Postmortem imaging of perimortem skeletal trauma

Combining anthropology and imaging to reconstruct antemortem trauma for identification purposes

Identification of unidentified remains involves a comparison of ante- and postmortem features using biological identifiers. Anthropological identifiers, referred to by International Criminal Police Organization (INTERPOL) as secondary identifiers, have often been judged less reliable than DNA, fingerprints and dental records (referred to as primary identifiers). However, anthropological identifiers have been proven as discriminatory as the primary sources in many instances, and play a decisive role in positive identification. To guarantee better use of anthropological identifiers, it is not only essential to develop standard protocols and statistical frameworks, but also to test different identification approaches in cases from daily practice. Evidence of skeletal antemortem trauma can be a valuable aid in the identification process, especially if the exact type of traumatic event causing the injury is identified. Here, we present a case in which the combination of anthropological analysis and imaging confirmed an interesting and unique sequence of antemortem traumatic events in incomplete skeletal remains. The remains were assumed to pertain to an individual who went missing several years earlier, and whose medical records revealed a unique history of trauma to the right femur. The individual had sustained a fracture due to a fall from a high height followed, 10 years after the primary trauma, by a gunshot wound to the same bone; both treated by intramedullary nail fixation. While the anthropological analysis matched the biological profile of the missing individual and identified a healed defect to the right femur compatible with a gunshot wound, the radiological examination indicated that the bone underwent three surgical procedures on different occasions. Radiological examination also identified a pre-existing healed fracture adjacent to the gunshot defect. In addition to presenting the identification process in this specific case, this article discusses the difficulties in antemortem trauma interpretation, importance of combining macroscopic and radiological analysis to aid the reconstruction of previous traumatic events and mechanisms of injury from healed fractures that can play important roles in forensic human identification.

What we see is what we touch? Sex estimation on the skull in virtual anthropology

BACKGROUND

The increased use of virtual bone images in forensic anthropology requires a comprehensive study on the observational errors between dry bones and CT reconstructions. Here, we focus on the consistency of nonmetric sex estimation traits on the human skull.

MATERIALS AND METHODS

We scored nine nonmetric traits on dry crania and mandibles (n = 223) of archaeological origin and their CT reconstructions. Additionally, we 3D surface scanned a subsample (n = 50) and repeated our observations. Due to the intricate anatomy of the mental eminence, we split it into two separate traits: the bilateral mental tubercles and the midsagittal mental protuberance. We provide illustrations and descriptions for both these traits.

RESULTS

We obtained supreme consistency values between the CT and 3D surface modalities. The most consistent cranial traits were the glabella and the supraorbital margin, followed by the nuchal crest, zygomatic extension, mental tubercles, mental protuberance, mental eminence, mastoid process and ramus flexure, in descending order. The mental tubercles show higher consistency scores than the mental eminence and the mental protuberance.

DISCUSSION

The increased interchangeability of the virtual modalities with each other as compared to the dry bone modality could be due to the lack of tactility on both the CT and surface scans. Moreover, tactility appears less essential with experience than a precise trait description. Future studies could revolve around the most consistent cranial traits, combining them with pelvic traits from a previous study, to test for accuracy.

Korean radiographers' awareness, experiences, and education needs in forensic medicine and forensic radiology

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.

3D-3D Superimposition of Pubic Bones: Expanding the Anthropological Toolkit for the Pair-Matching of Commingled Skeletal Remains

Virtual anthropology (VA) has recently produced an additional tool for the analysis of commingled remains and is based on the distance analysis between three-dimensional (3D) models of bones. To date, the pair-matching of the innominate bone through a 3D approach remains partially unexplored. Here, 44 abdominal CT scans (22 males and 22 females) were selected from a hospital database, and the pubic bones were segmented through ITK-SNAP software. The models were hollowed with Viewbox4 to minimize the amount of trabecular bone. The left pubic bones were mirrored and superimposed on the right ones, according to the smallest point-to-point difference between the two surfaces through VAM software. RMS distances between models were calculated through VAM, producing RMS values for 20 matches and 420 mismatches for each sex group. Differences in RMS distance values between matches and mismatches were investigated through Mann−Whitney tests (p < 0.05); the repeatability of the procedure was assessed through absolute and relative technical error measurement (TEM and rTEM). RMS distance values of matches and mismatches were significantly different (p < 0.01) in both groups. The method yielded optimal results with high sensitivity (100.0%) and specificity (99.8% in males, 98.8% in females) rates according to the chosen threshold. This project contributes to the research field of VA with a valuable adjunct that may bolster and strengthen the results of the current visual and osteometric methods through a multidisciplinary approach.

