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Gascho D, von Allmen A, Landsmann A, Hünermund T, Tappero C, Thali MJ, Deininger-Czermak E. Diagnostic value of T 1- and T 2-weighted 3-Tesla MRI for postmortem detection and age stage classification of myocardial infarction. Forensic Sci Med Pathol 2024; 20:14-22. [PMID: 36862287 PMCID: PMC10944381 DOI: 10.1007/s12024-023-00592-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2023] [Indexed: 03/03/2023]
Abstract
The aims of this study are to retrospectively evaluate the diagnostic value of T1- and T2-weighted 3-T magnetic resonance imaging (MRI) for postmortem detection of myocardial infarction (MI) in terms of sensitivity and specificity and to compare the MRI appearance of the infarct area with age stages. Postmortem MRI examinations (n = 88) were retrospectively reviewed for the presence or absence of MI by two raters blinded to the autopsy results. The sensitivity and specificity were calculated using the autopsy results as the gold standard. A third rater, who was not blinded to the autopsy findings, reviewed all cases in which MI was detected at autopsy for MRI appearance (hypointensity, isointensity, hyperintensity) of the infarct area and the surrounding zone. Age stages (peracute, acute, subacute, chronic) were assigned based on the literature and compared with the age stages reported in the autopsy reports. The interrater reliability between the two raters was substantial (κ = 0.78). Sensitivity was 52.94% (both raters). Specificity was 85.19% and 92.59%. In 34 decedents, autopsy identified an MI (peracute: n = 7, acute: n = 25, chronic: n = 2). Of 25 MI classified as acute at autopsy, MRI classified peracute in four cases and subacute in nine cases. In two cases, MRI suggested peracute MI, which was not detected at autopsy. MRI could help to classify the age stage and may indicate the area for sampling for further microscopic examination. However, the low sensitivity requires further additional MRI techniques to increase the diagnostic value.
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Affiliation(s)
- Dominic Gascho
- Department of Forensic Medicine and Imaging, Zurich Institute of Forensic Medicine, University of Zurich, Zurich, Switzerland.
| | - Alexandre von Allmen
- Department of Forensic Medicine and Imaging, Zurich Institute of Forensic Medicine, University of Zurich, Zurich, Switzerland
| | - Anna Landsmann
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Tobias Hünermund
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Carlo Tappero
- Department of Forensic Medicine and Imaging, Zurich Institute of Forensic Medicine, University of Zurich, Zurich, Switzerland
- Department of Radiology, Hôpital Fribourgeois, Fribourg, Switzerland
| | - Michael J Thali
- Department of Forensic Medicine and Imaging, Zurich Institute of Forensic Medicine, University of Zurich, Zurich, Switzerland
| | - Eva Deininger-Czermak
- Department of Forensic Medicine and Imaging, Zurich Institute of Forensic Medicine, University of Zurich, Zurich, Switzerland
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
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Genter J, Croci E, Oberreiter B, Eckers F, Bühler D, Gascho D, Müller AM, Mündermann A, Baumgartner D. The influence of rotator cuff tear type and weight bearing on shoulder biomechanics in an ex vivo simulator experiment. J Biomech 2024; 166:112055. [PMID: 38522362 DOI: 10.1016/j.jbiomech.2024.112055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 02/16/2024] [Accepted: 03/18/2024] [Indexed: 03/26/2024]
Abstract
Glenohumeral biomechanics after rotator cuff (RC) tears have not been fully elucidated. This study aimed to investigate the muscle compensatory mechanism in weight-bearing shoulders with RC tears and asses the induced pathomechanics (i.e., glenohumeral translation, joint instability, center of force (CoF), joint reaction force). An experimental, glenohumeral simulator with muscle-mimicking cable system was used to simulate 30° scaption motion. Eight fresh-frozen shoulders were prepared and mounted in the simulator. Specimen-specific scapular anthropometry was used to test six RC tear types, with intact RC serving as the control, and three weight-bearing loads, with the non-weight-bearing condition serving as the control. Glenohumeral translation was calculated using instantaneous helical axis. CoF, muscle forces, and joint reaction forces were measured using force sensors integrated into the simulator. Linear mixed effects models (RC tear type and weight-bearing) with random effects (specimen and sex) were used to assess differences in glenohumeral biomechanics. RC tears did not change the glenohumeral translation (p > 0.05) but shifted the CoF superiorly (p ≤ 0.005). Glenohumeral translation and joint reaction forces increased with increasing weight bearing (p < 0.001). RC and deltoid muscle forces increased with the presence of RC tears (p ≤ 0.046) and increased weight bearing (p ≤ 0.042). The synergistic muscles compensated for the torn RC tendons, and the glenohumeral translation remained comparable to that for the intact RC tendons. However, in RC tears, the more superior CoF was close to where glenoid erosion occurs in RC tear patients with secondary osteoarthritis. These findings underscore the importance of early detection and precise management of RC tears.
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Affiliation(s)
- Jeremy Genter
- IMES Institute of Mechanical Systems, Zurich University of Applied Sciences ZHAW, Winterthur, Switzerland; Department of Biomedical Engineering, University of Basel, Basel, Switzerland; Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland.
| | - Eleonora Croci
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland; Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
| | - Birgit Oberreiter
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
| | - Franziska Eckers
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
| | - Dominik Bühler
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
| | - Dominic Gascho
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Zurich, Switzerland
| | - Andreas M Müller
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
| | - Annegret Mündermann
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland; Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland; Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Daniel Baumgartner
- IMES Institute of Mechanical Systems, Zurich University of Applied Sciences ZHAW, Winterthur, Switzerland
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Gascho D, Stephan R, Zoelch N, Vogt M, Oesch MA, Thali M, Richter H. Ballistic study on the penetration potential and injury potential of different bullet types in the use of a newly developed bullet shooting stunner for adequate stunning of heavy cattle. Front Vet Sci 2023; 10:1143744. [PMID: 36937020 PMCID: PMC10014789 DOI: 10.3389/fvets.2023.1143744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 02/08/2023] [Indexed: 03/05/2023] Open
Abstract
Introduction Recently, a special bullet shooting stunner for heavy cattle has been developed that fires a bullet instead of a bolt. In the search for a suitable ammunition, the following criteria must be met: First, the energy of the bullet must be sufficient to penetrate the thick frontal bones of heavy cattle. Second, the injury potential at the corresponding penetration depth should preferably be large in order to damage brain tissue relevant to stunning. Third, the bullet must not perforate the occipital bone (over-penetration). Methods Four different bullet types [Hornady FTX, Hydra-Shok, Black Mamba, and a common full metal jacket (FMJ) bullet] were evaluated in a series of experiments on soap blocks and removed bone plates followed by computed tomography examinations. Penetration potential was evaluated in terms of kinetic energy relative to the caliber of the bullet, i.e., mean energy density (ED). Injury potential was evaluated by the mean extent of the cavity volume (e CV ) at the relevant penetration depth of 5.5 to 7.5 cm in the soap block. Results All four bullet types passed through the frontal bone plate. The ED was 17.50 J/mm2 (Hornady FTX), 17.46 J/mm2 (Hydra-Shok), 13.47 J/mm2 (Black Mamba), and 13.47 J/mm2 (FMJ). The Hornady FTX and the Hydra-Shok each fragmented heavily. The FMJ was excluded after three experiments due to over-penetrations. The e CV was e CV = 3.77 cm2 (Hornady FTX), 2.71 cm2 (Hydra-Shok), and 1.31 cm2 (Black Mamba), with a significant difference (p = 0.006) between the Hornady FTX and the Black Mamba. Discussion For use in heavy cattle, the Hornady FTX and the Hydra-Shok are recommended due to the larger e CV than the Black Mamba.
