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Solomon N, Elifritz J, Adolphi NL, Decker SJ, Filograna L, Kroll JJF, Gascho D, Thali MJ, Gosangi B, Sanchez H, Revzin MV, Sinusas AJ. Postmortem CT: Applications in Clinical and Forensic Medicine. Radiographics 2025; 45:e240192. [PMID: 40372934 DOI: 10.1148/rg.240192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2025]
Abstract
Just as radiography has been used in forensic medicine since shortly after the discovery of x-rays in 1895, CT was introduced to postmortem investigation not long after its introduction to medicine in the 1970s. In recent decades, forensic radiology has declared itself as a new subspecialty capable of revolutionizing death investigation and research. A variety of postmortem imaging techniques have emerged. Postmortem CT (PMCT) is widely accepted around the world as a supplementary tool and, in specific cases and settings, an alternative to full autopsy. As its popularity grows, however, it is important for radiologists and pathologists to expand their understanding of the applications, benefits, and limitations of these techniques, as well as the unique nuances of postmortem imaging interpretation. This will ensure high-quality interpretations and avoid potential pitfalls that could result in premature or erroneous conclusions. The authors introduce the reader, particularly the radiologist, to the growing subspecialty of forensic imaging (focusing on imaging of the deceased), specifically focusing on PMCT and its applications in death investigation in both clinical and forensic settings. The authors also discuss the benefits and limitations of PMCT as well as important nuances of PMCT interpretation, emphasizing the similarities and differences between clinical and postmortem studies, the necessity of conducting thorough death investigations, and the importance of pursuing specialized education or training in postmortem imaging interpretation. Applications of more specialized imaging techniques to postmortem and forensic investigations are described, including developing research in this area. ©RSNA, 2025 Supplemental material is available for this article.
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Affiliation(s)
- Nadia Solomon
- From the Departments of Radiology and Biomedical Imaging (N.S., B.G., M.V.R.) and Pathology (H.S.), Yale University School of Medicine, 20 York St, New Haven, CT 06510; Investigative Medicine Program, Yale University Graduate School of Arts and Sciences, New Haven, Conn (N.S.); Yale Translational Research Imaging Center, Yale University School of Medicine, New Haven, Conn (N.S., A.J.S.); The Forensic Radiology Group, Anderson, SC (J.E.); Center for Forensic Imaging, Office of the Medical Investigator, University of New Mexico, Albuquerque, NM (J.E., N.L.A.); Center for Advanced Visualization Technologies in Medicine (VISTA), Keck School of Medicine, University of Southern California, Los Angeles, Calif (S.J.D.); Department of Radiological Sciences, Institute of Radiology, Catholic University of the Sacred Heart, Milan, Italy (L.F.); Eurofins The Maastricht Forensic Institute, Maastricht, the Netherlands (J.J.F.K.); Institute of Forensic Medicine Zurich, University of Zurich, Zurich, Switzerland (D.G., M.J.T.); and Department of Medicine, Section of Cardiology, Yale Translational Research Imaging Center, Yale University School of Medicine, New Haven, Conn (A.J.S.)
| | - Jamie Elifritz
- From the Departments of Radiology and Biomedical Imaging (N.S., B.G., M.V.R.) and Pathology (H.S.), Yale University School of Medicine, 20 York St, New Haven, CT 06510; Investigative Medicine Program, Yale University Graduate School of Arts and Sciences, New Haven, Conn (N.S.); Yale Translational Research Imaging Center, Yale University School of Medicine, New Haven, Conn (N.S., A.J.S.); The Forensic Radiology Group, Anderson, SC (J.E.); Center for Forensic Imaging, Office of the Medical Investigator, University of New Mexico, Albuquerque, NM (J.E., N.L.A.); Center for Advanced Visualization Technologies in Medicine (VISTA), Keck School of Medicine, University of Southern California, Los Angeles, Calif (S.J.D.); Department of Radiological Sciences, Institute of Radiology, Catholic University of the Sacred Heart, Milan, Italy (L.F.); Eurofins The Maastricht Forensic Institute, Maastricht, the Netherlands (J.J.F.K.); Institute of Forensic Medicine Zurich, University of Zurich, Zurich, Switzerland (D.G., M.J.T.); and Department of Medicine, Section of Cardiology, Yale Translational Research Imaging Center, Yale University School of Medicine, New Haven, Conn (A.J.S.)
| | - Natalie L Adolphi
- From the Departments of Radiology and Biomedical Imaging (N.S., B.G., M.V.R.) and Pathology (H.S.), Yale University School of Medicine, 20 York St, New Haven, CT 06510; Investigative Medicine Program, Yale University Graduate School of Arts and Sciences, New Haven, Conn (N.S.); Yale Translational Research Imaging Center, Yale University School of Medicine, New Haven, Conn (N.S., A.J.S.); The Forensic Radiology Group, Anderson, SC (J.E.); Center for Forensic Imaging, Office of the Medical Investigator, University of New Mexico, Albuquerque, NM (J.E., N.L.A.); Center for Advanced Visualization Technologies in Medicine (VISTA), Keck School of Medicine, University of Southern California, Los Angeles, Calif (S.J.D.); Department of Radiological Sciences, Institute of Radiology, Catholic University of the Sacred Heart, Milan, Italy (L.F.); Eurofins The Maastricht Forensic Institute, Maastricht, the Netherlands (J.J.F.K.); Institute of Forensic Medicine Zurich, University of Zurich, Zurich, Switzerland (D.G., M.J.T.); and Department of Medicine, Section of Cardiology, Yale Translational Research Imaging Center, Yale University School of Medicine, New Haven, Conn (A.J.S.)
| | - Summer J Decker
- From the Departments of Radiology and Biomedical Imaging (N.S., B.G., M.V.R.) and Pathology (H.S.), Yale University School of Medicine, 20 York St, New Haven, CT 06510; Investigative Medicine Program, Yale University Graduate School of Arts and Sciences, New Haven, Conn (N.S.); Yale Translational Research Imaging Center, Yale University School of Medicine, New Haven, Conn (N.S., A.J.S.); The Forensic Radiology Group, Anderson, SC (J.E.); Center for Forensic Imaging, Office of the Medical Investigator, University of New Mexico, Albuquerque, NM (J.E., N.L.A.); Center for Advanced Visualization Technologies in Medicine (VISTA), Keck School of Medicine, University of Southern California, Los Angeles, Calif (S.J.D.); Department of Radiological Sciences, Institute of Radiology, Catholic University of the Sacred Heart, Milan, Italy (L.F.); Eurofins The Maastricht Forensic Institute, Maastricht, the Netherlands (J.J.F.K.); Institute of Forensic Medicine Zurich, University of Zurich, Zurich, Switzerland (D.G., M.J.T.); and Department of Medicine, Section of Cardiology, Yale Translational Research Imaging Center, Yale University School of Medicine, New Haven, Conn (A.J.S.)
| | - Laura Filograna
- From the Departments of Radiology and Biomedical Imaging (N.S., B.G., M.V.R.) and Pathology (H.S.), Yale University School of Medicine, 20 York St, New Haven, CT 06510; Investigative Medicine Program, Yale University Graduate School of Arts and Sciences, New Haven, Conn (N.S.); Yale Translational Research Imaging Center, Yale University School of Medicine, New Haven, Conn (N.S., A.J.S.); The Forensic Radiology Group, Anderson, SC (J.E.); Center for Forensic Imaging, Office of the Medical Investigator, University of New Mexico, Albuquerque, NM (J.E., N.L.A.); Center for Advanced Visualization Technologies in Medicine (VISTA), Keck School of Medicine, University of Southern California, Los Angeles, Calif (S.J.D.); Department of Radiological Sciences, Institute of Radiology, Catholic University of the Sacred Heart, Milan, Italy (L.F.); Eurofins The Maastricht Forensic Institute, Maastricht, the Netherlands (J.J.F.K.); Institute of Forensic Medicine Zurich, University of Zurich, Zurich, Switzerland (D.G., M.J.T.); and Department of Medicine, Section of Cardiology, Yale Translational Research Imaging Center, Yale University School of Medicine, New Haven, Conn (A.J.S.)
| | - Jeroen J F Kroll
- From the Departments of Radiology and Biomedical Imaging (N.S., B.G., M.V.R.) and Pathology (H.S.), Yale University School of Medicine, 20 York St, New Haven, CT 06510; Investigative Medicine Program, Yale University Graduate School of Arts and Sciences, New Haven, Conn (N.S.); Yale Translational Research Imaging Center, Yale University School of Medicine, New Haven, Conn (N.S., A.J.S.); The Forensic Radiology Group, Anderson, SC (J.E.); Center for Forensic Imaging, Office of the Medical Investigator, University of New Mexico, Albuquerque, NM (J.E., N.L.A.); Center for Advanced Visualization Technologies in Medicine (VISTA), Keck School of Medicine, University of Southern California, Los Angeles, Calif (S.J.D.); Department of Radiological Sciences, Institute of Radiology, Catholic University of the Sacred Heart, Milan, Italy (L.F.); Eurofins The Maastricht Forensic Institute, Maastricht, the Netherlands (J.J.F.K.); Institute of Forensic Medicine Zurich, University of Zurich, Zurich, Switzerland (D.G., M.J.T.); and Department of Medicine, Section of Cardiology, Yale Translational Research Imaging Center, Yale University School of Medicine, New Haven, Conn (A.J.S.)
| | - Dominic Gascho
- From the Departments of Radiology and Biomedical Imaging (N.S., B.G., M.V.R.) and Pathology (H.S.), Yale University School of Medicine, 20 York St, New Haven, CT 06510; Investigative Medicine Program, Yale University Graduate School of Arts and Sciences, New Haven, Conn (N.S.); Yale Translational Research Imaging Center, Yale University School of Medicine, New Haven, Conn (N.S., A.J.S.); The Forensic Radiology Group, Anderson, SC (J.E.); Center for Forensic Imaging, Office of the Medical Investigator, University of New Mexico, Albuquerque, NM (J.E., N.L.A.); Center for Advanced Visualization Technologies in Medicine (VISTA), Keck School of Medicine, University of Southern California, Los Angeles, Calif (S.J.D.); Department of Radiological Sciences, Institute of Radiology, Catholic University of the Sacred Heart, Milan, Italy (L.F.); Eurofins The Maastricht Forensic Institute, Maastricht, the Netherlands (J.J.F.K.); Institute of Forensic Medicine Zurich, University of Zurich, Zurich, Switzerland (D.G., M.J.T.); and Department of Medicine, Section of Cardiology, Yale Translational Research Imaging Center, Yale University School of Medicine, New Haven, Conn (A.J.S.)
| | - Michael J Thali
- From the Departments of Radiology and Biomedical Imaging (N.S., B.G., M.V.R.) and Pathology (H.S.), Yale University School of Medicine, 20 York St, New Haven, CT 06510; Investigative Medicine Program, Yale University Graduate School of Arts and Sciences, New Haven, Conn (N.S.); Yale Translational Research Imaging Center, Yale University School of Medicine, New Haven, Conn (N.S., A.J.S.); The Forensic Radiology Group, Anderson, SC (J.E.); Center for Forensic Imaging, Office of the Medical Investigator, University of New Mexico, Albuquerque, NM (J.E., N.L.A.); Center for Advanced Visualization Technologies in Medicine (VISTA), Keck School of Medicine, University of Southern California, Los Angeles, Calif (S.J.D.); Department of Radiological Sciences, Institute of Radiology, Catholic University of the Sacred Heart, Milan, Italy (L.F.); Eurofins The Maastricht Forensic Institute, Maastricht, the Netherlands (J.J.F.K.); Institute of Forensic Medicine Zurich, University of Zurich, Zurich, Switzerland (D.G., M.J.T.); and Department of Medicine, Section of Cardiology, Yale Translational Research Imaging Center, Yale University School of Medicine, New Haven, Conn (A.J.S.)
| | - Babina Gosangi
- From the Departments of Radiology and Biomedical Imaging (N.S., B.G., M.V.R.) and Pathology (H.S.), Yale University School of Medicine, 20 York St, New Haven, CT 06510; Investigative Medicine Program, Yale University Graduate School of Arts and Sciences, New Haven, Conn (N.S.); Yale Translational Research Imaging Center, Yale University School of Medicine, New Haven, Conn (N.S., A.J.S.); The Forensic Radiology Group, Anderson, SC (J.E.); Center for Forensic Imaging, Office of the Medical Investigator, University of New Mexico, Albuquerque, NM (J.E., N.L.A.); Center for Advanced Visualization Technologies in Medicine (VISTA), Keck School of Medicine, University of Southern California, Los Angeles, Calif (S.J.D.); Department of Radiological Sciences, Institute of Radiology, Catholic University of the Sacred Heart, Milan, Italy (L.F.); Eurofins The Maastricht Forensic Institute, Maastricht, the Netherlands (J.J.F.K.); Institute of Forensic Medicine Zurich, University of Zurich, Zurich, Switzerland (D.G., M.J.T.); and Department of Medicine, Section of Cardiology, Yale Translational Research Imaging Center, Yale University School of Medicine, New Haven, Conn (A.J.S.)
| | - Harold Sanchez
- From the Departments of Radiology and Biomedical Imaging (N.S., B.G., M.V.R.) and Pathology (H.S.), Yale University School of Medicine, 20 York St, New Haven, CT 06510; Investigative Medicine Program, Yale University Graduate School of Arts and Sciences, New Haven, Conn (N.S.); Yale Translational Research Imaging Center, Yale University School of Medicine, New Haven, Conn (N.S., A.J.S.); The Forensic Radiology Group, Anderson, SC (J.E.); Center for Forensic Imaging, Office of the Medical Investigator, University of New Mexico, Albuquerque, NM (J.E., N.L.A.); Center for Advanced Visualization Technologies in Medicine (VISTA), Keck School of Medicine, University of Southern California, Los Angeles, Calif (S.J.D.); Department of Radiological Sciences, Institute of Radiology, Catholic University of the Sacred Heart, Milan, Italy (L.F.); Eurofins The Maastricht Forensic Institute, Maastricht, the Netherlands (J.J.F.K.); Institute of Forensic Medicine Zurich, University of Zurich, Zurich, Switzerland (D.G., M.J.T.); and Department of Medicine, Section of Cardiology, Yale Translational Research Imaging Center, Yale University School of Medicine, New Haven, Conn (A.J.S.)
