新生儿死后肝脏下垂:辐射和病理特征

O. V. Savva, U. N. Tumanova, V. Bychenko, A. I. Shchegolev
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引用次数: 0

摘要

背景:在病理和法医尸体解剖过程中,会对死者尸体进行检查,以确定尸体的非特异性变化。这些变化包括内出血,其特点是在重力作用下组织和器官中的血液重新分布[1, 2]。这种死后内膜增生反映了死亡年龄,但也使非特异性尸变的生前病理过程和病变的鉴别诊断变得复杂[3,4]。死后磁共振成像是一种客观、无创的检查方法,尤其适用于器官和组织相对不成熟的新生儿死亡病例。因此,它可能被证明是一种很有前途的方法,可用于观察和评估尸体的后遗症[5, 6]。目的:本研究的目的是调查已故新生儿肝脏中尸变的表现,重点是尸变持续时间的影响。为此,我们使用了死后磁共振成像和形态学检查。材料和方法:该研究基于对 62 名死亡时间在 1.5 小时至 49 天的新生儿和婴儿尸体进行的全面死后放射学和病理解剖检查。在选择研究对象时,排除了发育异常和患有肝脏疾病的婴儿。在 3T 西门子 Magnetom Verio 仪器上进行了死后磁共振成像检查,随后进行了病理解剖。对 T1 和 T2 加权图像进行了评估,以确定肝组织腹侧(上部)和背侧(下部)磁共振信号强度梯度线的存在和严重程度。解剖后,从肝脏腹侧和背侧区域获取组织样本,然后对苏木精和伊红染色的制备物进行显微分析。结果:死后磁共振成像的结果确定了尸变引起的肝组织辐射特征和组织学变化。在尸体磁共振成像中,尸体肝脏骨质增生最显著的表现是器官上方和下方区域的磁共振信号强度发生变化,并伴有信号强度梯度的出现。这种梯度反映了尸体死后的位置,并随着死后时间的长短而变化。与T2加权图像相比,在T1加权图像上更常观察到信号强度梯度。肝组织制片的组织学检查显示,肝窦的大小增加,肝梁的面积减少,这种变化随着死亡年龄的增加而加剧,在肝下部表现得更为明显。这些变化无疑是辐射特征的形态学基础。结论:尸检磁共振成像和形态学研究揭示了尸体肝下垂的具体特征,在分析结果和确定死亡新生儿肝下垂发生的联系时,应将其考虑在内。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Postmortem liver hypostases in newborns: radiation and pathological characteristics
BACKGROUND: During pathological and forensic autopsies, the bodies of the deceased are examined to identify nonspecific cadaveric changes. These changes include internal hypostases, which are characterized by the redistribution of blood in tissues and organs under the influence of gravity [1, 2]. Such postmortem hypostases reflect the age of death, but they also complicate the differential diagnosis of lifetime pathological processes and lesions with nonspecific cadaveric changes [3, 4]. Postmortem magnetic resonance imaging represents an objective and noninvasive method of investigation, particularly in cases of neonatal death characterized by relative immaturity of organs and tissues. It may therefore prove to be a promising approach to visualize and evaluate cadaveric hypostases [5, 6]. AIM: The aim of this study was to investigate the manifestations of cadaveric hypostases in the liver of deceased neonates, with a focus on the impact of postmortem period duration. This was achieved through the use of postmortem magnetic resonance imaging and morphologic examination. MATERIALS AND METHODS: The study was based on a comprehensive postmortem radiology and pathological anatomical examination of the bodies of 62 newborns and infants who died at the age of 1.5 hours to 49 days. The subjects were selected to exclude those with developmental anomalies and liver diseases. A postmortem magnetic resonance imaging examination was conducted on a 3T Siemens Magnetom Verio apparatus, followed by a subsequent pathological and anatomic autopsy. The T1- and T2-weighted images were evaluated to determine the presence and severity of the magnetic resonance signal intensity gradient line in the ventral (superior) and dorsal (inferior) regions of the liver tissue. Following the autopsy, tissue samples were obtained from the ventral and dorsal regions of the liver, and subsequently subjected to microscopic analysis of hematoxylin and eosin-stained preparations. RESULTS: The results of postmortem magnetic resonance imaging have enabled the establishment of the radiation characteristics and histological changes in liver tissue caused by cadaveric hypostases. The most notable manifestation of cadaveric hypostases in the liver at postmortem magnetic resonance imaging is the change in magnetic resonance signal intensities in the above and below-located regions of the organ, accompanied by the emergence of a signal intensity gradient. This gradient reflects the location of the body after death and varies depending on the duration of the postmortem period. The signal intensity gradient was more frequently observed on T1-weighted images compared to T2-weighted images. Histological examination of liver tissue preparations revealed an increase in the size of sinusoids and a decrease in the area of hepatic beams, which was observed to progress with increasing age at death and was expressed to a greater extent in the lower liver region. These changes are undoubtedly a morphologic substrate of radiation characteristics. CONCLUSIONS: The specific characteristics of cadaveric liver hypostases, as revealed by postmortem magnetic resonance imaging and morphological study, should be taken into account when analyzing the results and determining the links of thanatogenesis of dead newborns.
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