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Affiliation(s)
- Dominic Gascho
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Zurich, Switzerland
- *Correspondence: Dominic Gascho
| | - Roger Stephan
- Institute for Food Safety and Hygiene, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Niklaus Zoelch
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Zurich, Switzerland
| | | | - Michelle Aimée Oesch
- Scientific Communication and Public Relations, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Michael Thali
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Zurich, Switzerland
| | - Henning Richter
- Diagnostic Imaging Research Unit, Clinic for Diagnostic Imaging, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
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Deininger-Czermak E, Gascho D, Franckenberg S, Kälin P, Blüthgen C, Villefort C, Thali MJ, Guggenberger R. Added value of ultra-short echo time and fast field echo using restricted echo-spacing MR imaging in the assessment of the osseous cervical spine. Radiol Med 2023; 128:234-241. [PMID: 36637741 PMCID: PMC9938813 DOI: 10.1007/s11547-023-01589-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 01/04/2023] [Indexed: 01/14/2023]
Abstract
PURPOSE To evaluate the added value of ultra-short echo time (UTE) and fast field echo resembling a CT using restricted echo-spacing (FRACTURE) MR sequences in the assessment of the osseous cervical spine using CT as reference. MATERIALS AND METHODS Twenty-seven subjects underwent postmortem CT and MRI within 48 h. Datasets were anonymized and analyzed retrospectively by two radiologists. Morphological cervical spine alterations were rated on CT, UTE and FRACTURE images. Afterward, neural foraminal stenosis was graded on standard MR and again after viewing additional UTE/FRACTURE sequences. To evaluate interreader and intermodality reliability, intra-class correlation coefficients (ICC) and for stenosis grading Wilcoxon-matched-pairs testing with multiple comparison correction were calculated. RESULTS Moderate interreader reliability (ICC = 0.48-0.71) was observed concerning morphological findings on all modalities. Intermodality reliability was good between modalities regarding degenerative vertebral and joint alterations (ICC = 0.69-0.91). Compared to CT neural stenosis grades were more often considered as nonsignificant on all analyzed MR sequences. Neural stenosis grading scores differed also significantly between specific bone imaging sequences, UTE and FRACTURE, to standard MR sequences. However, no significant difference was observed between UTE and FRACTURE sequences. CONCLUSION Compared to CT as reference, UTE or FRACTURE sequence added to standard MR sequences can deliver comparable information on osseous cervical spine status. Both led to changes in clinically significant stenosis gradings when added to standard MR, mainly reducing the severity of neural foramina stenosis.
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Affiliation(s)
- Eva Deininger-Czermak
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Zurich, Switzerland. .,Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.
| | - Dominic Gascho
- grid.7400.30000 0004 1937 0650Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Zurich, Switzerland
| | - Sabine Franckenberg
- grid.7400.30000 0004 1937 0650Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Zurich, Switzerland ,grid.412004.30000 0004 0478 9977Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - Pascal Kälin
- grid.412004.30000 0004 0478 9977Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - Christian Blüthgen
- grid.412004.30000 0004 0478 9977Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - Christina Villefort
- grid.412373.00000 0004 0518 9682Orthopedic Surgery, Balgrist University Hospital, Zurich, Switzerland
| | - Michael J. Thali
- grid.7400.30000 0004 1937 0650Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Zurich, Switzerland
| | - Roman Guggenberger
- grid.412004.30000 0004 0478 9977Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
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Jakobsen SR, Boel LWT, Gascho D, Thali M, Hansen K. Optimal pressure for mimicking clinical breath holding inspiratory CT in the deceased for VPMCT. Forensic Imaging 2022. [DOI: 10.1016/j.fri.2022.200530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Rüegger CM, Gascho D, Bode PK, Bruder E, Haslinger C, Ross S, Schmid K, Knöpfli C, Hofer LJ, Held L, Martinez RM, Bucher HU. Post-mortem magnetic resonance imaging with computed tomography-guided biopsy for foetuses and infants: a prospective, multicentre, cross-sectional study. BMC Pediatr 2022; 22:464. [PMID: 35918685 PMCID: PMC9347089 DOI: 10.1186/s12887-022-03519-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 07/25/2022] [Indexed: 12/02/2022] Open
Abstract
Background Post-mortem imaging has been suggested as an alternative to conventional autopsy in the prenatal and postnatal periods. Noninvasive autopsies do not provide tissue for histological examination, which may limit their clinical value, especially when infection-related morbidity and mortality are suspected. Methods We performed a prospective, multicentre, cross-sectional study to compare the diagnostic performance of post-mortem magnetic resonance imaging with computed tomography-guided biopsy (Virtopsy®) with that of conventional autopsy in foetuses and infants. Cases referred for conventional autopsy were eligible for enrolment. After post-mortem imaging using a computed tomography scanner and a magnetic resonance imaging unit, computed tomography-guided tissue sampling was performed. Virtopsy results were compared with conventional autopsy in determining the likely final cause of death and major pathologies. The primary outcome was the proportion of cases for which the same cause of death was determined by both methods. Secondary outcomes included the proportion of false positive and false negative major pathological lesions detected by virtopsy and the proportion of computed tomography-guided biopsies that were adequate for histological examination. Results Overall, 101 cases (84 fetuses, 17 infants) were included. Virtopsy and autopsy identified the same cause of death in 91 cases (90.1%, 95% CI 82.7 to 94.5). The sensitivity and specificity of virtopsy for determining the cause of death were 96.6% (95% CI 90.6 to 98.8) and 41.7% (95% CI 19.3 to 68.0), respectively. In 32 cases (31.7%, 95% CI 23.4 to 41.3), major pathological findings remained undetected by virtopsy, and in 45 cases (44.6%, 95% CI 35.2 to 54.3), abnormalities were diagnosed by virtopsy but not confirmed by autopsy. Computed tomography-guided tissue sampling was adequate for pathological comments in 506 of 956 biopsies (52.7%) and added important diagnostic value in five of 30 cases (16.1%) with an unclear cause of death before autopsy compared with postmortem imaging alone. In 19 of 20 infective deaths (95%), biopsies revealed infection-related tissue changes. Infection was confirmed by placental examination in all fetal cases. Conclusions Virtopsy demonstrated a high concordance with conventional autopsy for the detection of cause of death but was less accurate for the evaluation of major pathologies. Computed tomography-guided biopsy had limited additional diagnostic value. Trial registration ClinicalTrials.gov (NCT01888380). Supplementary Information The online version contains supplementary material available at 10.1186/s12887-022-03519-4.
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Affiliation(s)
- Christoph Martin Rüegger
- Newborn Research, Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
| | - Dominic Gascho
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Zurich, Switzerland
| | - Peter Karl Bode
- Department of Pathology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Elisabeth Bruder
- Pathology, Institute of Medical Genetics and Pathology, University Hospital and University of Basel, Basel, Switzerland
| | - Christian Haslinger
- Department of Obstetrics, University Hospital and University of Zurich, Zurich, Switzerland
| | - Steffen Ross
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Zurich, Switzerland
| | - Kevin Schmid
- Department of Intensive Care and Neonatology, University Children's Hospital Zurich, Zurich, Switzerland
| | - Claudia Knöpfli
- Newborn Research, Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Lisa J Hofer
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland
| | - Leonhard Held
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland
| | - Rosa Maria Martinez
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Zurich, Switzerland
| | - Hans Ulrich Bucher
- Newborn Research, Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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Gascho D, Stephan R, Bauer C, Oesch MA, Richter H. Assessment of a newly designed double-barreled bullet-shooting stunner for adequate stunning of water buffaloes. Meat Sci 2022; 193:108933. [DOI: 10.1016/j.meatsci.2022.108933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 06/14/2022] [Accepted: 08/02/2022] [Indexed: 10/31/2022]
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Gascho D, Stephan R, Bauer C, Oesch MA, Richter H. BigBovid- Evaluation of a Newly Developed 9 mm Bullet-Shooting Stunner for Adequate Stunning of Heavy Cattle. Front Vet Sci 2022; 9:949198. [PMID: 35968016 PMCID: PMC9363664 DOI: 10.3389/fvets.2022.949198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 06/24/2022] [Indexed: 11/16/2022] Open
Abstract
The stunning of heavy cattle and water buffalo is an animal welfare problem, as conventional cartridge fired captive-bolt stunners are not suitable due to the thicker skull bones and the greater depth of penetration required to reach and damage the relevant brain regions for deep unconsciousness. This current animal welfare problem requires a suitable and feasible as well as commercially available and legally approved stunning device to ensure deep unconsciousness of these animals. In this study, the use of a newly developed bullet-shooting stunner, the BigBovid, with two different types of hunting ammunition, namely .38 SPL FMJ-TC and .357 MAG FTX® bullets, was evaluated on 22 heavy cattle (mean weight: 1062.27 kg, standard deviation: 124.09 kg). In ballistic experiments, the BigBovid reached a mean energy density of 8.18 J/mm2 (mean error: 0.45 J/mm2) for the .38 SPL FMJ-TC and 17.56 J/mm2 (mean error: 2.67 J/mm2) for the .357 MAG FTX®. In in vivo experiments, the use of the .38 SPL FMJ-TC resulted in overpenetration three times. The .357 MAG FTX® bullets showed to be more advantageous, because on the one hand no overpenetration occurred and on the other hand the bullets fragmented into small parts after penetration into the skull. The fragments were scattered in the brain tissue, such as the thalamus and the brain stem, and thus there is a high probability to damage the brain regions relevant for deep unconsciousness. Based on the results of this study, the use of the BigBovid in combination with the .357 MAG FTX® bullet is found to be suitable for stunning heavy cattle.
