1
|
Overfield CJ, Bhatt AA. Interpreting the Post-Treatment Orbit: Pearls and Pitfalls. Semin Roentgenol 2023; 58:261-271. [PMID: 37507168 DOI: 10.1053/j.ro.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 01/11/2023] [Accepted: 01/13/2023] [Indexed: 02/16/2023]
Affiliation(s)
- Cameron J Overfield
- Department of Radiology, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224
| | - Alok A Bhatt
- Department of Radiology, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224.
| |
Collapse
|
2
|
Moore M, Moharram M, Poon A, Tse R, Aitken-Buck HM, Lamberts RS, Coffey S. A simple and reproducible measure of adipose depots with non-contrast post-mortem computed tomography. IMAGING 2022. [DOI: 10.1556/1647.2022.00066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
AbstractBackground and aimObesity is associated with an increase in different adipose depots. The anatomic distribution of internal adipose confers different risks. Recently, significant interest has emerged in the expansion of epicardial adipose tissue (EAT) as a mediator of adverse cardiovascular events. Often, post-mortem examination remains the best method of investigating morphological changes in health and disease. This study aimed to develop a simple, reproducible, and non-invasive protocol for the measurement of internal adiposity using post-mortem computed tomography (PMCT).Patients and methods101 consecutive post-mortem subjects underwent non-contrast computed tomography scans. Measurements were performed using the open-source software 3D Slicer by a non-expert researcher. An expert radiologist and cardiologist verified the abdominal and cardiac sites of adiposity, respectively. We aimed to develop a protocol to measure total EAT, sub-depots of EAT, extra-pericardial adipose, visceral and subcutaneous adipose, and suprasternal adipose.ResultsWe found excellent reproducibility for our measures of total EAT, anterior right atrial EAT, extra-pericardial adipose, and visceral adipose tissue, with intraclass correlations between 0.82 and 0.99 for each measure. Due to a lack of suitable anatomical boundaries, other sub-depots of EAT, including in the interventricular groove, were not reproducible.ConclusionsQuantification of total EAT and anterior right atrial EAT are readily reproducible using 3D Slicer on post-mortem CT. They can be reliably measured by non-expert researchers with a small amount of training, and therefore be used to investigate morphological changes in adiposity in health and disease.
Collapse
Affiliation(s)
- Matthew Moore
- Department of Medicine, HeartOtago, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Mohammed Moharram
- Department of Medicine, HeartOtago, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Andre Poon
- Department of Radiology, Dunedin Hospital, Southern District Health Board, Dunedin, New Zealand
| | - Rexson Tse
- Department of Forensic Pathology, LabPLUS, Auckland City Hospital, Auckland, New Zealand
| | - Hamish M. Aitken-Buck
- Department of Physiology, HeartOtago, School of Biomedical Sciences, University of Otago, Dunedin, New Zealand
| | - Regis S. Lamberts
- Department of Physiology, HeartOtago, School of Biomedical Sciences, University of Otago, Dunedin, New Zealand
| | - Sean Coffey
- Department of Medicine, HeartOtago, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
- Department of Cardiology, Dunedin Hospital, Southern District Health Board, Dunedin, New Zealand
| |
Collapse
|
3
|
Pelkey LJ, Canty BJ, Ferris SP, Mistry DT, Figueroa BE. Aneurysmal Bone Cyst of the Sphenoid Body Mimicking Craniopharyngioma: A Case Report. Cureus 2022; 14:e23128. [PMID: 35308188 PMCID: PMC8918117 DOI: 10.7759/cureus.23128] [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] [Accepted: 03/13/2022] [Indexed: 11/06/2022] Open
Abstract
An aneurysmal bone cyst is a locally destructive benign lesion that predominately affects the long bones. Sphenoid body involvement is rare. To date, only 19 primary aneurysmal bone cysts of the sphenoid body have been reported. We describe the case of an 18-year-old male with a one-week history of severe right eye pain and lacrimation, right-sided diplopia, right-sided headache, photophobia, nausea, and vomiting. Magnetic resonance imaging (MRI) demonstrated a lobulated lesion centered in the sphenoid body with expansion into the cavernous sinus, sellar region, and clivus. The lesion had a homogenous hyperintense T2 signal with enhancing sidewalls and minimal septations. Computed tomography (CT) angiography revealed a hypoattenuating lesion containing a substance of nine Hounsfield units, compatible with water density. The clinicoradiologic findings were consistent with a craniopharyngioma. Intraoperatively, the lesion was confirmed to contain clear fluid and have prominent arterial feeding vessels. The extradural tumor was then excised with intralesional curettage. The histopathologic analysis resulted in a diagnosis of an aneurysmal bone cyst. This case highlights the potentially non-specific and variable appearance of aneurysmal bone cysts and the need to consider it in the differential diagnosis of sphenoid bone lesions.
Collapse
|
4
|
Woźniak KJ, Moskała A, Kluza P, Rzepecka-Woźniak E. Blunt Force, Gunshot, and Sharp Force Injuries. FORENSIC IMAGING 2022. [DOI: 10.1007/978-3-030-83352-7_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
5
|
Effects of blood loss on organ attenuation on postmortem CT and organ weight at autopsy. Int J Legal Med 2021; 136:649-656. [PMID: 34817651 PMCID: PMC8847164 DOI: 10.1007/s00414-021-02731-8] [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] [Received: 02/04/2021] [Accepted: 10/18/2021] [Indexed: 10/28/2022]
Abstract
BACKGROUND Cases of external hemorrhage are difficult to recognize on postmortem computed tomography (PMCT). PURPOSE To investigate the effects of blood loss on CT attenuation of the spleen, liver, kidneys, and lungs on PMCT and to assess the relationship between blood loss and organ weight. METHODS A total of 125 cases with blood loss were sex- and age-matched to 125 control cases without blood loss. Individual organ attenuation was measured on transverse CT images. Organ weights of the liver, spleen, kidneys, and lung were extracted from the autopsy protocols. RESULTS Organ weight was significantly lower in cases with blood loss (lung 30%, spleen 28%, kidneys 14%, liver 18%) than in controls. CT attenuation of the lungs was significantly lower (30%) in cases with blood loss than in controls. CT attenuation of the spleen and kidneys did not significantly differ between cases and controls. CT attenuation of the liver was significantly higher (25%) in cases with blood loss than in controls. CONCLUSION Blood loss decreases organ weight and CT attenuation of the lungs but appears to have no significant effect on CT attenuation of the spleen and kidneys. The increased liver attenuation in cases with blood loss compared to controls was an unexpected finding and remains challenging to explain. One probable interpretation refers to different levels of hepatic glycogen; however, further work is warranted to substantiate this hypothesis.