Perimortem Skeletal Sharp Force Trauma: Detection Reliability on CT Data, Demographics and Anatomical Patterns from a Forensic Dataset

Simple Summary

The increased use of computed tomography images in forensic anthropology is easily explained with a variety of benefits: among other reasons they are digitally stored, they can easily be shared and they are non-invasive. However, it is not clear how suitable these images are for forensic anthropologists to detect sharp force trauma. Therefore, we analyzed computed tomography images, by observing digital images of 41 forensic cases in different viewing modalities. In addition, we looked for anatomical injury patterns in the soft- and hard-tissues and any significant correlations between the manner of death (suicide or homicide) with different parameters. Our findings indicated a superiority of viewing the images in 2D, but not all bone lesions were detected. The manner of death was significantly correlated to some of the parameters, which could be extrapolated to future forensic anthropological cases. We promote the inclusion of imaging training into the anthropological curricula.

Abstract

The increasing importance of trauma analysis by means of postmortem computed tomography (PMCT) is insufficiently reflected in forensic curricula, nor are best practice manuals available. We attempt to detect sharp force bone lesions on PMCT of closed forensic cases with the aims of assessing errors and pointing out patterns in anatomical location and manner of death (MOD). We investigated 41 closed sharp force fatality cases, with available PMCT and forensic reports. Two observers with different radiological training assessed the lesions on PMCT scans (2D and 3D) for comparison with the reports. Between 3% (suicides) and 15.3% (homicides) of sharp force injuries caused visible bone lesions. While our observations were repeatable, each forensic investigation left a similar number of bone lesions undetected. Injury patterns differed between MOD, with thoracic bone lesions being most frequent overall. Soft tissue injury location varied between the MOD. Associations between MOD and age as well as number of injuries were significant. The detection of bone lesions on PMCT for untrained forensic specialists is challenging, curricula and pertinent manuals are desirable. With the low frequency of bone lesions compared to soft tissue injuries, we should be aware when analyzing decomposed bodies.

The big puzzle: A critical review of virtual re-association methods for fragmented human remains in a DVI context'

During a Disaster Victims Identification (DVI) mission, international protocols rely on interdisciplinary work, especially between specialists from forensic imaging and anthropology. In case of air crashes or explosions, DVI units may face thousands of fragmented human remains (FHRs). The physical re-association of FHRs and the identification process is very complex and challenging, and relies upon expensive and destructive DNA analysis. A virtual re-association (VRA) of these fragments, using Multidetector Computed Tomography (MDCT), could be a helpful tool in forensic anthropology analysis, as it could assist in reducing the number of DNA samples. However, there is no standardized protocol for including such an approach into a DVI procedure. The aim of this study was to summarize and analyze existing techniques through a systematic review and to develop a protocol for virtual re-association of FHRs, adapted to the DVI context. A keyword-based literature search was conducted, focusing on the VRA methods using MDCT imaging and 3D surface scan methodology. Reviews and primary articles, published between 2005 and 2020 in the fields of forensic anthropology, paleoanthropology, archeology, and fracture reduction surgery were sorted out. A total of 45 publications were selected and analyzed based on their content and relevance. The results show that research on the re-association of FHRs increased significantly during the last five years. Seven steps regarding the MDCT-based method for the virtual re-association of FHRs could be identified: acquisition of 3D-images, segmentation of the MDCT-data, post-processing and surface generation, identification of intact and fracture surfaces, identification and registration of matching fragments, and validation of the re-association. The literature is surprisingly sparse regarding the FHRs re-association as a forensic tool, and mainly consists in case reports, whereas validated methods were presented in archeology and surgery publications. However, we were able to adapt the MDCT-based approach for the virtual re-association of the FHRs and propose an innovative protocol for DVI missions. This protocol includes the needed details, from the acquisition of MDCT imaging to the virtual re-association of 3D models and its validation. Each step has to be fully tested, adapted and validated in future studies.

