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Coraline E, Kim W, Paul V, Laurent S, Francesco D, Pierre B, Silke G. Post-mortem changes of the vascular system-a thanatological study using multidetector computed tomography. Int J Legal Med 2023:10.1007/s00414-023-02999-y. [PMID: 37099083 PMCID: PMC10247833 DOI: 10.1007/s00414-023-02999-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 04/06/2023] [Indexed: 04/27/2023]
Abstract
Forensic pathologists have to deal with post-mortem changes of the human body. Those post-mortem phenomena are familiar and largely described in thanatology. However, knowledge about the influence of post-mortem phenomena on the vascular system is more limited, except for the apparition and development of cadaveric lividity. The introduction of multidetector computed tomography (MDCT) and magnetic resonance imaging (MRI) in the forensic field and the expansion of their usage in medico-legal routine, allow for exploring the inside of corpses differently and may play a part in the understanding of thanatological processes. This study aimed to describe post-mortem changes in the vascular system by investigating the presence of gas and collapsed vessels.We investigated post-mortem MDCT data of 118 human bodies. Cases with internal/external bleeding or corporal lesion allowing contamination with external air were excluded. Major vessels and heart cavities were systematically explored and a trained radiologist semi-quantitatively assessed the presence of gas.Collapsed veins were observed in 61.9% of cases (CI95% 52.5 to 70.6) and arteries in 33.1% (CI95% 24.7 to 42.3). Vessels most often affected were for arteries: common iliac (16.1%), abdominal aorta (15.3%), external iliac (13.6%), and for veins: infra-renal vena cava (45.8%), common iliac (22.0%), renal (16.9%), external iliac (16.1%), and supra-renal vena cava (13.6%). Cerebral arteries and veins, coronary arteries, and subclavian vein were unaffected. The presence of collapsed vessels was associated with a minor degree of cadaveric alteration. We observed that arteries and veins follow the same pattern of gas apparition for both the quantity and the location.In post-mortem radiology, collapsed vessels and intravascular gas are frequently visualized and as a result of all post-mortem changes, the assessment of the distribution of blood can be confusing. Therefore, knowledge of thanatological phenomena is crucial to prevent post-mortem radiological misapprehensions and possible false diagnoses.
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Affiliation(s)
- Egger Coraline
- University Center of Legal Medicine Lausanne-Geneva, Rue Michel-Servet 1, 1211, Geneva, Switzerland.
- Geneva University Hospital and University of Geneva, Geneva, Switzerland.
| | - Wiskott Kim
- University Center of Legal Medicine Lausanne-Geneva, Rue Michel-Servet 1, 1211, Geneva, Switzerland
- Geneva University Hospital and University of Geneva, Geneva, Switzerland
| | - Vaucher Paul
- University Center of Legal Medicine Lausanne-Geneva, Chemin de la Vulliette 4, 1000, Lausanne, Switzerland
- University of Applied Sciences and Arts Western Switzerland (HES-SO), School of Health Sciences, Boulevard de Pérolles 80, 1700, Fribourg, Switzerland
| | - Suppan Laurent
- Geneva University Hospital and University of Geneva, Geneva, Switzerland
- Division of Emergency Medicine, Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205, Genève, Switzerland
| | - Doenz Francesco
- Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Department of Radiology and Interventional Radiology, Centre Hospitalier Universitaire Vaudois (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Bize Pierre
- Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Department of Radiology and Interventional Radiology, Centre Hospitalier Universitaire Vaudois (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Grabherr Silke
- University Center of Legal Medicine Lausanne-Geneva, Rue Michel-Servet 1, 1211, Geneva, Switzerland
- Geneva University Hospital and University of Geneva, Geneva, Switzerland
- University Center of Legal Medicine Lausanne-Geneva, Chemin de la Vulliette 4, 1000, Lausanne, Switzerland
- Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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2
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Bryce AJ, Dandrieux JR, Lenard Z, Chen Y, Milne ME. Veterinary forensic radiology–Development of a cost-effective and easily performed post mortem computed tomographic angiography protocol. FORENSIC IMAGING 2022. [DOI: 10.1016/j.fri.2022.200528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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3
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Robinson L, Smit C, Bernitz H. Dental radiographic superimposition: An exciting addition to the forensic odontology armamentarium. FORENSIC IMAGING 2022. [DOI: 10.1016/j.fri.2022.200513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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4
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The application of CT for 3D visualization of concealed bodies. Sci Justice 2022; 62:424-432. [DOI: 10.1016/j.scijus.2022.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/11/2022] [Accepted: 05/02/2022] [Indexed: 11/20/2022]
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5
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Okumura S, Usui A, Kawasumi Y, Odagiri H, Funayama M, Kaneta T. Diagnostic Accuracy of Liver Damage Based on Postmortem Computed Tomography Findings in High-Energy Trauma. TOHOKU J EXP MED 2022; 257:327-332. [PMID: 35691914 DOI: 10.1620/tjem.2022.j046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Satsuki Okumura
- Department of Diagnostic Image Analysis, Tohoku University Graduate School of Medicine
| | - Akihito Usui
- Department of Diagnostic Image Analysis, Tohoku University Graduate School of Medicine
| | - Yusuke Kawasumi
- Department of Clinical Imaging, Tohoku University Graduate School of Medicine
| | - Hayato Odagiri
- Department of Diagnostic Image Analysis, Tohoku University Graduate School of Medicine
| | - Masato Funayama
- Department of Forensic Medicine, Tohoku University Graduate School of Medicine
| | - Tomohiro Kaneta
- Department of Diagnostic Image Analysis, Tohoku University Graduate School of Medicine
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Braun S, Indra L, Lösch S, Milella M. Perimortem Skeletal Sharp Force Trauma: Detection Reliability on CT Data, Demographics and Anatomical Patterns from a Forensic Dataset. BIOLOGY 2022; 11:biology11050666. [PMID: 35625394 PMCID: PMC9138488 DOI: 10.3390/biology11050666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/19/2022] [Accepted: 04/25/2022] [Indexed: 11/30/2022]
Abstract
Simple Summary The increased use of computed tomography images in forensic anthropology is easily explained with a variety of benefits: among other reasons they are digitally stored, they can easily be shared and they are non-invasive. However, it is not clear how suitable these images are for forensic anthropologists to detect sharp force trauma. Therefore, we analyzed computed tomography images, by observing digital images of 41 forensic cases in different viewing modalities. In addition, we looked for anatomical injury patterns in the soft- and hard-tissues and any significant correlations between the manner of death (suicide or homicide) with different parameters. Our findings indicated a superiority of viewing the images in 2D, but not all bone lesions were detected. The manner of death was significantly correlated to some of the parameters, which could be extrapolated to future forensic anthropological cases. We promote the inclusion of imaging training into the anthropological curricula. Abstract The increasing importance of trauma analysis by means of postmortem computed tomography (PMCT) is insufficiently reflected in forensic curricula, nor are best practice manuals available. We attempt to detect sharp force bone lesions on PMCT of closed forensic cases with the aims of assessing errors and pointing out patterns in anatomical location and manner of death (MOD). We investigated 41 closed sharp force fatality cases, with available PMCT and forensic reports. Two observers with different radiological training assessed the lesions on PMCT scans (2D and 3D) for comparison with the reports. Between 3% (suicides) and 15.3% (homicides) of sharp force injuries caused visible bone lesions. While our observations were repeatable, each forensic investigation left a similar number of bone lesions undetected. Injury patterns differed between MOD, with thoracic bone lesions being most frequent overall. Soft tissue injury location varied between the MOD. Associations between MOD and age as well as number of injuries were significant. The detection of bone lesions on PMCT for untrained forensic specialists is challenging, curricula and pertinent manuals are desirable. With the low frequency of bone lesions compared to soft tissue injuries, we should be aware when analyzing decomposed bodies.
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Le AB, Brown CK, Gibbs SG, Uhrig A, Green AD, Broch Brantsæter A, Herstein JJ, Vasa A, Shugart J, Wilson Egbe W, Lowe JJ. Best practices of highly infectious decedent management: Consensus recommendations from an international expert workshop. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2022; 19:129-138. [PMID: 35025726 DOI: 10.1080/15459624.2022.2027427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
With the increasing number of highly infectious disease incidents, outbreaks, and pandemics in our society (e.g., Ebola virus disease, Lassa fever, coronavirus diseases), the need for consensus and best practices on highly infectious decedent management is critical. In January 2020, a workshop of subject matter experts from across the world convened to discuss highly infectious live patient transport and highly infectious decedent management best practices. This commentary focuses on the highly infectious decedent management component of the workshop. The absence of guidance or disparate guidance on highly infectious decedent management can increase occupational safety and health risks for death care sector workers. To address this issue, the authorship presents these consensus recommendations on best practices in highly infectious decedent management, including discussion of what is considered a highly infectious decedent; scalability and storage for casualty events; integration of key stakeholders; infection control and facility considerations; transport; care and autopsy; psychological, ethical, and cultural considerations as well as multi-national care perspectives. These consensus recommendations are not intended to be exhaustive but rather to underscore this overlooked area and serve as a starting point for much-needed conversations.