| | - Margarita V Revzin
- From the Departments of Radiology and Biomedical Imaging (N.S., B.G., M.V.R.) and Pathology (H.S.), Yale University School of Medicine, 20 York St, New Haven, CT 06510; Investigative Medicine Program, Yale University Graduate School of Arts and Sciences, New Haven, Conn (N.S.); Yale Translational Research Imaging Center, Yale University School of Medicine, New Haven, Conn (N.S., A.J.S.); The Forensic Radiology Group, Anderson, SC (J.E.); Center for Forensic Imaging, Office of the Medical Investigator, University of New Mexico, Albuquerque, NM (J.E., N.L.A.); Center for Advanced Visualization Technologies in Medicine (VISTA), Keck School of Medicine, University of Southern California, Los Angeles, Calif (S.J.D.); Department of Radiological Sciences, Institute of Radiology, Catholic University of the Sacred Heart, Milan, Italy (L.F.); Eurofins The Maastricht Forensic Institute, Maastricht, the Netherlands (J.J.F.K.); Institute of Forensic Medicine Zurich, University of Zurich, Zurich, Switzerland (D.G., M.J.T.); and Department of Medicine, Section of Cardiology, Yale Translational Research Imaging Center, Yale University School of Medicine, New Haven, Conn (A.J.S.)
| | - Albert J Sinusas
- From the Departments of Radiology and Biomedical Imaging (N.S., B.G., M.V.R.) and Pathology (H.S.), Yale University School of Medicine, 20 York St, New Haven, CT 06510; Investigative Medicine Program, Yale University Graduate School of Arts and Sciences, New Haven, Conn (N.S.); Yale Translational Research Imaging Center, Yale University School of Medicine, New Haven, Conn (N.S., A.J.S.); The Forensic Radiology Group, Anderson, SC (J.E.); Center for Forensic Imaging, Office of the Medical Investigator, University of New Mexico, Albuquerque, NM (J.E., N.L.A.); Center for Advanced Visualization Technologies in Medicine (VISTA), Keck School of Medicine, University of Southern California, Los Angeles, Calif (S.J.D.); Department of Radiological Sciences, Institute of Radiology, Catholic University of the Sacred Heart, Milan, Italy (L.F.); Eurofins The Maastricht Forensic Institute, Maastricht, the Netherlands (J.J.F.K.); Institute of Forensic Medicine Zurich, University of Zurich, Zurich, Switzerland (D.G., M.J.T.); and Department of Medicine, Section of Cardiology, Yale Translational Research Imaging Center, Yale University School of Medicine, New Haven, Conn (A.J.S.)
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Jupin-Delevaux E, Provost C, Hmeydia G, Richard ME, Hamza L, Delabarde T, Crahès M, Pierre V, Ludes B, Oppenheim C, Benzakoun J. Identification of gunshot entry wounds using hyperdense rim sign on post-mortem computed tomography. Int J Legal Med 2025; 139:619-626. [PMID: 39480552 DOI: 10.1007/s00414-024-03362-5] [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: 12/26/2023] [Accepted: 10/25/2024] [Indexed: 11/02/2024]
Abstract
Post-mortem computed tomography (PMCT) is an increasingly utilized tool in forensic medicine for evaluating head gunshot injuries. Vault bevelling sign, when present, provides information regarding entry and exit wounds; when absent, identifying wound type on PMCT remains challenging. A cutaneous hyperdense ring, described in an animal study by Junno et al. (2022), may be indicative of contact shots. We hypothesized that it could also be observed in human gunshot injuries. Our study evaluates the reliability of the cutaneous hyperdense rim sign for identifying entry gunshot wounds in PMCT. After excluding complex and mucosal wounds, two operators retrospectively evaluated 64 gunshot wounds (30 entry and 34 exit wounds) in 34 head PMCT cases (2018-2022). Gold standard for wound type determination was the autopsy report. The hyperdense rim sign was defined as at least two-thirds of a continuous cutaneous hyperdense circle on a multiplanar reconstruction of cutaneous tissue tangent to the wound. The hyperdense rim sign demonstrated a specificity of 97% (95% CI: 85-100%) and a sensitivity of 63% (95% CI: 44-80%) for identifying entry wounds. Moreover, in 16 external examination reports where the presence of powder residues or bullet wipe at entry wound was explicitly mentioned, a positive association was observed between hyperdense rim sign and the presence of these elements (p = 0.018). These findings suggest that the hyperdense rim sign, when present, may be a valuable tool for entry wound determination in gunshot injuries, interpreted in conjunction with other CT and autopsy features.
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Affiliation(s)
- Emilien Jupin-Delevaux
- Service de Radiologie, GHU Paris Psychiatrie Et Neurosciences, Site Sainte-Anne, 1, Rue Cabanis, 75014, Paris, France
| | - Corentin Provost
- Service de Radiologie, GHU Paris Psychiatrie Et Neurosciences, Site Sainte-Anne, 1, Rue Cabanis, 75014, Paris, France
- Institute of Psychiatry and Neuroscience of Paris (IPNP), Université Paris Cité, INSERM U1266, 75014, Paris, France
| | - Ghazi Hmeydia
- Service de Radiologie, GHU Paris Psychiatrie Et Neurosciences, Site Sainte-Anne, 1, Rue Cabanis, 75014, Paris, France
- Institute of Psychiatry and Neuroscience of Paris (IPNP), Université Paris Cité, INSERM U1266, 75014, Paris, France
| | - Marie-Edith Richard
- Service de Radiologie, GHU Paris Psychiatrie Et Neurosciences, Site Sainte-Anne, 1, Rue Cabanis, 75014, Paris, France
- Institute of Psychiatry and Neuroscience of Paris (IPNP), Université Paris Cité, INSERM U1266, 75014, Paris, France
| | - Lilia Hamza
- Institut Medico-Légal de Paris, Paris, France
- Pôle Universitaire d'imagerie Post-Mortem, Université de Paris, Paris, France
| | - Tania Delabarde
- Institut Medico-Légal de Paris, Paris, France
- Pôle Universitaire d'imagerie Post-Mortem, Université de Paris, Paris, France
| | | | - Validire Pierre
- Institut Medico-Légal de Paris, Paris, France
- Département d'Anatomie Pathologique, Institut Mutualiste Montsouris, Paris, France
| | - Bertrand Ludes
- Institut Medico-Légal de Paris, Paris, France
- Pôle Universitaire d'imagerie Post-Mortem, Université de Paris, Paris, France
| | - Catherine Oppenheim
- Service de Radiologie, GHU Paris Psychiatrie Et Neurosciences, Site Sainte-Anne, 1, Rue Cabanis, 75014, Paris, France
- Institute of Psychiatry and Neuroscience of Paris (IPNP), Université Paris Cité, INSERM U1266, 75014, Paris, France
| | - Joseph Benzakoun
- Service de Radiologie, GHU Paris Psychiatrie Et Neurosciences, Site Sainte-Anne, 1, Rue Cabanis, 75014, Paris, France.
- Institute of Psychiatry and Neuroscience of Paris (IPNP), Université Paris Cité, INSERM U1266, 75014, Paris, France.
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Aulino G, Rega M, Rossi V, Zedda M, Oliva A. Postmortem CT and autopsy findings in an elevator-related death: a case report. Forensic Sci Med Pathol 2024:10.1007/s12024-024-00896-3. [PMID: 39302607 DOI: 10.1007/s12024-024-00896-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2024] [Indexed: 09/22/2024]
Abstract
Elevator-related fatalities and injuries are rarely discussed. Falls have been identified as the first cause of mortality in the majority of these accidents. Evidence suggests that many elevator accidents may be attributed to inadequate equipment maintenance or malfunctions of the devices. This study examines a case involving an elevator maintenance worker found within an elevator shaft, using postmortem computed tomography (PMCT) along with a full autopsy. The autopsy revealed that the cause of death was severe polytrauma resulting from dragging, compression, and crushing mechanisms, which resulted in a dislocated skull and multiple thoraco-abdominal injuries, including exposed organs and viscera. Detailed examination identified a cranio-encephalic crush, leading to a significant alteration in the physiognomy of the facial structures. Additionally, PMCT revealed complex spinal fractures, such as a Jefferson fracture and a complete Chance fracture at the D6 vertebra, accompanied by spinal deviation proximal to the fracture site. Autopsy findings corroborated these PMCT results. A multidisciplinary approach, including PMCT, is proposed as a strategic method for the comprehensive reconstruction of such accidents, facilitating the collection of extensive data.
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Affiliation(s)
- Giovanni Aulino
- Department of Health Surveillance and Bioethics, Section of Legal Medicine, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Francesco Vito, 1, Rome, 00168, Italy.
| | - Michele Rega
- Department of Health Surveillance and Bioethics, Section of Legal Medicine, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Francesco Vito, 1, Rome, 00168, Italy
| | - Vittoria Rossi
- Department of Health Surveillance and Bioethics, Section of Legal Medicine, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Francesco Vito, 1, Rome, 00168, Italy
| | - Massimo Zedda
- Department of Health Surveillance and Bioethics, Section of Legal Medicine, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Francesco Vito, 1, Rome, 00168, Italy
| | - Antonio Oliva
- Department of Health Surveillance and Bioethics, Section of Legal Medicine, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Francesco Vito, 1, Rome, 00168, Italy
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Fukuda H, Tokue H, Hayakawa A, Kominato Y, Sano R. Superimposed Imaging of Knife and Stab Wound Relationships Through Pre-autopsy and Intra-autopsy Computed Tomography Integration: A Case Report. Cureus 2024; 16:e66720. [PMID: 39262519 PMCID: PMC11390124 DOI: 10.7759/cureus.66720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2024] [Indexed: 09/13/2024] Open
Abstract
Three-dimensional (3D) reconstruction images using postmortem computed tomography (PMCT) are increasingly used to convey complex information to non-medical professionals, such as police and jurors. This case report demonstrates the effective use of 3D reconstruction images by integrating pre-autopsy, intra-autopsy, and knife CT data to achieve precise visualization of the wound path and associated injuries. The case involved a man in his 40s who was stabbed multiple times and pronounced dead approximately two hours after receiving emergency treatment. Initial PMCT revealed an intraperitoneal hemorrhage; however, no injuries to the abdominal organs or aorta were identified. During the autopsy, a critical abdominal aortic injury was discovered, prompting a further CT scan; however, the aorta remained in situ. By utilizing pre-autopsy, intra-autopsy, and knife CT data, the spatial relationships between the stab wound in the right hypochondriac area, aortic injury, and knife were effectively visualized. This novel approach highlights the potential of intra-autopsy CT for precise forensic visualization, offering a strategy for improvements in the accuracy and clarity of forensic evidence presentation.
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Affiliation(s)
- Haruki Fukuda
- Department of Legal Medicine, Gunma University, Graduate School of Medicine, Maebashi, JPN
| | - Hiroyuki Tokue
- Department of Diagnostic Radiology & Nuclear Medicine, Gunma University, Graduate School of Medicine, Maebashi, JPN
| | - Akira Hayakawa
- Department of Forensic Sciences, Akita University, Graduate School of Medicine, Akita, JPN
| | - Yoshihiko Kominato
- Department of Legal Medicine, Gunma University, Graduate School of Medicine, Maebashi, JPN
| | - Rie Sano
- Department of Forensic Medicine, Faculty of Life Sciences, Kumamoto University, Kumamoto, JPN
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Shimbashi S, Takeuchi A, Yoshimiya M, Jin S, Matoba K, Hyodoh H. Postmortem contrast-enhanced computed tomography via direct large-vessel puncture. Leg Med (Tokyo) 2024; 69:102448. [PMID: 38640871 DOI: 10.1016/j.legalmed.2024.102448] [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: 09/15/2023] [Revised: 03/06/2024] [Accepted: 04/15/2024] [Indexed: 04/21/2024]
Abstract
The aim of this study was to assess the usefulness of postmortem contrast-enhanced CT (PMeCT) performed via direct large-vessel puncture when routine postmortem CT suggests a vascular lesion as the cause of death. PMeCT was performed in 9 cases (4 male, 5 female) with a mean age of 76 years (range 52-92) at the time of death. The mean time elapsed since death was 29.1 h (12.0-72.0). The location of the target vessel for puncture was determined based on the CT table position and a grid placed on the body surface. An 18-G spinal needle was advanced to the puncture site, and the needle tip was confirmed to have reached the intended blood vessel. Using negative pressure with a 20-ml syringe, the needle tip was advanced until reverse bleeding was confirmed. Diluted contrast medium was injected slowly to ensure its dispersion within the blood vessels. Following confirmation of no extravasation, additional doses of diluted contrast agent were injected in 3-4 divided doses, with CT scans obtained at each step to track the distribution of contrast agent over time. PMeCT was successful in all cases, revealing cardiac tamponade in 7 (ascending aortic dissection, n = 6; cardiac rupture, n = 1), thoracic aortic aneurysm rupture, n = 1, and iliac artery aneurysm rupture, n = 1. There were no cases of procedure-related extravasation (pseudo-lesions). When postmortem CT reveals pericardial hematoma or bleeding in the thoracic or abdominal cavity, PMeCT can identify the source of bleeding.
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Affiliation(s)
- Shogo Shimbashi
- University of Fukui School of Medical Sciences, Department of Forensic Medicine, Japan.
| | - Akiko Takeuchi
- Hokkaido University, Faculty of Medicine, Center for Cause of Death Investigation, Japan.
| | - Motoo Yoshimiya
- University of Fukui School of Medical Sciences, Department of Forensic Medicine, Japan.
| | - Shigeki Jin
- Hokkaido University, Faculty of Medicine, Department of Forensic Medicine, Japan.
| | - Kotaro Matoba
- Hokkaido University, Faculty of Medicine, Department of Forensic Medicine, Japan.
| | - Hideki Hyodoh
- University of Fukui School of Medical Sciences, Department of Forensic Medicine, Japan; Hokkaido University, Faculty of Medicine, Department of Forensic Medicine, Japan.