Identification of antemortem and postmortem fractures in a complex environment by FTIR spectroscopy based on a rabbit tibial fracture self-control model

The identification of antemortem and postmortem fractures is a critical and challenging task for forensic researchers. Based on our preliminary studies, we explored whether the combination of Fourier transform infrared spectroscopy (FTIR) and chemometrics can identify antemortem and postmortem fractures in complex environments. The impacts of the four environments on the bone spectrum were analyzed by principal component analysis (PCA). It was found that the bone degradation rate in the submerged and ground surface (GS) environments was higher than that in the buried and constant temperature and moisture (CTM) environments. Additionally, the bone degradation rate in buried environment higher than that in the CTM environment. The average spectrum, PCA and partial least squares discriminant analysis (PLS-DA) results all revealed that there were significant differences between the antemortem fracture and the remaining three groups in a complex environment. Compared with the antemortem fracture, the antemortem fracture control (AFC) and postmortem fracture control (PFC) tended to be more similar to the postmortem fracture. According to the loading plot, amide I and amide II were the main components that contributed to the identification of the antemortem fracture, AFC, postmortem fracture, and PFC. Finally, we established a differential model for the antemortem and postmortem fractures (an accuracy of 96.9%), and a differentiation model for the antemortem fracture, AFC, postmortem fracture, and PFC (an accuracy of 87.5%). In conclusion, FTIR spectroscopy is a reliable tool for the identification of antemortem and postmortem fractures in complex environments.

[Technical and methodological support for postmortem radiation examinations in the pathological departments and the forensic bureau]

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.

A comparison on the detection accuracy of ante mortem computed tomography vs. autopsy for the diagnosis of pelvic ring injury in legal medicine

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.

A practical review of adipocere: Key findings, case studies and operational considerations from crime scene to autopsy

After death, the body begins decomposition, a process that starts with the breakdown of organic matter and typically leads to the complete degradation of a body. Such a process is highly affected by (micro and macro) environmental factors of intrinsic and extrinsic nature. Adipocere is a substance formed from the decomposition of adipose tissue and represents a disruption to the typical decomposition process. Such disruption causes decomposition to slow or arrest completely, placing a body into a state of preservation, and determines complications in the estimation of the time since death (Post-Mortem Interval, PMI). While several studies have been performed on the nature, the formation and the degradation of adipocere, there is still no reliable model to assess the PMI of a body exhibiting it. Case studies are an important source to aid pathologists and investigators during a case. This review presents a summary and an update on the knowledge surrounding the chemistry and the factors affecting adipocere formation and degradation, the timing and the distribution of adipocere throughout a body, and the techniques used to investigate it. Furthermore, a table of the most important case studies involving adipocere since 1950, several images and descriptions of recent cases and operational considerations for the best practice at the crime scene and autopsy are presented to be used as a reference to facilitate forensic professionals in adipocere cases.

Identification of antemortem, perimortem and postmortem fractures by FTIR spectroscopy based on a rabbit tibial fracture model

The identification of antemortem, perimortem and postmortem fractures is very important for forensic pathologists and anthropologists. However, traditional methods are subjective, time-consuming, and have low accuracy, which do not fundamentally solve the problem. In this study, we utilized Fourier transform infrared (FTIR) spectroscopy and chemometrics to identify antemortem, perimortem and postmortem fractures in a rabbit tibial fracture model. Based on the results of the principal component analysis (PCA), changes in the ante-perimortem fracture repair process are mainly associated with protein variations, while postmortem fractures are more likely to result in lipid changes during degradation. Then, a partial least squares discriminant analysis (PLS-DA) was performed to assess the classification ability of the training and predictive datasets, with classification accuracies of 88.9% and 86.7%, respectively. According to the latent variable 1 (LV1) loading plot, amide I and amide II (proteins) are mostly classified as ante-perimortem and postmortem fractures. In conclusion, FTIR spectroscopy is a reliable tool to identify antemortem, perimortem and postmortem fractures. FTIR has the advantages of rapid, objective and strong discrimination. and shows great potential for analyzing forensic cases under actual natural conditions.

Morphology of direct and indirect rib fractures

Rib fractures are a common finding in legal medicine and information on the impact mechanism is relevant for trauma reconstruction. This study focuses on morphological characteristics of rib fractures resulting from direct or indirect force. Fresh human ribs (n = 312) were divided into two groups and broken through local force (direct) and bending (indirect) in anterolateral areas. The ribs were macerated, visually investigated and the results statistically analysed. The indirect fractures showed a significant larger lateral offset of the internal and external fracture ends while the fracture ends of the direct fractures were more often straight, in line. Also, the morphology of the inner and outer fracture edges was significantly related to fracture type. Direct fractures mostly had rough and jagged inner edges (tension side) and straight, smooth outer edges (compression side), whereas indirect fractures more often showed the characteristics vice versa. The results were more convincing in combination and in ribs from persons aged ≤ 75 years at death. In summary, the direct and indirect rib fractures showed significantly different characteristics regarding orientation and offset of the fracture lines and roughness of the inner and outer fracture edges, which can be helpful to distinguish the traumatizing impact mechanisms in forensic autopsy routine.