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Affiliation(s)
- Aurora B Le
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Christopher K Brown
- Division of Emergency Operations, Center for Preparedness and Response, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Shawn G Gibbs
- Department of Environmental and Occupational Health, Texas A&M University School of Public Health, College Station, Texas
| | - Alexander Uhrig
- Department of Infectious Diseases, Pulmonary and Critical Care Medicine, Charité University Medical Center, Berlin, Germany
| | | | - Arne Broch Brantsæter
- Department of Infectious Diseases and Department of Acute Medicine, Oslo University Hospital, Oslo, Norway
| | - Jocelyn J Herstein
- Department of Environmental, Agricultural and Occupational Health, University of Nebraska Medical Center College of Public Health, Omaha, Nebraska
| | | | - Jill Shugart
- Center for State, Tribal, Local and Territorial Support, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Wanda Wilson Egbe
- Department of Health and Human Services, Assistant Secretary for Preparedness and Response, Washington, DC
| | - John J Lowe
- Department of Environmental, Agricultural and Occupational Health, University of Nebraska Medical Center College of Public Health, Omaha, Nebraska
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Balzli D, Rehberg D, Ebert LC, Enders M, Sieberth T. 3D multimodal teaching of human anatomy and autopsy with real human data. FORENSIC IMAGING 2022. [DOI: 10.1016/j.fri.2022.200491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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9
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Fukumoto W, Kitera N, Mitani H, Sueoka T, Kondo S, Kawashita I, Nakamura Y, Nagao M, Awai K. Global illumination rendering versus volume rendering for the forensic evaluation of stab wounds using computed tomography. Sci Rep 2022; 12:2452. [PMID: 35165357 PMCID: PMC8844357 DOI: 10.1038/s41598-022-06541-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 02/01/2022] [Indexed: 11/15/2022] Open
Abstract
We compared three-dimensional (3D) CT images of stabbing victims subjected to volume-rendering (VR) or global illumination-rendering (GIR), a new technique now available for the reconstruction of 3D CT images. It simulates the complete interactions of photons with the scanned object, thereby providing photorealistic images. The diagnostic value of the images was also compared with that of macroscopic photographs. We used postmortem 3D CT images of 14 stabbing victims who had undergone autopsy and CT studies. The 3D CT images were subjected to GIR or VR and the 3D effect and the smoothness of the skin surface were graded on a 5-point scale. We also compared the 3D CT images of 37 stab wounds with macroscopic photographs. The maximum diameter of the wounds was measured on VR and GIR images and compared with the diameter recorded at autopsy. The overall image-quality scores and the ability to assess the stab wounds were significantly better on GIR than VR images (median scores: VR = 3 vs GIR = 4, p < 0.01). The mean difference between the wound diameter measured on VR and GIR images and at autopsy were both 0.2 cm, respectively. For the assessment of stab wounds, 3D CT images subjected to GIR were superior to VR images. The diagnostic value of 3D CT GIR image was comparable to that of macroscopic photographs.
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10
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Khalikov AA, Kildyushov EM, Kuznetsov KO, Komlev DS, Khalikova LV. [Diagnostics of the presence of once of death and peculiarities of performance of the forensic medical examination in post-mortal facial condition]. Sud Med Ekspert 2022; 65:16-19. [PMID: 35416010 DOI: 10.17116/sudmed20226502116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The purpose of the research is to summarize the current information about post-mortem interval (PMI) estimating and the peculiarities of the forensic medical examination in postmortem glaciation of the corpse. On the territory of most regions of the Russian Federation, the autumn-winter period passes with a significant decrease in ambient temperature, which makes this topic relevant. The article describes in detail the mechanisms of freezing of human cells and tissues, methods for diagnosing PMI, the peculiarities of the examination in postmortem glaciation, and also put forward directions for further research.
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Affiliation(s)
| | - E M Kildyushov
- Pirogov Russian National Research Medical University, Moscow, Russia
| | | | - D S Komlev
- Bashkir State Medical University, Ufa, Russia
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11
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Kudo S, Kawasumi Y, Usui A, Igari Y, Funayama M, Ueda T, Ishibashi T, Saito H. Cervical intervertebral separation caused by trauma on post-mortem computed tomography: Possibility of a diagnosis based on intervertebral gas. Forensic Sci Int 2021; 330:111049. [PMID: 34844118 DOI: 10.1016/j.forsciint.2021.111049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 09/28/2021] [Accepted: 10/05/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Gas is a common finding in cervical intervertebral separation. However, intervertebral gas is also found in many decedents without intervertebral separation. Here, we quantified intervertebral gas and examined its value in the diagnosis of cervical intervertebral separation. METHODS We retrospectively reviewed data from 1118 decedents who underwent post-mortem computed tomography (CT) and autopsy from May 2011 to July 2016 and selected those with cervical intervertebral gas with or without intervertebral separation. These data comprised 56 cervical intervertebral spaces with gas [intervertebral separation in 19 (33.9%)] in 43 subjects [intervertebral separation in 17 (39.5%)]. We categorised the decedents according to gas volume, position, and shape and determined the significance of the differences between the decedents with and without separation. RESULTS The gas volume did not differ significantly between decedents with and without separation (p = 0.063). However, there were significant differences in the gas position between decedents with and without separation. In the sagittal plane: gas was seen in the "centred" position in the ventral-to-dorsal direction in more decedents without separation than in those with separation (p = 0.018). Gas was seen in the ventral-to-dorsal positions in more decedents with separation than in those without separation (p = 0.049). In the cranio-caudal direction, gas in the upper position was more common in decedents with separation than in those without separation in the sagittal plane (p = 0.03). In the coronal plane: gas was seen in the upper position more frequently in decedents with separation in the cranio-caudal direction than in those without separation (p = 0.001). A significant difference in gas shape was observed only in the coronal plane (p = 0.024); irregular gas was associated with decedents without separation. CONCLUSION Gas in the ventral-to-dorsal and upper positions in the sagittal plane and in the upper position in the coronal plane was rather indicative of cervical intervertebral separation. An irregular gas shape in the coronal plane was indicative of degenerative changes.
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Affiliation(s)
- Seina Kudo
- Tohoku University Graduate School of Medicine, Department of Clinical Imaging, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575, Japan.
| | - Yusuke Kawasumi
- Tohoku University Graduate School of Medicine, Department of Clinical Imaging, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575, Japan
| | - Akihito Usui
- Tohoku University Graduate School of Medicine, Department of Diagnostic Image Analysis, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575, Japan
| | - Yui Igari
- Tohoku University Graduate School of Medicine, Department of Forensic Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575, Japan
| | - Masato Funayama
- Tohoku University Graduate School of Medicine, Department of Forensic Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575, Japan
| | - Takuya Ueda
- Tohoku University Graduate School of Medicine, Department of Clinical Imaging, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575, Japan
| | - Tadashi Ishibashi
- Tohoku University Graduate School of Medicine, Department of Clinical Imaging, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575, Japan
| | - Haruo Saito
- Tohoku University Graduate School of Medicine, Department of Diagnostic Image Analysis, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575, Japan
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Sieberth T, Seckiner D, Dobay A, Dobler E, Golomingi R, Ebert L. The forensic holodeck - Recommendations after 8 years of experience for additional equipment to document VR applications. Forensic Sci Int 2021; 329:111092. [PMID: 34773822 DOI: 10.1016/j.forsciint.2021.111092] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 10/25/2021] [Accepted: 10/27/2021] [Indexed: 11/28/2022]
Abstract
The forensic holodeck was first introduced in 2013, using the first upcoming commercially available virtual reality gaming headsets to visualize forensic 3D reconstructions. Following the publication of this development virtual reality was introduced in case work in a variety of different ways. After 8 years of using virtual reality in a professional forensic capacity this professional practice report will show, which equipment is necessary in addition to a virtual reality setup. This mostly includes audio-visual and broadcasting technology for complete documentation of the application of virtual reality, but also some other IT equipment, which should be available for as low as 20'000 US$. Guidelines, hints and tips regarding equipment acquisition, setup and use will be provided and discussed.
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Affiliation(s)
- Till Sieberth
- 3D Zentrum Zürich, Institute of Forensic Medicine, University of Zurich, Winterthurerstr. 190/52, CH-8057 Zürich, Switzerland.
| | - Dilan Seckiner
- 3D Zentrum Zürich, Institute of Forensic Medicine, University of Zurich, Winterthurerstr. 190/52, CH-8057 Zürich, Switzerland.
| | - Akos Dobay
- 3D Zentrum Zürich, Institute of Forensic Medicine, University of Zurich, Winterthurerstr. 190/52, CH-8057 Zürich, Switzerland.
| | - Erika Dobler
- 3D Zentrum Zürich, Zurich Forensic Science Institute, Zeughausstrasse 11, CH-8004 Zürich, Switzerland.
| | - Raffael Golomingi
- 3D Zentrum Zürich, Institute of Forensic Medicine, University of Zurich, Winterthurerstr. 190/52, CH-8057 Zürich, Switzerland.
| | - Lars Ebert
- 3D Zentrum Zürich, Institute of Forensic Medicine, University of Zurich, Winterthurerstr. 190/52, CH-8057 Zürich, Switzerland.
