The study, conducted by Xiaofei Liu, Zhengqi Han, Yuling Duan, and corresponding author Tiantong Yang of the China University of Political Science and Law together with the Beijing Municipal Public Security Bureau, employed a suite of sophisticated bibliometric tools, including VOSviewer, CiteSpace, and Bibliometrix, to chart the field’s growth trajectory, intellectual structure, collaborative networks, and research fronts. Bibliometrics, at its core, applies quantitative methods to the corpus of published science: co-citation analysis reveals which papers anchor a discipline’s conceptual foundations, keyword co-occurrence mapping exposes its thematic anatomy, and citation burst detection identifies moments when particular lines of inquiry suddenly ignited collective interest. Applied to post-mortem imaging, these methods produce something that no traditional narrative review can: a data-driven reconstruction of how an entire scientific paradigm was born, consolidated, and redefined over twenty years.

The temporal picture that emerges is one of sustained and accelerating expansion. Annual scientific production climbed steadily across the study window, with the compound annual growth rate of 11.47 percent signaling a field that has more than kept pace with the broader explosion of medical imaging research. Two journals, Forensic Science International and the International Journal of Legal Medicine, were identified as the central publication hubs where the field’s most consequential findings are disseminated, while in terms of countries, Switzerland and Japan stood out as the leading contributors. This is perhaps unsurprising. Switzerland is home to the University of Zurich’s Institute of Forensic Medicine, where the Virtopsy project, the portmanteau of “virtual” and “autopsy” that gave the field its name, was conceived and refined. Japan, meanwhile, developed its own robust tradition of routine post-mortem computed tomography, driven by pioneering institutes that embedded PMCT scanning into standard medico-legal practice early on.

The most influential individual figure to emerge from the citation analysis is Michael J. Thali, the Swiss forensic pathologist whose foundational work with Richard Dirnhofer and colleagues established the paradigm. The bibliometric engine identified the field’s founding documents with striking clarity. Chief among them is the 2006 Radiographics paper by Dirnhofer, Jackowski, Vock, Potter, and Thali, “Virtopsy: Minimally invasive, imaging-guided virtual autopsy,” which codified the concept for a broad radiological audience. Alongside it stand the 2003 Journal of Forensic Sciences feasibility study that first demonstrated virtual autopsy using post-mortem multislice computed tomography and magnetic resonance imaging, and Levy and colleagues’ landmark 2006 Radiology paper on virtual autopsy in high-velocity gunshot wound victims, which showed that multidetector CT could outperform conventional autopsy in visualizing bullet trajectories and retained fragments. Citation burst analysis further highlighted the explosive impact of validation studies published in The Lancet, including the 2012 post-mortem imaging validation study by Roberts and colleagues and the 2017 investigation by Rutty and colleagues of post-mortem CT with targeted coronary angiography, both of which addressed the field’s central clinical question: can imaging replace, or at least reliably complement, the traditional autopsy?

Technically, the story of virtopsy over these two decades is one of methodological refinement driven by the unique physics of the dead body. Clinical radiology assumes a beating heart, circulating blood, and living physiology; a corpse violates all of these assumptions. Post-mortem CT must contend with livor mortis, putrefactive gas, sedimentation of blood within vessels, and the absence of vascular contrast flow. The field’s response was inventive. Ross and colleagues in 2008 evaluated whole-body post-mortem CT angiography with different contrast media solutions, and Jackowski’s group tackled a vexing problem: post-mortem angiography-induced tissue edema, mitigating it by using polyethylene glycol as a contrast agent dissolver. The culmination of these efforts was the development of multi-phase post-mortem CT angiography, standardized by Grabherr and colleagues in a widely cited 2011 paper in the International Journal of Legal Medicine, which introduced a systematic, multiphase arterial and venous perfusion protocol that dramatically improved visualization of the vascular system in the deceased. Christe and colleagues added an equally important conceptual contribution in 2010, systematically cataloging the specific and unspecific post-mortem signs on imaging and demonstrating that clinical radiology and post-mortem imaging “are not the same,” a distinction that remains foundational to competent virtopsy interpretation today.

