Postmortem CT angiography of fetuses, infants and children up to 12 years old a systematic review and conceptual decision tree.

backgroundPostmortem CT angiography (PMCTA) enhances traditional autopsy by enabling detailed visualization of vascular structures and sources of hemorrhage. However, its application in fetuses and children remains limited due to small vessel size and the lack of standardized techniques. This systematic review critically evaluates existing literature on PMCTA in decedents under 12 years old, with the aim of identifying current practices and methodological variations to assist practitioners in selecting appropriate protocols based on age and anatomical characteristics. MATERIALS AND

methodsA systematic literature research was conducted following PRISMA guidelines using PubMed, Scopus, Embase and Google Scholar from 2004 to 2024. Eligible articles investigated PMCTA in fetuses and children up to 12 year old. Extracted data covered technical protocols, vascular access, contrast preparation, perfusion parameters and imaging outcomes. A decision tree was constructed to illustrate potential approaches by age group and anatomical features.

resultsTen studies met inclusion criteria: five focused on fetal PMCTA, four on children, and one on both populations. Considerable heterogeneity was found across protocols, especially regarding contrast media preparation and injection techniques. A conceptual decision tree was developed based on reported practices. This framework is not a validated algorithm and should be applied cautiously, with attention to individual anatomical and contextual factors.

conclusionThis review underscores the lack of standardized fetal and pediatric PMCTA protocols. It offers structured guidance while highlighting the need for further research to develop and validate consistent approaches in this vulnerable population.