Collapse
|
6
|
De-Giorgio F, Ciasca G, Fecondo G, Mazzini A, De Spirito M, Pascali VL. Estimation of the time of death by measuring the variation of lateral cerebral ventricle volume and cerebrospinal fluid radiodensity using postmortem computed tomography. Int J Legal Med 2021; 135:2615-2623. [PMID: 34562107 PMCID: PMC8523388 DOI: 10.1007/s00414-021-02698-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 08/27/2021] [Indexed: 12/21/2022]
Abstract
Using postmortem CT (PMCT), changes in the volume of the lateral cerebral ventricles (LCVs) and modifications of the radiodensity of cerebrospinal fluid (CSF) have been examined to identify a possible relationship between these changes and the time of death. Subsequent periodical CT scans termed "sequential scans" for ten corpses at known time of death were obtained, and a 3D segmentation of the entire LCV was carried out to measure its volume and radiodensity over time from ~ 5.5- h up to 273-h postmortem. A linear decrease of the LCV volume for all the cases was observed in the investigated time range, together with an overall logarithmic increase of radiodensity. Although a larger sampling should be performed to improve the result reliability, our finding suggests that the postmortem variation of CSF radiodensity can be a potentially useful tool in determining postmortem interval, a finding that is worthy of further investigation.
Collapse
Affiliation(s)
- Fabio De-Giorgio
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
- Department of Healthcare Surveillance and Bioethics, Section of Legal Medicine, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Gabriele Ciasca
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Neuroscience Department, Section of Physics, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gennaro Fecondo
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Department of Healthcare Surveillance and Bioethics, Section of Legal Medicine, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alberto Mazzini
- Neuroscience Department, Section of Physics, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Marco De Spirito
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Neuroscience Department, Section of Physics, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Vincenzo L Pascali
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Department of Healthcare Surveillance and Bioethics, Section of Legal Medicine, Università Cattolica del Sacro Cuore, Rome, Italy
| |
Collapse
|
7
|
Chatzaraki V, Thali MJ, Ampanozi G. Diagnostic accuracy of postmortem computed tomography for bleeding source determination in cases with hemoperitoneum. Int J Legal Med 2021; 135:593-603. [PMID: 33410928 PMCID: PMC7870604 DOI: 10.1007/s00414-020-02472-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 11/18/2020] [Indexed: 11/26/2022]
Abstract
Aim The aim of this retrospective study was to determine the accuracy of postmortem computed tomography and different radiological signs for the determination of the bleeding source in cases with hemoperitoneum confirmed at autopsy. Methods Postmortem computed tomography data of consecutive cases with hemoperitoneum confirmed at autopsy were reviewed by two raters, blinded to the autopsy findings. The determination of possible bleeding sources was based on the presence of the sentinel clot sign, blood or sedimented blood surrounding an organ, intraparenchymal abnormal gas distribution, and parenchymal disruption. The bleeding source and the cause of hemoperitoneum (traumatic, surgical, natural, or resuscitation) as reported in the autopsy report were noted. The survival intervals of the deceased were calculated when information about the time of an incident related to death was available in the autopsy reports. Results Eighty-five cases were included in the study. Postmortem computed tomography showed 79% sensitivity and 92.1% specificity for the detection of the bleeding source. The sentinel clot sign was associated with surgical or natural causes of hemoperitoneum and longer survival intervals. Sedimented blood around the bleeding source was associated with resuscitation. Abnormal gas distribution within organs and combination of multiple radiological signs provided higher sensitivity. Conclusion Postmortem computed tomography provides moderate sensitivity and high specificity for determining the bleeding source in cases with hemoperitoneum. Different PMCT signs are associated with different causes of hemoperitoneum and survival intervals.
Collapse
Affiliation(s)
- Vasiliki Chatzaraki
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, CH-8057, Zurich, Switzerland.
- Department of Radiology, Kantonsspital Baden AG, Im Ergel 1, CH-5404, Baden, Switzerland.
| | - Michael J Thali
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, CH-8057, Zurich, Switzerland
| | - Garyfalia Ampanozi
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, CH-8057, Zurich, Switzerland
| |
Collapse
|
8
|
Kranioti EF, Nathena D, Spanakis K, Karantanas A, Bouhaidar R, McLaughlin S, Thali MJ, Ampanozi G. Unenhanced PMCT in the diagnosis of fatal traumatic brain injury in a charred body. J Forensic Leg Med 2020; 77:102093. [PMID: 33316735 DOI: 10.1016/j.jflm.2020.102093] [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: 06/16/2020] [Revised: 11/18/2020] [Accepted: 12/03/2020] [Indexed: 10/22/2022]
Abstract
Traffic incidents are one of the most frequent causes of death in young adults worldwide. Depending on the location of the incident, the velocity of the vehicle(s), the weather condition, traffic incidents are often complicated making the investigation of the circumstances difficult. Here we report a case of an incinerated body involved in a vehicle incident. Differential diagnosis included natural cause of death during driving, fatal traumatic injuries, death due to fire and positional asphyxia. The body was submitted to PMCT prior to autopsy as part of a research protocol (N. 1388/2016) at the Department of Medical Imaging of the University Hospital of Heraklion in Crete, Greece. Unenhanced PMCT revealed craniofacial fractures, a thin film of subdural haemorrhage and an epidural fluid collection. The findings were interpreted as consistent with an impact to the face, causing craniofacial fractures mainly on the right side, and an acute subdural hematoma. Autopsy findings corroborated the diagnosis. The epidural hematoma was deemed to be post-mortem heat-induced. This case is an excellent example of the diagnostic value of PMCT in the medicolegal investigation of death.
Collapse
Affiliation(s)
- Elena F Kranioti
- Forensic Medicine Unit, Department of Forensic Sciences, Medical School, University of Crete, Heraklion, Greece; Edinburgh Forensic Radiology and Anthropology Imaging Centre, Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh, UK.
| | - Despoina Nathena
- Forensic Medicine Unit, Department of Forensic Sciences, Medical School, University of Crete, Heraklion, Greece.
| | | | - Apostolos Karantanas
- Department of Medical Imaging, Heraklion University Hospital, Heraklion, Greece.
| | - Ralph Bouhaidar
- Division of Forensic Pathology, Medical School, University of Edinburgh, UK; Edinburgh Forensic Radiology and Anthropology Imaging Centre, Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh, UK.
| | - Siobhan McLaughlin
- Edinburgh Forensic Radiology and Anthropology Imaging Centre, Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh, UK.
| | - Michael J Thali
- Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, 8057, Zurich, Switzerland.
| | - Garyfalia Ampanozi
- Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, 8057, Zurich, Switzerland.
