Autopsy has long been regarded as the gold standard for determining the cause of death, offering invaluable insights into disease processes, trauma, and forensic investigations. Despite its diagnostic value, the practice of traditional autopsy has witnessed a global decline due to various factors, including cultural and religious objections, emotional discomfort among families, and logistical challenges. This has created a pressing need for alternative or complementary methods that are both scientifically robust and socially acceptable.1

 A virtual autopsy also called virtopsy or digital autopsy is a non-invasive post-mortem examination that uses advanced imaging technologies like CT scans, MRI, and 3D reconstruction to analyze a body without making physical incisions. It is revolutionizing forensic medicine by offering a respectful, efficient, and highly detailed alternative to traditional autopsies.2

 The postmortem CT represented by multi slice images provide layer by layer depiction of body at all spatial levels along with the optional 3D reconstruction which corresponds to the internal examination of the corpse at autopsy.3While virtual autopsy has gained traction in developed countries, its implementation in Indian healthcare settings remains limited.

 This retrospective study aims to evaluate the diagnostic utility of CT virtual autopsy and its potential to bridge the gap between modern imaging technology and traditional autopsy practices. By comparing findings from postmortem CT imaging with those from conventional autopsy including gross pathology, histopathology, and toxicology This study seeks to assess the concordance between the two modalities and explore how their integration can enhance diagnostic accuracy, medico-legal documentation, and cultural acceptability in postmortem investigations.

Study Design:

Retrospective record based study.

Study Period:

12 months (January 2024 to December 2024)

Study Population:

Cases subjected to CT Virtual Autopsy prior to Traditional Autopsy during the study period.

Sample Size:

15 (Number of cases subjected to virtual autopsy according previous records)

Sampling Method:

Purposive sampling.

Inclusion Criteria:

1. All the Autopsy cases subjected to CT Virtual Autopsy prior to Traditional Postmortem Examination.

Exclusion Criteria:

1. Cases with incomplete, inadequate, or poor-quality PMCT scans.
2. Cases which are subjected for second autopsy as there will be alteration in the anatomical integrity.
3. Embalmed bodies.

The Postmortem CT Virtual Autopsy and Traditional postmortem examination was done in succession. The Virtual Autopsy was carried out using uCT 780 scanner (160 slice) multiplanar. The images were obtained from the Picture archiving and communication system(PACS) which included axial, sagittal, and coronal reconstructions, as well as 3D reconstruction images. Scan was done from head to toe in soft tissue window(WW-300 , WL-40). The scanned regions included the head, face, neck, trunk and limbs. Traditional Autopsy was done following the CT examination. After external examination, Virchow’s method of organ dissection was done and organs examined for gross pathology. Viscera was collected for toxicological examination and Dissected visceral organs were collected and sent for Histopathological examination. The data regarding the findings of the external and internal examination from Traditional Autopsy and the Radiology report acquired from the CT examination was compared to know the concordance between the 2 methods.

Analysis:

The external and internal examination findings of the traditional autopsy and the radiological data obtained from CT Virtual autopsy of each case was compared with the cause of death. Concordance of both the methods with the cause of death was interpreted. If both methods identified the same cause of death or major findings it was interpreted to be concordant.

Among the 15 cases analyzed there were 9 female cases (60%) and 6 male cases (40%), age ranging between newborn to 53 years with mean age being 27.4.

Table 1: Comparison data between Traditional and CT Virtual Autopsy findings.

Table 2: Cause of Death Categories

Table 3: Concordance between CT and Traditional Autopsy

High concordance was observed in trauma-related and septic cases and Low concordance was noted in asphyxial deaths and poisonings, where CT failed to detect soft tissue changes or toxicological evidence.

Table 4: Diagnostic Strengths of CT Virtual Autopsy

 Statistical summary shows overall concordance rate of 46.7%, CT sensitivity for trauma-related findings in ~90–100% of the cases and CT sensitivity for asphyxial and toxicological causes: <30%

This retrospective study aimed to evaluate the diagnostic utility of CT virtual autopsy in comparison with traditional autopsy, with a focus on determining the concordance between the two modalities across various causes of death. The overall concordance rate between CT virtual autopsy and traditional autopsy was 46.7%, indicating moderate agreement. High concordance was observed in trauma-related and septic cases, where CT imaging effectively identified structural abnormalities such as skull fractures, subdural and subarachnoid hemorrhages, and emphysematous changes. These findings are consistent with previous studies that have demonstrated the high sensitivity of postmortem CT in detecting bony injuries and intracranial hemorrhages.4

 However, CT showed limited sensitivity in detecting soft tissue injuries which are critical in diagnosing asphyxial deaths like strangulation and hanging. In such cases, traditional autopsy remains indispensable due to its ability to reveal subtle tissue changes and provide histopathological confirmation. Similarly, CT failed to detect poisoning in two pediatric cases, where diagnosis relied entirely on toxicological analysis—an area where imaging inherently lacks diagnostic capability. Additionally, CT offers the advantage of being non-invasive, preserving the integrity of the body, and providing permanent digital records that can be reviewed and reanalyzed if needed.

 The findings of this study suggest that CT virtual autopsy can serve as a valuable adjunct to traditional autopsy, particularly in trauma and infectious cases. Its non-invasive nature may also improve acceptance among families who are reluctant to consent to conventional autopsy due to cultural or religious reasons. However, it should not be viewed as a replacement for traditional autopsy, especially in cases where soft tissue, histological, or toxicological evaluation is essential.

In resource-limited settings like Mandya, the integration of CT virtual autopsy into routine postmortem protocols could enhance diagnostic accuracy, expedite forensic investigations, and modernize medico-legal documentation. However, this would require investment in imaging infrastructure, training of radiologists in postmortem imaging, and interdisciplinary collaboration between forensic pathologists and radiologists.

 CT virtual autopsy holds significant promise as a complementary tool to traditional autopsy. While it excels in trauma and structural pathology, its limitations in soft tissue and toxicological assessment necessitate a hybrid approach. Future studies with larger sample sizes and multicenter collaboration are needed to further validate its role and optimize its integration into forensic practice.

1. Sonnemans LJP, Kubat B, Prokop M, Klein WM. Can virtual autopsy with postmortem CT improve clinical diagnosis of cause of death? A retrospective observational cohort study in a Dutch tertiary referral centre. BMJ Open. 2018;8(3):e018834. doi:10.1136/bmjopen-2017-018834.
2. Virtual Autopsy: The Hidden Science Behind Digital Post-Mortem Analysis [Internet]. Simplyforensic. 2025 [cited 2025 May 10]. Available from: https://simplyforensic.com/virtual-autopsy-the-hidden-science-behind-digital-post-mortem-analysis/
3. Brogdon’s Forensic Radiology. CRC Press; 2010. Pg 352.
4. Thali MJ, Jackowski C, Oesterhelweg L, Ross SG, Dirnhofer R. VIRTOPSY – The Swiss virtual autopsy approach. Legal Medicine. 2007 Mar;9(2):100–4.