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Hussein MN, Heinemann A, Shokry DA, Elgebely M, Pueschel K, Hassan FM. Postmortem computed tomography differentiation between intraperitoneal decomposition gas and pneumoperitoneum. Int J Legal Med 2021; 136:229-235. [PMID: 34708283 DOI: 10.1007/s00414-021-02732-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 10/18/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE The aim of this study is to investigate the ability of postmortem computed tomography (PMCT) to distinguish intraperitoneal decomposition gas from pneumoperitoneum due to intestinal perforation. METHODS This retrospective study investigated the factors affecting intraperitoneal gas in two groups of 14 decedents as detected by postmortem CT performed in the Department of Legal Medicine of Hamburg University. The first group died with a cause of death associated with intestinal perforation, and the second group with other different natural causes of death. These factors include postmortem interval, gas volume, gas distribution, radiology alteration index (RAI), and pneumoperitoneum-associated pathology. RESULTS The findings of this study showed the appearance of specific gas distribution patterns and a significant increase in gas volumes in the cases of intestinal perforation. Moreover, postmortem interval and the pneumoperitoneum-associated pathology could help distinguish postmortem-generated gas from pneumoperitoneum. CONCLUSION Based on the findings of this study, we propose that these findings can improve the proper detection of intestinal perforation cases in the future.
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Affiliation(s)
- Maged Nabil Hussein
- Forensic Medicine Authority, Ministry of Justice, 14 Berium Eltonsy Street, Elsayda Zainb, Cairo, Egypt.
| | - Axel Heinemann
- Department of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg University, Butenfeld 34, 22529, Hamburg, Germany
| | - Dina Ali Shokry
- Forensic Medicine & Clinical Toxicology Department, Faculty of Medicine, Cairo University, kasr Alainy Street, Cairo, 11562, Egypt
| | - Mohamed Elgebely
- Lecturer of Forensic Medicine & Clinical Toxicology Department, Faculty of Medicine, Suez University, Cairo-suez road, 41522, Al-salam city, Egypt
| | - Klaus Pueschel
- Department of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg University, Butenfeld 34, 22529, Hamburg, Germany
| | - Fatma Mohamed Hassan
- Forensic Medicine & Clinical Toxicology Department, Faculty of Medicine, Cairo University, kasr Alainy Street, Cairo, 11562, Egypt
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Zwirner J, Bohnert S, Franke H, Garland J, Hammer N, Möbius D, Tse R, Ondruschka B. Assessing Protein Biomarkers to Detect Lethal Acute Traumatic Brain Injuries in Cerebrospinal Fluid. Biomolecules 2021; 11:biom11111577. [PMID: 34827575 PMCID: PMC8615532 DOI: 10.3390/biom11111577] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/30/2021] [Accepted: 10/22/2021] [Indexed: 11/16/2022] Open
Abstract
Diagnosing traumatic brain injury (TBI) from body fluids in cases where there are no obvious external signs of impact would be useful for emergency physicians and forensic pathologists alike. None of the previous attempts has so far succeeded in establishing a single biomarker to reliably detect TBI with regards to the sensitivity: specificity ratio in a post mortem setting. This study investigated a combination of body fluid biomarkers (obtained post mortem), which may be a step towards increasing the accuracy of biochemical TBI detection. In this study, serum and cerebrospinal fluid (CSF) samples from 30 acute lethal TBI cases and 70 controls without a TBI-related cause of death were evaluated for the following eight TBI-related biomarkers: brain-derived neurotrophic factor (BDNF), ferritin, glial fibrillary acidic protein (GFAP), interleukin 6 (IL-6), lactate dehydrogenase, neutrophil gelatinase-associated lipocalin (NGAL), neuron-specific enolase and S100 calcium-binding protein B. Correlations among the individual TBI biomarkers were assessed, and a specificity-accentuated threshold value analysis was conducted for all biomarkers. Based on these values, a decision tree modelling approach was performed to assess the most accurate biomarker combination to detect acute lethal TBIs. The results showed that 92.45% of acute lethal TBIs were able to be diagnosed using a combination of IL-6 and GFAP in CSF. The probability of detecting an acute lethal TBI was moderately increased by GFAP alone and considerably increased by the remaining biomarkers. BDNF and NGAL were almost perfectly correlated (p = 0.002; R2 = 0.944). This study provides evidence that acute lethal TBIs can be detected to a high degree of statistical accuracy using forensic biochemistry. The high inter-individual correlations of biomarkers may help to estimate the CSF concentration of an unknown biomarker, using extrapolation techniques.
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Affiliation(s)
- Johann Zwirner
- Department of Anatomy, University of Otago, Dunedin 9016, New Zealand
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, 22529 Hamburg, Germany;
- Institute of Legal Medicine, University of Leipzig, 04103 Leipzig, Germany
- Correspondence: (J.Z.); (B.O.); Tel.: +49-178-3551783 (J.Z.)
| | - Simone Bohnert
- Institute of Forensic Medicine, University of Wuerzburg, 97078 Wuerzburg, Germany;
| | - Heike Franke
- Rudolf Boehm Institute of Pharmacology and Toxicology, University of Leipzig, 04107 Leipzig, Germany;
| | - Jack Garland
- Forensic and Analytical Science Service, NSW Health Pathology, Lidcombe 2141, Australia;
| | - Niels Hammer
- Institute of Macroscopic and Clinical Anatomy, University of Graz, 8010 Graz, Austria;
- Department of Orthopedic and Trauma Surgery, University of Leipzig, 04103 Leipzig, Germany
- Fraunhofer IWU, 47720 Dresden, Germany
| | - Dustin Möbius
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, 22529 Hamburg, Germany;
| | - Rexson Tse
- Department of Forensic Pathology, LabPLUS, Auckland City Hospital, Auckland 1148, New Zealand;
| | - Benjamin Ondruschka
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, 22529 Hamburg, Germany;
- Correspondence: (J.Z.); (B.O.); Tel.: +49-178-3551783 (J.Z.)
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Bryce AJ, Dandrieux JR, Tyrrell D, Milne ME. The evolving use of post-mortem veterinary imaging in a university specialist hospital. FORENSIC IMAGING 2021. [DOI: 10.1016/j.fri.2021.200475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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16
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Roy J, Shahu U, Shirpure P, Soni S, Parekh U, Johnson A. A literature review on dental autopsy - an invaluable investigative technique in forensics. Autops Case Rep 2021; 11:e2021295. [PMID: 34458165 PMCID: PMC8387071 DOI: 10.4322/acr.2021.295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 04/14/2021] [Indexed: 12/03/2022]
Abstract
Forensic odontology is a specialty of dental sciences that deals with dental evidence in the interest of the justice system. The science of autopsy has been developing from the ancient times even before the popularization of general medicine. The objective of a medico-legal autopsy is to identify significant clues for an ongoing forensic investigation. However, in certain circumstances, it is difficult to conduct an oral examination owing to the anatomic location of the oral cavity. The onset of rigor mortis after death poses further complications. Thus, skillful and sequential dissections of the oral and para-oral structures are required to expose the dentition. Dental autopsy includes incisions and resection of the jaw for the detailed examination of the oral cavity. The procedure involves various modes of examination, including visual and radiographic, which help in human identification in forensic investigation. The present paper provides an overview of the various methods of dental autopsy.
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Affiliation(s)
- Jyotirmoy Roy
- National Forensic Sciences University, School of Forensic Science, Laboratory of Forensic Odontology, Gandhinagar, Gujarat, India
| | - Ujwal Shahu
- National Forensic Sciences University, School of Forensic Science, Laboratory of Forensic Odontology, Gandhinagar, Gujarat, India
| | - Payal Shirpure
- National Forensic Sciences University, School of Forensic Science, Laboratory of Forensic Odontology, Gandhinagar, Gujarat, India
| | - Supriya Soni
- National Forensic Sciences University, School of Forensic Science, Laboratory of Forensic Odontology, Gandhinagar, Gujarat, India
| | - Utsav Parekh
- Pramukhswami Medical College, Department of Forensic Medicine and Toxicology, Gujarat, India
| | - Abraham Johnson
- National Forensic Sciences University, School of Forensic Science, Laboratory of Forensic Odontology, Gandhinagar, Gujarat, India
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17
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Yamaguchi R, Makino Y, Torimitsu S, Chiba F, Kihara Y, Iwase H. Fatal bilateral pneumothoraces after electroacupuncture treatment: A case report and literature review. J Forensic Sci 2021; 67:377-383. [PMID: 34435369 DOI: 10.1111/1556-4029.14874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 08/09/2021] [Accepted: 08/11/2021] [Indexed: 11/30/2022]
Abstract
Acupuncture is practiced as a complementary medicine worldwide. Although it is considered a safe practice, pneumothorax is one of its most common serious complications. However, there have been few reports of deaths due to pneumothorax after acupuncture treatment, especially focused on electroacupuncture. We report an autopsy case of a man in his 60s who went into cardiopulmonary arrest and died immediately after receiving electroacupuncture. Postmortem computed tomography (PMCT) showed bilateral pneumothoraces, as well as the presence of numerous gold threads embedded subcutaneously. An autopsy revealed two ecchymoses in the right thoracic cavity and a pinhole injury on the lower lobe of the right lung, suggesting that the needles had penetrated the lung. There were marked emphysematous changes in the lung, suggesting that rupture of bullae might also have contributed to bilateral pneumothoraces and fatal outcome. The acupuncture needles may have been drawn deeper into the body than at the time of insertion due to electrical pulses and muscle contraction, indicating the need for careful determination of treatment indications and technical safety measures, such as fail-safe mechanisms. This is the first case report of fatal bilateral pneumothoraces after electroacupuncture reported in the English literature. This case sheds light on the safety of electroacupuncture and the need for special care when administering it to patients with pulmonary disease who may be at a higher risk of pneumothorax. This is also the first report of three-dimensional reconstructed PMCT images showing the whole-body distribution of embedded gold acupuncture threads, which is unusual.