| |
Collapse
|
9
|
P M, M JT, M G. CT Role in the Assessment of Existence of Breast Cancerous Cells. J Biomed Phys Eng 2020; 10:349-356. [PMID: 32637379 PMCID: PMC7321400 DOI: 10.31661/jbpe.v0i0.384] [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] [Received: 05/26/2015] [Accepted: 06/19/2015] [Indexed: 06/11/2023]
Abstract
BACKGROUND Application of CT- scanning image information and radiation physical characteristics of the biomaterials are two measurable assays for presenting modified cells. OBJECTIVE This study presented that CT number (HU) and linear attenuation coefficient contain useful information which can be determined during usual CT scanning for the prediction of breast cancerous cells existence based on hemoglobin concentration. MATERIAL AND METHODS This experimental study used breast phantom containing major and minor vessels with diameters of 10 and 5 mm, respectively. The major vessels are filled by water, fat, hemoglobin (Hb) as a normal and 4× concentration of hemoglobin (4×Hb) as a cancerous breast cells, then scanned by single slice CT (GE, Hi Speed) 120 kVp, 100 mA for the determination of linear attenuation coefficient (μL ). RESULTS The CT numbers were for water (-7 to +7 HU), Hb (22±6 HU) and 4×Hb (80±4 HU). The difference between Hb and 4×Hb was significant (p <0.000). Minimum μL was 0.1190±0.00680 cm-1 for fat and maximum was 0.1449±0.00794 cm-1 for 4×Hb. CONCLUSION The study of CT number and linear attenuation coefficient of different concentration of Hb provides a possibility for early predicting of breast cancerous cells existence (4×Hb).
Collapse
Affiliation(s)
- Mehnati P
- PhD, Department of Medical Physics, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Jafari Tirtash M
- MSc Student, Department of Medical Physics, School of Medicine Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ghavami M
- MD, Department of Radiology, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| |
Collapse
|
10
|
Koedwut S, Kaewlai R, Sudsang T, Kiranantawat K, Wongwaisayawan S. Clear Sinus Sign on Head CT Scan: Reliable Criterion to Exclude Paranasal Sinus Fracture. J Oral Maxillofac Surg 2020; 78:996.e1-996.e6. [PMID: 32035837 DOI: 10.1016/j.joms.2020.01.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 01/06/2020] [Accepted: 01/07/2020] [Indexed: 11/18/2022]
Abstract
PURPOSE The clear sinus sign has been described in facial computed tomography (CT) as an indication of the absence of fluid in the paranasal sinuses. It is a highly reliable criterion to exclude fracture involving the paranasal sinus wall. Very scarce data on this sign on head CT scan is currently available. We conducted the present study to assess the usefulness of the clear sinus sign on head CT scan to exclude paranasal sinus fracture. MATERIALS AND METHODS A retrospective cross-sectional review of the medical records and head and facial CT images was performed for 80 trauma patients with a total of 640 paranasal sinuses. The presence and absence of paranasal sinus fracture was recorded and analyzed. RESULTS The clear sinus sign was found in 207 paranasal sinuses (32.3%) on head CT, and none of these had a paranasal sinus fracture (P < .001). CONCLUSIONS The presence of the clear sinus sign on head CT scans is an excellent indication for exclusion of a paranasal sinus fracture in trauma patients.
Collapse
Affiliation(s)
- Suwalai Koedwut
- Resident, Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Rathachai Kaewlai
- Lecturer, Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Thanwa Sudsang
- Lecturer, Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Kidakorn Kiranantawat
- Lecturer, Division of Plastic and Maxillofacial Surgery, Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Sirote Wongwaisayawan
- Lecturer, Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
| |
Collapse
|
11
|
Heimer J, Gascho D, Tappero C, Thali MJ, Zoelch N. Noninvasive analysis and identification of an intramuscular fluid collection by postmortem 1H-MRS in a case of a fatal motor vehicle accident. Int J Legal Med 2019; 134:1167-1174. [PMID: 31713679 DOI: 10.1007/s00414-019-02190-2] [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: 05/06/2019] [Accepted: 10/17/2019] [Indexed: 10/25/2022]
Abstract
In a case of a fatal traffic accident, a suspicious finding was identified in the muscular tissue of the left thigh by whole-body postmortem computed tomography. To better interpret the finding, the lower extremities were investigated by magnetic resonance imaging (MRI) and proton magnetic resonance spectroscopy (1H-MRS). MRI revealed the presence of an evenly distributed intramuscular fluid and 1H-MRS of a volume within the fluid detected concentrations of acetate and lactate. The fluid was assumed to be an extravasation of an intraosseous infusion, erroneously administered to the intermediate vastus of the left thigh during resuscitation, which was later confirmed when access to resuscitation protocols was granted. Further ex situ 1H-MRS investigations of five different infusion fluids showed the possible discrimination of the fluids and further indicated the unknown fluid to be a Ringer's acetate solution. This paper presents the case-based application of postmortem intramuscular 1H-MRS and introduces the possibility of its use to differentiate exo- and endogenic fluids for forensic interpretation. Further research for this method regarding problems in forensic pathology is needed.
Collapse
Affiliation(s)
- Jakob Heimer
- Institute of Forensic Medicine, Department of Forensic Medicine and Imaging, University of Zurich, Zurich, Switzerland.
| | - Dominic Gascho
- Institute of Forensic Medicine, Department of Forensic Medicine and Imaging, University of Zurich, Zurich, Switzerland
| | - Carlo Tappero
- Institute of Forensic Medicine, Department of Forensic Medicine and Imaging, University of Zurich, Zurich, Switzerland.,Department of Radiology, Hôpital Fribourgeois, Fribourg, Switzerland
| | - Michael J Thali
- Institute of Forensic Medicine, Department of Forensic Medicine and Imaging, University of Zurich, Zurich, Switzerland
| | - Niklaus Zoelch
- Institute of Forensic Medicine, Department of Forensic Medicine and Imaging, University of Zurich, Zurich, Switzerland.,Hospital of Psychiatry, Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland
| |
Collapse
|
12
|
Iliopsoas Mass, Hydroureter, and Back Squats: Using Biomechanics and Diagnostic Persistence to Diagnose a Germ Cell Tumor. Ochsner J 2019; 19:152-156. [PMID: 31258427 DOI: 10.31486/toj.18.0024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background: Lesions in the iliopsoas compartment carry a broad differential diagnosis, including infection, tumor, or hematoma, and less commonly, retroperitoneal fibrosis, atrophy secondary to paralysis or muscle disease, foreign body, calcifications secondary to trauma, or rhabdomyolysis. Iliopsoas lesions are oftentimes accompanied by nonspecific symptoms, resulting in a delayed diagnosis. Case Report: We present the case of a 43-year-old male with acute radiating groin pain who was found to have a traumatic iliopsoas hemorrhagic lesion causing ureteral compression and ureteral dilatation, all presumably originating from a new-onset weight-training program. The patient had a drain placed for fluid removal and decompression, with the initial pathologic specimen confirming muscle fibers and an inflammatory process. Further patient symptomology with combined imaging and pathologic persistence yielded a diagnosis of a germ cell tumor. Conclusion: The importance of a plausible differential diagnosis combined with clinical diagnostic persistence must be stressed to all clinicians. Our patient's unrelenting inguinal pain led to a justified repeat psoas mass biopsy, imaging, and laboratory workup that led to a diagnosis of psoas germ cell tumor and immediate chemotherapy plan.
