Post-mortem MR angiography: quantitative investigation and intravascular retention of perfusates in ex situ porcine hearts

As the implementation of minimally invasive imaging techniques in both forensic and pathological practice increases, research in this area focuses on addressing recognised diagnostic weaknesses of current approaches. Assessment of sudden cardiac death (SCD) can be considered one such area in which post-mortem imaging still shows diagnostic weaknesses. We hypothesise that magnetic resonance imaging (MRI) with an angiographic adjunct may improve the visualisation and interpretation of cardiac pathologies in a post-mortem setting. To systematically investigate this hypothesis, selected perfusates (paraffin oil, Gadovist®;-doped physiological solution and polyethylene glycol (PEG)) were injected into the left anterior descending (LAD) artery of ex situ porcine hearts to assess the visualisation of perfusates in MRI as well as their intravascular retention over 12 h. Morphological images were acquired and quantitative T₁ maps were generated from inversion recovery data. Visualisation of vascular structure and image quality were assessed using signal-to-noise and contrast-to-noise ratios. Intravascular retention was assessed both visually and statistically using a volume of interest (VOI) approach to analyse significant changes in signal intensity in and around the filled LAD artery, as well as changes in the longitudinal relaxation time (T₁) in adjacent myocardium. In addition to presenting possible mechanisms explaining perfusate extravasation given the increased permeability of post-mortem vessels, the potential diagnostic consequences of this phenomenon and the importance of contrast stability and extended intravascular retention are discussed. In light of our findings and these considerations, paraffin oil emerged as the preferred perfusate for use in post-mortem MR angiography.