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# Postmortem imaging and virtual autopsy

- Method

CT and MRI of the body, before or instead of the autopsy, show fractures, gas, projectiles and bleeding, but do not replace the autopsy in a suspicious death.

Updated Nov 13, 2026

## Key points

- PMCT: skeleton, gas, projectiles and radiopaque foreign bodies; a quick overview before the autopsy.
- PMCT angiography: source of bleeding, coronary arteries, vascular injuries.
- PMMR: soft tissues and organs; preferred in fetuses and children; can show myocardial infarction.
- Does not see small skin injuries or colour, and cannot replace toxicology or histology.
- Postmortem artefacts mislead: decomposition gas, postmortem clots that mimic pulmonary embolism, collapsed vessels.
- Minnesota Protocol: a supplement, not a substitute, in a potentially unlawful death; if no autopsy is done, justify it in writing.

## What it is

Postmortem imaging uses radiology on the dead body: plain X-rays, CT (PMCT), CT with injected contrast to show the vessels (PMCT angiography), MRI (PMMR) and 3D surface scanning. The term 'virtual autopsy' has raised the expectation that a scan can replace the dissection, but the UN Minnesota Protocol says that is still far from true: imaging adds information and does not replace the autopsy in a potentially unlawful death. Its strengths are a fast overview of the whole body, fractures in places the autopsy rarely opens, gas, radiopaque foreign bodies and projectiles, a permanent digital record that others can review, and triage in disasters. Its weaknesses are poor soft-tissue and vessel detail without contrast, no colour and no small skin injuries, and the fact that samples for toxicology, histology and microbiology still require access to the body.

## Accuracy and limits

- In trauma, a systematic review found PMCT agreed with autopsy on the cause of death in 46–100 % of cases and detected 53–100 % of injuries.
- The same review found injuries on PMCT that the autopsy had missed, so the two are complementary.
- PMCT alone cannot confirm a cardiac cause of sudden death: it only shows coronary calcification.
- Gas starts forming within hours of death, so its origin on imaging is hard to interpret.
- Costly equipment, not widely available; sensitivity and specificity compared with autopsy are not fully studied.

## What it is based on

- X-rays pass through the body in a CT scanner and build cross-sectional images; dense structures (bone, metal) stand out.
- MRI uses magnetic fields and shows soft tissues better; metal objects are a danger in the scanner.
- In angiography, contrast is pumped into the vessels through a cannula to show leaks and blockages.
- Images are stored digitally and can be reviewed by another expert or shown in court as 3D reconstructions.

## How it is applied

- Scan the body in its bag, before undressing, when the case allows it.
- Read the images with a radiologist trained in postmortem changes, before the autopsy starts.
- Use the findings to guide the autopsy: where the projectile is, which fractures to expose, where gas lies.
- Take samples for microbiology and toxicology before injecting contrast, which can spoil them.
- Correlate each imaging finding with the autopsy and state which method showed it.
- If the authority decides on no autopsy, document the reasons and the limits of the conclusions.

## Next step: what to do and document

- In a gunshot death, request imaging before the autopsy to locate projectiles and fragments.
- In child deaths, consider skeletal imaging or CT to look for old and new fractures.
- Record in the report which imaging was done, when, by whom it was read and what it added.
- Keep the images as part of the case file so that another expert can review them.
- Do not issue a cause of death in a violent or suspicious death based on imaging alone.

## Common mistakes

- Reading decomposition gas as air embolism.
- Reading postmortem clots or lividity in the lungs as disease.
- Assuming a normal scan rules out an injury: small bruises, abrasions and many soft-tissue lesions are not seen.
- Injecting contrast before taking samples for microbiology or toxicology.

## Test yourself

Think of the answer, then tap the question to see it.

## Can postmortem CT replace the autopsy in a potentially unlawful death?

No. According to the Minnesota Protocol it supplements the autopsy; samples and naked-eye findings still need the dissection.

## Which imaging method is best for the source of internal bleeding and the coronary arteries?

Postmortem CT angiography, which injects contrast into the vessels.

## Which postmortem imaging method is preferred for fetuses and young children?

MRI, because of its soft-tissue detail.

## Which two things does postmortem CT not show well?

Small skin injuries and colour (bruises, abrasions) and the detail of soft tissues and vessels without contrast; it also cannot give toxicology or histology.

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## Connections

## Related 5

- [The internal examination and the samples to take](https://durgical.com/en/forensic-medicine/the-internal-examination-and-the-samples-to-take/)
- [The external examination of the body](https://durgical.com/en/forensic-medicine/the-external-examination-of-the-body/)
- [Special autopsy techniques: air embolism, pneumothorax, neck dissection](https://durgical.com/en/forensic-medicine/special-autopsy-techniques-air-embolism-pneumothorax-neck-dissection/)
- [Disaster victim identification](https://durgical.com/en/forensic-medicine/disaster-victim-identification/)
- [Sudden unexpected death in adults and infants](https://durgical.com/en/forensic-medicine/sudden-unexpected-death-in-adults-and-infants/)

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Educational content on forensic and legal medicine; not legal advice and no substitute for the technical guides of Colombia's National Institute of Legal Medicine and Forensic Sciences. Laws change: each page links the official text and says when it was last checked. For a real case, follow the guide in force and ask the competent authority.

Sources: [Modern post-mortem imaging: an update on recent developments](https://pmc.ncbi.nlm.nih.gov/articles/PMC6197109/) (Forensic Sciences Research (Grabherr S et al.), 2017); [The value of postmortem computed tomography as an alternative for autopsy in trauma victims: a systematic review](https://pmc.ncbi.nlm.nih.gov/articles/PMC2758189/) (European Radiology (Scholing M et al.), 2009); [The Minnesota Protocol on the Investigation of Potentially Unlawful Death (2016)](https://www.ohchr.org/sites/default/files/Documents/Publications/MinnesotaProtocol.pdf) (Office of the United Nations High Commissioner for Human Rights, 2017).

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License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/forensic-medicine/postmortem-imaging-and-virtual-autopsy/