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Affiliation(s)
- Dominic Gascho
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Zurich, Switzerland
- *Correspondence: Dominic Gascho
| | - Roger Stephan
- Institute for Food Safety and Hygiene, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Clemens Bauer
- Veterinary Services, Environmental and Health Protection, Zurich, Switzerland
| | - Michelle Aimée Oesch
- Scientific Communication and Public Relations, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Henning Richter
- Diagnostic Imaging Research Unit (DIRU), Clinic for Diagnostic Imaging, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Heimer J, Gascho D, Thali MJ, Zoelch N. Fundamentals of in situ Postmortem Magnetic Resonance Spectroscopy of the Brain in the Forensic Framework - A Review and Outlook. Forensic Imaging 2022. [DOI: 10.1016/j.fri.2022.200499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Dervas E, Hatt J, Kummrow M, Grimm F, Imkamp F, Peterhans S, Gascho D, Rushing E. Necrotizing Encephalitis Caused by Balamuthia mandrillaris in a Western Lowland Gorilla (Gorilla gorilla gorilla). J Comp Pathol 2022. [DOI: 10.1016/j.jcpa.2021.11.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Gascho D, Kottner S, Buehlmann A, Schweizer D, Bolliger SA, Thali MJ, Zoelch N. Annular distribution patterns of .357 Magnum fragments in soft tissue simulants after striking hard material that prevented the bullet from exiting. J Forensic Leg Med 2021; 85:102286. [PMID: 34844085 DOI: 10.1016/j.jflm.2021.102286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 11/09/2021] [Accepted: 11/11/2021] [Indexed: 11/18/2022]
Abstract
The distribution of bullet fragments inside the body can provide information for the reconstruction of events in shooting incidents. The formation of an annular distribution pattern of bullet fragments was recently presented in a case report. The fragments were scattered radially around an exit-re-entrance wound resulting from collision of the bullet with a floor tile immediately after perforating the body. Such an annular distribution pattern of bullet fragments around an exit-re-entrance wound would indicate that a body was in close contact with hard material, for instance, lying on hard ground or leaning against a concrete wall, when the shot was fired. The aim of this experimental study was to investigate the formation and reproducibility of the annular distribution pattern of bullet fragments. It was assumed that the distribution pattern would be formed when hard material blocks a bullet from exiting a soft tissue simulant. Furthermore, the dependency of this distribution pattern on the impact angle was assessed. For this purpose, .357 Magnum bullets were fired at ballistic soap blocks with a steel plate at the rear end of the soap block. Six shots were performed at an impact angle of 90° (experiment 1), and six shots were performed at an impact angle of 45° (experiment 2). The distribution pattern of the fragments inside the individual soap blocks was examined via computed tomography (CT). In experiment 1, the bullets burst, and large fragments formed annular distribution patterns with a radial extent of approximately 4.9 cm and a maximum depth of approximately 2.3 cm. In experiment 2, the bullets ricocheted from the steel plate, and tiny fragments formed small annular distribution patterns at the points of ricochet with a radial extent of approximately 1.5 cm and a maximum depth of approximately 1.2 cm. The end position of the large main fragments was approximately 9.7 cm distant from the point of ricochet at a mean depth of 2.7 cm. The mean kinetic energy of the bullets at the time of impact was 580 J in experiment 1 and 394 J in experiment 2. Distribution patterns of bullet fragments in the body may provide information not only on the impact angle of a bullet but also on whether the body was in contact with a hard material that blocked the bullet from exiting the body. CT proved to be an appropriate imaging method for such investigations.
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Affiliation(s)
- D Gascho
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Switzerland.
| | - S Kottner
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Switzerland
| | - A Buehlmann
- Zurich Forensic Science Institute, Zurich Canton Police and Zurich City Police, Switzerland
| | - D Schweizer
- Zurich Forensic Science Institute, Zurich Canton Police and Zurich City Police, Switzerland
| | - S A Bolliger
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Switzerland
| | - M J Thali
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Switzerland
| | - N Zoelch
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Switzerland; Department of Psychiatry, Psychotherapy and Psychosomatics, Hospital of Psychiatry, University of Zurich, Switzerland
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13
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Deininger-Czermak E, Euler A, Franckenberg S, Finkenstaedt T, Villefort C, Gascho D, Guggenberger R. Evaluation of ultrashort echo-time (UTE) and fast-field-echo (FRACTURE) sequences for skull bone visualization and fracture detection - A postmortem study. J Neuroradiol 2021; 49:237-243. [PMID: 34758365 DOI: 10.1016/j.neurad.2021.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 10/11/2021] [Accepted: 11/02/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE CT is considered the modality of choice in the assessment of the skull due to the fast and accurate depiction of bone structures. Nevertheless, MRI has evolved into a possible alternative due to optimal soft tissue contrast and recent advances with the ability to visualize tissues with shortest T2 times, such as osseous structures. In this study we compare skull bone visualization and fracture detection across two MRI sequences to CT as reference standard. MATERIAL AND METHODS Twenty subjects underwent CT and MRI with less than 72 h between examination. The MRI protocol included a 2D ultrashort echo time (UTE) and a 3D multi-echo in-phase fast-field-echo (FRACTURE) sequence. Independent raters evaluated qualitative characteristics and fracture detectability in different skull subregions (skull vault, skull base and viscerocranium). Interrater and intermodality agreement was evaluated by calculating intraclass coefficients (ICC). RESULTS FRACTURE ICC indicated a good agreement in all subregions (ICC = 0.83 - 0.88), whereas UTE had excellent results calculated in the skull vault and viscerocranium (ICC = 0.91 - 0.94). At the skull vault, both MRI sequences received an overall good rating (UTE: 2.63 ± 0.42 FRACTURE. 2.81 ± 0.32). Fracture detection using MRI sequences for the skull vault, was highest compared to other subregions. CONCLUSIONS Both MRI sequences may provide an alternative e.g. for surgical planning or follow up exams of the osseous neurocranium; although, at the skull base and viscerocranium bone visualization with MRI bone imaging sequences perform inferior to CT standard imaging.
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Affiliation(s)
- Eva Deininger-Czermak
- Institute of Forensic Medicine, University of Zurich, Zurich, Switzerland; Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Andre Euler
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Sabine Franckenberg
- Institute of Forensic Medicine, University of Zurich, Zurich, Switzerland; Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Tim Finkenstaedt
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | | | - Dominic Gascho
- Institute of Forensic Medicine, University of Zurich, Zurich, Switzerland.