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Affiliation(s)
- Rutsuko Yamaguchi
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Department of Legal Medicine, Graduate School of Medicine, Chiba University, Chiba City, Japan
| | - Yohsuke Makino
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Department of Legal Medicine, Graduate School of Medicine, Chiba University, Chiba City, Japan
| | - Suguru Torimitsu
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Department of Legal Medicine, Graduate School of Medicine, Chiba University, Chiba City, Japan
| | - Fumiko Chiba
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Department of Legal Medicine, Graduate School of Medicine, Chiba University, Chiba City, Japan
| | - Yuko Kihara
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hirotaro Iwase
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Department of Legal Medicine, Graduate School of Medicine, Chiba University, Chiba City, Japan
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18
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Kasagawa A, Usui A, Kawasumi Y, Funayama M, Saito H. Block-like and cast-like hyperdense areas in the right heart cavities on post-mortem CT strongly suggest the presence of intracardiac blood clots at autopsy. Eur Radiol 2021; 31:8879-8886. [PMID: 34100997 DOI: 10.1007/s00330-021-08052-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 03/25/2021] [Accepted: 05/06/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To classify the types of hyperdense areas in the heart cavities on post-mortem CT (PMCT) and compare them according to the presence of blood clots in the heart cavities at forensic autopsy. METHODS One hundred and twelve cases with CT images taken before forensic autopsy were evaluated. The presence and shape of hyperdense areas in the right or left heart cavities were retrospectively evaluated on PMCT images and were classified into four types (block-like, cast-like, fluid level-like, and unclear). The presence of blood clots was confirmed when there were clots in the heart cavities at forensic autopsy. RESULTS Of the 112 cases, 57 exhibited blood clots in the heart cavities at forensic autopsy. The hyperdense areas in the right heart cavities on PMCT in 57 cases exhibiting blood clots at forensic autopsy were classified as follows: block-like, 32; fluid level-like, 4; cast-like, 17; and unclear, 4. The sensitivity of block-like and cast-like hyperdense areas in the right heart cavities on PMCT for the presence of clots in the heart cavities at forensic autopsy was 86% (95% confidence interval [CI]: 74-94%); the corresponding specificity, PPV, and NPV were 95% (95% CI: 85-99%), 94% (95% CI: 84-99%), and 87% (95% CI: 75-94%), respectively. CONCLUSION Block-like and cast-like hyperdense areas in the right heart cavities on PMCT predicted the presence of intracardiac blood clots at forensic autopsy. KEY POINTS • Clinical radiologists likely have no experience of interpreting findings of blood clots on post-mortem CT (PMCT). • The appearance of blood clots on PMCT provides important clues for diagnosing the cause and process of death. • The shapes of the hyperdense areas in the heart cavities were classified into four types, and two of these types could be used to predict the presence of blood clots in the heart cavities at forensic autopsy.
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Affiliation(s)
- Akito Kasagawa
- Department of Diagnostic Image Analysis, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Akihito Usui
- Department of Diagnostic Image Analysis, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan.
| | - Yusuke Kawasumi
- Department of Clinical Imaging, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Masato Funayama
- Department of Forensic Medicine, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Haruo Saito
- Department of Diagnostic Image Analysis, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
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19
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Macoin E, Kintz P, Gressel A, Leyendecker P, Raul JS, Walch A. The Importance of Autopsy in a Case of Digestive Perforation Undetected by Postmortem Computed Tomography. Am J Forensic Med Pathol 2021; 42:201-204. [PMID: 32956075 DOI: 10.1097/paf.0000000000000617] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Cases of foreign body ingestion in the forensic literature are mainly described in children or psychiatric patients. Postmortem imaging can detect most foreign bodies, but its sensitivity depends, among other things, on the type of item and its location. In some cases, the ingestion of foreign bodies can remain unnoticed and have serious consequences for the patient. We describe the case of a patient who died in a psychiatric seclusion room with no obvious cause and for whom a forensic autopsy was requested. Further investigations showed the existence of a subdural hematoma associated with a midline shift, secondary to a skull fracture that was considered to be the cause of death. Toxicological analyses identified in blood several drugs, including diazepam (24 ng/mL) and its major metabolite nordazepam (24 ng/mL), propranolol (57 ng/mL), paliperidone (9 ng/mL), and loxapine (620 ng/mL). The forensic autopsy revealed the existence of a gastrointestinal perforation after the ingestion of a plastic teaspoon, which the postmortem CT scan had failed to detect. Although technological advances continue to assist the forensic pathologist in his diagnosis, autopsy still has a leading role in forensic investigations and does not yet seem to be replaceable by imaging techniques alone.
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Affiliation(s)
| | - Pascal Kintz
- Toxicology Laboratory at the Institute of Legal Medicine
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20
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Ferrante B, Baroni C, Muramoto C, Ribas L, Torres L, Catão-Dias J, Pinto A. Histological effect caused by contrast solution injection for post mortem computed tomography angiography in dogs. FORENSIC IMAGING 2021. [DOI: 10.1016/j.fri.2021.200435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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21
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Correlation of age, sex and season with the state of human decomposition as quantified by postmortem computed tomography. Forensic Sci Med Pathol 2021; 17:185-191. [PMID: 33587253 PMCID: PMC8119255 DOI: 10.1007/s12024-021-00356-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2021] [Indexed: 11/29/2022]
Abstract
Dead bodies exhibit a variable range of changes with advancing decomposition. To quantify intracorporeal gas, the radiological alteration index (RAI) has been implemented in the assessment of postmortem whole-body computed tomography. We used this RAI as a proxy for the state of decomposition. This study aimed to (I) investigate the correlation between the state of decomposition and the season in which the body was discovered; and (II) evaluate the correlations between sociodemographic factors (age, sex) and the state of decomposition, by using the RAI as a proxy for the extent of decomposition. In a retrospective study, we analyzed demographic data from all autopsy reports from the Institute of Forensic Medicine of Zurich between January 2017 to July 2019 and evaluated the radiological alteration index from postmortem whole-body computed tomography for each case. The bodies of older males showed the highest RAI. Seasonal effects had no significant influence on the RAI in our urban study population with bodies mostly being discovered indoors. Autopsy reports contain valuable data that allow interpretation for reasons beyond forensic purposes, such as sociopolitical observations.
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22
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Tsuneya S, Makino Y, Chiba F, Kojima M, Yoshida M, Kishimoto T, Mukai H, Hattori S, Iwase H. Postmortem magnetic resonance imaging revealed bilateral globi pallidi lesions in a death associated with prolonged carbon monoxide poisoning: a case report. Int J Legal Med 2021; 135:921-928. [PMID: 33447889 DOI: 10.1007/s00414-021-02506-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 01/08/2021] [Indexed: 11/28/2022]
Abstract
A man and a woman were found dead in the same car with a burned coal briquette. The cause of death of the woman was assigned to acute carbon monoxide (CO) poisoning without difficulty based on typical findings associated with this condition, including elevation of carboxyhaemoglobin (COHb). However, the man had an unremarkable elevation of COHb and a higher rectal temperature compared to that of the woman. Postmortem computed tomography (PMCT) revealed ambiguous low-density areas in the bilateral globi pallidi. Further analysis by postmortem magnetic resonance (PMMR) imaging showed these lesions more clearly; the lesions appeared as marked high signal intensity areas on both the T2-weighted images and the fluid-attenuated inversion recovery sequences. A subsequent autopsy revealed signs of pneumonia, dehydration, starvation, and hypothermia, suggesting that the man died from prolonged CO poisoning. Both globi pallidi contained grossly ambiguous lesions, and a detailed neuropathologic investigation revealed these lesions to be coagulative necrotic areas; this finding was compatible with a diagnosis of prolonged CO poisoning. This case report shows that postmortem imaging, especially PMMR, is useful for detecting necrotic lesions associated with prolonged CO poisoning. This report further exemplifies the utility of PMMR for detecting brain lesions, which may be difficult to detect by macroscopic analysis.
