To image or to autopsy?

Burton and Mossa-Basha comment on a study by Wichmann and colleagues concluding that virtual autopsy may be useful in finding previously unknown diagnoses that are traditionally identified by conventional autopsy, but recognize that further studies are warranted before widespread use of virtual autopsy as an alternative to conventional autopsy. Unfortunately, they point out that many of the problems that afflict autopsy studies seem to have the same effect on postmortem imaging studies. Most studies have been observational in design, with marked variability in the methodology and the reporting quality, thus hindering assessment of the strengths and weaknesses of the studies and the generalizability of the results. Before recommendations can be made that essentially change practice, they stress that the quality of the existing evidence must be rated and the strength of the recommendation graded.