| | - Roman Guggenberger
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
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14
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Serrano N, Kissling M, Krafft H, Link K, Ullrich O, Buck FM, Mathews S, Serowy S, Gascho D, Grüninger P, Fornaciari P, Bouaicha S, Müller-Gerbl M, Rühli FJ, Eppler E. CT-based and morphological comparison of glenoid inclination and version angles and mineralisation distribution in human body donors. BMC Musculoskelet Disord 2021; 22:849. [PMID: 34610804 PMCID: PMC8493698 DOI: 10.1186/s12891-021-04660-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 08/25/2021] [Indexed: 11/11/2022] Open
Abstract
Background For optimal prosthetic anchoring in omarthritis surgery, a differentiated knowledge on the mineralisation distribution of the glenoid is important. However, database on the mineralisation of diseased joints and potential relations with glenoid angles is limited. Methods Shoulder specimens from ten female and nine male body donors with an average age of 81.5 years were investigated. Using 3D-CT-multiplanar reconstruction, glenoid inclination and retroversion angles were measured, and osteoarthritis signs graded. Computed Tomography-Osteoabsorptiometry (CT-OAM) is an established method to determine the subchondral bone plate mineralisation, which has been demonstrated to serve as marker for the long-term loading history of joints. Based on mineralisation distribution mappings of healthy shoulder specimens, physiological and different CT-OAM patterns were compared with glenoid angles. Results Osteoarthritis grades were 0-I in 52.6% of the 3D-CT-scans, grades II-III in 34.3%, and grade IV in 13.2%, with in females twice as frequently (45%) higher grades (III, IV) than in males (22%, III). The average inclination angle was 8.4°. In glenoids with inclination ≤10°, mineralisation was predominantly centrally distributed and tended to shift more cranially when the inclination raised to > 10°. The average retroversion angle was − 5.2°. A dorsally enhanced mineralisation distribution was found in glenoids with versions from − 15.9° to + 1.7°. A predominantly centrally distributed mineralisation was accompanied by a narrower range of retroversion angles between − 10° to − 0.4°. Conclusions This study is one of the first to combine CT-based analyses of glenoid angles and mineralisation distribution in an elderly population. The data set is limited to 19 individuals, however, indicates that superior inclination between 0° and 10°-15°, and dorsal version ranging between − 9° to − 3° may be predominantly associated with anterior and central mineralisation patterns previously classified as physiological for the shoulder joint. The current basic research findings may serve as basic data set for future studies addressing the glenoid geometry for treatment planning in omarthritis. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04660-4.
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Affiliation(s)
- Nabil Serrano
- Institute of Evolutionary Medicine (IEM), University of Zurich, Zurich, Switzerland
| | - Marc Kissling
- Institute of Anatomy, University of Bern, Bern, Switzerland
| | - Hannah Krafft
- Division of Gross Anatomy, Institute of Anatomy, University of Zurich, Zurich, Switzerland
| | - Karl Link
- Division of Gross Anatomy, Institute of Anatomy, University of Zurich, Zurich, Switzerland.,Anatomy, University of Fribourg, Fribourg, Switzerland
| | - Oliver Ullrich
- Division of Gross Anatomy, Institute of Anatomy, University of Zurich, Zurich, Switzerland
| | - Florian M Buck
- Medical Radiology Institute, Schulthess Clinic, Zurich, Switzerland
| | - Sandra Mathews
- Institute of Evolutionary Medicine (IEM), University of Zurich, Zurich, Switzerland
| | - Steffen Serowy
- Clinic of Neuroradiology, University Hospital of Magdeburg, Magdeburg, Germany
| | - Dominic Gascho
- Institute of Forensic Medicine, University of Zurich, Zurich, Switzerland
| | | | - Paolo Fornaciari
- Department of Orthopaedics, Balgrist University Hospital, Zurich, Switzerland.,Department of Orthopaedic Surgery and Traumatology, University Hospital Fribourg, Fribourg, Switzerland
| | - Samy Bouaicha
- Department of Orthopaedics, Balgrist University Hospital, Zurich, Switzerland
| | - Magdalena Müller-Gerbl
- Musculoskeletal Research, Department of Biomedicine, University of Basel, Basel, Switzerland
| | - Frank-Jakobus Rühli
- Institute of Evolutionary Medicine (IEM), University of Zurich, Zurich, Switzerland.
| | - Elisabeth Eppler
- Musculoskeletal Research, Department of Biomedicine, University of Basel, Basel, Switzerland. .,Clinic of Neuroradiology, University Hospital of Magdeburg, Magdeburg, Germany. .,Institute of Anatomy, University of Bern, Bern, Switzerland.
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15
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Gascho D, Thali MJ, Martinez RM, Bolliger SA. Cinematic rendering of a burst sagittal suture caused by an occipito-frontal gunshot wound. Forensic Sci Med Pathol 2021; 17:726-729. [PMID: 34106424 PMCID: PMC8629876 DOI: 10.1007/s12024-021-00387-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2021] [Indexed: 11/27/2022]
Abstract
The computed tomography (CT) scan of a 19-year-old man who died from an occipito-frontal gunshot wound presented an impressive radiating fracture line where the entire sagittal suture burst due to the high intracranial pressure that arose from a near-contact shot from a 9 mm bullet fired from a Glock 17 pistol. Photorealistic depictions of the radiating fracture lines along the cranial bones were created using three-dimensional reconstruction methods, such as the novel cinematic rendering technique that simulates the propagation and interaction of light when it passes through volumetric data. Since the brain had collapsed, depiction of soft tissue was insufficient on CT images. An additional magnetic resonance imaging (MRI) examination was performed, which enabled the diagnostic assessment of cerebral injuries.
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Affiliation(s)
- Dominic Gascho
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, CH-8057, Zurich, Switzerland.
| | - Michael J Thali
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, CH-8057, Zurich, Switzerland
| | - Rosa M Martinez
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, CH-8057, Zurich, Switzerland
| | - Stephan A Bolliger
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, CH-8057, Zurich, Switzerland
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16
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Pedersen CCE, Villa C, Asingh P, Thali MJ, Gascho D. Looking deep into the past – virtual autopsy of a Mongolian warrior. Forensic Imaging 2021. [DOI: 10.1016/j.fri.2021.200455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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17
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Brockbals L, Staeheli SN, Gascho D, Ebert LC, Kraemer T, Steuer AE. Time- and Site-Dependent Postmortem Redistribution of Antidepressants and Neuroleptics in Blood and Alternative Matrices. J Anal Toxicol 2021; 45:356-367. [PMID: 32856054 DOI: 10.1093/jat/bkaa092] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 03/26/2021] [Accepted: 04/02/2021] [Indexed: 02/05/2023] Open
Abstract
Postmortem redistribution (PMR) leads to challenges in postmortem case interpretation. Particularly antidepressants and neuroleptics are expected to undergo PMR based on their physico-chemical properties. For the current study, time- and site-dependent PMR of 20 antidepressants and neuroleptics were investigated in humans (authentic cases); five of which are discussed in detail (citalopram, mirtazapine, quetiapine, risperidone and venlafaxine) along with two metabolites (9-OH-risperidone and O-desmethylvenlafaxine). Blood [femoral (pB) and heart blood (HB)] and tissue biopsy samples (lung, kidney, liver, spleen, thigh muscle and adipose tissue) were collected upon admission to the institute utilizing a computed tomography-guided sample collection workflow (t1). Approximately 24 h later (t2; mean 23 ± 9.3 h), samples from the same body regions were collected manually. Liquid chromatography-tandem mass spectrometry was used for quantification. Most antidepressants and neuroleptics showed significant time-dependent concentration changes indicating the occurrence of PMR. For the first time, two phases of redistribution in pB for quetiapine were proposed (concentration decreases in the early postmortem phase, followed by concentration increases) and contrasting existing literature, both concentration increases and decreases in pB overtime were observed for risperidone and 9-OH-risperidone. Venlafaxine and its metabolite only showed minimal concentration changes, while citalopram exhibited a trend for concentration increases and mirtazapine for concentration decreases in pB overtime. Based on time-dependent tissue data, passive diffusion processes along the muscle-to-pB, liver-to-HB and lung-to-HB concentration gradients could be proposed along with bacterial degradation. Overall, no case interpretation had to be adjusted, which suggests that PMR changes of antidepressants and neuroleptics do not seem to be relevant for forensic case interpretation within the 24 h period that was investigated. However, limitations of the current study (e.g., temperature-controlled storage of the bodies) could have led to an underestimation of occurring postmortem changes, hence, interpretation of postmortem results should always be conducted with care, considering PMR phenomena and inter-individual variability.