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Affiliation(s)
- Shigeki Tsuneya
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.,Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Yohsuke Makino
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan. .,Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan.
| | - Fumiko Chiba
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.,Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Masatoshi Kojima
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Maiko Yoshida
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Takashi Kishimoto
- Department of Molecular Pathology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8677, Japan
| | - Hiroki Mukai
- Department of Radiology, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8677, Japan
| | - Shinya Hattori
- Department of Radiology, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8677, Japan
| | - Hirotaro Iwase
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.,Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
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23
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Kreul D, Gascho D, Franckenberg S, Eggert S, Fliss B, Kubik-Huch R, Thali M, Niemann T. Postmortem determination of hepatic steatosis. Comparing Rho/Z and fat fraction measurements on dual-energy CT for histological grading: A retrospective analysis. FORENSIC IMAGING 2020. [DOI: 10.1016/j.fri.2020.200422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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24
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Nasir MU, Chandy PE, Roberts J, O'Neill SB. A Guide to Mass Casualty Incidents for Radiology Residents: Strategies, Ethics, Directions. Curr Probl Diagn Radiol 2020; 50:555-559. [PMID: 32951950 PMCID: PMC7448733 DOI: 10.1067/j.cpradiol.2020.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 08/11/2020] [Accepted: 08/21/2020] [Indexed: 11/25/2022]
Abstract
Mass casualty incidents, by nature of their scale and unpredictability, can rapidly overwhelm health infrastructure. Preparation is the key to managing these crises with the lowest risk to emergency and health personnel, while providing maximal life saving measures. We present an overview of the multitiered planning that should go into forming a well set out emergency response plan and one that is capable of being adapted to a wide range of mass casualty scenarios. We highlight the ethical implications that a healthcare team faces while making challenging decisions rapidly in a high-pressure environment. Radiology trainees should be aware of the response systems in place at their institutions and the role that is expected of them in mass casualty incidents.
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Affiliation(s)
- Muhammad Umer Nasir
- Department of Emergency and Trauma Radiology, Vancouver General Hospital, Vancouver, British Columbia, Canada; Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Poornima Elizabeth Chandy
- Department of Emergency and Trauma Radiology, Vancouver General Hospital, Vancouver, British Columbia, Canada; Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - James Roberts
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Siobhán B O'Neill
- Department of Emergency and Trauma Radiology, Vancouver General Hospital, Vancouver, British Columbia, Canada; Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
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25
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Qamar SR, Evans D, Gibney B, Redmond CE, Nasir MU, Wong K, Nicolaou S. Emergent Comprehensive Imaging of the Major Trauma Patient: A New Paradigm for Improved Clinical Decision-Making. Can Assoc Radiol J 2020; 72:293-310. [PMID: 32268772 DOI: 10.1177/0846537120914247] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Modern advances in the medical imaging layered onto sophisticated trauma resuscitation strategies in highly organized regionalized trauma systems have created a paradigm shift in the management of severely injured patients. Although immediate exploratory surgery to identify and control life-threatening injuries still has its place, accelerated image acquisition and interpretation procedures now make it rare for trauma surgeons in major centers to venture into damage control surgery unaided by computed tomography (CT) or other imaging, particularly in cases of blunt trauma. Indeed, because of the high incidence of clinically occult injuries associated with major mechanism trauma, and even lower energy trauma in frail or elderly patients, CT imaging has become as invaluable as physical examination, if not more so, in critical decision-making in support of optimal outcomes. In particular, whole-body computed tomography (WBCT) completed promptly after initial assessment of a major trauma provides a quick, comprehensive survey of injuries that enables better surgical planning, obviates the need for multiple subsequent studies, and permits specialized reconstructions when needed. For those at risk for problematic occult injury after modest trauma, WBCT facilitates safer discharge planning and simplified follow-up. Through standardized guidelines, streamlined protocols, synoptic reporting, accessible web-based platforms, and active collaboration with clinicians, radiologists dedicated to trauma and emergency imaging enable clearer understanding of complex injuries in high-risk patients which leads to superior clinical decision-making. Whereas dated dogma has long warned that the CT scanner is the last place to take a challenging trauma patient, modern practice suggests that, more often than not, early comprehensive imaging can be done safely and efficiently and is in the patient's best interest. This article outlines how the role of diagnostic imaging for major trauma has evolved considerably in recent years.
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Affiliation(s)
- Sadia Raheez Qamar
- Department of Emergency and Trauma Radiology, Vancouver General Hospital, 8166University of British Columbia, Vancouver, British Columbia, Canada
| | - David Evans
- Department of Surgery, 8167Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Brian Gibney
- Department of Emergency and Trauma Radiology, Vancouver General Hospital, 8166University of British Columbia, Vancouver, British Columbia, Canada
| | - Ciaran E Redmond
- Department of Emergency and Trauma Radiology, Vancouver General Hospital, 8166University of British Columbia, Vancouver, British Columbia, Canada
| | - Muhammad Umer Nasir
- Department of Emergency and Trauma Radiology, Vancouver General Hospital, 8166University of British Columbia, Vancouver, British Columbia, Canada
| | - Kenneth Wong
- Department of Radiology, 71511Royal Columbian Hospital, New Westminster, British Columbia, Canada
| | - Savvas Nicolaou
- Department of Emergency and Trauma Radiology, Vancouver General Hospital, 8166University of British Columbia, Vancouver, British Columbia, Canada
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26
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Visualization and documentation of perimortem traits in long bone fractures using computed tomography. Forensic Sci Med Pathol 2020; 16:281-286. [PMID: 32201926 DOI: 10.1007/s12024-020-00237-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2020] [Indexed: 11/27/2022]
Abstract
Perimortem fracture patterns in long bones, defined in previous publications, include layered breakage, bone scales, crushed margins, flakes with flake defect, wave lines, and plastic deformation. The traits help professionals during trauma analysis to differentiate peri- from post-mortem fractures. This study will therefore investigate whether these traits can be recorded with Computed Tomography (CT) as the non-invasive 3D imaging technique is becoming more popular in forensic science. CT scans of macerated bone samples (n = 15; humerus: n = 1; ulna: n = 1; radius: n = 1; femur: n = 12) were investigated using multi-planar reconstructions (MPRs) and volume renderings. Tension lines and severe plastic deformation were visible on the individual multi-planar reconstructions (MPRs) and the 3D models. Additionally, layered breakage and flake defects were also clearly distinguishable on the volume renderings. Based on the results, CT imaging may be a useful and fast tool to document, visualize, and analyze findings of blunt force trauma.
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27
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Mohd Ali SH, Omar N, Shafie MS, Nik Ismail NA, Hadi H, Nor FM. Sex estimation using subpubic angle from reconstructed three-dimensional computed tomography pelvic model in a contemporary Malaysian population. Anat Cell Biol 2020; 53:27-35. [PMID: 32274246 PMCID: PMC7118257 DOI: 10.5115/acb.19.135] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 09/02/2019] [Accepted: 09/25/2019] [Indexed: 12/17/2022] Open
Abstract
Research in forensic anthropology is recent in Malaysia due to limited access to documented skeletal collections. However, advanced imaging techniques provide virtual bone samples for use in morphometric studies to establish population-specific standards by virtual anthropology. This study examined sexual dimorphism in the subpubic angle using a three-dimensional computed tomography model of the pelvis, in a contemporary Malaysian population. The sample comprised multidetector computed tomography (MDCT) scans of 50 male and 50 female adults. Segmentation of the MDCT scans was performed using 3D Slicer, and four landmarks were acquired using Stratovan Checkpoint for the subpubic angle measurement. The technical error of measurement (TEM), relative TEM, and coefficient of reliability (R) exhibited high reliability in measurements. Results showed that the subpubic angle in males was 68.6°±7.6° and in females 87.4°±6.5°. The subpubic angle in females was significantly larger than in males (P<0.001). Inverse correlation was found between the subpubic angle and age, in both males (r=−0.449, P<0.01) and females (r=−0.385, P<0.01). The overall accuracy of sex estimation using the subpubic angle was 94% (P<0.001). The subpubic angle, with a demarcating point of 78.6°, showed a sensitivity and specificity of 94% in the classification of female individuals. In conclusion, sex estimation using the subpu bic angle is highly accurate, with a high degree of expected sensitivity and specificity in the Malaysian population.