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Jeong K, Seo J, Han M, Jung D. Korean radiographers' awareness, experiences, and education needs in forensic medicine and forensic radiology. Heliyon 2024; 10:e32219. [PMID: 38873674 PMCID: PMC11170207 DOI: 10.1016/j.heliyon.2024.e32219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 04/15/2024] [Accepted: 05/29/2024] [Indexed: 06/15/2024] Open
Abstract
This study assesses the need for education in forensic medicine and forensic radiology among radiographers by investigating the perceptions and experiences of Korean radiographers working in medical institutions. A structured questionnaire was administered to participants, collected, and analyzed. The results showed that despite receiving frequent forensic cases, Korean radiographers face difficulties in taking appropriate measures about forensic radiology due to a lack of awareness and knowledge of its forensic aspects. The participants indicated that university education in forensic medicine and forensic radiology is necessary. Therefore, it is imperative to develop and implement policies for forensic education programs to enhance radiographers' forensic knowledge and capabilities. Universities should conduct courses on forensic radiology and provide continuing education for radiographers working in this field.
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Affiliation(s)
- Kyeonghwan Jeong
- Department of Radiological Science, Daewon University, Jecheon, Republic of Korea
| | - Jeongmin Seo
- Department of Radiological Science, Catholic University of Pusan, Busan, Republic of Korea
| | - Mihyun Han
- Department of Nursing, Keimyung College University, Daegu, Republic of Korea
| | - Dongkyung Jung
- Department of Radiological Science, Daegu Health College, Daegu, Republic of Korea
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Mentink MG, Latten BGH, Bakers FCH, Mihl C, Benali F, Nelemans PJ, Rennenberg RJMW, Koopmans RP, Bergmans DCJJ, Kubat B, Hofman PAM. Efficacy of postmortem CT and tissue sampling in establishing the cause of death in clinical practice: a prospective observational study. J Clin Pathol 2024; 77:259-265. [PMID: 36581447 DOI: 10.1136/jcp-2021-207946] [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: 09/13/2021] [Accepted: 12/18/2022] [Indexed: 12/30/2022]
Abstract
AIMS The aim of this study is to evaluate whether agreement with autopsy-determined cause of death (COD) increases by use of postmortem CT (PMCT) or PMCT in combination with postmortem sampling (PMS), when compared with clinical assessment only. METHODS This prospective observational study included deceased patients from the intensive care unit and internal medicine wards between October 2013 and August 2017. The primary outcome was percentage agreement on COD between the reference standard (autopsy) and the alternative postmortem examinations (clinical assessment vs PMCT or PMCT+PMS). In addition, the COD of patient groups with and without conventional autopsy were compared with respect to involved organ systems and pathologies. RESULTS Of 730 eligible cases, 144 could be included for analysis: 63 underwent PCMT without autopsy and 81 underwent both PMCT and autopsy. Agreement with autopsy-determined COD was significantly higher for both PMCT with PMS (42/57, 74%), and PMCT alone (53/81, 65%) than for clinical assessment (40/81, 51%; p=0.007 and p=0.03, respectively). The difference in agreement between PMCT with PMS and PMCT alone was not significant (p=0.13). The group with autopsy had a significantly higher prevalence of circulatory system involvement and perfusion disorders, and a lower prevalence of pulmonary system involvement. CONCLUSION PMCT and PMS confer additional diagnostic value in establishing the COD. Shortcomings in detecting vascular occlusions and perfusion disorders and susceptibility to pulmonary postmortem changes could in future be improved by additional techniques. Both PMCT and PMS are feasible in clinical practice and an alternative when autopsy cannot be performed.
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Affiliation(s)
- Max Guillaume Mentink
- Radiology & Nuclear Medicine, Maastricht Universitair Medisch Centrum+, Maastricht, Netherlands
| | - Bart G H Latten
- Pathology, Maastricht Universitair Medisch Centrum+, Maastricht, Netherlands
- Pathology, Netherlands Forensic Institute, Den Haag, Netherlands
| | - Frans C H Bakers
- Radiology & Nuclear Medicine, Maastricht Universitair Medisch Centrum+, Maastricht, Netherlands
| | - Casper Mihl
- Radiology & Nuclear Medicine, Maastricht Universitair Medisch Centrum+, Maastricht, Netherlands
- CARIM school for Cardiovascular Diseases, Maastricht University, Maastricht, Netherlands
| | - Faysal Benali
- Radiology & Nuclear Medicine, Maastricht Universitair Medisch Centrum+, Maastricht, Netherlands
| | | | | | - Richard P Koopmans
- Internal Medicine, Maastricht Universitair Medisch Centrum+, Maastricht, Netherlands
| | | | - Bela Kubat
- Pathology, Maastricht Universitair Medisch Centrum+, Maastricht, Netherlands
| | - Paul A M Hofman
- Radiology & Nuclear Medicine, Maastricht Universitair Medisch Centrum+, Maastricht, Netherlands
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8
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Modzelewski W, Janica J. The role of computed tomography in post-mortem examinations. ARCHIVES OF FORENSIC MEDICINE AND CRIMINOLOGY 2024; 74:124-133. [PMID: 39470757 DOI: 10.4467/16891716amsik.24.011.20340] [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: 03/26/2024] [Accepted: 07/09/2024] [Indexed: 11/01/2024] Open
Abstract
In the study, data from the literature regarding the use of computed tomography in post-mortem examinations (post-mortem computed tomography - PMCT) were analyzed. Literature data indicate that PMCT should be used as a complementary tool rather than an alternative to autopsy, detecting additional changes that may have been unnoticed due to anatomical location or the need to extend traditional autopsy techniques. The ability to save, create and reconstruct images is very helpful in creating documentation and final opinions. There is a need to develop standards for the evaluation of post-mortem computed tomography images, which will enable further development of virtual autopsy techniques in the field of forensic medicine, supported by artificial intelligence.
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Affiliation(s)
- Wojciech Modzelewski
- Department of Imaging Diagnostics, University Children Clinical Hospital in Białystok, Poland
| | - Jacek Janica
- Department of Imaging Diagnostics, University Children Clinical Hospital in Białystok, Poland
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9
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Latten BGH, Kubat B, van den Brandt PA, zur Hausen A, Schouten LJ. Cause of death and the autopsy rate in an elderly population. Virchows Arch 2023; 483:865-872. [PMID: 37269366 PMCID: PMC10238230 DOI: 10.1007/s00428-023-03571-0] [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: 02/16/2023] [Revised: 05/12/2023] [Accepted: 05/22/2023] [Indexed: 06/05/2023]
Abstract
Autopsy rates are declining, while major discrepancies between autopsies and clinical diagnoses remain. Still, little is known about the impact of suspected underlying diseases, for example, a diagnosis of cancer, on the autopsy rate. The aim of this study was to investigate the relation between the clinical cause of death, a history of cancer, and the medical autopsy rate using data from the Netherlands Cohort Study on Diet and Cancer (NLCS), a large prospective cohort study with a long follow-up. The NLCS is a prospective study initiated in 1986 and includes 120,852 persons (58,279 males and 62,573 females), 55-69 years of age at the time of enrollment. The NLCS was linked with the Dutch Nationwide Pathology Databank (PALGA), the Dutch Population Register (GBA), the Netherlands Cancer Registry, and the causes of death registry (Statistics Netherlands). If applicable, the 95% confidence intervals were calculated. During the follow-up of the NLCS, 59,760 deaths were recorded by linkage with the GBA from 1991 until 2009. Of these, a medical autopsy was performed on 3736 deceased according to linkage with PALGA, resulting in an overall autopsy rate of 6.3%. Major variations in the autopsy rate were observed according to the cause of death. The autopsy rate increased according to the number of contributing causes of death. Lastly, a diagnosis of cancer affected the autopsy rate. The clinical cause of death and a history of cancer both influenced the medical autopsy rate in a large national cohort. The insight this study provides may help clinicians and pathologists counteracting the further downfall of the medical autopsy.
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Affiliation(s)
- Bartholomeus G. H. Latten
- Department of Pathology, Maastricht University Medical Centre+, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
| | - Bela Kubat
- Department of Pathology, Maastricht University Medical Centre+, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
| | - Piet A. van den Brandt
- Department of Epidemiology, GROW–School for Oncology and Reproduction, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - Axel zur Hausen
- Department of Pathology, Maastricht University Medical Centre+, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
- Department of Pathology, GROW–School for Oncology and Reproduction, Maastricht University, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
| | - Leo J. Schouten
- Department of Epidemiology, GROW–School for Oncology and Reproduction, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
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10
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Funayama K, Koyama A, Katsuragi-Go R, Aoyama T, Watanabe H, Takahashi N, Takatsuka H. Bleeding-Source Exploration in Subdural Hematoma: Observational Study on the Usefulness of Postmortem Computed Tomography Angiography. Diagnostics (Basel) 2023; 13:2286. [PMID: 37443680 DOI: 10.3390/diagnostics13132286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 06/29/2023] [Accepted: 07/04/2023] [Indexed: 07/15/2023] Open
Abstract
In a few cases, postmortem computed tomography angiography (PMCTA) is effective in postmortem detection of cortical artery rupture causing subdural hematoma (SDH), which is difficult to detect at autopsy. Here, we explore the usefulness and limitations of PMCTA in detecting the sites of cortical arterial rupture for SDH. In 6 of 10 cases, extravascular leakage of contrast material at nine different places enabled PMCTA to identify cortical arterial rupture. PMCTA did not induce destructive arterial artifacts, which often occur during autopsy. We found that, although not in all cases, PMCTA could show the site of cortical arterial rupture causing subdural hematoma in some cases. This technique is beneficial for cases of SDH autopsy, as it can be performed nondestructively and before destructive artifacts from the autopsy occur.
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Affiliation(s)
- Kazuhisa Funayama
- Division of Legal Medicine, Department of Community Preventive Medicine, Graduate School of Medicine and Dental Sciences, Niigata University, Niigata 951-8510, Japan
- Center of Cause of Death Investigation, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8510, Japan
| | - Akihide Koyama
- Division of Legal Medicine, Department of Community Preventive Medicine, Graduate School of Medicine and Dental Sciences, Niigata University, Niigata 951-8510, Japan
- Center of Cause of Death Investigation, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8510, Japan
| | - Rieka Katsuragi-Go
- Division of Legal Medicine, Department of Community Preventive Medicine, Graduate School of Medicine and Dental Sciences, Niigata University, Niigata 951-8510, Japan
- Center of Cause of Death Investigation, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8510, Japan
| | - Takashi Aoyama
- Division of Legal Medicine, Department of Community Preventive Medicine, Graduate School of Medicine and Dental Sciences, Niigata University, Niigata 951-8510, Japan
| | - Hiraku Watanabe
- Division of Legal Medicine, Department of Community Preventive Medicine, Graduate School of Medicine and Dental Sciences, Niigata University, Niigata 951-8510, Japan
| | - Naoya Takahashi
- Center of Cause of Death Investigation, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8510, Japan
- Department of Radiological Technology, Graduate School of Health Sciences, Niigata University, Niigata 951-8518, Japan
| | - Hisakazu Takatsuka
- Division of Legal Medicine, Department of Community Preventive Medicine, Graduate School of Medicine and Dental Sciences, Niigata University, Niigata 951-8510, Japan
- Center of Cause of Death Investigation, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8510, Japan
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Golomingi R, Dobay A, Franckenberg S, Ebert L, Sieberth T. Augmented reality in forensics and forensic medicine - Current status and future prospects. Sci Justice 2023; 63:451-455. [PMID: 37453776 DOI: 10.1016/j.scijus.2023.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 03/27/2023] [Accepted: 04/22/2023] [Indexed: 07/18/2023]
Abstract
Forensic investigations require a vast variety of knowledge and expertise of each specialist involved. With the increase in digitization and advanced technical possibilities, the traditional use of a computer with a screen for visualization and a mouse and keyboard for interactions has limitations, especially when visualizing the content in relation to the real world. Augmented reality (AR) can be used in such instances to support investigators in various tasks at the scene as well as later in the investigation process. In this article, we present current applications of AR in forensics and forensic medicine, the technological basics of AR, and the advantages that AR brings for forensic investigations. Furthermore, we will have a brief look at other fields of application and at future developments of AR in forensics.
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Affiliation(s)
- Raffael Golomingi
- 3D Center Zurich, Institute of Forensic Medicine, University of Zurich, 8057 Zurich, Switzerland.
| | - Akos Dobay
- 3D Center Zurich, Institute of Forensic Medicine, University of Zurich, 8057 Zurich, Switzerland.
| | - Sabine Franckenberg
- 3D Center Zurich, Institute of Forensic Medicine, University of Zurich, 8057 Zurich, Switzerland; Diagnostic and Interventional Radiology, University Hospital Zurich, 8091 Zurich, Switzerland.
| | - Lars Ebert
- 3D Center Zurich, Institute of Forensic Medicine, University of Zurich, 8057 Zurich, Switzerland.
| | - Till Sieberth
- 3D Center Zurich, Institute of Forensic Medicine, University of Zurich, 8057 Zurich, Switzerland.