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Affiliation(s)
- Lana Brockbals
- Department of Forensic Pharmacology and Toxicology, Zurich Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, Zurich, Switzerland
| | - Sandra N Staeheli
- Department of Forensic Pharmacology and Toxicology, Zurich Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, Zurich, Switzerland
| | - Dominic Gascho
- Department of Forensic Medicine and Imaging, Zurich Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, 8057 Zurich, Switzerland
| | - Lars C Ebert
- Department of Forensic Medicine and Imaging, Zurich Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, 8057 Zurich, Switzerland
| | - Thomas Kraemer
- Department of Forensic Pharmacology and Toxicology, Zurich Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, Zurich, Switzerland
| | - Andrea E Steuer
- Department of Forensic Pharmacology and Toxicology, Zurich Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, Zurich, Switzerland
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18
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Gascho D, Zoelch N, Sommer S, Tappero C, Thali MJ, Deininger-Czermak E. 7-T MRI for brain virtual autopsy: a proof of concept in comparison to 3-T MRI and CT. Eur Radiol Exp 2021; 5:3. [PMID: 33442787 PMCID: PMC7806692 DOI: 10.1186/s41747-020-00198-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 11/26/2020] [Indexed: 11/10/2022] Open
Abstract
The detection and assessment of cerebral lesions and traumatic brain injuries are of particular interest in forensic investigations in order to differentiate between natural and traumatic deaths and to reconstruct the course of events in case of traumatic deaths. For this purpose, computed tomography (CT) and magnetic resonance imaging (MRI) are applied to supplement autopsy (traumatic death) or to supplant autopsy (natural deaths). This approach is termed “virtual autopsy.” The value of this approach increases as more microlesions and traumatic brain injuries are detected and assessed. Focusing on these findings, this article describes the examination of two decedents using CT, 3-T, and 7-T MRI. The main question asked was whether there is a benefit in using 7-T over 3-T MRI. To answer this question, the 3-T and 7-T images were graded regarding the detectability and the assessability of coup/contrecoup injuries and microlesions using 3-point Likert scales. While CT missed these findings, they were detectable on 3-T and 7-T MRI. However, the 3-T images appeared blurry in direct comparison with the 7-T images; thus, the detectability and assessability of small findings were hampered on 3-T MRI. The potential benefit of 7-T over 3-T MRI is discussed.
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Affiliation(s)
- Dominic Gascho
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, CH-8057, Zurich, Switzerland.
| | - Niklaus Zoelch
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, CH-8057, Zurich, Switzerland.,Department of Psychiatry, Psychotherapy and Psychosomatics, Hospital of Psychiatry, University of Zurich, Zurich, Switzerland
| | - Stefan Sommer
- Siemens Healthcare AG, Zurich, Switzerland.,Swiss Center for Musculoskeletal Imaging (SCMI), Balgrist Campus AG, Zurich, Switzerland
| | - Carlo Tappero
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, CH-8057, Zurich, Switzerland.,Department of Radiology, Hôpital Fribourgeois, Villars-sur-Glâne, Switzerland
| | - Michael J Thali
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, CH-8057, Zurich, Switzerland
| | - Eva Deininger-Czermak
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, CH-8057, Zurich, Switzerland.,Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
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19
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Whitby E, Offiah AC, Shelmerdine SC, van Rijn RR, Aertsen M, Klein WM, Perry D, Goergen SK, Abel C, Taranath A, Gascho D, Miller E, Arthurs OJ. Current state of perinatal postmortem magnetic resonance imaging: European Society of Paediatric Radiology questionnaire-based survey and recommendations. Pediatr Radiol 2021; 51:792-799. [PMID: 33367939 PMCID: PMC8055569 DOI: 10.1007/s00247-020-04905-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 09/02/2020] [Accepted: 11/09/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Postmortem magnetic resonance imaging (MRI) in perinatal and childhood deaths is increasingly used as a noninvasive adjunct or alternative to autopsy. Imaging protocols vary between centres and consensus guidelines do not exist. OBJECTIVE Our aim was to develop practical, standardised recommendations for perinatal postmortem MRI. MATERIALS AND METHODS Recommendations were based on the results of two surveys regarding local postmortem MRI practices sent electronically to all 14 members of the European Society of Paediatric Radiology (ESPR) Postmortem Imaging Task Force and 17 members of the International Society of Forensic Radiology and Imaging Task Force (25 different centres). RESULTS Overall, 11/14 (78.6%) respondents from different institutions perform postmortem MRI. All of these centres perform postmortem MRI for perinatal and neonatal deaths, but only 6/11 (54.5%) perform imaging in older children. CONCLUSION We propose a clinical standard for postmortem MRI sequences plus optional sequences for neuroimaging and cardiac anatomy depending on available scanning time and referral indications.
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Affiliation(s)
- Elspeth Whitby
- University of Sheffield and Sheffield Teaching Hospitals Foundation Trust, Jessop Wing, Tree Root Walk, Sheffield, S10 1SF, UK.
| | - Amaka C. Offiah
- Academic Unit of Child Health, University of Sheffield, Sheffield, UK ,Department of Radiology, Sheffield Children’s NHS Foundation Trust, University of Sheffield, Sheffield, UK
| | - Susan C. Shelmerdine
- Department of Clinical Radiology, Great Ormond Street Hospital for Children, London, UK ,UCL Great Ormond Street Institute of Child Health, London, UK
| | - Rick R. van Rijn
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Michael Aertsen
- Department of Radiology, University Hospitals KU Leuven, Leuven, Belgium
| | - Willemijn M. Klein
- Department of Radiology and Nuclear Medicine and Anatomy, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - David Perry
- Radiology Department, National Women’s Health and Starship Children’s Hospital, Auckland City Hospital, Auckland, New Zealand
| | - Stacy K. Goergen
- Monash Imaging, Clayton, Victoria Australia ,School of Clinical Sciences, Monash University, Clayton, Victoria Australia
| | - Christian Abel
- Department of Medical Imaging, John Hunter Hospital, Newcastle, New South Wales Australia
| | - Ajay Taranath
- Department of Medical Imaging, Women’s and Children’s Hospital, North Adelaide, South Australia Australia ,University of Adelaide, Adelaide, South Australia Australia
| | - Dominic Gascho
- Zurich Institute of Forensic Medicine, University of Zurich, Zurich, Switzerland
| | - Elka Miller
- Department of Medical Imaging, Children’s Hospital of Eastern Ontario, University of Ottawa, Ottawa, Canada
| | - Owen J. Arthurs
- Department of Clinical Radiology, Great Ormond Street Hospital for Children, London, UK ,UCL Great Ormond Street Institute of Child Health, London, UK
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20
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Deininger-Czermak E, Villefort C, von Knebel Doeberitz N, Franckenberg S, Kälin P, Kenkel D, Gascho D, Piccirelli M, Finkenstaedt T, Thali MJ, Guggenberger R. Comparison of MR Ultrashort Echo Time and Optimized 3D-Multiecho In-Phase Sequence to Computed Tomography for Assessment of the Osseous Craniocervical Junction. J Magn Reson Imaging 2020; 53:1029-1039. [PMID: 33368790 DOI: 10.1002/jmri.27478] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 12/03/2020] [Accepted: 12/03/2020] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND To assess changes of the craniocervical junction (CCJ), computed tomography (CT) is considered the reference standard. Recent advances in bone depiction on magnetic resonance imaging (MRI) enable high-quality visualization of osseous structures. Consequently, MRI may serve as an alternative to CT, without the use of ionizing radiation. PURPOSE To compare two MRI sequences optimized for bone visualization to the CT reference standard in the assessment of the osseous CCJ. STUDY TYPE Prospective. POPULATION/SUBJECTS Twenty-seven decedents and five healthy volunteers. FIELD STRENGTH/SEQUENCE 3T/ultrashort-echo time gradient echo (UTE) and optimized 3D-multiecho in-phase gradient echo sequences (FRACTURE). ASSESSMENT All decedents were scanned with both MRI sequences and CT. Three observers rated degeneration to obtain a score for the upper (atlanto-dental and left/right atlanto-occipital joint) and for the lower part of the CCJ (left and right atlanto-axial joint). Two reader rated the following quantitative parameters: basion-axial-interval, atlanto-dental-interval, atlanto-occipital-interval, Powers-ratio, and signal/contrast-to-noise-ratio. As a proof of concept, five healthy volunteers were scanned with both MRI sequences. STATISTICAL TESTS Degeneration was assessed on a Likert scale by three independent observers. Interrater and intermodality reliability were calculated using an intraclass correlation coefficient. To compare distance measurements between examination methods, a Friedman test, between-degenerative ratings, and a Kruskal-Wallis test were performed. RESULTS Degenerative ratings of the CCJ between MRI sequences and CT showed a good interrater and intermodality agreement. MRI sequences tended to underestimate the degree of degeneration compared to CT, and this became more marked with increasing degeneration severity. There were no significant relationships between distance measurements and the degree of degeneration (PCT = 0.62, PUTE = 0.64, PFRACTURE = 0.67). The in vivo examination proved the feasibility of both MRI methods in a clinical setting. DATA CONCLUSION Quantitative and qualitative ratings on MR images were comparable to CT images; thus, MRI may be a valid alternative to CT assessing the CCJ. LEVEL OF EVIDENCE 1. TECHNICAL EFFICACY STAGE 3.