Collapse
|
13
|
Post-mortem computed tomography (PMCT) radiological findings and assessment in advanced decomposed bodies. Radiol Med 2019; 124:1018-1027. [PMID: 31254219 DOI: 10.1007/s11547-019-01052-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Accepted: 06/18/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE The aim of the study is to report radiological findings and features in advanced decomposed bodies obtained by post-mortem computed tomography (PMCT) with autopsy correlation. MATERIALS AND METHODS This retrospective descriptive multicentric study included 41 forensic cases examined between May 2013 and November 2016. All the bodies were PMCT-scanned prior to autopsy, and internal putrefactive state was determined using the radiological alteration index (RAI) by a radiologist with expertise in forensic radiology and a forensic pathologist trained in forensic imaging. After PMCT scans, grade of external putrefaction (GEP) was assigned during the external examination and the complete autopsy was performed by forensic pathologists. RESULTS The PMCT images evaluation revealed that the RAI index was > 61 in all bodies, corresponding to a moderate-massive presence of putrefactive gas. The gas grade was > II in correspondence of the major vessels, heart cavities, liver parenchyma, vertebra L3 and subcutaneous pectoral tissues, and varied from I to III in correspondence of the kidney. Cadaveric external examination revealed the presence of advanced transformative phenomena, with a GEP3 and GEP4 in most of the cases, with body swelling, eyes and tongue protrusion, body fluids expulsion and fat liquefaction. CONCLUSION Radiological imaging by PMCT as an adjunct to autopsy in advanced decomposed bodies represents a useful tool in detecting post-mortem gas, even in very small amounts. A correct interpretation process of the PMCT data is essential to avoid images pitfalls, due to natural decomposition that can be mistaken for pathologic processes.
Collapse
|
14
|
Tisch C, Brencicova E, Schwendener N, Lombardo P, Jackowski C, Zech WD. Hounsfield unit values of liver pathologies in unenhanced post-mortem computed tomography. Int J Legal Med 2019; 133:1861-1867. [DOI: 10.1007/s00414-019-02016-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 02/01/2019] [Indexed: 12/11/2022]
|
15
|
Kim H, Kim YT, Song ES, Yoon BC, Choi YH, Kim K, Kim DJ. Changes in the gray and white matter of patients with ischemic-edematous insults after traumatic brain injury. J Neurosurg 2018; 131:1243-1253. [PMID: 30485242 DOI: 10.3171/2018.5.jns172711] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 05/10/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Gray matter (GM) and white matter (WM) are vulnerable to ischemic-edematous insults after traumatic brain injury (TBI). The extent of secondary insult after brain injury is quantifiable using quantitative CT analysis. One conventional quantitative CT measure, the gray-white matter ratio (GWR), and a more recently proposed densitometric analysis are used to assess the extent of these insults. However, the prognostic capacity of the GWR in patients with TBI has not yet been validated. This study aims to test the prognostic value of the GWR and evaluate the alternative parameters derived from the densitometric analysis acquired during the acute phase of TBI. In addition, the prognostic ability of the conventional TBI prognostic models (i.e., IMPACT [International Mission for Prognosis and Analysis of Clinical Trials in TBI] and CRASH [Corticosteroid Randomisation After Significant Head Injury] models) were compared to that of the quantitative CT measures. METHODS Three hundred patients with TBI of varying ages (92 pediatric, 94 adult, and 114 geriatric patients) and admitted between 2008 and 2013 were included in this retrospective cohort study. The normality of the density of the deep GM and whole WM was evaluated as the proportion of CT pixels with Hounsfield unit values of 31-35 for GM and 26-30 for WM on CT images of the entire supratentorial brain. The outcome was evaluated using the Glasgow Outcome Scale (GOS) at discharge (GOS score ≤ 3, n = 100). RESULTS Lower proportions of normal densities in the deep GM and whole WM indicated worse outcomes. The proportion of normal WM exhibited a significant prognostic capacity (area under the curve [AUC] = 0.844). The association between the outcome and the normality of the WM density was significant in adult (AUC = 0.792), pediatric (AUC = 0.814), and geriatric (AUC = 0.885) patients. In pediatric patients, the normality of the overall density and the density of the GM were indicative of the outcome (AUC = 0.751). The average GWR was not associated with the outcome (AUC = 0.511). IMPACT and CRASH models showed adequate and reliable performance in the pediatric and geriatric groups but not in the adult group. The highest overall predictive performance was achieved by the densitometry-augmented IMPACT model (AUC = 0.881). CONCLUSIONS Both deep GM and WM are susceptible to ischemic-edematous insults during the early phase of TBI. The extent of the secondary injury was better evaluated by analyzing the normality of the deep GM and WM rather than by calculating the GWR.
Collapse
Affiliation(s)
- Hakseung Kim
- 1Department of Brain and Cognitive Engineering, Korea University, Seongbuk-gu, Seoul, South Korea
| | - Young-Tak Kim
- 1Department of Brain and Cognitive Engineering, Korea University, Seongbuk-gu, Seoul, South Korea
| | - Eun-Suk Song
- 1Department of Brain and Cognitive Engineering, Korea University, Seongbuk-gu, Seoul, South Korea
| | - Byung C Yoon
- 2Department of Radiology, Stanford University School of Medicine, Stanford, California; and
| | | | - Keewon Kim
- 4Rehabilitation, Seoul National University Hospital, College of Medicine, Jongno-gu, Seoul, South Korea
| | - Dong-Joo Kim
- 1Department of Brain and Cognitive Engineering, Korea University, Seongbuk-gu, Seoul, South Korea
| |
Collapse
|
16
|
|
17
|
Lacoste Jeanson A, Dupej J, Villa C, Brůžek J. Body composition estimation from selected slices: equations computed from a new semi-automatic thresholding method developed on whole-body CT scans. PeerJ 2017; 5:e3302. [PMID: 28533960 PMCID: PMC5438582 DOI: 10.7717/peerj.3302] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 04/12/2017] [Indexed: 12/12/2022] Open
Abstract
Background Estimating volumes and masses of total body components is important for the study and treatment monitoring of nutrition and nutrition-related disorders, cancer, joint replacement, energy-expenditure and exercise physiology. While several equations have been offered for estimating total body components from MRI slices, no reliable and tested method exists for CT scans. For the first time, body composition data was derived from 41 high-resolution whole-body CT scans. From these data, we defined equations for estimating volumes and masses of total body AT and LT from corresponding tissue areas measured in selected CT scan slices. Methods We present a new semi-automatic approach to defining the density cutoff between adipose tissue (AT) and lean tissue (LT) in such material. An intra-class correlation coefficient (ICC) was used to validate the method. The equations for estimating the whole-body composition volume and mass from areas measured in selected slices were modeled with ordinary least squares (OLS) linear regressions and support vector machine regression (SVMR). Results and Discussion The best predictive equation for total body AT volume was based on the AT area of a single slice located between the 4th and 5th lumbar vertebrae (L4-L5) and produced lower prediction errors (|PE| = 1.86 liters, %PE = 8.77) than previous equations also based on CT scans. The LT area of the mid-thigh provided the lowest prediction errors (|PE| = 2.52 liters, %PE = 7.08) for estimating whole-body LT volume. We also present equations to predict total body AT and LT masses from a slice located at L4-L5 that resulted in reduced error compared with the previously published equations based on CT scans. The multislice SVMR predictor gave the theoretical upper limit for prediction precision of volumes and cross-validated the results.