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Affiliation(s)
- Siti Hanum Mohd Ali
- Forensic Unit, Department of Pathology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia.,Department of Basic Medical Science I, Faculty of Medicine and Health Sciences, Universiti Sains Islam Malaysia, Kuala Lumpur, Malaysia
| | - Normaliza Omar
- Forensic Unit, Department of Pathology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia.,Department of Basic Medical Science I, Faculty of Medicine and Health Sciences, Universiti Sains Islam Malaysia, Kuala Lumpur, Malaysia
| | - Mohamed Swarhib Shafie
- Forensic Unit, Department of Pathology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Nik Azuan Nik Ismail
- Radiology Department, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Helmi Hadi
- School of Health Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - Faridah Mohd Nor
- Forensic Unit, Department of Pathology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
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28
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Zheng J, Liu X, Yang S, Wei C, Feng X. Risk identification and protection during high-risk forensic autopsy. JOURNAL OF FORENSIC SCIENCE AND MEDICINE 2020. [DOI: 10.4103/jfsm.jfsm_25_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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29
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Gascho D, Thali MJ, Bolliger SA. Hidden shot pellets on postmortem computed tomography and their utilization for radiologic identification of decedents. Forensic Sci Med Pathol 2019; 16:340-344. [DOI: 10.1007/s12024-019-00213-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2019] [Indexed: 01/17/2023]
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30
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Little JP, Rayward L, Pearcy MJ, Izatt MT, Green D, Labrom RD, Askin GN. Predicting spinal profile using 3D non-contact surface scanning: Changes in surface topography as a predictor of internal spinal alignment. PLoS One 2019; 14:e0222453. [PMID: 31557174 PMCID: PMC6762190 DOI: 10.1371/journal.pone.0222453] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 08/29/2019] [Indexed: 01/20/2023] Open
Abstract
Introduction 3D non-contact surface scanners capture highly accurate, calibrated images of surface topography for 3D structures. This study sought to establish the efficacy and accuracy of using 3D surface scanning to characterise spinal curvature and sagittal plane contour. Methods 10 healthy female adults with a mean age of 25 years, (standard deviation: 3.6 years) underwent both MRI and 3D surface scanning (3DSS) (Artec Eva, Artec Group Inc., Luxembourg) while lying in the lateral decubitus position on a rigid substrate. Prior to 3DSS, anatomical landmarks on the spinous processes of each participant were demarcated using stickers attached to the skin surface. Following 3DSS, oil capsules (fiducial markers) were overlaid on the stickers and the subject underwent MRI. MRI stacks were processed to measure the thoracolumbar spinous process locations, providing an anatomical reference. 3D coordinates for the markers (surface stickers and MRI oil capsules) and for the spinous processes mapped the spinal column profiles and were compared to assess the quality of fit between the 3DSS and MRI marker positions. Results The RMSE for the polynomials fit to the spinous process, fiducial and surface marker profiles ranged from 0.17–1.15mm for all subjects. The MRI fiducial marker location was well aligned with the spinous process profile in the thoracic and upper lumbar spine for nine of the subjects. Over the 10 subjects, the mean RMSE between the MRI and 3D scan sagittal profiles for all surface markers was 9.8mm (SD 4.2mm). Curvature was well matched for seven of the subjects, with two showing differing curvatures across the lumbar spine due to inconsistent subject positioning. Conclusion Comparison of the observed trends for vertebral position measured from MRI and 3DSS, suggested the surface markers may provide a useful method for measuring internal changes in sagittal curvature or skeletal changes.
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Affiliation(s)
- J. Paige Little
- Biomechanics and Spine Research Group, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
- * E-mail:
| | - Lionel Rayward
- Biomechanics and Spine Research Group, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Mark J. Pearcy
- Biomechanics and Spine Research Group, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Maree T. Izatt
- Biomechanics and Spine Research Group, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | | | - Robert D. Labrom
- Biomechanics and Spine Research Group, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
- Wesley Hospital, Brisbane, Australia
| | - Geoffrey N. Askin
- Biomechanics and Spine Research Group, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
- Mater Health Services, Brisbane, Australia
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Obertová Z, Leipner A, Messina C, Vanzulli A, Fliss B, Cattaneo C, Sconfienza LM. Postmortem imaging of perimortem skeletal trauma. Forensic Sci Int 2019; 302:109921. [DOI: 10.1016/j.forsciint.2019.109921] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 07/31/2019] [Accepted: 08/04/2019] [Indexed: 12/30/2022]
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Latten BG, Bakers FC, Hofman PA, zur Hausen A, Kubat B. The needle in the haystack: Histology of post-mortem computed tomography guided biopsies versus autopsy derived tissue. Forensic Sci Int 2019; 302:109882. [DOI: 10.1016/j.forsciint.2019.109882] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 06/12/2019] [Accepted: 07/15/2019] [Indexed: 10/26/2022]
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Nioi M, Napoli PE, Mayerson SM, Fossarello M, d’Aloja E. Optical coherence tomography in forensic sciences: a review of the literature. Forensic Sci Med Pathol 2019; 15:445-452. [DOI: 10.1007/s12024-019-00136-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2019] [Indexed: 12/20/2022]
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Antúnez S, Grevent D, Boddaert N, Vergnaud E, Vecchione A, Ferrant-Azoulay O, Orliaguet G, Meyer PG. "Perimortem" total body CT-scan examination in severely injured children: an informative insight into the causes of death. Int J Legal Med 2019; 134:625-635. [PMID: 31065793 DOI: 10.1007/s00414-019-02058-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Accepted: 04/05/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To report routine practice of "perimortem" CT-scan imaging to determine the causes of death in children dying from severe accidental injuries within the first hours following hospital admission. SETTINGS Trauma center of a University Pediatric Hospital. METHODS A retrospective study was conducted in children (0 to 15 years old) referred for severe trauma (GCS ≤ 8) to a regional pediatric trauma center, presenting with at least spontaneous cardiac rhythm and dying within the first 12 h after admission. "Perimortem" CT-scan consisted in high-resolution, contrast-enhanced, full-body CT-scan imaging, performed whatever child's clinical status. Lethal and associated lesions found were analyzed and classified according to validated scales. The comparison between clinical and radiological examinations and CT-scan findings evaluated the accuracy of clinical examination to predict lethal lesions. RESULTS CT-scan performed in 73 children detected 132 potentially lethal lesions, at least 2 lesions in 63%, and 1 in 37% of the cases. More frequent lethal lesions were brain (43%), and chest injuries (33%), followed by abdominal (12%), and cervical spine injuries (12%). Clinical and minimal radiological examinations were poorly predictive for identifying abdominal/chest lesions. Clinical and imaging data provided to the medical examiner were considered sufficient to identify the cause of death, and to deliver early burial certificates in 70 children. Only three legal autopsies were commanded. CONCLUSIONS Perimortem CT imaging could provide an insight into the causes of death in traumatized children. Performed on an emergency basis near death, it eliminates the difficulties encountered in forensic radiology. It could be a possible alternative to full-scale forensic examination, at least regarding elucidation of the potential, or highly probable causes of death.
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Affiliation(s)
- Sue Antúnez
- Forensic Medical Unit, Unité Médico Judiciaire des Yvelines (UMJ 78), Centre Hospitalier Versailles Le Chesnay, Le Chesnay, France.
| | - David Grevent
- Paediatric Radiology Department, Centre Hospitalier Universitaire Necker Enfants Malades, Assistance Publique Hôpitaux de Paris, Université Descartes-Paris 5, Paris, France
| | - Nathalie Boddaert
- Paediatric Radiology Department, Centre Hospitalier Universitaire Necker Enfants Malades, Assistance Publique Hôpitaux de Paris, Université Descartes-Paris 5, Paris, France
| | - Estelle Vergnaud
- Department of Pediatric Anesthesiology and Critical Care, and SAMU de Paris, Paediatric Neurosurgical Critical Care Unit, Centre Hospitalier Universitaire Necker Enfants Malades, Assistance Publique Hopitaux de Paris, Paris, France
| | - Antonio Vecchione
- Department of Pediatric Anesthesiology and Critical Care, and SAMU de Paris, Paediatric Neurosurgical Critical Care Unit, Centre Hospitalier Universitaire Necker Enfants Malades, Assistance Publique Hopitaux de Paris, Paris, France
| | - Ophélie Ferrant-Azoulay
- Forensic Medical Unit, Unité Médico Judiciaire des Yvelines (UMJ 78), Centre Hospitalier Versailles Le Chesnay, Le Chesnay, France
| | - Gilles Orliaguet
- Department of Pediatric Anesthesiology and Critical Care, and SAMU de Paris, Paediatric Neurosurgical Critical Care Unit, Centre Hospitalier Universitaire Necker Enfants Malades, Assistance Publique Hopitaux de Paris, Paris, France
| | - Philippe G Meyer
- Department of Pediatric Anesthesiology and Critical Care, and SAMU de Paris, Paediatric Neurosurgical Critical Care Unit, Centre Hospitalier Universitaire Necker Enfants Malades, Assistance Publique Hopitaux de Paris, Paris, France
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State of the art in post-mortem computed tomography: a review of current literature. Virchows Arch 2019; 475:139-150. [PMID: 30937612 DOI: 10.1007/s00428-019-02562-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 02/06/2019] [Accepted: 03/12/2019] [Indexed: 12/14/2022]
Abstract
Computed tomography (CT) and other advanced diagnostic imaging techniques are gaining popularity in forensic pathology. This paper aims to define and offer complete and easily accessible "state of the art" for post-mortem computed tomography (PMCT), by reviewing the latest international literature. The proposed format answers the "five Ws" that follows: (1) What: We report the different kinds of CT scan and settings generally used in post-mortem imaging. The machine most employed is a 8/16-slice spiral CT, usually without contrast enhancement. The introduction of some variables, such as CT-guided biopsies, post-mortem ventilation, and PMCT angiography is becoming increasingly useful. (2) Why: Literature highlights the many advantages of PMCT. Limitations can be partly overcome by modern imaging techniques and combined evaluation with traditional autopsy. (3) Who: Most authors agree that collaboration between different specialists, i.e., radiologists and pathologists, is the best scenario, since radiologic, anatomic, and forensic skills are needed simultaneously. The most important human factor is "teamwork". (4) When: Literature provides no absolute limits for performing PMCT. Some authors have tested PMCT as a replacement for conventional autopsy but found some limitations. Others evaluated PMCT as a guide or screening tool for traditional autopsy. (5) Where: Many research groups around the world have performed studies on the use of PMCT. Although few countries adopt PMCT in routine practice, its use is rapidly spreading.