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Affiliation(s)
- Eva Deininger-Czermak
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Zurich, Switzerland.,Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | | | | | - Sabine Franckenberg
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Zurich, Switzerland.,Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Pascal Kälin
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - David Kenkel
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Dominic Gascho
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Zurich, Switzerland
| | - Marco Piccirelli
- Department of Neuroradiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Tim Finkenstaedt
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Michael J Thali
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Zurich, Switzerland
| | - Roman Guggenberger
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
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21
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Kirschenbaum D, Imbach LL, Rushing EJ, Frauenknecht KBM, Gascho D, Ineichen BV, Keller E, Kohler S, Lichtblau M, Reimann RR, Schreib K, Ulrich S, Steiger P, Aguzzi A, Frontzek K. Intracerebral endotheliitis and microbleeds are neuropathological features of COVID-19. Neuropathol Appl Neurobiol 2020; 47:454-459. [PMID: 33249605 PMCID: PMC7753688 DOI: 10.1111/nan.12677] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 11/02/2020] [Accepted: 11/17/2020] [Indexed: 11/26/2022]
Abstract
Coronavirus disease 19 (COVID‐19) is a rapidly evolving pandemic caused by the coronavirus Sars‐CoV‐2. Clinically manifest central nervous system symptoms have been described in COVID‐19 patients and could be the consequence of commonly associated vascular pathology, but the detailed neuropathological sequelae remain largely unknown. A total of six cases, all positive for Sars‐CoV‐2, showed evidence of cerebral petechial hemorrhages and microthrombi at autopsy. Two out of six patients showed an elevated risk for disseminated intravascular coagulopathy according to current criteria and were excluded from further analysis. In the remaining four patients, the hemorrhages were most prominent at the grey and white matter junction of the neocortex, but were also found in the brainstem, deep grey matter structures and cerebellum. Two patients showed vascular intramural inflammatory infiltrates, consistent with Sars‐CoV‐2‐associated endotheliitis, which was associated by elevated levels of the Sars‐CoV‐2 receptor ACE2 in the brain vasculature. Distribution and morphology of patchy brain microbleeds was clearly distinct from hypertension‐related hemorrhage, critical illness‐associated microbleeds and cerebral amyloid angiopathy, which was ruled out by immunohistochemistry. Cerebral microhemorrhages in COVID‐19 patients could be a consequence of Sars‐ CoV‐2‐induced endotheliitis and more general vasculopathic changes and may correlate with an increased risk of vascular encephalopathy.
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Affiliation(s)
| | - Lukas L Imbach
- Department of Neurology, University of Zurich, Zurich, Switzerland
| | | | | | - Dominic Gascho
- Institute of Forensic Medicine, University of Zurich, Zurich, Switzerland
| | | | - Emanuela Keller
- Department of Neurosurgery and Institute of Intensive Care Medicine, University of Zurich, Zurich, Switzerland
| | - Sibylle Kohler
- Department of Internal Medicine, Spital Zollikerberg, Zollikerberg, Switzerland
| | - Mona Lichtblau
- Department of Pulmonology, University of Zurich, Zurich, Switzerland
| | - Regina R Reimann
- Institute of Neuropathology, University of Zurich, Zurich, Switzerland
| | - Katharina Schreib
- Department of Internal Medicine, Spital Zollikerberg, Zollikerberg, Switzerland
| | - Silvia Ulrich
- Department of Pulmonology, University of Zurich, Zurich, Switzerland
| | - Peter Steiger
- Institute of Intensive Care Medicine, University of Zurich, Zurich, Switzerland
| | - Adriano Aguzzi
- Institute of Neuropathology, University of Zurich, Zurich, Switzerland
| | - Karl Frontzek
- Institute of Neuropathology, University of Zurich, Zurich, Switzerland
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22
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Bulliard J, Eggert S, Ampanozi G, Affolter R, Gascho D, Sieberth T, Thali MJ, Ebert LC. Preliminary testing of an augmented reality headset as a DICOM viewer during autopsy. Forensic Imaging 2020. [DOI: 10.1016/j.fri.2020.200417] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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23
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Kreul D, Gascho D, Franckenberg S, Eggert S, Fliss B, Kubik-Huch R, Thali M, Niemann T. Postmortem determination of hepatic steatosis. Comparing Rho/Z and fat fraction measurements on dual-energy CT for histological grading: A retrospective analysis. Forensic Imaging 2020. [DOI: 10.1016/j.fri.2020.200422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Gascho D, Bolliger SA, Thali MJ. CT and MRI of a transcardiac gunshot wound with an annular distribution of bullet fragments surrounding an exit-re-entrance wound after the bullet burst from a floor tile upon exiting the lying body. J Forensic Leg Med 2020; 77:102087. [PMID: 33249345 DOI: 10.1016/j.jflm.2020.102087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 11/04/2020] [Accepted: 11/14/2020] [Indexed: 01/19/2023]
Abstract
This case report describes medicolegal examinations of a decedent with a fatal gunshot wound. The decedent lied on the floor as a bullet was fired into his chest. Computed tomography (CT) and magnetic resonance imaging (MRI) were performed as part of the judicial investigation. The MRI examination was valuable for delineating the wound channel through the left ventricle, which was deemed the main cause for internal bleeding and fatal blood loss. The diagnostic value of CT for the detection of injuries was low in this case. However, CT allowed for the virtual investigation of bullet fragments. According to CT-based dual-energy index calculations, it could be inferred that the fragments were most likely made of lead matching .357 Magnum R-P cartridges that were found at the scene. The bullet fragments were located underneath the skin at the suspected exit wound. The exit wound was actually an exit-re-entrance wound, as it can be assumed that the fragments re-entered the body after the bullet burst from hard ground upon exiting the body of the decedent, who was lying on the floor. CT visualized an uncommon annular distribution pattern for the bullet fragments surrounding the exit-re-entrance wound. The formation of such an annular distribution pattern of bullet fragments and the relevant conclusions that may be drawn from such a distribution pattern are discussed in this article.
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Affiliation(s)
- Dominic Gascho
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Zurich, Switzerland.
| | - Stephan A Bolliger
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Zurich, Switzerland
| | - Michael J Thali
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Zurich, Switzerland
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Schmid FA, Gascho D, Zoelch N, Prange JA, Colacicco G, Eberli D. Feasibility, technique and accuracy of ultrasound-guided transurethral injections into the urinary sphincter of female cadavers: proof of concept. BMC Urol 2020; 20:167. [PMID: 33097063 PMCID: PMC7583166 DOI: 10.1186/s12894-020-00719-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 09/14/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The injection of muscle precursor cells (MPC) into the external urinary sphincter muscle (EUS) is a promising therapeutic option for regenerative treatment of stress urinary incontinence (SUI). The objective of the present project was to conduct a pre-clinical trial to investigate the feasibility and accuracy of ultrasound (US) guided, transurethral injections into the EUS of female cadavers. METHODS This is a prospective, anatomical, interventional and radiological cadaveric laboratory investigation. Two urologists performed transurethral US-guided injections to deliver nano-iron particles into the EUS. The intervention was performed in three unfixed, fresh female cadavers. Each cadaver received MRI before and CT as well as MRI of the pelvis after the injections. RESULTS The precision and accumulation of nano-iron particles in the EUS was compared using a rating scale to evaluate left versus right and anterior versus posterior distribution in axial and sagittal orientation with US, MRI and CT. The accuracy of our US-guided injections into the anterior target region yielded 4 points on the rating scale. Adequate precision and accumulation of particles in the left versus right EUS were also demonstrated (3 vs. 3.33 points, respectively). Signal intensity in MRI revealed a mean ratio of 0.33 before and after injection. CT scans showed no relevant artefacts impairing the assessment. CONCLUSION US-guided, transurethral injection into the EUS is feasible and imaging reveals a precise accumulation in the target region. Our method provides an appropriate approach to deliver MPC in the EUS muscle for a regenerative treatment of SUI in the near future.