Collapse
Affiliation(s)
- Alizé Lacoste Jeanson
- Faculty of Natural Sciences, Department of Anthropology and Human Genetics, Charles University, Prague, Czech Republic
| | - Ján Dupej
- Faculty of Natural Sciences, Department of Anthropology and Human Genetics, Charles University, Prague, Czech Republic.,Faculty of Mathematics and Physics, Department of Software and Computer Science Education, Charles University, Prague, Czech Republic
| | - Chiara Villa
- Department of Forensic Medicine, Unit of Forensic Anthropology, University of Copenhagen, Copenhagen, Denmark
| | - Jaroslav Brůžek
- Faculty of Natural Sciences, Department of Anthropology and Human Genetics, Charles University, Prague, Czech Republic.,PACEA, UMR 5199, CNRS, Université de Bordeaux, Bordeaux, France
| |
Collapse
|
18
|
Torimitsu S, Makino Y, Saitoh H, Sakuma A, Ishii N, Yajima D, Inokuchi G, Motomura A, Chiba F, Yamaguchi R, Hashimoto M, Hoshioka Y, Iwase H. Stature estimation in a contemporary Japanese population based on clavicular measurements using multidetector computed tomography. Forensic Sci Int 2017; 275:316.e1-316.e6. [PMID: 28343812 DOI: 10.1016/j.forsciint.2017.02.037] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 01/28/2017] [Accepted: 02/28/2017] [Indexed: 11/26/2022]
Abstract
The aims of this study was to assess the correlation between stature and clavicular measurements in a contemporary Japanese population using three-dimensional (3D) computed tomographic (CT) images, and to establish regression equations for predicting stature. A total of 249 cadavers (131 males, 118 females) underwent postmortem CT scanning and subsequent forensic autopsy between October 2011 and May 2016 in our department. Four clavicular variables (linear distances between the superior margins of the left and right sternal facets to the anterior points of the left and right acromial ends and between the superior margins of the left and right sternal facets to the left and right conoid tubercles) were measured using 3D CT reconstructed images that extracted only bone data. The correlations between stature and each of the clavicular measurements were assessed with Pearson product-moment correlation coefficients. These clavicular measurements correlated significantly with stature in both sexes. The lowest standard error of estimation value in all, male, and female subjects was 3.62cm (r2=0.836), 3.55cm (r2=0.566), and 3.43cm (r2=0.663), respectively. In conclusion, clavicular measurements obtained from 3D CT images may be useful for stature estimation of Japanese individuals, particularly in cases where better predictors, such as long bones, are not available.
Collapse
Affiliation(s)
- Suguru Torimitsu
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan; Chiba University Center for Education and Research in Legal Medicine, 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; Chiba University Center for Education and Research in Legal Medicine, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan.
| | - Hisako Saitoh
- Chiba University Center for Education and Research in Legal Medicine, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan.
| | - Ayaka Sakuma
- Chiba University Center for Education and Research in Legal Medicine, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan.
| | - Namiko Ishii
- Chiba University Center for Education and Research in Legal Medicine, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan.
| | - Daisuke Yajima
- Chiba University Center for Education and Research in Legal Medicine, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan.
| | - Go Inokuchi
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan; Chiba University Center for Education and Research in Legal Medicine, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan.
| | - Ayumi Motomura
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan; Chiba University Center for Education and Research in Legal Medicine, 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; Chiba University Center for Education and Research in Legal Medicine, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan.
| | - Rutsuko Yamaguchi
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan; Chiba University Center for Education and Research in Legal Medicine, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan.
| | - Mari Hashimoto
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan; Chiba University Center for Education and Research in Legal Medicine, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan.
| | - Yumi Hoshioka
- Chiba University Center for Education and Research in Legal Medicine, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, 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; Chiba University Center for Education and Research in Legal Medicine, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan.
| |
Collapse
|
19
|
Scaparra E, Peschel O, Kirchhoff C, Reiser M, Kirchhoff SM. Detection of blood aspiration in deadly head gunshots comparing postmortem computed tomography (PMCT) and autopsy. Eur J Med Res 2016; 21:43. [PMID: 27802829 PMCID: PMC5090890 DOI: 10.1186/s40001-016-0237-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 10/17/2016] [Indexed: 11/30/2022] Open
Abstract
Background The aim of our study was to analyze the reliability of postmortem computed tomography (PMCT) versus autopsy in detecting signs of blood aspiration in a distinct group of patients following deadly head, mouth or floor of mouth gunshot injuries. Methods In this study, in 41 cases PMCT was compared to autopsy reports, the gold standard of postmortem exams, regarding detection of blood aspiration. PMCT was evaluated for the presence and level of typical signs of blood aspiration in the major airways and lung using a semi-quantitative scale ranging from level 0 (no aspiration) to 3 (significant aspiration) also taking density values of the described potential aspiratory changes into account. Results Overall, in 29 (70.7%) of 41 enrolled cases PMCT and autopsy revealed the same level of aspiration. A difference of one level between PMCT and autopsy resulted for 5 (12.2%) of the remaining 12 cases. More than one level difference between both methods resulted for 7 cases (17.2%). Autopsy described no signs of aspiration in 10 cases, compared to 31 cases with reported blood aspiration. In contrast, PMCT revealed no signs of blood aspiration in 15 cases whereas 26 cases were rated as positive for signs of aspiration in the major airways. In 18 of these 26 cases considered positive for blood aspiration by autopsy and PMCT, clear signs of aspiration signs were also described bilaterally by both methods. Conclusions The presented study provides evidence for the assumption that PMCT seems to be helpful in the detection of blood aspiration in cases of deadly head gunshots. In conclusion, it seems reasonable to suggest performing PMCT additionally to traditional postmortem exams in cases of suspected aspiration to rule out false-negative cases and to possibly allow for a more detailed and rather evidence based examination reconnoitering the cause of death. However, the adequate use of PMCT in this context needs further evaluation and the definition of an objective scale for aspiration detection on PMCT needs to be established in future studies.