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12
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R. H. Branch K, Gatewood MO, Kudenchuk PJ, Maynard C, Sayre MR, Carlbom DJ, Edwards RM, Counts CR, Probstfield JL, Brusen R, Johnson N, Gunn ML. Diagnostic Yield, Safety, and Outcomes of Head-to-Pelvis Sudden Death CT Imaging in Post Arrest Care: The CT FIRST Cohort Study. Resuscitation 2023:109785. [PMID: 37019352 DOI: 10.1016/j.resuscitation.2023.109785] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 03/08/2023] [Accepted: 03/26/2023] [Indexed: 04/05/2023]
Abstract
AIM Our aim was to test whether a head-to-pelvis CT scan improves diagnostic yield and speed to identify causes for out of hospital circulatory arrest (OHCA). METHODS CT FIRST was a prospective observational pre-/post-cohort study of patients successfully resuscitated from OHCA. Inclusion criteria included unknown cause for arrest, age>18 years, stability to undergo CT, and no known cardiomyopathy or obstructive coronary artery disease. A head-to-pelvis sudden death CT (SDCT) scan within 6 hours of hospital arrival was added to the standard of care for patients resuscitated from OHCA (post-cohort) and compared to standard of care (SOC) alone (pre-cohort). The primary outcome was SDCT diagnostic yield. Secondary outcomes included time to identifying OHCA cause and time-critical diagnoses, SDCT safety, and survival to hospital discharge. RESULTS Baseline characteristics between the SDCT (N=104) and the SOC (N=143) cohorts were similar. CT scans (either head, chest, and/or abdomen) were ordered in 74 (52%) of SOC patients. Adding SDCT scanning identified 92% of causes for arrest compared to 75% (SOC-cohort; p value <0.001) and reduced the time to diagnosis by 78% (SDCT 3.1 hours, SOC alone 14.1 hours, p <0.0001). Identification of critical diagnoses was similar between cohorts, but SDCT reduced delayed (>6 hours) identification of critical diagnoses by 81% (p<0.001). SDCT safety endpoints were similar including acute kidney injury. Patient survival to discharge was similar between cohorts. DISCUSSION SDCT scanning early after OHCA resuscitation safely improved the efficiency and diagnostic yield for causes of arrest compared to the standard of care alone. CLINICAL TRIALS NUMBER NCT03111043.
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13
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Michaud K, Jacobsen C, Basso C, Banner J, Blokker BM, de Boer HH, Dedouit F, O'Donnell C, Giordano C, Magnin V, Grabherr S, Suvarna SK, Wozniak K, Parsons S, van der Wal AC. Application of postmortem imaging modalities in cases of sudden death due to cardiovascular diseases-current achievements and limitations from a pathology perspective : Endorsed by the Association for European Cardiovascular Pathology and by the International Society of Forensic Radiology and Imaging. Virchows Arch 2023; 482:385-406. [PMID: 36565335 PMCID: PMC9931788 DOI: 10.1007/s00428-022-03458-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 11/11/2022] [Accepted: 11/15/2022] [Indexed: 12/25/2022]
Abstract
Postmortem imaging (PMI) is increasingly used in postmortem practice and is considered a potential alternative to a conventional autopsy, particularly in case of sudden cardiac deaths (SCD). In 2017, the Association for European Cardiovascular Pathology (AECVP) published guidelines on how to perform an autopsy in such cases, which is still considered the gold standard, but the diagnostic value of PMI herein was not analyzed in detail. At present, significant progress has been made in the PMI diagnosis of acute ischemic heart disease, the most important cause of SCD, while the introduction of postmortem CT angiography (PMCTA) has improved the visualization of several parameters of coronary artery pathology that can support a diagnosis of SCD. Postmortem magnetic resonance (PMMR) allows the detection of acute myocardial injury-related edema. However, PMI has limitations when compared to clinical imaging, which severely impacts the postmortem diagnosis of myocardial injuries (ischemic versus non-ischemic), the age-dating of coronary occlusion (acute versus old), other potentially SCD-related cardiac lesions (e.g., the distinctive morphologies of cardiomyopathies), aortic diseases underlying dissection or rupture, or pulmonary embolism. In these instances, PMI cannot replace a histopathological examination for a final diagnosis. Emerging minimally invasive techniques at PMI such as image-guided biopsies of the myocardium or the aorta, provide promising results that warrant further investigations. The rapid developments in the field of postmortem imaging imply that the diagnosis of sudden death due to cardiovascular diseases will soon require detailed knowledge of both postmortem radiology and of pathology.
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Affiliation(s)
- Katarzyna Michaud
- University Center of Legal Medicine Lausanne - Geneva, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
| | - Christina Jacobsen
- Section of Forensic Pathology, Department of Forensic Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Cristina Basso
- Cardiovascular Pathology Unit, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Jytte Banner
- Section of Forensic Pathology, Department of Forensic Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | - Hans H de Boer
- Department of Forensic Medicine, Victorian Institute of Forensic Medicine, Monash University, Melbourne, Australia
| | - Fabrice Dedouit
- GRAVIT, Groupe de Recherche en Autopsie Virtuelle et Imagerie Thanatologique, Forensic Department, University Hospital, Rangueil, Toulouse, France
| | - Chris O'Donnell
- Department of Forensic Medicine, Victorian Institute of Forensic Medicine, Monash University, Melbourne, Australia
| | - Carla Giordano
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Virginie Magnin
- University Center of Legal Medicine Lausanne - Geneva, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Geneva University Hospital, University of Geneva, Geneva, Switzerland
| | - Silke Grabherr
- University Center of Legal Medicine Lausanne - Geneva, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Geneva University Hospital, University of Geneva, Geneva, Switzerland
| | - S Kim Suvarna
- Department of Histopathology, Northern General Hospital, The University of Sheffield, Sheffield, UK
| | - Krzysztof Wozniak
- Department of Forensic Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Sarah Parsons
- Department of Forensic Medicine, Victorian Institute of Forensic Medicine, Monash University, Melbourne, Australia
| | - Allard C van der Wal
- Department of Pathology, Amsterdam UMC, Academic Medical Center, Amsterdam, The Netherlands.
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Application of postmortem MRI for identification of medulla oblongata contusion as a cause of death: a case report. Int J Legal Med 2023; 137:115-121. [PMID: 36303078 DOI: 10.1007/s00414-022-02909-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 10/19/2022] [Indexed: 01/10/2023]
Abstract
Whiplash injury is common in traffic accidents, and severe whiplash is characterized by cervical spinal cord injuries with cervical dislocation or fracture, that can be diagnosed by postmortem computed tomography (PMCT), postmortem magnetic resonance (PMMR), or conventional autopsy. However, for cervical spinal cord injury without fracture and dislocation, PMMR can be more informative because it provides higher resolution of soft tissues. We report the case of a 29-year-old male who died immediately following a traffic accident, in which the vehicle hit an obstacle at a high speed, causing deformation of the bumper and severe damage of the vehicle body. PMCT indicated no significant injuries or diseases related to death, but PMMR showed patchy abnormal signals in the medulla oblongata, and the lower edge of the cerebellar tonsil was herniated out of the foramen magnum. The subsequent pathological and histological results confirmed that death was caused by medulla oblongata contusion combined with cerebellar tonsillar herniation. Our description of this case of a rare but fatal whiplash injury in which there was no fracture or dislocation provides a better understanding of the potentially fatal consequences of cervical spinal cord whiplash injury without fracture or dislocation and of the underlying lethal mechanisms. Compared with PMCT, PMMR provides important diagnostic information in forensic practice for the identification of soft tissue injuries, and is therefore an important imaging modality for diagnosis of whiplash injury when there is no fracture or dislocation.
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15
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Filograna L, Manenti G, Grassi S, Zedda M, Mecchia D, Briganti F, Ryan CP, Pascali VL, Floris R, Oliva A. Analysis of the role of PMCT during the COVID-19 pandemic: a systematic review. FORENSIC IMAGING 2022. [PMCID: PMC9134788 DOI: 10.1016/j.fri.2022.200505] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Objectives During COVID-19 pandemic PMCT has been proposed as a forensic investigation method. This systematic review is aimed to systematize evidence and peer-reviewed opinions reported during the first two years of pandemic, to evaluate the role of PMCT during the COVID-19 pandemic. Materials and methods An online literature search was performed to identify publications on PMCT during the COVID-19 pandemic between December 2019 and March 2022. For each publication included, the following data were collected: title and abstract, year of publication, type of article, number and type of individuals examined. The selected publications were also categorized based on PMCT findings, histopathological results, the comparison between PMCT and histopathological findings, cause of death and proposed role of PMCT during the pandemic. Results A total of 20 publications were included, mostly case reports (9/20). All cases examined included adults. The most frequent PMCT pattern in positive cases was diffuse mixed densities with prevalence of consolidations (pattern 1) (54%). In 97% of the cases where a comparison between PMCT and histological results was performed, a correspondence was found. In 82% of the cases the principal cause of death was COVID-19 pneumonia. PMCT has been proposed as a pre-autopsy screening tool in 62%, and as a method for augmenting post-mortem data in 50% of the papers reporting this issue. Conclusion This systematic review suggests that PMCT should be regarded as a highly valuable investigative technique for the forensic evaluation of deaths with ascertained or suspected COVID-19 pneumonia.
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Ursprung R, Eggert S, Ampanozi G, Gascho D, Thali M, Franckenberg S. Gunshot wounds to the head: a comparison of postmortem magnetic resonance imaging, computed tomography, and autopsy. Acta Radiol 2022; 63:513-519. [PMID: 33779322 DOI: 10.1177/0284185121999999] [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: 11/17/2022]
Abstract
BACKGROUND Postmortem imaging has become a powerful diagnostic tool in forensics. Postmortem computed tomography (PMCT) is often used currently to complement and sometimes even replace an autopsy. PURPOSE To compare PMCT, postmortem magnetic resonance imaging (PMMRI), and autopsy findings for gunshot wounds to the head. MATERIAL AND METHODS Cross-sectional study. We performed a retrospective analysis of 24 cases with gunshot wounds to the head that underwent both PMCT and PMMRI between 2011 and 2018 at the Institute of Forensic Medicine, University of Zurich (Switzerland). RESULTS Our study confirms that PMCT and, to a slightly lesser degree, PMMRI provide additional information that is valuable when combined with autopsy findings. Air embolism was solely detected in PMCT (67% vs. 0% at autopsy). A retained bullet or projectile and bone fragments were diagnosed more frequently with PMCT (42%, 67%, and 92%) than at autopsy (33%, 42%, and 46%). Soft tissue lesions were more often detected with PMMRI than with PMCT. With regard to autopsy, subdural hemorrhage and ventricular hemorrhage were slightly more frequently diagnosed with PMMRI (63% and 75% vs. 38% and 58% at autopsy). Intracerebral hemorrhage was by far most often diagnosed with PMMRI (92%) compared with both PMCT (38%) and autopsy (14%). CONCLUSION All three modalities should ideally be considered in cases of craniocerebral gunshot wounds. However, it might be conceivable that depending on the forensic query, PMCT and PMMRI may be an adequate replacement for an autopsy.
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Affiliation(s)
- Reto Ursprung
- Institute of Forensic Medicine and Imaging, University of Zürich, Zürich, Switzerland
| | - Sebastian Eggert
- Institute of Forensic Medicine and Imaging, University of Zürich, Zürich, Switzerland
| | - Garyfalia Ampanozi
- Institute of Forensic Medicine and Imaging, University of Zürich, Zürich, Switzerland
| | - Dominic Gascho
- Institute of Forensic Medicine and Imaging, University of Zürich, Zürich, Switzerland
| | - Michael Thali
- Institute of Forensic Medicine and Imaging, University of Zürich, Zürich, Switzerland
| | - Sabine Franckenberg
- Institute of Forensic Medicine and Imaging, University of Zürich, Zürich, Switzerland
- Institute of Diagnostic and Interventional Radiology, University Hospital of Zürich, Zürich, Switzerland
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Henningsen MJ, Larsen ST, Jacobsen C, Villa C. Sensitivity and specificity of post-mortem computed tomography in skull fracture detection-a systematic review and meta-analysis. Int J Legal Med 2022; 136:1363-1377. [PMID: 35286468 DOI: 10.1007/s00414-022-02803-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 02/16/2022] [Indexed: 11/29/2022]
Abstract
Post-mortem computed tomography (PMCT) has been increasingly used as routine examination in forensic pathology. No recent review of the growing number of papers on the ability of PMCT to detect skull fracture exists, and original papers report sensitivities from 0.85 to 1.00. This systematic review (PROSPERO: CRD42021233264) aims to provide a meta-analysis of sensitivity and specificity of PMCT in skull fracture detection. We searched PubMed, MEDLINE and Embase for papers published between January 2000 and August 2021 reporting raw numbers, sensitivity and specificity or Abbreviated Injury Score for PMCT compared to autopsy. Papers without both PMCT and autopsy, no separate reporting of the neuro-cranium, exclusively on children, sharp trauma, gunshot or natural death as well as case reports and reviews were excluded. Two authors independently performed inclusion, bias assessment and data extraction. QUADAS-2 was used for bias assessment and a random effects models used for meta-analysis. From 4.284 hits, 18 studies were eligible and 13 included in the meta-analysis for a total of 1538 cases. All deceased were scanned on multi-slice scanners with comparable parameters. Images were evaluated by radiologists or pathologists. Intra- and inter-observer analyses were rarely reported. In summary, sensitivity of PMCT for detection of fractures in the skull base was 0.87 [0.80; 0.92] with specificity 0.96 [0.90; 0.98], and sensitivity for the vault was 0.89 [0.80; 0.94] with specificity 0.96 [0.91; 0.98]. The mixed samples are a limitation of the review.
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Affiliation(s)
- Mikkel Jon Henningsen
- Department of Forensic Medicine, Section of Forensic Pathology, University of Copenhagen, Frederik V's vej 11, 2100, Copenhagen, Denmark.
| | - Sara Tangmose Larsen
- Department of Forensic Medicine, Section of Forensic Pathology, University of Copenhagen, Frederik V's vej 11, 2100, Copenhagen, Denmark
| | - Christina Jacobsen
- Department of Forensic Medicine, Section of Forensic Pathology, University of Copenhagen, Frederik V's vej 11, 2100, Copenhagen, Denmark
| | - Chiara Villa
- Department of Forensic Medicine, Section of Forensic Pathology, University of Copenhagen, Frederik V's vej 11, 2100, Copenhagen, Denmark
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Abstract
Forensic imaging is a non-invasive examination process during the forensic investigation. It is mainly used in forensic pathology as an adjunct to the traditional autopsy. In the past two decades, forensic imaging has been vigorously developed by forensic experts from computed tomography (CT) to multiple augmented techniques through CT and magnetic resonance imaging (MRI). The application field of forensic imaging has also been broadened as its advantages are recognised by more forensic practitioners. In addition to the forensic pathology, this technique has been used in other forensic disciplines, including forensic anthropology, forensic odontology, forensic ballistics and wildlife forensics, etc. This article reviews the development of forensic imaging as the practice and research development in different forensic disciplines based on the relevant literature analysis.
