Postmortem CT angiography in infants and young children (pedPMCTA): Technical feasibility and emerging forensic insights from a 30-case study.

BACKGROUND & OBJECTIVES: Postmortem CT angiography (PMCTA) is increasingly used in forensic imaging but remains underexplored in pediatric populations. This study assesses the feasibility of pediatric PMCTA (pedPMCTA) using a weight-adapted manual protocol with a lipophilic contrast agent and explores its forensic application, particularly for investigating abusive head trauma. MATERIALS & METHODS: Thirty pediatric cases (0–3.6 years; 2.2–25.4 kg) underwent PMCTA prior to autopsy. A biphasic protocol (arterial and venous) was applied using Angiofil™ diluted in rapeseed oil or paraffinum perliquidum. Vascular access included femoral, intraosseous, umbilical and peripheral routes. Vascular filling was assessed using a semiquantitative score for arteries (max 34) and veins (max 24). Diagnostically sufficient opacification was defined as > 17/34 for arteries and > 12/24 for veins. Access types, scores and technical success were analyzed. RESULTS: PMCTA was technically feasible in all cases. Diagnostically sufficient arterial opacification was achieved in 23/30 cases (76.7%), and venous opacification in 24/30 (80.0%). Femoral venous access yielded the highest venous scores. In some cases, arterial opacification occurred despite venous-only injection, suggesting passive filling via arteriovenous shunts. Opacification scores showed no significant correlation with age or postmortem interval and only weak correlation with weight despite the weight-adapted protocol. CONCLUSION: PedPMCTA with a lipophilic contrast agent is feasible and diagnostically informative, including in neonates. It may complement forensic autopsy, especially in cases involving vascular lesions or suspected abusive injuries. These findings highlight the forensic value of pedPMCTA in determining causes of death in infants and young children.