Collapse
Affiliation(s)
- E Scaparra
- Ludwig-Maximilians-University Munich, Munich, Germany
| | - O Peschel
- Institute of Forensic Medicine, Ludwig Maximilians University, Nussbaumstrasse 11, 80336, Munich, Germany
| | - C Kirchhoff
- Department of Trauma Surgery, Klinikum Rechts der Isar, Technische Universität München, Ismaninger Strasse 22, 81675, Munich, Germany
| | - M Reiser
- Institute of Clinical Radiology, Ludwig Maximilians University Munich, Klinikum Großhadern, Marchioninistrasse 15, 81377, Munich, Germany
| | - S M Kirchhoff
- Institute of Clinical Radiology, Ludwig Maximilians University Munich, Klinikum Großhadern, Marchioninistrasse 15, 81377, Munich, Germany.
| |
Collapse
|
20
|
Schober D, Schwendener N, Zech WD, Jackowski C. Post-mortem CT: Hounsfield unit profiles obtained in the lungs with respect to the cause of death assessment. Int J Legal Med 2016; 131:199-210. [PMID: 27766411 DOI: 10.1007/s00414-016-1454-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 09/15/2016] [Indexed: 11/26/2022]
Abstract
Segmentation of the lungs using post-mortem computed tomography (PMCT) data was so far not feasible due to post-mortem changes such as internal livores. Recently, an Osirix plug-in has been developed allowing automatically segmenting lungs also in PMCT data. The aim of this study was to investigate if the Hounsfield unit (HU) profiles obtained in PMCT data of the segmented lung tissue present with specific behaviour in relation to the cause of death. In 105 PMCT data sets of forensic cases, the entire lung volumes were segmented using the Mia Lite plug-in on Osirix. HU profiles of the lungs were generated and correlated to cause of death groups as assessed after forensic autopsy (cardiac death, fatal haemorrhage, craniocerebral injury, intoxication, drowning, hypothermia, hanging and suffocation). Especially cardiac death cases, intoxication cases, fatal haemorrhage cases and hypothermia cases showed very specific HU profiles. In drowning, the profiles showed two different behaviours representing wet and dry drowning. HU profiles rather varied in craniocerebral injury cases, hanging cases as well as in suffocation cases. HU profiles of the lungs segmented from PMCT data may support the cause of death diagnosis as they represent specific morphological changes in the lungs such as oedema, congestion or blood loss. Especially in cardiac death, intoxication, fatal haemorrhage, hypothermia and drowning cases, HU profiles may be very supportive for the forensic pathologist.
Collapse
Affiliation(s)
- Daniel Schober
- Institute of Forensic Medicine, University of Bern, Bühlstr. 20, CH-3012, Bern, Switzerland
| | - Nicole Schwendener
- Institute of Forensic Medicine, University of Bern, Bühlstr. 20, CH-3012, Bern, Switzerland
| | - Wolf-Dieter Zech
- Institute of Forensic Medicine, University of Bern, Bühlstr. 20, CH-3012, Bern, Switzerland
| | - Christian Jackowski
- Institute of Forensic Medicine, University of Bern, Bühlstr. 20, CH-3012, Bern, Switzerland.
| |
Collapse
|
21
|
Papilledema as a Diagnostic Sign of Cerebral Edema on Postmortem Magnetic Resonance Imaging. Am J Forensic Med Pathol 2016; 37:264-269. [PMID: 27571174 DOI: 10.1097/paf.0000000000000265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The purpose of this study was to investigate papilledema (PA) as a diagnostic criterion for the presence of antemortem or agonal cerebral edema despite normal postmortem brain swelling on postmortem magnetic resonance imaging (PMMR) in comparison with conventional autopsy.One hundred subjects with head PMMR and autopsy were included in this study. The sensitivities, spec icities, positive predictive values (PPVs), negative predictive values (NPVs), and accuracies were calculated in terms of the PA, PMMR, and cerebral edema on autopsy. Spearman r tests were used to analyze the linear correlations of PA and the radiological and autoptic determination of cerebral edema.In autopsy, the sensitivity regarding the presence of PA and cerebral edema was 66.2% (PPV, 70.5%), and specificity was 48.6% (NPV, 28.3%), with an overall accuracy of 60%. On PMMR, the sensitivity was 86.6% (PPV, 95%). The specificity was 90.9% (NPV, 34%), with an overall accuracy of 88%. The Spearman correlation revealed a statistically significant result (P < 0.001), which indicated a strong linear correlation of the presence of PA and cerebral edema with the autopsy results and the PMMR results.The presence of PA may aid in the diagnoses of cerebral edema despite normal postmortem brain swelling based on PMMR.
Collapse
|
22
|
Post-mortem CT and MR brain imaging of putrefied corpses. Int J Legal Med 2016; 130:1061-1068. [DOI: 10.1007/s00414-016-1385-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 05/03/2016] [Indexed: 10/21/2022]
|
23
|
The radiodensity of cerebrospinal fluid and vitreous humor as indicator of the time since death. Forensic Sci Med Pathol 2016; 12:248-56. [PMID: 27117292 PMCID: PMC4967095 DOI: 10.1007/s12024-016-9778-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2016] [Indexed: 11/21/2022]
Abstract
Purpose After death, a series of changes occur naturally in the human body in a fairly regular pattern. These postmortem changes are detectable on postmortem CT scans (PMCT) and may be useful in estimating the postmortem interval (PMI). The purpose of our study is to correlate the PMCT radiodensities of the cerebrospinal fluid (CSF) and vitreous humor (VH) to the PMI. Methods Three patient groups were included: group A consisted of 5 donated cadavers, group B, 100 in-hospital deceased patients, and group C, 12 out-of-hospital forensic cadavers. Group A were scanned every hour for a maximum of 36 h postmortem, and the tympanic temperature was measured prior to each scan. Groups B and C were scanned once after death (PMI range 0.2–63.8 h). Radiodensities of the VH and CSF were measured in Hounsfield units. Correlation between density and PMI was determined using linear regression and the influence of temperature was assessed by a multivariate regression model. Results from group A were validated in groups B and C. Results Group A showed increasing radiodensity of the CSF and VH over time (r2 CSF, 0.65). PMI overruled the influence of temperature (r = 0.99 and p = 0.000). Groups B and C showed more diversity, with CSF and VH radiodensities below the mean regression line of Group A. The formula of this upper limit indicated the maximum PMI and was correct for >95 % of the cadavers. Conclusion The results of group A showed a significant correlation between CSF radiodensity and PMI. The radiodensities in groups B and C were higher than in group A, therefore the maximum PMI can be estimated with the upper 95 % confidence interval of the correlation line of group A.
Collapse
|
24
|
Bolliger SA, Thali MJ. Imaging and virtual autopsy: looking back and forward. Philos Trans R Soc Lond B Biol Sci 2016; 370:rstb.2014.0253. [PMID: 26101279 DOI: 10.1098/rstb.2014.0253] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
In order to create a three-dimensional (3D) documentation of findings which can be reassessed if necessary by other experts, the research project 'Virtopsy®' was launched in the late 1990s. This project combined autopsy results with forensic imaging in the form of computed tomography, magnetic resonance tomography and 3D surface scanning. The success of this project eventually succeeded in convincing the courts in Switzerland to accept these novel methods as evidence. As opposition towards autopsies has grown over the last decades, Virtopsy also strives to find and elaborate additional methods which can answer the main forensic questions without autopsy. These methods comprise post-mortem angiography for illustration of the vascular bed and image-guided tissue and fluid sampling for histological, toxicological and microbiological examinations. Based on the promising results, post-mortem imaging, especially with 3D surface scanning, has meanwhile also been applied to living victims of assault, who have suffered patterned injuries due to bites, blows with objects, etc. In our opinion, forensic imaging is an objective method which offers the possibility for a reassessment of the findings by other experts, even after burial or cremation of the corpse, or healing of the injuries in living victims, thus leading to a greater security in court.