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Affiliation(s)
- Min Zhang
- Faculty of Forensic Investigation Department of Criminal Justice, Coppin State University, Baltimore, MD, USA
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19
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Image segmentation of post-mortem computed tomography data in forensic imaging: Methods and applications. FORENSIC IMAGING 2022. [DOI: 10.1016/j.fri.2021.200483] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Henningsen MJ, Harving ML, Jacobsen C, Villa C. Fractures of the neuro-cranium: sensitivity and specificity of post-mortem computed tomography compared with autopsy. Int J Legal Med 2022; 136:1379-1389. [PMID: 35084533 DOI: 10.1007/s00414-022-02779-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 01/17/2022] [Indexed: 01/22/2023]
Abstract
Post-mortem computed tomography (PMCT) is a routine tool in many forensic pathology departments as it is fast and non-destructive and allows less gruesome visualization than photographs, and the images are indefinitely storable. Several studies investigated congruence between PMCT and autopsy for skull fracture but registered only the presence or absence of fracture systems. The objective of this study was to determine location-specific sensitivity and specificity of PMCT for individual fracture lines in blunt force head trauma. Accurate 3D models based on PMCT data with all fracture lines visible are important for future studies on fractures, applying finite element analysis (FEA). We retrospectively sampled adult cases from 2013 to 2019 with skull fracture mentioned in the autopsy report. PMCT was on a Siemens 64-slice scanner and autopsy according to international guidelines. The location and direction of all fracture lines at autopsy and at de novo interpretation of scans were registered and compared. Ninety-nine cases with 4809 individual findings were included. Age ranged from 18 to 100 years. The overall sensitivity was 0.58, and specificity was 0.91. For individual locations, sensitivity ranged from 0.24 to 0.85, and specificity ranged from 0.73 to 1.00. Intra-observer agreement was 0.74, and inter-observer agreement ranged from 0.43 to 0.58. In conclusion, PMCT is suited for detection of fracture systems, but not for detection of all individual fracture lines. Our results differed from the existing literature due to the methodological choices of registering individual fracture lines. Future studies utilising FEA must supplement PMCT with autopsy data.
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Affiliation(s)
- Mikkel Jon Henningsen
- Department of Forensic Medicine, Section of Forensic Pathology, University of Copenhagen, Copenhagen, Denmark.
| | | | - Christina Jacobsen
- Department of Forensic Medicine, Section of Forensic Pathology, University of Copenhagen, Copenhagen, Denmark
| | - Chiara Villa
- Department of Forensic Medicine, Section of Forensic Pathology, University of Copenhagen, Copenhagen, Denmark
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21
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Bertozzi G, Cafarelli FP, Ferrara M, Di Fazio N, Guglielmi G, Cipolloni L, Manetti F, La Russa R, Fineschi V. Sudden Cardiac Death and Ex-Situ Post-Mortem Cardiac Magnetic Resonance Imaging: A Morphological Study Based on Diagnostic Correlation Methodology. Diagnostics (Basel) 2022; 12:218. [PMID: 35054385 PMCID: PMC8774558 DOI: 10.3390/diagnostics12010218] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 01/07/2022] [Accepted: 01/12/2022] [Indexed: 02/01/2023] Open
Abstract
During the last years, post-mortem imaging has gradually been assumed within research in the field of forensic pathology. This role appears to be clearly and simply applied in the trauma field with the use of conventional radiography or Post Mortem Computed Tomography (PMCT). Recently, particular attention was paid to cardiovascular imaging using Post Mortem Magnetic Resonance Imaging (PMMRI). The present experimental study aims to: (i) confirm the efficacy of a Post Mortem Cardiac Resonance Imaging (PMCRI) study protocol for the study of human hearts collected during the autopsy; (ii) apply the defined protocol on subjects who died of "SCD (sudden cardiac death)", to identify alterations that could guide subsequent sampling. Two hearts of healthy subjects (A: male 22 years; B: female 26 years), who died from causes other than SCD were collected and compared to hearts that belonged to SCD individuals (C: male, 47 years old; D: female, 44 years old; E: male; 72 years old). The exams were performed on a 1.5 T scanner (Philips Intera Achieva, Best, the Netherlands) on hearts collected during autopsy and after a 30-day formalin fixation. Two readers analyzed the obtained images blindly and after randomization. From the comparison between the data from imaging and the macroscopic and histological investigations carried out, the present study proved the effectiveness of a PMMRI protocol to study ex-situ hearts. Moreover, it suggested the following semeiology in post-mortem SCD cases: the hyperintense area with indistinct margins in the Short Tau Inversion Recovery (STIR) sequence was linked to edema or area of pathological fibers, whereas the hypointense area in the T2-FFE sequences was linked to fibrosis. PMMRI can provide a valuable benefit to post-mortem investigations, helping to distinctly improve the success rate of histological sampling and investigations, which remains the gold standard in the diagnosis of sudden death.
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Affiliation(s)
- Giuseppe Bertozzi
- Department of Clinical and Experimental Medicine, University of Foggia, 71100 Foggia, Italy; (G.B.); (F.P.C.); (G.G.); (L.C.); (R.L.R.)
| | - Francesco Pio Cafarelli
- Department of Clinical and Experimental Medicine, University of Foggia, 71100 Foggia, Italy; (G.B.); (F.P.C.); (G.G.); (L.C.); (R.L.R.)
| | - Michela Ferrara
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, 00185 Rome, Italy; (M.F.); (N.D.F.); (F.M.)
| | - Nicola Di Fazio
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, 00185 Rome, Italy; (M.F.); (N.D.F.); (F.M.)
| | - Giuseppe Guglielmi
- Department of Clinical and Experimental Medicine, University of Foggia, 71100 Foggia, Italy; (G.B.); (F.P.C.); (G.G.); (L.C.); (R.L.R.)
| | - Luigi Cipolloni
- Department of Clinical and Experimental Medicine, University of Foggia, 71100 Foggia, Italy; (G.B.); (F.P.C.); (G.G.); (L.C.); (R.L.R.)
| | - Federico Manetti
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, 00185 Rome, Italy; (M.F.); (N.D.F.); (F.M.)
| | - Raffaele La Russa
- Department of Clinical and Experimental Medicine, University of Foggia, 71100 Foggia, Italy; (G.B.); (F.P.C.); (G.G.); (L.C.); (R.L.R.)
| | - Vittorio Fineschi
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, 00185 Rome, Italy; (M.F.); (N.D.F.); (F.M.)
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Buja LM, Zhao B, Segura A, Lelenwa L, McDonald M, Michaud K. Cardiovascular pathology: guide to practice and training. Cardiovasc Pathol 2022. [DOI: 10.1016/b978-0-12-822224-9.00001-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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23
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Wang Y, Liu N, Yang M, Tian Z, Dong H, Lu Y, Zou D. Application and Prospect of Postmortem Imaging Technology in Forensic Cardiac Pathology: A Systemic Review. JOURNAL OF FORENSIC SCIENCE AND MEDICINE 2022. [DOI: 10.4103/jfsm.jfsm_129_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
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24
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Jin X, Chen D, Li X, Zeng X, Xu L, Hu B, Xu G. Advances in forensic diagnosis of electric shock death in the absence of typical electrical marks. Int J Legal Med 2021; 135:2469-2478. [PMID: 34313847 DOI: 10.1007/s00414-021-02658-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 06/29/2021] [Indexed: 10/20/2022]
Abstract
Electrical injury is a relatively uncommon but potentially devastating form of multi-system injury with high morbidity and mortality. In common electric injury cases, it is usually difficult to find characteristic changes of electric injury in major organs by using routine histopathological test methods unless there are landmark traces of electric injury, known as electric marks. How to determine electric shock death, especially in the absence of typical electrical marks on the body surface in some cases (which account for about two-thirds of electric injury cases), remains a challenging problem in forensic practice. Our summary shows that many current related studies have focused their efforts to find characteristic histopathological changes in major organs of the body caused by electric injury. Based on the results obtained through comparison of the literature, we find that it may be more urgent and important to find the optimal autopsy or sampling sites in cases with no typical electric marks, knowing that these sites may often reflect the most significant histopathological changes of electric injury, for instance anatomy and sampling of the anterior wrist and the medial malleolus in cases involving the hand-to-foot electric circuit pathway. In this article, we make a summary of advances in identification methods of electric injury, hoping that it could provide some new insights for further research in this field.
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Affiliation(s)
- Xin Jin
- Forensic and Pathology Laboratory, Judicial Expertise Center, Jiaxing University Medical College, Jiaxing, 314001, ZJ, China
| | - Deqing Chen
- Forensic and Pathology Laboratory, Judicial Expertise Center, Jiaxing University Medical College, Jiaxing, 314001, ZJ, China
| | - Xuebo Li
- Key Laboratory of Evidence Identification in Universities of Shandong Province, Shandong University of Political Science and Law, Jinan, 250014, SD, China
| | - Xiansi Zeng
- Forensic and Pathology Laboratory, Judicial Expertise Center, Jiaxing University Medical College, Jiaxing, 314001, ZJ, China
| | - Long Xu
- Forensic and Pathology Laboratory, Judicial Expertise Center, Jiaxing University Medical College, Jiaxing, 314001, ZJ, China
| | - Bo Hu
- Department of Pathology and Key-Innovative Discipline Molecular Diagnostics, Jiaxing Hospital of Traditional Chinese Medicine, Jiaxing University, Jiaxing, 314001, ZJ, China
| | - Guangtao Xu
- Forensic and Pathology Laboratory, Judicial Expertise Center, Jiaxing University Medical College, Jiaxing, 314001, ZJ, China.
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25
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Hammarlebiod S, Farrugia A, Bierry G, Raul JS, Willaume T. Thermal bone injuries: postmortem computed tomography findings in 25 cases. Int J Legal Med 2021; 136:219-227. [PMID: 34570270 DOI: 10.1007/s00414-021-02708-7] [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: 04/15/2021] [Accepted: 09/13/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Fire death investigations attempt to determine whether a subject was alive or dead before the fire started. Therefore, it is essential to assess if the bone damage is traumatic or the result of exposure to heat. This observational study aims to expose the specific CT semiology of thermal bone lesions to allow the forensic radiologist to identify and distinguish them from traumatic lesions that would have preceded death. MATERIALS AND METHODS We retrospectively reviewed the CT findings of 25 bodies with thermal bone lesions for which a postmortem computed tomography (PMCT) was performed prior to an autopsy. Imaging findings were correlated to the autopsy data to identify the specific features of thermal bone lesions. RESULTS Specific signs of thermal injuries to bone were identified on PMCT on all deceased cases. Thermal damages predominated in areas directly exposed to flames (rib cage, distal extremities) with less soft tissue coverage ("soft tissue shielding"). The mottled appearance of bone marrow was a constant sign of burned bones. Heat fractures such as trans-diploic fractures of flat bones and beveled ("flute-mouthpiece") fractures of extremities seemed specifically related to thermal mechanism. In addition, we provided a better description of superficial cortical fissures of flat bones ("ancient Chinese porcelain") and observed a "stair step" fracture of a long bone until now undescribed in radiological literature. CONCLUSION Thermal bone lesions have specific CT findings, different on several points from traumatic injuries. Their knowledge is essential for radiologists and forensic physicians to provide an accurate report of injury and conclusions.
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Affiliation(s)
- Sarah Hammarlebiod
- Department of Radiology, University Hospital of Strasbourg, 1 Avenue Molière, 67200, Strasbourg, France
| | - Audrey Farrugia
- Institute of Legal Medicine, Hospital of Strasbourg, University of Strasbourg, 11, rue Humann, 67085, Strasbourg cedex, France.
| | - Guillaume Bierry
- Department of Radiology, University Hospital of Strasbourg, 1 Avenue Molière, 67200, Strasbourg, France
| | - Jean-Sébastien Raul
- Institute of Legal Medicine, Hospital of Strasbourg, University of Strasbourg, 11, rue Humann, 67085, Strasbourg cedex, France
| | - Thibault Willaume
- Department of Radiology, University Hospital of Strasbourg, 1 Avenue Molière, 67200, Strasbourg, France
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26
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Arnold I, Schwendener N, Lombardo P, Jackowski C, Zech WD. 3Tesla post-mortem MRI quantification of anatomical brain structures. Forensic Sci Int 2021; 327:110984. [PMID: 34482282 DOI: 10.1016/j.forsciint.2021.110984] [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] [Received: 10/27/2020] [Revised: 03/04/2021] [Accepted: 08/17/2021] [Indexed: 01/31/2023]
Abstract
Quantitative post-mortem magnetic resonance imaging (PMMR) allows for measurement of T1 and T2 relaxation times and proton density (PD) of brain tissue. Quantitative PMMR values may be used for advanced post-mortem neuro-imaging diagnostics such as computer aided diagnosis. So far, the quantitative T1, T2 and PD post-mortem values of regular anatomical brain structures were unknown for a 3 Tesla PMMR application. The goal of this basic research study was to evaluate the quantitative values of post-mortem brain structures for a 3 T post-mortem magnetic resonance application with regard to various corpse temperatures. In 50 forensic cases, a quantitative PMMR brain sequence was applied prior to autopsy. Measurements of T1 (in ms), T2 (in ms), and PD (in %) values of cerebrum (Group 1: frontal grey matter, frontal white matter, thalamus, caudate nucleus, globus pallidus, putamen, internal capsule) brainstem and cerebellum (Group 2: cerebral peduncle, substantia nigra, red nucleus, pons, middle cerebellar peduncle, cerebellar hemisphere, medulla oblongata) were conducted in synthetically calculated axial PMMR brain images. Assessed quantitative values were corrected for corpse temperature. Temperature dependence was observed mainly for T1 values. ANOVA testing resulted in significant differences of quantitative values between the investigated anatomical brain structures in both groups. It can be concluded that temperature corrected 3 Tesla PMMR T1, T2 and PD values are feasible for characterization and discrimination of regular anatomical brain structures. This may provide a base for future advanced diagnostics of forensically relevant brain lesions and pathology.