The thematic evolution mapping in the new analysis reveals a discipline that has progressed through identifiable phases. The earliest work focused on foundational comparisons: imaging findings versus autopsy findings, one modality versus another, PMCT versus conventional dissection in specific causes of death such as drowning, hemorrhage, and gunshot injury. A second phase saw the specialization of applications, with virtopsy techniques extending into forensic anthropology, where CT and MRI measurements of the scapula, atlas, calcaneus, and pelvis were used for stature estimation, sex estimation, and forensic age estimation; into mass disaster management, exemplified by the deployment of post-mortem multidetector CT in victim identification after the 2009 Victorian bushfires in Australia; and into pediatric and fetal imaging, where post-mortem MRI emerged as a less invasive alternative to conventional autopsy in fetuses and children, a question rigorously tested in Thayyil and colleagues’ 2013 Lancet validation study. More recently, the thematic center of gravity has shifted toward what the authors describe as mechanistic synthesis focused on the process of death itself, with imaging increasingly deployed not merely to document injuries but to understand the biological changes that unfold after circulatory arrest.

The current thematic landscape, as characterized by the study’s strategic diagram analysis, places “death” at the heart of the field as its central motor theme, the driving conceptual engine around which the most developed and most consequential research revolves. Around this core, the authors identified basic themes such as “autopsy” and “age,” well-established areas that support the field’s infrastructure, while niche themes including “fractures” represent specialized territories that are developed but still peripheral to the mainstream. This structure is telling. It suggests a discipline whose core preoccupation is no longer simply the technology itself, but the fundamental forensic question of how, when, and why death occurred, with imaging serving as the window onto the post-mortem process. It also points to areas, such as skeletal trauma interpretation, where established techniques persist but quantitative and mechanistic approaches are still maturing.

Perhaps the most vivid illustration of the field’s current technical frontier is its engagement with sudden cardiac death, one of the most common and diagnostically challenging categories encountered by forensic pathologists. Post-mortem coronary angiography has evolved from experimental contrast injections to refined protocols, including dedicated coronary techniques using pigtail catheters and high-pressure injectors, calcification subtraction methods that strip away confounding calcium signal, and phantom-based image quality evaluation. Studies correlating post-mortem CT angiographic features of high-risk coronary plaque with histopathology, published by Michaud and colleagues in 2024, exemplify the new integrative mode of virtopsy research, in which imaging, histology, and clinical data are woven together to reconstruct the mechanism of arrhythmic death or myocardial infarction. Similar integrative logic now animates work on post-mortem MRI signal characteristics of intracranial hemorrhage at different aging stages, on distinguishing true from pseudo-hematoma in the cervical spinal canal, and on quantifying intravascular and intraorgan gas volumes as a function of putrefaction.

The bibliometric analysis also identifies where the field is headed, and the trajectory is unmistakably computational and quantitative. The authors forecast three principal directions. The first is the integration of quantitative biomarkers, most prominently through radiomics, the high-throughput extraction of large numbers of quantitative imaging features from radiological images, which is already being applied to estimate the post-mortem interval from PMCT-derived lung changes. Standardization of such biomarkers, the authors argue, will be essential for their admissibility in court. The second is advanced vascular imaging, building on the multi-phase angiography protocols to push deeper into cardiac and cerebrovascular death investigation. The third is the development of specialized imaging protocols for sensitive cases, including fetal and infant post-mortem examinations, where emerging technologies such as 0.31 Tesla low-field MRI are being tested to make minimally invasive examination more accessible, and where 7 Tesla ultra-high-field imaging has been trialed in fetal virtopsy against classical autopsy. Running through all three directions is the thread of artificial intelligence, whose applications in post-mortem imaging are proliferating even as the community grapples with validation challenges and, more broadly, with the risk of deskilling in medicine as algorithmic interpretation spreads.

For a field that has always depended on interdisciplinary trust, between radiologists who read the images and pathologists who understand the corpse, the study offers something valuable beyond its technical findings: an evidence-based roadmap. By delineating the field’s past achievements, its current thematic dynamics, and its most promising future directions, the analysis gives researchers and practitioners a shared cartography of where forensic post-mortem imaging has been and where it must go next. From a Swiss feasibility study in 2003 to 1,635 publications spanning every continent, virtopsy has grown from a radical proposition, that images could speak for the dead, into a quantitative, mechanistic, and increasingly intelligent science of the dying process. The dead, it turns out, have a great deal left to say, and the tools for listening have never been more precise.