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Gascho D, Heimer J, Tappero C, Schaerli S. Relevant findings on postmortem CT and postmortem MRI in hanging, ligature strangulation and manual strangulation and their additional value compared to autopsy - a systematic review. Forensic Sci Med Pathol 2019; 15:84-92. [PMID: 30627977 DOI: 10.1007/s12024-018-0070-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2018] [Indexed: 12/25/2022]
Abstract
Several articles have described the use of postmortem computed tomography (CT) and postmortem magnetic resonance imaging (MRI) in forensic medicine. Although access to CT scanners and, particularly, access to MRI scanners, is still limited for several institutes, both modalities are being applied with increasing frequency in the forensic setting. Certainly, postmortem imaging can provide crucial information prior to autopsy, and this method has even been considered a replacement to autopsy in selected cases by some forensic institutes. However, the role of postmortem imaging has to be assessed individually according to various injury categories and causes of death. Therefore, this systematic review focuses on the role of postmortem CT and MRI in cases of hanging and ligature and manual strangulation. We assessed the most common and relevant findings on CT and MRI in cases of strangulation and compared the detectability of these findings among CT, MRI and autopsy. According to the available literature, mainly fractures of the hyoid bone or thyroid cartilage were investigated using postmortem CT. Compared to autopsy, CT demonstrated equivalent results concerning the detection of these fractures. A currently described "gas bubble sign" may even facilitate the detection of laryngeal fractures on CT. Regarding the detection of hemorrhages in the soft tissue of the neck, postmortem MRI is more suitable for the detection of this "vital sign" in strangulation. Compared to autopsy, postmortem MRI is almost equally accurate for the detection of hemorrhages in the neck. Another "vital sign", gas within the soft tissue in hanging, which is hardly detectable by conventional autopsy, can be clearly depicted by CT and MRI. The number of cases of manual and ligature strangulation that were investigated by means of postmortem CT and MRI is much smaller than the number of cases of hanging that were investigated by CT and MRI. Likewise, judicial hanging and the hangman's fracture on postmortem imaging were described in only a few cases. Based on the results of this systematic review, we discuss the additional value of CT and MRI in fatal strangulation compared to autopsy, and we reflect on where the literature is currently lacking.
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Affiliation(s)
- Dominic Gascho
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, 8057, Zurich, Switzerland.
| | - Jakob Heimer
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, 8057, Zurich, Switzerland
| | - Carlo Tappero
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, 8057, Zurich, Switzerland.,Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, Freiburgstrasse, 3010, Bern, Switzerland
| | - Sarah Schaerli
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, 8057, Zurich, Switzerland
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Ding B, Song W, Du F, Chen L, Song X. Complete resection of adult prostatic rhabdomyosarcoma with 3D video and printing model: A case report and literature review. JOURNAL OF X-RAY SCIENCE AND TECHNOLOGY 2019; 27:177-183. [PMID: 30562915 DOI: 10.3233/xst-180458] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Prostatic rhabdomyosarcoma (RMS) is a subtype of prostate sarcoma which is rarely reported in adults and usually huge in size. Although there is no consensus on the standard therapy to prostatic RMS, complete resection with negative margin is identified as the best way for maximum survival time. However, to remove a much enlarged prostate completely from a RMS patient is still a very difficult task for a skilled urologist so far. As three-dimension (3D) technology becomes more widely used in medicine, surgeons have the opportunity to challenge previously impossible surgery. In this paper, we reported a 36-year-old male patient with a 9.6*5.3*7.6 cm prostatic RMS. With the aid of 3D reconstructed video and printing model, the giant tumor was entirely removed without surgery complications and adjacent organs injury. The patient was alive and had no recurrence after 18 months from surgery. This case revealed that 3D reconstruction technology could help in the preoperative assessment and gave benefits to both patients and surgeons.
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Affiliation(s)
- Beichen Ding
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Wen Song
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Feilong Du
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Liang Chen
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xiaodong Song
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
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Chatzaraki V, Heimer J, Thali M, Dally A, Schweitzer W. Role of PMCT as a triage tool between external inspection and full autopsy – Case series and review. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.jofri.2018.10.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Chatzaraki V, Tappero C, Thali MJ, Schweitzer W. Death by hanging: a retrospective case-control investigation of the intervertebral disc vacuum phenomenon on PMCT. Forensic Sci Med Pathol 2018; 14:484-496. [PMID: 30426338 DOI: 10.1007/s12024-018-0034-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2018] [Indexed: 01/30/2023]
Abstract
During hanging gravitational forces affect the spine. Intervertebral vacuum phenomenon (VP) implies that gas accumulations in the discs are caused by degeneration of the spine and trauma. It was hypothesized that VP detected on postmortem computed tomography (PMCT) has a higher incidence in hanging deaths, which can be correlated to age, degenerative spinal changes and type of hanging (complete-incomplete). Secondly, it was investigated whether the presence of Simon's bleedings is related to hanging type and VP on PMCT. A retrospective hanging case-control study of 72 cases was conducted. PMCT data were evaluated by two observers for the presence of VP and its localization within the thoracic and lumbar discs, and for any degenerative changes of the spine. Autopsy protocols were assessed for the presence of Simon's bleedings during autopsy. VP did not statistically differ among hanging and control cases but it was statistically correlated to complete hanging, increasing age and degenerative spinal changes. Centrally located VP within the discs was correlated to hanging, especially complete hanging, and younger ages, contrary to control cases that showed gas at the disc periphery. Simon's bleedings were correlated with complete hanging and centrally located VP. Centrally located VP within the discs increases the probability for complete hanging, while increasing age and degenerative changes reduce this probability. Intervertebral VP is multifactorial radiological entity. The presence of centrally located VP can indicate that hanging could be considered as an alternative mechanism of death and that great forces and loads may have affected the spine perimortem, especially with decreasing age and when Simon's bleedings are present.
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Affiliation(s)
- Vasiliki Chatzaraki
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, CH-8057, Zurich, Switzerland.
| | - Carlo Tappero
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, CH-8057, Zurich, Switzerland
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, Freiburgstrasse, 3010, Bern, Switzerland
| | - Michael J Thali
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, CH-8057, Zurich, Switzerland
| | - Wolf Schweitzer
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, CH-8057, Zurich, Switzerland
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40
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La Russa R, Catalano C, Di Sanzo M, Scopetti M, Gatto V, Santurro A, Viola RV, Panebianco V, Frati P, Fineschi V. Postmortem computed tomography angiography (PMCTA) and traditional autopsy in cases of sudden cardiac death due to coronary artery disease: a systematic review and meta-analysis. Radiol Med 2018; 124:109-117. [PMID: 30259270 DOI: 10.1007/s11547-018-0943-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 09/11/2018] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Several studies have been performed to assess the efficacy of postmortem computed tomography angiography (PMCTA) in solving cases of sudden cardiac death, even in comparison with the traditional autopsy. However, the results were often inconsistent and inconclusive. Therefore, a global discussion on the subject through a systematic review of the literature and a meta-analysis is necessary. METHODS A systematic search of PubMed was performed up to April 23, 2018. Studies exploring the role of PMCTA in cases of sudden cardiac death and the accuracy of this method in diagnosing the cause of death compared to traditional autopsy were included. RESULTS The overall sensitivity and specificity of the seven included studies, using conventional autopsy as a reference standard, were 92% and 95%, respectively. The positive and negative likelihood ratios were, respectively, 20.76 (95% CI 1.16-370.2) and 0.08 (95% CI 0.03-0.17), showing that PMCTA represents a strong indicator of the posttest probability of disease. The diagnostic odds ratio and the area under the curve were, respectively, 261.54 (95% CI 1.87-5760.53) and 0.93 (95% CI 0.90-0.95), indicating a high diagnostic power of the test. CONCLUSION PMCTA demonstrated a high accuracy in the diagnosis of parietal and luminal coronary changes but was less effective in detecting myocardial ischemia and necrosis. Therefore, the only radiological investigation is often insufficient to determine the cause of sudden death and the conventional autopsy remains the gold standard. However, PMCTA can improve the performance of the autopsy, serving as an aid and guide in the sampling phase for histopathological investigations.