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Affiliation(s)
- Isabel Arnold
- Institute of Forensic Medicine, University of Bern, Switzerland
| | | | - Paolo Lombardo
- Institute of Forensic Medicine, University of Bern, Switzerland; Department of Diagnostic, Interventional and Pediatric Radiology, University of Bern, Inselspital Bern, Switzerland
| | | | - Wolf-Dieter Zech
- Institute of Forensic Medicine, University of Bern, Switzerland.
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27
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The role of PMCT for the assessment of the cause of death in natural disaster (landslide and flood): a Sicilian experience. Int J Legal Med 2021; 136:237-244. [PMID: 34476607 PMCID: PMC8813687 DOI: 10.1007/s00414-021-02683-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 08/09/2021] [Indexed: 11/12/2022]
Abstract
In this report, the authors provide a contribution of PMCT in assessing the cause of death due to natural disasters. Here, the PMCT findings of 43 subjects who died during both landslide and flood were described. The post-mortem imaging revealed, clearly, traumatic injuries and/or the presence of foreign material in airways allowing to assess the cause of death of each subject, together with external inspection and the collected circumstantial data. Particularly, the PMCT has been helpful for characterization and localization of the clogging substance in airways providing findings on bronchial branches involvement. Moreover, the investigation offered detailed data on skeletal injuries in all anatomic districts and put in evidence both the precise fracturing site and the characteristics of fracture stubs for each bone fracture. This report supports the recommendation of the virtual autopsy in a case with several victims, as in natural disasters, and its role as an alternative diagnostic investigation when the standard autopsy is not feasible.
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28
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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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29
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A 5-Year Retrospective Study on Infant Homicide Presenting as Cot Death: Are we missing infant homicides? Am J Forensic Med Pathol 2021; 42:324-327. [PMID: 34054016 DOI: 10.1097/paf.0000000000000693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Being found dead in cot or bed is the most common presentation encountered with infant deaths. These deaths are often associated with unsafe sleep environment. The postmortem examination in such cases is often negative, and along with family objections, cultural, and other factors, may lead to a coroner considering not authorizing a postmortem examination. However, not identifying a homicide is a potential risk if a postmortem examination is not performed. This 5-year retrospective study investigated the proportion of infant homicide death initially presenting as cot death. Of a total of 103 cases of infants initially presenting as being found dead in cot or bed, 3 (approximately 3%) were classified as homicides after postmortem examination. During the study period, a total of 9 infant homicides were reported, translating to 33% (3 of 9) of infant homicides presented as cot deaths. Postmortem radiology was a valuable adjunct, but was unable to recognize 2 of the homicide cases with traumatic head injuries (with subdural hemorrhage and brain injury only). We strongly advocate that all infant deaths presenting as cot death require a full postmortem examination.
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30
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Virtual Trauma Analysis of the Nineteenth-Century Severed Head of the Greek Outlaw Stavrou. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021. [PMID: 33945131 DOI: 10.1007/978-3-030-61125-5_3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register]
Abstract
Human remains have been displayed in museums in Europe since many centuries for historical, cultural, and educational reasons. Of particular interest are skeletal remains and body parts that have suffered violent deaths and such remains often feature in Criminology Museums. Despite the well-acknowledged value of human remains in medical education, bioarchaeology, and research, the display of human remains still raises ethical considerations ranging in severity depending on the cultural substrate and legal framework of each country. Recent developments in medical imaging and visualisation are offering an alternative way. Taking into account the emerging issues regarding exhibition and handling of human remains, this research project aims to use virtual methods to reconstruct the circumstances of the death of a nineteenth-century outlaw comprising one of the human exhibits at the Criminology Museum of Athens in Greece.For the purpose of the project, the severed head of the outlaw Stavrou was CT scanned, and the data were used to reconstruct and to evaluate the ballistic trauma sustained at the time of his death. From the scans, it was possible to determine the minimum number of shots, entrance and exit wounds, approximate calibre of the bullets, approximate distance from which they were fired, and general velocity of the round.Shots are fired from the lateral left and backside of the head and bullets exited from the right frontal and temporal area causing extensive damage to the right craniofacial region. The direction of the shots coming from the back and left suggests that Stavrou was more likely ambushed by gendarmerie squads and not shot in a fair fight which would have caused entry wounds in the anterior surface of the body. This is in agreement with historical evidence that placed him in gunfire with his fellow gang member Karapanos against a government squad. On the other hand, the possibility of being captured alive and executed cannot be rejected based only on wound ballistics.This work would be excellent supplementary material to the actual human exhibit for the accurate presentation of Stavrou's history at the Criminology Museum. In addition, it would allow the virtual exhibition of the material for historical and teaching purposes to museums and universities anywhere in Greece and along the globe, thus overcoming the obstacles of moving the actual remains.
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31
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A review of visualization techniques of post-mortem computed tomography data for forensic death investigations. Int J Legal Med 2021; 135:1855-1867. [PMID: 33931808 PMCID: PMC8354982 DOI: 10.1007/s00414-021-02581-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 03/16/2021] [Indexed: 11/17/2022]
Abstract
Postmortem computed tomography (PMCT) is a standard image modality used in forensic death investigations. Case- and audience-specific visualizations are vital for identifying relevant findings and communicating them appropriately. Different data types and visualization methods exist in 2D and 3D, and all of these types have specific applications. 2D visualizations are more suited for the radiological assessment of PMCT data because they allow the depiction of subtle details. 3D visualizations are better suited for creating visualizations for medical laypersons, such as state attorneys, because they maintain the anatomical context. Visualizations can be refined by using additional techniques, such as annotation or layering. Specialized methods such as 3D printing and virtual and augmented reality often require data conversion. The resulting data can also be used to combine PMCT data with other 3D data such as crime scene laser scans to create crime scene reconstructions. Knowledge of these techniques is essential for the successful handling of PMCT data in a forensic setting. In this review, we present an overview of current visualization techniques for PMCT.
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32
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Ebert LC, Seckiner D, Sieberth T, Thali MJ, Franckenberg S. An algorithm for automatically generating gas, bone and foreign body visualizations from postmortem computed tomography data. Forensic Sci Med Pathol 2021; 17:254-261. [PMID: 33905073 PMCID: PMC8119247 DOI: 10.1007/s12024-021-00363-3] [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: 02/15/2021] [Indexed: 11/24/2022]
Abstract
Post mortem computed tomography (PMCT) can aid in localizing foreign bodies, bone fractures, and gas accumulations. The visualization of these findings play an important role in the communication of radiological findings. In this article, we present an algorithm for automated visualization of gas distributions on PMCT image data of the thorax and abdomen. The algorithm uses a combination of region growing segmentation and layering of different visualization methods to automatically generate overview images that depict radiopaque foreign bodies, bones and gas distributions in one image. The presented method was tested on 955 PMCT scans of the thorax and abdomen. The algorithm managed to generate useful images for all cases, visualizing foreign bodies as well as gas distribution. The most interesting cases are presented in this article. While this type of visualization cannot replace a real radiological analysis of the image data, it can provide a quick overview for briefings and image reports.
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Affiliation(s)
- Lars C Ebert
- 3D Center Zurich, Institute of Forensic Medicine Zurich, University of Zurich, Winterthurerstrasse 190/52 CH-8052, Zurich, Switzerland.
| | - Dilan Seckiner
- 3D Center Zurich, Institute of Forensic Medicine Zurich, University of Zurich, Winterthurerstrasse 190/52 CH-8052, Zurich, Switzerland
| | - Till Sieberth
- 3D Center Zurich, Institute of Forensic Medicine Zurich, University of Zurich, Winterthurerstrasse 190/52 CH-8052, Zurich, Switzerland
| | - Michael J Thali
- 3D Center Zurich, Institute of Forensic Medicine Zurich, University of Zurich, Winterthurerstrasse 190/52 CH-8052, Zurich, Switzerland
| | - Sabine Franckenberg
- 3D Center Zurich, Institute of Forensic Medicine Zurich, University of Zurich, Winterthurerstrasse 190/52 CH-8052, Zurich, Switzerland.,Institute for Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
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Strano-Rossi S, Mestria S, Bolino G, Polacco M, Grassi S, Oliva A. Scopolamine fatal outcome in an inmate after buscopan® smoking. Int J Legal Med 2021; 135:1455-1460. [PMID: 33890166 PMCID: PMC8062144 DOI: 10.1007/s00414-021-02583-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 03/16/2021] [Indexed: 01/31/2023]
Abstract
Scopolamine is an alkaloid which acts as competitive antagonists to acetylcholine at central and peripheral muscarinic receptors. We report the case of a 41-year-old male convict with a 27-year history of cannabis abuse who suddenly died in the bed of his cell after having smoked buscopan® tablets. Since both abuse of substances and recent physical assaults had been reported, we opted for a comprehensive approach (post-mortem computed tomography CT (PMCT), full forensic autopsy, and toxicology testing) to determine which was the cause of the death. Virtopsy found significant cerebral edema and lungs edema that were confirmed at the autopsy and at the histopathological examination. Scopolamine was detected in peripheral blood at the toxic concentration of 14 ng/mL in blood and at 263 ng/mL in urine, and scopolamine butyl bromide at 17 ng/mL in blood and 90 ng/mL in urine. Quetiapine, mirtazapine, lorazepam, diazepam, and metabolites and valproate were also detected (at therapeutic concentrations). Inmates, especially when they have a history of drug abuse, are at risk to use any substance they can find for recreational purposes. In prisons, active surveillance on the management and assumption of prescribed drugs could avoid fatal acute intoxication.
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Affiliation(s)
- Sabina Strano-Rossi
- Section of Legal Medicine, Department of Health Surveillance and Bioethics, Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168, Rome, Italy
| | - Serena Mestria
- Section of Legal Medicine, Department of Health Surveillance and Bioethics, Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168, Rome, Italy
| | - Giorgio Bolino
- Unit of Forensic Pathology, SAIMLAL Department, Sapienza University of Rome, Rome, Italy
| | - Matteo Polacco
- Section of Legal Medicine, Department of Health Surveillance and Bioethics, Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168, Rome, Italy
| | - Simone Grassi
- Section of Legal Medicine, Department of Health Surveillance and Bioethics, Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168, Rome, Italy
| | - Antonio Oliva
- Section of Legal Medicine, Department of Health Surveillance and Bioethics, Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168, Rome, Italy.
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Girolami I, Neil D, Segev DL, Furian L, Zaza G, Boggi U, Gambaro G, De Feo T, Casartelli-Liviero M, Cardillo M, Lombardini L, Zampicinini L, D'Errico A, Eccher A. Discovered cancers at postmortem donor examination: A starting point for quality improvement of donor assessment. Transplant Rev (Orlando) 2021; 35:100608. [PMID: 33647551 DOI: 10.1016/j.trre.2021.100608] [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: 10/23/2020] [Revised: 02/07/2021] [Accepted: 02/08/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND clinical and imaging investigations allow a detailed assessment of an organ donor, but a quota of cancer still elude detection. Complete autopsy of donors is even less frequently performed, due to economic issues and increasing availability of high-quality imaging. The aim of this study is to gather evidence from the literature on donor malignancy discovered at autopsy following organ donation and to discuss the utility and limitations of autopsy practice in the field of transplantation. METHODS A systematic search according to PRISMA guidelines was carried out in Pubmed and Embase databases until September 2020 to select articles with reporting of cancer discovered in a donor at postmortem examination. Cancer discover in not-transplant setting were excluded. A descriptive synthesis was provided. RESULTS Of 7388 articles after duplicates removal, 56 were included. Fifty-one studies reported on complete autopsy, while 5 dealt only with limited autopsy (prostate and central nervous system). The number of autopsies ranged between 1 and 246 with a total of 823 autopsies performed. The most frequent cancer discovered at autopsy was lymphoma (n = 13, 15%), followed by renal cell carcinoma (RCC) (n = 11, 13%), non-small cell lung cancer (NSCLC) (n = 10, 11%), melanoma (n = 10, 11%), choriocarcinoma (n = 6, 7%) and glioblastoma (GBM) (n = 6, 7%). CONCLUSIONS Lymphoma and melanoma are still difficult-to-detect cancers both during donor investigation and at procurement, whilst prostate cancer and choriocarcinoma are almost always easily detected nowadays thank to blood markers and clinical examination. There have been improvements with time in pre-donation detection procedures which are now working well, particularly when complete imaging investigations are performed, given that detection rate of CT/MRI is high and accurate. Autopsy can play a role to help to establish the correct donor management pathways in case of cancer discover. Furthermore, it helps to better understand which cancers are still eluding detection and consequently to refine guidelines' assessment procedures.
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Affiliation(s)
- Ilaria Girolami
- Division of Pathology, Central Hospital Bolzano, Bolzano, Italy
| | - Desley Neil
- Department of Cellular Pathology, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Dorry Lidor Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Lucrezia Furian
- Kidney and Pancreas Transplantation Unit, Department of Surgical, Oncological and Gastroenterological Sciences, University and Hospital Trust of Padua, Padua, Italy
| | - Gianluigi Zaza
- Renal Unit, University and Hospital Trust of Verona, Verona, Italy
| | - Ugo Boggi
- Division of General and Transplant Surgery, University of Pisa, Pisa, Italy
| | - Giovanni Gambaro
- Renal Unit, University and Hospital Trust of Verona, Verona, Italy
| | - Tullia De Feo
- North Italy Transplant Program, Coordinamento Trapianti, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Marilena Casartelli-Liviero
- Neurosurgery and Intensive Care Unit, Department of Surgical Science, University and Hospital Trust of Verona, Verona, Italy
| | | | | | - Laura Zampicinini
- Neurosurgery and Intensive Care Unit, Department of Surgical Science, University and Hospital Trust of Verona, Verona, Italy
| | - Antonietta D'Errico
- Pathology Unit, University of Bologna, IRCCS Policlinico St. Orsola-Malpighi Hospital, Bologna, Italy
| | - Albino Eccher
- Department of Pathology and Diagnostics, University and Hospital Trust of Verona, Verona, Italy.
