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Objective:
Despite its importance to families, determination of imminent death in cancer patients is highly problematic. Laboratory values and clinical signs are consulted but tend to be unreliable. The goal of this study is to identify CT signs that might improve identification of impending demise.

Materials and Methods:
This HIPAA-compliant, single center retrospective study was performed under a waiver of informed consent from the institutional review board. The electronic hospital record was searched over a nine-year period for solid organ cancer patients who had an abdominal/pelvic CT within 24 hours of death. This scan and the one immediately prior were reviewed for changes, which included third-spacing of fluid, and body wall fat and muscle attenuation. Lab values collected at the time of the scan included white blood cell count, neutrophil count, hemoglobin, total bilirubin. albumin, creatinine, serum sodium and alkaline phosphatase. Third-spacing was scored using published scales. Statistical comparisons between the two scans were based on the Wilcoxon signed rank test for all variables.

Results:
Twenty-eight patients (16M/12F, mean age = 71.1+/-11.8) were identified. Median third-spacing score just prior to death was 7+/-5, compared to 3+/-6 on the most recent prior scan (p<0.0001). Right and left pleural fluid scores were found to increase significantly (p<0.003 and <0.002, respectively). Median anasarca score also increased to a median of 2+/-2 from 0+/-1 (p<0.001). Ascites score, body wall fat and muscle attenuation did not change significantly (p>0.05). The only lab value that changed significantly was neutrophil count (p=0.03).

Conclusion:
The most salient finding of imminent death on abdominal/pelvic CT of cancer patients is third-spacing of fluid, especially as pleural effusions and anasarca. Increase in neutrophil count also correlated with impending demise.