmortem CT angiography of fetuses with a lipophilic contrast agent” describes the design and validation of an innovative fetal PMCTA (FPMCTA) technique. Thanks to a lipophilic contrast agent, better suited to postmortem vascular changes, this protocol achieved superior vascular opacification compared to previous water-soluble approaches (hydrophilic contrast medium used in the living). It provided reliable visualization of major fetal vessels and offered a reproducible method for integrating angiography into the postmortem investigation of fetal deaths.
The second article, Postmortem CT angiography of fetuses, infants and children up to 12 years old: a systematic review and conceptual decision tree” presents a comprehensive synthesis of the existing literature on fetal and pediatric PMCTA. Beyond highlighting the current lack of standardization in clinical practice, the review led to the proposal of a decision tree designed to guide protocol selection based on age, weight, vascular accessibility and diagnostic objectives. This practical framework serves as a reference for clinicians and forensic practitioners.
The third article, “Postmortem CT angiography in infants and young children (PedPMCTA): Technical feasibility and emerging forensic insights from a 30-case study” empirically evaluates a weight-adapted lipophilic PMCTA protocol in 30 individuals aged 1 day to 3.6 years. Feasibility was confirmed across the entire pediatric age range studied, with consistently high arterial and venous opacification and reliable vascular access routes, particularly via the femoral approach. Arteriovenous shunts were observed in several cases and key forensic structures, including the superior sagittal sinus, bridging veins and ocular vessels, were successfully visualized in a substantial proportion of examinations. Although artifacts such as contrast extravasation and air bubbles were encountered, they did not hinder diagnostic interpretation.