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35
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Tumanova UN, Shchegolev AI, Kovalev AV. [Technical and methodological support for postmortem radiation examinations in the pathological departments and the forensic bureau]. Sud Med Ekspert 2021; 64:51-57. [PMID: 33739071 DOI: 10.17116/sudmed20216402151] [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] [Indexed: 11/17/2022]
Abstract
The purpose of the work is to analyze the technical and methodological features of postmortem radiation studies based on literature data and the results of our own experience. To designate such studies, the term thanatoradiology has been proposed. The basis for the effective conduct of a thanatodiological examination is adequate technical support, which equally consists of the capabilities of the equipment for obtaining radiographs, CT and MR tomograms (type and generation of the device, technical features of a particular model), as well as the capabilities of the radiologist's workstation with the help of which the computer processing of the obtained images is carried out, three-dimensional reconstructions are performed, the calculation of planar and volumetric parameters and additional information is obtained. The use of an X-ray unit allows one to assess only pronounced pathology and the presence of foreign objects. The effectiveness of a computed tomography device depends on the choice of the slice thickness and the step of the examination table. Research on a magnetic resonance imager is effective at certain magnetic induction strength, the form of a magnetic coil and the used mode of recording a pulse sequence. The objectivity and efficiency of digital processing of tomograms consists of the type of a radiologist's workstation and installed programs for post-processing tomograms, including for modeling three-dimensional images and color mapping. The choice of a specific method of postmortem radiation research should be determined mainly by the research objectives. Research should be carried out taking into account age, body weight, individual characteristics and the state of body tissues. Today, it is advisable to use radiation methods as part of a comprehensive pathological and anatomical or forensic medical research to improve the quality and shorten the autopsy duration. The development of a unified protocol for postmortem CT and MRI studies that meets the pathological, anatomical and forensic requirements remains an urgent task.
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Affiliation(s)
- U N Tumanova
- Acad. V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Moscow, Russia
| | - A I Shchegolev
- Acad. V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Moscow, Russia
| | - A V Kovalev
- Russian Medical Academy of Continuing Postgraduate Education, Moscow, Russia
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36
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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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Höch A, Özkurtul O, Hammer N, Heinemann A, Tse R, Zwirner J, Henkelmann J, Fakler J, Ondruschka B. A comparison on the detection accuracy of ante mortem computed tomography vs. autopsy for the diagnosis of pelvic ring injury in legal medicine. J Forensic Sci 2021; 66:919-925. [PMID: 33512022 DOI: 10.1111/1556-4029.14677] [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: 10/08/2020] [Revised: 01/06/2021] [Accepted: 01/08/2021] [Indexed: 11/28/2022]
Abstract
A detailed knowledge on the exact morphology of pelvic injuries provided crucial information in understanding the mechanisms of injury and has influence on the natural course and subsequent mortality. However, forensic medical literature investigating pelvic fractures in detail is scarce to date. This case series aims to compare the accuracy in detecting pelvic injuries using autopsy and ante mortem computed tomography (CT). Nineteen deceased patients with CT scans of pelvic fractures were included retrospectively. Pelvic injuries were independently assessed by a board-certified radiologist (R) and a board-certified trauma surgeon (T), both using the ante mortem CT scans, and by a board-certified forensic pathologist using autopsy (A) results without knowledge of the CT scan findings. No patient had died causatively from a pelvic fracture. Most injuries of the pelvis were present in the pubic rami (16/18) and sacral bone (13/18), followed by the sacroiliac joint (9/18) and iliac bone fractures (8/18). Ilium fractures (A:100%;R:67%;T:67%) and injuries of the sacroiliac joint (A:83%;R:50%;T:42%) were best detected via autopsy. The diagnosis of sacral fractures (A:19%;R:94%;T:88%) and fractures of the pubic rami (A:67%;R:96%;T:96%) were most often missed in autopsy. The results show deficits in the assessment of the pelvic injury for both CT and autopsy. Autopsy was superior in detecting injuries of the sacroiliac joint, but inferior in detecting sacral and pubic bone fractures. For an encompassing evaluation of ligamento-skeletal pelvic injuries, the complementary use of both CT and autopsy is recommended.
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Affiliation(s)
- Andreas Höch
- Department of Orthopedic, Trauma and Plastic Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Orkun Özkurtul
- Department of Orthopedic, Trauma and Plastic Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Niels Hammer
- Department of Orthopedic, Trauma and Plastic Surgery, University Hospital Leipzig, Leipzig, Germany.,Department of Macroscopic and Clinical Anatomy, Medical University of Graz, Graz, Austria
| | - Axel Heinemann
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Rexson Tse
- Department of Forensic Pathology, LabPLUS, Auckland City Hospital, Auckland, New Zealand
| | - Johann Zwirner
- Department of Anatomy, University of Otago, Dunedin, New Zealand
| | - Jeanette Henkelmann
- Department of Diagnostic and Interventional Radiology, University Hospital Leipzig, Leipzig, Germany
| | - Johannes Fakler
- Department of Orthopedic, Trauma and Plastic Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Benjamin Ondruschka
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Institute of Legal Medicine, University Hospital Leipzig, Leipzig, Germany
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Oliva A, Grassi S, Grassi VM, Pinchi V, Floris R, Manenti G, Colosimo C, Filograna L, Pascali VL. Postmortem CT and autopsy findings in nine victims of terrorist attack. Int J Legal Med 2021; 135:605-618. [PMID: 33420525 DOI: 10.1007/s00414-020-02492-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 12/17/2020] [Indexed: 12/26/2022]
Abstract
In a foreign country, a religious terrorist group raided a restaurant, using pipe bombs, sharp-edged weapons, and various types of firearms (handguns, submachine guns, and AK-47 assault rifles) loaded with normal and prohibited bullets to kill foreigner customers, some of whom were Italian tourists. Local pathologists performed forensic autopsies on the bodies, but we were asked to perform additional external examinations, postmortem computed tomography (PMCT) scans, and then a second round of complete autopsies on nine victims (5 females and 4 males). Four victims had slash wounds inflicted by sharp-edged weapons, mostly localized in the head and neck. All but two victims had gunshot wounds. Finally, three casualties had injuries caused by the explosion of improvised explosive devices. In all cases, PMCT was a reliable source of information and provided strategic guide during autopsies, helping identify and describe the injuries and thus reconstruct the events. Therefore, in these cases, we suggest integrating the autopsy findings with the postmortem radiological data.
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Affiliation(s)
- Antonio Oliva
- Department of Health Surveillance and Bioethics, Section of Legal Medicine, Catholic University, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy.
| | - Simone Grassi
- Department of Health Surveillance and Bioethics, Section of Legal Medicine, Catholic University, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy
| | - Vincenzo M Grassi
- Department of Health Surveillance and Bioethics, Section of Legal Medicine, Catholic University, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy
| | - Vilma Pinchi
- Section of Forensic Medical Sciences, Department of Health Sciences, University of Florence, Florence, Italy
| | - Roberto Floris
- Department of Biomedicine and Prevention, UOC of Diagnostic Imaging, University of Rome, "Tor Vergata", Rome, Italy
| | - Guglielmo Manenti
- Department of Biomedicine and Prevention, UOC of Diagnostic Imaging, University of Rome, "Tor Vergata", Rome, Italy
| | - Cesare Colosimo
- Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology - Diagnostic Imaging Area, Fondazione Policlinico, Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Laura Filograna
- Department of Biomedicine and Prevention, UOC of Diagnostic Imaging, University of Rome, "Tor Vergata", Rome, Italy
| | - Vincenzo L Pascali
- Department of Health Surveillance and Bioethics, Section of Legal Medicine, Catholic University, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy
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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.
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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.
- 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
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40
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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.
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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.
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41
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A review on the evolution and characteristics of post-mortem imaging techniques. FORENSIC IMAGING 2020. [DOI: 10.1016/j.fri.2020.200420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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42
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Locci E, Bazzano G, Chighine A, Locco F, Ferraro E, Demontis R, d'Aloja E. Forensic NMR metabolomics: one more arrow in the quiver. Metabolomics 2020; 16:118. [PMID: 33159593 PMCID: PMC7648736 DOI: 10.1007/s11306-020-01743-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 10/29/2020] [Indexed: 12/13/2022]
Abstract
INTRODUCTION NMR metabolomics is increasingly used in forensics, due to the possibility of investigating both endogenous metabolic profiles and exogenous molecules that may help to describe metabolic patterns and their modifications associated to specific conditions of forensic interest. OBJECTIVES The aim of this work was to review the recent literature and depict the information provided by NMR metabolomics. Attention has been devoted to the identification of peculiar metabolic signatures and specific ante-mortem and post-mortem profiles or biomarkers related to different conditions of forensic concern, such as the identification of biological traces, the estimation of the time since death, and the exposure to drugs of abuse. RESULTS AND CONCLUSION The results of the described studies highlight how forensics can benefit from NMR metabolomics by gaining additional information that may help to shed light in several forensic issues that still deserve to be further elucidated.
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Affiliation(s)
- Emanuela Locci
- Department of Medical Sciences and Public Health, Section of Legal Medicine, University of Cagliari, Cagliari, Italy.
- Department of Medical Sciences and Public Health, Legal Medicine Section, University of Cagliari, Cittadella Universitaria di Monserrato, 09042, Monserrato, CA, Italy.
| | - Giovanni Bazzano
- Department of Medical Sciences and Public Health, Section of Legal Medicine, University of Cagliari, Cagliari, Italy
| | - Alberto Chighine
- Department of Medical Sciences and Public Health, Section of Legal Medicine, University of Cagliari, Cagliari, Italy
| | - Francesco Locco
- Department of Medical Sciences and Public Health, Section of Legal Medicine, University of Cagliari, Cagliari, Italy
| | - Ernesto Ferraro
- Department of Medical Sciences and Public Health, Section of Legal Medicine, University of Cagliari, Cagliari, Italy
| | - Roberto Demontis
- Department of Medical Sciences and Public Health, Section of Legal Medicine, University of Cagliari, Cagliari, Italy
| | - Ernesto d'Aloja
- Department of Medical Sciences and Public Health, Section of Legal Medicine, University of Cagliari, Cagliari, Italy
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Kniep I, Lutter M, Ron A, Edler C, Püschel K, Ittrich H, Heller M, Heinemann A. [Postmortem imaging of the lung in cases of COVID-19 deaths]. Radiologe 2020; 60:927-933. [PMID: 32809036 PMCID: PMC7433282 DOI: 10.1007/s00117-020-00733-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
CLINICAL/METHODOLOGICAL ISSUE COVID-19 is a new viral disease that is associated with inflammatory pulmonary changes which can be detected in computed tomography (CT). So far postmortem CT (PMCT) has not been used as a screening instrument for the evaluation of deaths with and without autopsy. In this respect, its validity has to be proved in comparison to clinical-radiological experiences. STANDARD RADIOLOGICAL METHODS Postmortem CT METHODICAL INNOVATIONS: So far, PMCT can be regarded as a methodological innovation that has not yet been sufficiently evaluated for pneumonia. PERFORMANCE CT in clinical routine has a high sensitivity for pneumonia. However, to what extent postmortem artifacts are relevant to PMCT still has to be determined. ACHIEVEMENTS There is still no standard procedure for the postmortem radiological diagnosis of COVID-19 disease. Despite postmortem artifacts, PMCT can provide valuable information about the presence of pneumonia with interstitial character, especially without autopsy. PRACTICAL RECOMMENDATIONS PMCT is particularly useful in the assessment of suspected cases of COVID-19 pneumonia for morphological assessment in the context of monitoring deaths in the current pandemic situation.
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Affiliation(s)
- I Kniep
- Institut für Rechtsmedizin, Universitätsklinikum Hamburg-Eppendorf, Butenfeld 34, 22529, Hamburg, Deutschland.
| | - M Lutter
- Institut für Rechtsmedizin, Universitätsklinikum Hamburg-Eppendorf, Butenfeld 34, 22529, Hamburg, Deutschland
| | - A Ron
- Institut für Rechtsmedizin, Universitätsklinikum Hamburg-Eppendorf, Butenfeld 34, 22529, Hamburg, Deutschland
| | - C Edler
- Institut für Rechtsmedizin, Universitätsklinikum Hamburg-Eppendorf, Butenfeld 34, 22529, Hamburg, Deutschland
| | - K Püschel
- Institut für Rechtsmedizin, Universitätsklinikum Hamburg-Eppendorf, Butenfeld 34, 22529, Hamburg, Deutschland
| | - H Ittrich
- Klinik und Poliklinik für Diagnostische und Interventionelle Radiologie und Nuklearmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - M Heller
- Institut für Rechtsmedizin, Universitätsklinikum Hamburg-Eppendorf, Butenfeld 34, 22529, Hamburg, Deutschland
| | - A Heinemann
- Institut für Rechtsmedizin, Universitätsklinikum Hamburg-Eppendorf, Butenfeld 34, 22529, Hamburg, Deutschland
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Dobay A, Ford J, Decker S, Ampanozi G, Franckenberg S, Affolter R, Sieberth T, Ebert LC. Potential use of deep learning techniques for postmortem imaging. Forensic Sci Med Pathol 2020; 16:671-679. [PMID: 32990926 PMCID: PMC7669812 DOI: 10.1007/s12024-020-00307-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2020] [Indexed: 01/05/2023]
Abstract
The use of postmortem computed tomography in forensic medicine, in addition to conventional autopsy, is now a standard procedure in several countries. However, the large number of cases, the large amount of data, and the lack of postmortem radiology experts have pushed researchers to develop solutions that are able to automate diagnosis by applying deep learning techniques to postmortem computed tomography images. While deep learning techniques require a good understanding of image analysis and mathematical optimization, the goal of this review was to provide to the community of postmortem radiology experts the key concepts needed to assess the potential of such techniques and how they could impact their work.