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Affiliation(s)
- Florian A Schmid
- Department of Urology, University Hospital of Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | - Dominic Gascho
- Institute of Forensic Medicine, University of Zurich, Zurich, Switzerland
| | - Niklaus Zoelch
- Institute of Forensic Medicine, University of Zurich, Zurich, Switzerland
| | - Jenny A Prange
- Department of Urology, University Hospital of Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | | | - Daniel Eberli
- Department of Urology, University Hospital of Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland.
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Gascho D, Hetzel U, Schmid N, Martinez RM, Thali MJ, Richter H. Virtopsy of a gravid Boa constrictor using computed tomography and magnetic resonance imaging. Vet Anim Sci 2020; 10:100150. [PMID: 33089008 PMCID: PMC7566950 DOI: 10.1016/j.vas.2020.100150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 05/29/2020] [Accepted: 10/01/2020] [Indexed: 11/18/2022] Open
Abstract
This article presents radiologic examinations of a deeply sedated Boa constrictor with boid inclusion body disease (BIBD) as an adjunction to the subsequent necropsy. This method is known as virtopsy. The Boa constrictor in the present case was gravid. Computed tomography (CT) allowed for the detailed depiction of a fetal skeleton at the rear end of the adult snake. Furthermore, tiny gas formation was detected inside the cranium of the fetus, which was deemed a radiologic sign for decomposition. Magnetic resonance imaging (MRI) delineated the soft tissue at high resolution. This article illustrates the use of CT and MRI for the examination of a gravid Boa constrictor before necropsy and demonstrates the detection of "normal" postmortem findings leading to the confirmation of fetal death in situ.
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Key Words
- BIBD, boid inclusion body disease
- Boa constrictor
- CT, computed tomography
- Computed tomography
- IHC, immunohistochemical
- MRI, Magnetic resonance imaging
- Magnetic resonance imaging
- Postmortem imaging
- RAVs, reptarenaviruses
- TE, echo time
- TR, repitition time
- Virtopsy
- Virtual necropsy
- kVp, kilovoltage peak
- mAs, milliampere seconds
- ms, milliseconds
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Affiliation(s)
- Dominic Gascho
- Institute of Forensic Medicine and Imaging, University of Zurich, Switzerland
- Corresponding author: Dominic Gascho, Department of Forensic Medicine and Imaging, Zurich Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, CH-8057 Zurich, Switzerland, Telephone number: +41 44 635 5611, Fax number: +41 44 635 6851
| | - Udo Hetzel
- Institute of Veterinary Pathology, Vetsuisse Faculty, University of Zurich, Switzerland
| | - Nicole Schmid
- Clinic for Zoo Animals, Exotic Pets and Wildlife, Vetsuisse Faculty, University of Zurich, Switzerland
| | - Rosa M Martinez
- Institute of Forensic Medicine and Imaging, University of Zurich, Switzerland
| | - Michael J Thali
- Institute of Forensic Medicine and Imaging, University of Zurich, Switzerland
| | - Henning Richter
- Diagnostic Imaging Research Unit (DIRU), Clinic for Diagnostic Imaging, Vetsuisse Faculty, University of Zurich, Switzerland
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Gascho D. Lodged bullets on computed tomography: Three classification procedures for the virtual investigation of bullets or their fragments that cannot be recovered from the living patient. Med Sci Law 2020; 60:245-248. [PMID: 33054596 DOI: 10.1177/0025802420962697] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Dominic Gascho
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Switzerland
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García-Martínez D, Bastir M, Gómez-Olivencia A, Maureille B, Golovanova L, Doronichev V, Akazawa T, Kondo O, Ishida H, Gascho D, Zollikofer CPE, de León MP, Heuzé Y. Early development of the Neanderthal ribcage reveals a different body shape at birth compared to modern humans. Sci Adv 2020; 6:6/41/eabb4377. [PMID: 33028520 PMCID: PMC7541074 DOI: 10.1126/sciadv.abb4377] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 08/25/2020] [Indexed: 05/12/2023]
Abstract
Ontogenetic studies provide clues for understanding important paleobiological aspects of extinct species. When compared to that of modern humans, the adult Neanderthal thorax was shorter, deeper, and wider. This is related to the wide Neanderthal body and is consistent with their hypothetical large requirements for energy and oxygen. Whether these differences were already established at birth or appeared later during development is unknown. To delve into this question, we use virtual reconstruction tools and geometric morphometrics to recover the 3D morphology of the ribcages of four Neanderthal individuals from birth to around 3 years old: Mezmaiskaya 1, Le Moustier 2, Dederiyeh 1, and Roc de Marsal. Our results indicate that the comparatively deep and short ribcage of the Neanderthals was already present at birth, as were other skeletal species-specific traits. This morphology possibly represents the plesiomorphic condition shared with Homo erectus, and it is likely linked to large energetic requirements.
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Affiliation(s)
- Daniel García-Martínez
- University of Bordeaux, CNRS, MCC, PACEA, UMR5199, Pessac, France.
- Paleobiology Department, Museo Nacional de Ciencias Naturales (MNCN-CSIC), c/ José Gutiérrez Abascal 2, 28006 Madrid, Spain
- Centro Nacional de Investigación sobre la Evolución Humana (CENIEH), Pso. Sierra de Atapuerca 3, 09002 Burgos, Spain
| | - Markus Bastir
- Paleobiology Department, Museo Nacional de Ciencias Naturales (MNCN-CSIC), c/ José Gutiérrez Abascal 2, 28006 Madrid, Spain
| | - Asier Gómez-Olivencia
- Departamento de Estratigrafía y Paleontología, Facultad de Ciencia y Tecnología, Universidad del País Vasco-Euskal Herriko Unibertsitatea (UPV/EHU), Barrio Sarriena s/n, 48940 Leioa, Spain
- Sociedad de Ciencias Aranzadi, Zorroagagaina 11, 20014 Donostia-San Sebastián, Spain
- Centro Mixto UCM-ISCIII de Investigación sobre Evolución y Comportamiento Humanos, c/ Avda. Monforte de Lemos 5 (Pabellón 14), 28029 Madrid, Spain
| | - Bruno Maureille
- University of Bordeaux, CNRS, MCC, PACEA, UMR5199, Pessac, France
| | | | | | | | - Osamu Kondo
- Department of Biological Sciences, Graduate School of Science, University of Tokyo, Tokyo 113-0033, Japan
| | - Hajime Ishida
- Department of Human Biology and Anatomy, Graduate School of Medicine, University of the Ryukyus Nishihara, Okinawa 903-0215, Japan
| | - Dominic Gascho
- Institute of Forensic Medicine, University of Zurich, CH-8057 Zurich, Switzerland
| | | | | | - Yann Heuzé
- University of Bordeaux, CNRS, MCC, PACEA, UMR5199, Pessac, France
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Gascho D, Deininger-Czermak E, Zoelch N, Tappero C, Sommer S, Hinterholzer N, Thali MJ. Noninvasive 7 tesla MRI of fatal craniocerebral gunshots - a glance into the future of radiologic wound ballistics. Forensic Sci Med Pathol 2020; 16:595-604. [PMID: 32920765 PMCID: PMC7669810 DOI: 10.1007/s12024-020-00300-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2020] [Indexed: 11/04/2022]
Abstract
Compared to computed tomography (CT), magnetic resonance imaging (MRI) provides superior visualization of the soft tissue. Recently, the first 7 Tesla (7 T) MRI scanner was approved for clinical use, which will facilitate access to these ultra-high-field MRI scanners for noninvasive examinations and scientific studies on decedents. 7 T MRI has the potential to provide a higher signal-to-noise ratio (SNR), a characteristic that can be directly exploited to improve image quality and invest in attempts to increase resolution. Therefore, evaluating the diagnostic potential of 7 T MRI for forensic purposes, such as assessments of fatal gunshot wounds, was deemed essential. In this article, we present radiologic findings obtained for craniocerebral gunshot wounds in three decedents. The decedents were submitted to MRI examinations using a 7 T MRI scanner that has been approved for clinical use and a clinical 3 T MRI scanner for comparison. We focused on detecting tiny injuries beyond the wound tract caused by temporary cavitation, such as microbleeds. Additionally, 7 T T2-weighted MRI highlighted a dark (hypo intense) zone beyond the permanent wound tract, which was attributed to increased amounts of paramagnetic blood components in damaged tissue. Microbleeds were also detected adjacent to the wound tract in the white matter on 7 T MRI. Based on the findings of radiologic assessments, the advantages and disadvantages of postmortem 7 T MRI compared to 3 T MRI are discussed with regard to investigations of craniocerebral gunshot wounds as well as the potential role of 7 T MRI in the future of forensic science.