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Affiliation(s)
- Raffaele La Russa
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161, Rome, Italy.,IRCCS Neuromed, Via Atinense 18, Pozzilli, 86077, Italy
| | - Carlo Catalano
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University, Viale Regina Elena 324, 00161, Rome, Italy
| | - Mariantonia Di Sanzo
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161, Rome, Italy
| | - Matteo Scopetti
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161, Rome, Italy
| | - Vittorio Gatto
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161, Rome, Italy
| | - Alessandro Santurro
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161, Rome, Italy
| | - Rocco Valerio Viola
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161, Rome, Italy
| | - Valeria Panebianco
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University, Viale Regina Elena 324, 00161, Rome, Italy
| | - Paola Frati
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161, Rome, Italy.,IRCCS Neuromed, Via Atinense 18, Pozzilli, 86077, Italy
| | - Vittorio Fineschi
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161, Rome, Italy. .,IRCCS Neuromed, Via Atinense 18, Pozzilli, 86077, Italy.
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Fatal Road Traffic Vehicle Collisions With Pedestrian Victims: Forensic Postmortem Computed Tomography and Autopsy Correlation. Am J Forensic Med Pathol 2018; 39:130-140. [PMID: 29438138 DOI: 10.1097/paf.0000000000000382] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Fatal car-to-pedestrian collisions regularly appear in the forensic pathologist's routine, particularly in places of extended urbanization. Postmortem computed tomography has gained an exceptional role to supplement autopsy worldwide, giving information that is supplementary or complimentary to conventional autopsy. In this retrospective study, a total number of 320 findings in a series of 21 pedestrians fatally hit by cars and trucks of both postmortem computed tomography and autopsy were correlated. According to our results, it is best to combine both methods to give well-founded answers to questions pertaining to both collision reconstruction and cause of death.
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42
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Willaume T, Farrugia A, Kieffer EM, Charton J, Geraut A, Berthelon L, Bierry G, Raul JS. The benefits and pitfalls of post-mortem computed tomography in forensic external examination: A retrospective study of 145 cases. Forensic Sci Int 2018; 286:70-80. [DOI: 10.1016/j.forsciint.2018.02.030] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 02/26/2018] [Accepted: 02/28/2018] [Indexed: 01/11/2023]
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Abstract
OBJECTIVE The aim of this article is to provide an overview of newer techniques and postprocessing tools that improve the potential impact of CT in forensic situations. CONCLUSION CT has become a standard tool in medicolegal practice. Postmortem CT is an essential aid to the pathologist during autopsies. Advances in technology and software are constantly leading to advances in its performance.
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Joseph TI, Girish KL, Sathyan P, Kiran MS, Vidya S. Virtopsy: An integration of forensic science and imageology. J Forensic Dent Sci 2018; 9:111-114. [PMID: 29657485 PMCID: PMC5887631 DOI: 10.4103/jfo.jfds_52_16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
In an era where noninvasive and minimally invasive techniques are heralding medical innovations and health science technology, necrological analysis is not bereft of this wave. Virtopsy is virtual autopsy. It is a new-age complimentary documentation approach to identify and analyze the details of demise. Utilizing virtual autopsy for orofacial forensic examination is an emerging specialty which holds a plethora of potential for future trends in forensic science. Being a noninvasive technique, it is a rapid method which facilitates the medicolegal process and aids in the delivery of justice. The present article is an overview of this emerging methodology.
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Affiliation(s)
- T Isaac Joseph
- Department of Oral Pathology, Sree Mookambika Institute of Dental Sciences, Kanyakumari, Tamil Nadu, India
| | - K L Girish
- Department of Oral Pathology, Sree Mookambika Institute of Dental Sciences, Kanyakumari, Tamil Nadu, India
| | - Pradeesh Sathyan
- Department of Oral Pathology, Sree Mookambika Institute of Dental Sciences, Kanyakumari, Tamil Nadu, India
| | - M Shashi Kiran
- Department of Oral Medicine and Radiology, Sree Mookambika Institute of Dental Sciences, Kanyakumari, Tamil Nadu, India
| | - S Vidya
- Department of Oral Pathology, Sree Mookambika Institute of Dental Sciences, Kanyakumari, Tamil Nadu, India
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46
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Abstract
Suitcases or other containers are occasionally involved in forensic investigations. If there is a suspicion that human remains are hidden inside such a container, medico-legal examinations are required. However, these containers are occasionally locked. Forced opening of a locked suitcase or container may cause damage to its contents. Additionally, the safety of the investigator has to be considered as such containers may be booby-trapped or contain other hazardous material. An overview of the contents before opening is desirable in order to avoid the possibility of encountering a Pandora's box. In forensic medicine, an established approach to examine the inside of a body before opening at autopsy is postmortem computed tomography (CT). However, there may be a reluctance to use this approach for suitcases or containers with metallic components because of the assumption that severe metal artifacts will result in inadequate images. In this article, we present a forensic case in which a CT scan of a metallic suitcase was performed in order to examine its contents. Additionally, we performed an experimental scan of a conventional safe in order to determine if CT is able to reveal the contents of such a highly radiopaque storage box.
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Affiliation(s)
- Dominic Gascho
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, 8057, Zurich, Switzerland.
| | - Stephan A Bolliger
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, 8057, Zurich, Switzerland
| | - Markus Enders
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, 8057, Zurich, Switzerland
| | - Michael J Thali
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, 8057, Zurich, Switzerland
| | - Barbara Fliss
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, 8057, Zurich, Switzerland
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Norman D, Watson D, Burnett B, Fenne P, Williams M. The cutting edge — Micro-CT for quantitative toolmark analysis of sharp force trauma to bone. Forensic Sci Int 2018; 283:156-172. [DOI: 10.1016/j.forsciint.2017.12.039] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 12/16/2017] [Accepted: 12/22/2017] [Indexed: 10/18/2022]
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Sutherland T, O'Donnell C. The artefacts of death: CT post-mortem findings. J Med Imaging Radiat Oncol 2017; 62:203-210. [DOI: 10.1111/1754-9485.12691] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 09/22/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Tom Sutherland
- Medical Imaging Department; St Vincent's Hospital; Melbourne Victoria Australia
- Faculty of Medicine; Dentistry and Health Science; University of Melbourne; Melbourne Victoria Australia
| | - Chris O'Donnell
- Victorian Institute of Forensic Medicine; Southbank Victoria Australia
- Department of Forensic Medicine; Monash University; Melbourne Victoria Australia
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49
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Matoba K, Hyodoh H, Murakami M, Saito A, Matoba T, Ishida L, Fujita E, Yamase M, Jin S. Estimating normal lung weight measurement using postmortem CT in forensic cases. Leg Med (Tokyo) 2017; 29:77-81. [DOI: 10.1016/j.legalmed.2017.10.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 10/25/2017] [Accepted: 10/30/2017] [Indexed: 10/18/2022]
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50
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Traumatic brain injury: Comparison between autopsy and ante-mortem CT. J Forensic Leg Med 2017; 52:62-69. [PMID: 28866283 DOI: 10.1016/j.jflm.2017.08.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 05/27/2017] [Accepted: 08/23/2017] [Indexed: 12/09/2022]
Abstract
PURPOSE The aim of this study was to compare pathological findings after traumatic brain injury between autopsy and ante-mortem computed tomography (CT). A second aim was to identify changes in these findings between the primary posttraumatic CT and the last follow-up CT before death. METHODS Through the collaboration between clinical radiology and forensic medicine, 45 patients with traumatic brain injury were investigated. These patients had undergone ante-mortem CT as well as autopsy. During autopsy, the brain was cut in fronto-parallel slices directly after removal without additional fixation or subsequent histology. Typical findings of traumatic brain injury were compared between autopsy and radiology. Additionally, these findings were compared between the primary CT and the last follow-up CT before death. RESULTS The comparison between autopsy and radiology revealed a high specificity (≥80%) in most of the findings. Sensitivity and positive predictive value were high (≥80%) in almost half of the findings. Sixteen patients had undergone craniotomy with subsequent follow-up CT. Thirteen conservatively treated patients had undergone a follow-up CT. Comparison between the primary CT and the last ante-mortem CT revealed marked changes in the presence and absence of findings, especially in patients with severe traumatic brain injury requiring decompression craniotomy. CONCLUSION The main pathological findings of traumatic brain injury were comparable between clinical ante-mortem CT examinations and autopsy. Comparison between the primary CT after trauma and the last ante-mortem CT revealed marked changes in the findings, especially in patients with severe traumatic brain injury. Hence, clinically routine ante-mortem CT should be included in the process of autopsy interpretation.
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