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Affiliation(s)
- Akos Dobay
- Zurich Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, CH-8057, Zurich, Switzerland. .,Department of Evolutionary Biology and Environmental Studies, University of Zurich, Winterthurerstrasse 190, CH-8057, Zurich, Switzerland.
| | - Jonathan Ford
- Department of Radiology, University of South Florida Morsani College of Medicine, 2 Tampa General Circle STC 6097, Tampa, FL, 33606, USA
| | - Summer Decker
- Department of Radiology, University of South Florida Morsani College of Medicine, 2 Tampa General Circle STC 6097, Tampa, FL, 33606, USA
| | - Garyfalia Ampanozi
- Zurich Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, CH-8057, Zurich, Switzerland
| | - Sabine Franckenberg
- Zurich Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, CH-8057, Zurich, Switzerland.,Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Raffael Affolter
- Zurich Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, CH-8057, Zurich, Switzerland
| | - Till Sieberth
- Zurich Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, CH-8057, Zurich, Switzerland
| | - Lars C Ebert
- Zurich Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, CH-8057, Zurich, Switzerland
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Hueck U, Muggenthaler H, Hubig M, Heinrich A, Güttler F, Wagner R, Mall G, Teichgräber U. Forensic postmortem computed tomography in suspected unnatural adult deaths. Eur J Radiol 2020; 132:109297. [PMID: 33035918 DOI: 10.1016/j.ejrad.2020.109297] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 09/04/2020] [Accepted: 09/18/2020] [Indexed: 01/16/2023]
Abstract
PURPOSE Our study sought to evaluate validity of forensic postmortem CT in establishing cause of death (COD) in suspected unnatural adult death based on the reference standard of autopsy. METHODS In our prospective, single-center study, 64 of 94 consecutive corpses (70.7 % male, mean age: 47.4 years) who underwent CT and autopsy between November 2013 and April 2019 were included in the analysis. Primary objective was agreement between CT and autopsy on primary COD using kappa statistics. Secondary objectives were competing COD and specific pathological findings. RESULTS Agreement on primary COD between forensic CT and autopsy without or in consideration of toxicological and histological findings was strong (85.9 % [55 of 64 corpses]; κ = 0.83 [95 %CI: 0.74 to 0.93] and 95.3 % [61 of 64 corpses]; κ = 0.94 [95 %CI: 0.84-1.04], respectively, McNemar p = 0.03). Sensitivity and specificity of CT in identification of acute heart failure, intracranial bleeding, burns and heat shocks, gunshot wounds, polytrauma, cranio-cerebral trauma, and strangulation or hanging was 100 %, each. Acute respiratory failure was detected with a sensitivity and specificity of 100 % and 96.8 %, cuts and stab wounds with 95.2 % and 100 %, and intoxication, pneumonia, or gastrointestinal bleeding with 60.0 % and 100 %, respectively. Agreement on competing COD was moderate (51.6 %, [33 of 64 corpses]; κ = 0.47 [95 %CI: 0.40 to 0.53], p < 0.001). CONCLUSIONS Forensic postmortem CT, complemented by external, toxicological, and histological examination was sufficiently valid to assess primary COD in the majority of suspected unnatural deaths with few restrictions.
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Affiliation(s)
- U Hueck
- Department of Radiology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - H Muggenthaler
- Department of Forensic Medicine, Jena University Hospital, Jena, Am Klinikum 1, 07747, Jena, Germany
| | - M Hubig
- Department of Forensic Medicine, Jena University Hospital, Jena, Am Klinikum 1, 07747, Jena, Germany
| | - A Heinrich
- Department of Radiology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - F Güttler
- Department of Radiology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - R Wagner
- Department of Forensic Medicine, Jena University Hospital, Jena, Am Klinikum 1, 07747, Jena, Germany
| | - G Mall
- Department of Forensic Medicine, Jena University Hospital, Jena, Am Klinikum 1, 07747, Jena, Germany
| | - U Teichgräber
- Department of Radiology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany.
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Imaizumi K, Bermejo E, Taniguchi K, Ogawa Y, Nagata T, Kaga K, Hayakawa H, Shiotani S. Development of a sex estimation method for skulls using machine learning on three-dimensional shapes of skulls and skull parts. FORENSIC IMAGING 2020. [DOI: 10.1016/j.fri.2020.200393] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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47
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Xia ZY, Bruguier C, Dedouit F, Grabherr S, Augsburger M, Liu BB. Oleic Acid (OA), A Potential Dual Contrast Agent for Postmortem MR Angiography (PMMRA): A Pilot Study. Curr Med Sci 2020; 40:786-794. [PMID: 32862391 DOI: 10.1007/s11596-020-2244-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 05/19/2020] [Indexed: 01/31/2023]
Abstract
Choosing proper perfusates as contrast agents is an important aspect for postmortem magnetic resonance angiography (PMMRA). However, in this emerging field, the number of suitable kinds of liquid is still very limited. The objective of this research is to compare MR images of oleic acid (OA) with paraffin oil (PO) in vitro and in ex situ animal hearts, in order to evaluate the feasibility to use OA as a novel contrast agent for PMMRA. In vitro, OA, PO and water (control) were introduced into three tubes separately and T1weighted-spin echo (T1w-SE) and T2w-SE images were acquired on a 1.5T MR scanner. In the second experiment, OA and PO were injected into left coronary artery (LCA) and left ventricle (LV) of ex situ bovine hearts and their T1w-SE, T2w-SE, T1w-multipoint Dixon (T1w-mDixon) and 3DT2w-mDixon images were acquired. The overall results indicate that OA may have a potential to be used as a dual (T1 and T2 based) contrast agent for PMMRA when proper sequence parameters are utilized. However, as the pilot study was based on limited number of animal hearts, more researches using OA in cadavers are needed to validate our findings.
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Affiliation(s)
- Zhi-Yuan Xia
- Institute of Evidence Law and Forensic Science, China University of Political Science and Law (CUPL), Key Laboratory of Evidence Law and Forensic Science, Ministry of Education, Beijing, 100088, China.
| | - Christine Bruguier
- University Center of Legal Medicine, Lausanne-Geneva (CURML), Lausanne, CH1000, Switzerland
| | - Fabrice Dedouit
- Service de Médecine Légale, Hôpital de Rangueil, Toulouse, 50032, France
| | - Silke Grabherr
- University Center of Legal Medicine, Lausanne-Geneva (CURML), Lausanne, CH1000, Switzerland
| | - Marc Augsburger
- University Center of Legal Medicine, Lausanne-Geneva (CURML), Lausanne, CH1000, Switzerland
| | - Bei-Bei Liu
- Dian Research Center for Postmortem Imaging & Angiography, Beijing, 100192, China
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48
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Mentink MG, Bakers FCH, Mihl C, Lahaye MJ, Rennenberg RJMW, Latten BGH, Kubat B, Hofman PAM. Introduction of postmortem CT increases the postmortem examination rate without negatively impacting the rate of traditional autopsy in daily practice: an implementation study. J Clin Pathol 2020; 74:177-181. [PMID: 32675309 DOI: 10.1136/jclinpath-2020-206734] [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: 05/08/2020] [Revised: 06/24/2020] [Accepted: 06/24/2020] [Indexed: 11/03/2022]
Abstract
AIM The aim of this implementation study was to assess the effect of postmortem CT (PMCT) and postmortem sampling (PMS) on (traditional) autopsy and postmortem examination rates. Additionally, the feasibility of PMCT and PMS in daily practice was assessed. METHODS For a period of 23 months, PMCT and PMS were used as additional modalities to the autopsy at the Department of Internal Medicine. The next of kin provided consent for 123 postmortem examinations. Autopsy rates were derived from the Dutch Pathology Registry, and postmortem examination rates were calculated for the period before, during and after the study period, and the exclusion rate, table time, time interval to informing the referring clinicians with results and the time interval to the Multidisciplinary Mortality Review Board (MMRB) meeting were objectified to assess the feasibility. RESULTS The postmortem examination rate increased (from 18.8% to 32.5%, p<0.001) without a decline in the autopsy rate. The autopsy rate did not change substantially after implementation (0.2% decrease). The exclusion rate was 2%, the table time was 23 min, and a median time interval of 4.1 hours between PMCT and discussing its results with the referring clinicians was observed. Additionally, more than 80% of the MMRB meetings were held within 8 weeks after the death of the patient. CONCLUSIONS Our study shows that the implementation of a multidisciplinary postmortem examination is feasible in daily practice and does not adversely affect the autopsy rate, while increasing the postmortem examination rate.
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Affiliation(s)
- Max G Mentink
- Department of Radiology and Nuclear Medicine, Maastricht Universitair Medisch Centrum+, Maastricht, The Netherlands
| | - Frans C H Bakers
- Department of Radiology and Nuclear Medicine, Maastricht Universitair Medisch Centrum+, Maastricht, The Netherlands
| | - Casper Mihl
- Department of Radiology and Nuclear Medicine, Maastricht Universitair Medisch Centrum+, Maastricht, The Netherlands.,Department of Radiology, CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
| | - Max J Lahaye
- Department of Radiology, Antoni van Leeuwenhoek, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Roger J M W Rennenberg
- Department of Internal Medicine, Maastricht Universitair Medisch Centrum+, Maastricht, The Netherlands
| | - Bart G H Latten
- Department of Pathology, Maastricht Universitair Medisch Centrum+, Maastricht, The Netherlands.,Department of Pathology, Netherlands Forensic Institute, Den Haag, The Netherlands
| | - Bela Kubat
- Department of Pathology, Maastricht Universitair Medisch Centrum+, Maastricht, The Netherlands.,Department of Pathology, Netherlands Forensic Institute, Den Haag, The Netherlands
| | - Paul A M Hofman
- Department of Radiology and Nuclear Medicine, Maastricht Universitair Medisch Centrum+, Maastricht, The Netherlands
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49
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Vester MEM, Nolte KB, Hatch GM, Gerrard CY, Stoel RD, van Rijn RR. Postmortem Computed Tomography in Firearm Homicides: A Retrospective Case Series. J Forensic Sci 2020; 65:1568-1573. [PMID: 32402110 PMCID: PMC7496672 DOI: 10.1111/1556-4029.14453] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 04/16/2020] [Accepted: 04/17/2020] [Indexed: 11/30/2022]
Abstract
Postmortem computed tomography (PMCT) is integrated into the evaluation of decedents in several American medical examiner offices and medicolegal death investigative centers in many other countries. We retrospectively investigated the value of PMCT in a series of firearm homicide cases from a statewide centralized medical examiner’s office that occurred during 2016. Autopsies were performed or supervised by board‐certified forensic pathologists who reviewed the PMCT scans prior to autopsy. PMCT scans were re‐evaluated by a forensic radiologist blinded to the autopsy findings and scored by body region (head–neck, thoracoabdominal, and extremities). Injury discrepancies were scored using a modified Goldman classification and analyzed with McNemar’s test. We included 60 males and 20 females (median age 31 years, range 3–73). Based on PMCT, 56 (79.1%) cases had injuries relevant to the cause of death in a single body region (24 head–neck region, 32 thoracoabdominal region). Out of these 56 cases, 9 had a missed major diagnosis by PMCT outside that region, including 6 extremity injuries visible during standard external examination. Yet all had evident lethal firearm injury. We showed that PMCT identifies major firearm injuries in homicide victims and excludes injuries related to the cause of death in other regions when a single body region is injured. Although PMCT has a known limited sensitivity for soft tissue and vascular pathology, it can be combined with external examination to potentially reduce or focus dissections in some of these cases depending on the circumstances and medicolegal needs.
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Affiliation(s)
- Marloes E M Vester
- Department of Forensic Medicine, Netherlands Forensic Institute, Laan van Ypenburg 6, 2497 GB, The Hague, The Netherlands.,Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Kurt B Nolte
- Office of the Medical Investigator, University of New Mexico School of Medicine, 1101 Camino de Salud, Albuquerque, NM, 87102
| | - Gary M Hatch
- Office of the Medical Investigator, University of New Mexico School of Medicine, 1101 Camino de Salud, Albuquerque, NM, 87102
| | - Chandra Y Gerrard
- Office of the Medical Investigator, University of New Mexico School of Medicine, 1101 Camino de Salud, Albuquerque, NM, 87102
| | - Reinoud D Stoel
- Department of Forensic Medicine, Netherlands Forensic Institute, Laan van Ypenburg 6, 2497 GB, The Hague, The Netherlands
| | - Rick R van Rijn
- Department of Forensic Medicine, Netherlands Forensic Institute, Laan van Ypenburg 6, 2497 GB, The Hague, The Netherlands.,Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
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50
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Stanley SA, Rutty GN, Rutty JE. Postmortem Computed Tomography: An Overview for Forensic Nurses Involved in Death Investigation. JOURNAL OF FORENSIC NURSING 2020; 16:90-98. [PMID: 32433192 DOI: 10.1097/jfn.0000000000000288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The traditional invasive autopsy has been considered the "gold standard" for death investigation worldwide. However, this has now been challenged by a new minimally invasive approach that utilizes cross-sectional radiological imaging to investigate the death. Globally, postmortem computed tomography is the most commonly used modality and is becoming increasingly available throughout the world. Forensic nurses working in association with coroners and medical examiners' offices, as well as mass fatality incidents, now need to update their knowledge base to understand these innovative techniques, the advantages and disadvantages to their use, and how they impact on medicolegal death investigation and the care of the deceased and bereaved. Using the example of the coroner system of England and Wales, this article provides a comparison between the traditional invasive autopsy and postmortem radiological alternatives and presents the impact postmortem radiology is now having on death investigation.
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Affiliation(s)
| | - Guy N Rutty
- East Midlands Forensic Pathology Unit, University of Leicester
| | - Jane E Rutty
- Faculty of Health and Life Sciences, De Montfort University
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