Collapse
Affiliation(s)
- Stephan A Bolliger
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Wintherthurerstrasse 190/52, Zurich 8057, Switzerland
| | - Michael J Thali
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Wintherthurerstrasse 190/52, Zurich 8057, Switzerland
| |
Collapse
|
25
|
Body height estimation from post-mortem CT femoral F1 measurements in a contemporary Swiss population. Leg Med (Tokyo) 2016; 19:61-6. [DOI: 10.1016/j.legalmed.2016.02.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2015] [Revised: 02/15/2016] [Accepted: 02/16/2016] [Indexed: 11/17/2022]
|
26
|
Andrews SW. Postmortem Changes as Documented in Postmortem Computed Tomography Scans. Acad Forensic Pathol 2016; 6:63-76. [PMID: 31239873 DOI: 10.23907/2016.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 01/31/2016] [Accepted: 02/16/2016] [Indexed: 11/12/2022]
Abstract
The benefits and uses of postmortem computed tomography (PMCT) have been well documented in the forensic pathology and radiology literature in recent years and research into its utility continue in earnest. Opinions and policies regarding who actually interprets the PMCT scans vary between institutions, but in general, scans will be read by a forensic pathologist, a clinical radiologist, or a clinical radiologist with a special interest or training in postmortem imaging. Differences between clinical computed tomography scans and PMCT scans have been well documented and knowledge of these differences, typically those due to postmortem changes, is essential to the reader of the PMCT scan so as to minimize the risk of misinterpretation and, potentially, misdiagnoses.
Collapse
|
27
|
Comparison of volume and attenuation of the spleen between postmortem and antemortem computed tomography. Int J Legal Med 2016; 130:1081-1087. [PMID: 26914802 DOI: 10.1007/s00414-016-1337-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2015] [Accepted: 02/12/2016] [Indexed: 12/13/2022]
Abstract
OBJECTIVES The purpose of this study is to compare the postmortem changes in computed tomography (CT) findings between normal spleen, splenic infarct, and splenic tumor infiltration. METHODS The institutional review board approved this study, and informed consent was obtained from the next of kin. We studied 63 consecutive subjects who underwent antemortem CT, postmortem CT, and autopsy between February 2012 and December 2013. Postmortem CT was performed within 1678 min after death and was followed by pathological studies. The subjects were divided into three groups based on the pathological findings: normal, splenic infarct, and splenic tumor infiltration. The volume and attenuation of the spleen were compared between antemortem and postmortem CT using paired t tests. Gender, age, time elapsed since death, and the causes of death were examined as potential confounding factors of the postmortem changes in volume and attenuation. RESULTS In all groups, the spleen decreased in volume and attenuation increased on postmortem CT compared with antemortem CT. The postmortem changes in spleen volume and attenuation were not significantly associated with sex, age, time elapsed since death, or causes of death. CONCLUSIONS Spleen volume decreased and attenuation increased on postmortem CT compared with antemortem CT in subjects with a normal spleen, splenic infarct, or splenic tumor infiltration. These results should caution us against underestimating the significance of splenomegaly on postmortem CT, misinterpreting reduced splenic volume as the presence of hypovolemic or distributive shock in the subject while alive, and confusing postmortem splenic hyperattenuation with diseases characterized by this finding.
Collapse
|
28
|
Athanasiou L, Rigas G, Sakellarios AI, Exarchos TP, Siogkas PK, Bourantas CV, Garcia-Garcia HM, Lemos PA, Falcao BA, Michalis LK, Parodi O, Vozzi F, Fotiadis DI. Three-dimensional reconstruction of coronary arteries and plaque morphology using CT angiography--comparison and registration with IVUS. BMC Med Imaging 2016; 16:9. [PMID: 26785613 PMCID: PMC4719213 DOI: 10.1186/s12880-016-0111-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 01/13/2016] [Indexed: 12/02/2022] Open
Abstract
Background The aim of this study is to present a new methodology for three-dimensional (3D) reconstruction of coronary arteries and plaque morphology using Computed Tomography Angiography (CTA). Methods The methodology is summarized in six stages: 1) pre-processing of the initial raw images, 2) rough estimation of the lumen and outer vessel wall borders and approximation of the vessel’s centerline, 3) manual adaptation of plaque parameters, 4) accurate extraction of the luminal centerline, 5) detection of the lumen - outer vessel wall borders and calcium plaque region, and 6) finally 3D surface construction. Results The methodology was compared to the estimations of a recently presented Intravascular Ultrasound (IVUS) plaque characterization method. The correlation coefficients for calcium volume, surface area, length and angle vessel were 0.79, 0.86, 0.95 and 0.88, respectively. Additionally, when comparing the inner and outer vessel wall volumes of the reconstructed arteries produced by IVUS and CTA the observed correlation was 0.87 and 0.83, respectively. Conclusions The results indicated that the proposed methodology is fast and accurate and thus it is likely in the future to have applications in research and clinical arena.
Collapse
Affiliation(s)
- Lambros Athanasiou
- Unit of Medical Technology and Intelligent Information Systems, Department of Materials Science and Engineering, University of Ioannina, PO Box 1186, GR 45110, Ioannina, Greece
| | - George Rigas
- Unit of Medical Technology and Intelligent Information Systems, Department of Materials Science and Engineering, University of Ioannina, PO Box 1186, GR 45110, Ioannina, Greece
| | - Antonis I Sakellarios
- Unit of Medical Technology and Intelligent Information Systems, Department of Materials Science and Engineering, University of Ioannina, PO Box 1186, GR 45110, Ioannina, Greece
| | - Themis P Exarchos
- Unit of Medical Technology and Intelligent Information Systems, Department of Materials Science and Engineering, University of Ioannina, PO Box 1186, GR 45110, Ioannina, Greece.,FORTH-Institute of Molecular Biology and Biotechnology, Department of Biomedical Research, GR 45110, Ioannina, Greece
| | - Panagiotis K Siogkas
- Unit of Medical Technology and Intelligent Information Systems, Department of Materials Science and Engineering, University of Ioannina, PO Box 1186, GR 45110, Ioannina, Greece
| | - Christos V Bourantas
- Department of Cardiology, Barts Heart Centre, London, UK.,Department of Cardiovascular Science, University College London, London, UK
| | - Hector M Garcia-Garcia
- Department of Interventional Cardiology, Erasmus University Medical Centre, Thoraxcenter, Rotterdam, The Netherlands
| | - Pedro A Lemos
- Department of Interventional Cardiology, Heart Institute, University of São Paulo, Medical School, São Paulo, Brazil
| | - Breno A Falcao
- Department of Interventional Cardiology, Heart Institute, University of São Paulo, Medical School, São Paulo, Brazil
| | - Lampros K Michalis
- Michaelidion Cardiac Center and Department of Cardiology, Medical School, University of Ioannina, GR 45110, Ioannina, Greece
| | - Oberdan Parodi
- Michaelidion Cardiac Center and Department of Cardiology, Medical School, University of Ioannina, GR 45110, Ioannina, Greece
| | - Federico Vozzi
- Institute of Clinical Physiology, National Research Council, Pisa, IT 56124, Italy
| | - Dimitrios I Fotiadis
- Unit of Medical Technology and Intelligent Information Systems, Department of Materials Science and Engineering, University of Ioannina, PO Box 1186, GR 45110, Ioannina, Greece. .,FORTH-Institute of Molecular Biology and Biotechnology, Department of Biomedical Research, GR 45110, Ioannina, Greece. .,Michaelidion Cardiac Center and Department of Cardiology, Medical School, University of Ioannina, GR 45110, Ioannina, Greece.
| |
Collapse
|
29
|
The importance of post-mortem computed tomography (PMCT) in confrontation with conventional forensic autopsy of victims of motorcycle accidents. Leg Med (Tokyo) 2016; 18:25-30. [DOI: 10.1016/j.legalmed.2015.11.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Revised: 11/22/2015] [Accepted: 11/23/2015] [Indexed: 11/24/2022]
|
30
|
Zech WD, Jackowski C, Schwendener N, Brencicova E, Schuster F, Lombardo P. Postmortem CT versus forensic autopsy: frequent discrepancies of tracheobronchial content findings. Int J Legal Med 2015; 130:191-8. [PMID: 26400026 DOI: 10.1007/s00414-015-1264-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 09/09/2015] [Indexed: 12/16/2022]
Abstract
In their daily forensic casework, the authors experienced discrepancies of tracheobronchial content findings between postmortem computed tomography (PMCT) and autopsy to an extent previously unnoticed in the literature. The goal of this study was to evaluate such discrepancies in routine forensic cases. A total of 327 cases that underwent PMCT prior to routine forensic autopsy were retrospectively evaluated for tracheal and bronchial contents according to PMCT and autopsy findings. Hounsfield unit (HU) values of tracheobronchial contents, causes of death, and presence of pulmonary edema were assessed in mismatching and matching cases. Comparing contents in PMCT and autopsy in each of the separately evaluated compartments of the respiratory tract low positive predictive values were assessed (trachea, 38.2%; main bronchi, 40%; peripheral bronchi, 69.1%) indicating high discrepancy rates. The majority of tracheobronchial contents were viscous stomach contents in matching cases and low radiodensity materials (i.e., HU < 30) in mismatching cases. The majority of causes of death were cardiac related in the matching cases and skull/brain trauma in the mismatching cases. In mismatching cases, frequency of pulmonary edema was significantly higher than in matching cases. It can be concluded that discrepancies in tracheobronchial contents observed between PMCT and routine forensic autopsy occur in a considerable number of cases. Discrepancies may be explained by the runoff of contents via nose and mouth during external examination and the flow back of tracheal and main bronchial contents into the lungs caused by upright movement of the respiratory tract at autopsy.
Collapse
Affiliation(s)
- Wolf-Dieter Zech
- Institute of Forensic Medicine, University of Bern, Buehlstrasse 20, 3012, Bern, Switzerland.
| | - Christian Jackowski
- Institute of Forensic Medicine, University of Bern, Buehlstrasse 20, 3012, Bern, Switzerland
| | - Nicole Schwendener
- Institute of Forensic Medicine, University of Bern, Buehlstrasse 20, 3012, Bern, Switzerland
| | - Eva Brencicova
- Institute of Forensic Medicine, University of Bern, Buehlstrasse 20, 3012, Bern, Switzerland
| | - Frederick Schuster
- Institute of Forensic Medicine, University of Bern, Buehlstrasse 20, 3012, Bern, Switzerland.,Department of Diagnostic, Interventional and Pediatric Radiology, University of Bern, Inselspital, Freiburgstrasse 10, Bern, CH-3010, Switzerland
| | - Paolo Lombardo
- Institute of Forensic Medicine, University of Bern, Buehlstrasse 20, 3012, Bern, Switzerland.,Department of Diagnostic Imaging and Radiotherapy of the University of Turin, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Via Genova 3, 10126, Torino, Italy
| |
Collapse
|
31
|
Postmortem quantitative 1.5-T MRI for the differentiation and characterization of serous fluids, blood, CSF, and putrefied CSF. Int J Legal Med 2015; 129:1127-36. [DOI: 10.1007/s00414-015-1218-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 06/22/2015] [Indexed: 12/12/2022]
|
32
|
Abstract
The authors present the opportunities of the application of post-mortem imaging, focusing on post-mortem computed tomography and post-mortem computed tomography angiography in modern forensic investigation of homicide cases. The paper is based on scientific publications related to the subject from ca. the past 10 years, supplemented by the authors' own experiences. The article is illustrated with reconstructions based on the authors' own cases related to homicide due to ballistic/sharp/blunt trauma. As is shown, the results of evaluation of post-mortem computed tomography allow better diagnosis, documentation and visualisation of forensic examinations.
Collapse
|
33
|
Acute enlargement of subdural hygroma due to subdural hemorrhage in a victim of child abuse. Leg Med (Tokyo) 2014; 17:116-9. [PMID: 25457269 DOI: 10.1016/j.legalmed.2014.10.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2014] [Revised: 09/29/2014] [Accepted: 10/12/2014] [Indexed: 11/21/2022]
Abstract
An 11-month-old female baby was found dead by her mother. Cranial postmortem CT prior to the forensic autopsy showed dilatation of bilateral extra-axial spaces and ventricles. The autopsy revealed a new linear fracture of the left parietal bone and occipital bone, and a healed linear fracture of the right parietal bone and occipital bone like a mirror image of the left one as well. Intracranially, 230ml of subdural fluid were collected, which was mixed with blood. There was a fresh hemorrhage around a bridging vein of the left parietal lobe and the dura mater. Moreover, the outer side of the cerebrum and the inner side of the dura mater were covered by a thin membrane, which mater might have been previously formed because of being positive for Fe-staining and anti-CD68 antibody. A subdural hematoma might have been developed when the right side of the skull was previously fractured, which was transformed into a subdural hygroma. Subsequently, it is likely that, after the left side fracture of the skull occurred, the subdural hygroma rapidly enlarged due to hemorrhaging from the bridging vein, which resulted in intracranial hypertension, because microbleeding was detected in the brain stem. Accordingly, we diagnosed the cause and manner of death as intracranial hypertension due to subdural hemorrhage in subdural hygroma, and homicide, including child abuse, respectively.
Collapse
|