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Affiliation(s)
- Dominic Gascho
- Department of Forensic Medicine and Imaging, Zurich Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, CH-8057, Zurich, Switzerland.
| | - Eva Deininger-Czermak
- Department of Forensic Medicine and Imaging, Zurich Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, CH-8057, Zurich, Switzerland.,Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Niklaus Zoelch
- Department of Forensic Medicine and Imaging, Zurich Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, CH-8057, Zurich, Switzerland.,Department of Psychiatry, Psychotherapy and Psychosomatics, Hospital of Psychiatry, University of Zurich, Zurich, Switzerland
| | - Carlo Tappero
- Department of Forensic Medicine and Imaging, Zurich Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, CH-8057, Zurich, Switzerland.,Department of Radiology, Hôpital Fribourgeois, Fribourg, Switzerland
| | - Stefan Sommer
- Siemens Healthcare AG, Zurich, Switzerland.,SCMI, Swiss Center for Musculoskeletal Imaging, Balgrist Campus AG, Zurich, Switzerland
| | - Natalie Hinterholzer
- SCMI, Swiss Center for Musculoskeletal Imaging, Balgrist Campus AG, Zurich, Switzerland
| | - Michael J Thali
- Department of Forensic Medicine and Imaging, Zurich Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, CH-8057, Zurich, Switzerland
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Gascho D, Zoelch N, Richter H, Buehlmann A, Wyss P, Thali MJ, Schaerli S. Heavy metal in radiology: how to reliably differentiate between lodged copper and lead bullets using CT numbers. Eur Radiol Exp 2020; 4:43. [PMID: 32632537 PMCID: PMC7338321 DOI: 10.1186/s41747-020-00168-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 06/15/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The in situ classification of bullets is of interest in forensic investigations when the bullet cannot be removed. Although computed tomography (CT) is usually performed on shooting victims, visual assessment, or caliber measurements using CT can be challenging or infeasible if the bullets are deformed or fragmented. Independent from the bullet's intactness, x-ray attenuation values (CT numbers) may provide information regarding the material of the bullet. METHODS Ethical approval was not required (animal cadavers) or waived by the ethics committee (decedents). Copper and lead bullets were fired into animal cadavers, which then underwent CT scanning at four energy levels (80, 100, 120, and 140 kVp). CT numbers were measured within regions of interest (ROIs). In addition to comparing CT numbers, the dual-energy index (DEI), representing the ratio between the CT numbers of two energy levels, was calculated. The most appropriate method was applied for decedents with fatal gunshot wounds. RESULTS CT numbers demonstrated no significant difference between copper and lead bullets, and false classifications can easily occur. DEI calculations revealed significant differences between the two groups of bullets. The 120/140 DEIs calculated from the maximum CT numbers obtained from ROIs at the edge of copper versus lead bullets presented a significant difference (p = 0.002) and a gap between the CT numbers of copper and lead bullets and was successfully applied for the decedents. CONCLUSIONS This study presents a viable method for distinguishing copper and lead bullets in situ via CT and highlights the potential pitfalls of incorrect classifications.
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Affiliation(s)
- Dominic Gascho
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, CH-8057, Zurich, Switzerland.
| | - Niklaus Zoelch
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, CH-8057, Zurich, Switzerland.,Department of Psychiatry, Psychotherapy and Psychosomatics, Hospital of Psychiatry, University of Zurich, Zurich, Switzerland
| | - Henning Richter
- Diagnostic Imaging Research Unit (DIRU), Clinic for Diagnostic Imaging, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Alexander Buehlmann
- Zurich Forensic Science Institute, Zurich Canton Police and Zurich City Police, Zurich, Switzerland
| | - Philipp Wyss
- Zurich Forensic Science Institute, Zurich Canton Police and Zurich City Police, Zurich, Switzerland
| | - Michael J Thali
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, CH-8057, Zurich, Switzerland
| | - Sarah Schaerli
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, CH-8057, Zurich, Switzerland.,Institute of Forensic Medicine, Health Department Basel, University of Basel, Basel, Switzerland
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Gascho D, Zoelch N, Deininger-Czermak E, Tappero C, Richter H, Thali MJ, Schaerli S. In situ identification of Action 4, SECA and QD-PEP bullets from special police ammunitions by computed tomography. Med Sci Law 2020; 60:188-195. [PMID: 32233731 DOI: 10.1177/0025802420911555] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Special deformation bullets were developed for police forces to achieve a defined penetration depth (avoiding over-penetration) and a controlled energy transfer (avoiding collateral damage). This article focuses on Action 4, SECA and QD-PEP bullets. These 9 mm bullets were specially designed for controlled deformation. The characteristic slight mushrooming with a front cross-section of approximately 11.5 mm after entering a ballistic simulant was verified in ballistic tests. To achieve such slight mushrooming, the projectile's core is hollowed. The purpose of this study was to investigate the feasibility of visualising the hollowed cores of Action 4, SECA and QD-PEP bullets using a standard clinical computed tomography (CT) scanner for non-invasive identification of these special bullets from police ammunitions. METHODS First, undeformed specimens were scanned to reveal the shape of the hollowed core of each type of special bullet. Second, Action 4, SECA and QD-PEP bullets were fired towards animal cadaver models to visualise their hollow core after deformation inside biological tissue. Third, two reviewers were tasked with identifying special bullets from police ammunition (Action 4 bullets: n = 3) among 10 CT examinations of humans with lodged projectiles who were selected by the supervisor of the study. RESULTS The CT scans of the undeformed specimens revealed the special design of the bullets' metal core. All special bullets from police ammunitions that were fired towards an animal cadaver model demonstrated the characteristic slight mushrooming. In accordance with the CT scans of the undeformed bullets, visualisation of the individual internal cavities of the special bullets allowed the Action 4, SECA and QD-PEP bullets to be clearly distinguished. With regard to the real forensic cases, both reviewers clearly identified each of the three Action 4 bullets among all other lodged projectiles. CONCLUSIONS This study demonstrates the feasibility of identifying Action 4, SECA and QD-PEP bullets from special police ammunitions by CT. The individual shapes of the cavity inside the bullets were clearly visible on CT. In situ identification of these bullets can aid in the assessment of injuries, and since these bullets are fabricated from non-ferromagnetic metals, their clear identification allows for magnetic resonance imaging (MRI) without the risk of bullet movement inside the body due to the magnetic pull of the MRI unit. Furthermore, this approach could be of great interest to forensic investigators if patients who received gunshot wounds underwent non-operative treatments and the projectile remains in the body. Since the use of CT is also increasing for medico-legal post-mortem examinations, the identification of lodged projectiles is of interest for a virtual autopsy or 'Virtopsy'.
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Affiliation(s)
- Dominic Gascho
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Switzerland
| | - Niklaus Zoelch
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Switzerland
- Department of Psychiatry, Psychotherapy and Psychosomatics, Hospital of Psychiatry, University of Zurich, Switzerland
| | - Eva Deininger-Czermak
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Switzerland
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Switzerland
| | - Carlo Tappero
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Switzerland
- Department of Radiology, Hôpital Fribourgeois, Switzerland
| | - Henning Richter
- Diagnostic Imaging Research Unit (DIRU), Clinic for Diagnostic Imaging, Vetsuisse Faculty, University of Switzerland
| | - Michael J Thali
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Switzerland
| | - Sarah Schaerli
- Institute of Forensic Medicine, Health Department Basel, University of Basel, Switzerland
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Heimer J, Gascho D, Odermatt R, Zoelch N, Kottner S, Thali M, Chatzaraki V. Full virtual autopsy in a case of a suicidal transthoracic gunshot injury. Forensic Imaging 2020. [DOI: 10.1016/j.fri.2020.200368] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Deininger-Czermak E, Heimer J, Tappero C, Thali MJ, Gascho D. The added value of postmortem magnetic resonance imaging in cases of hanging compared to postmortem computed tomography and autopsy. Forensic Sci Med Pathol 2020; 16:234-242. [PMID: 32221850 DOI: 10.1007/s12024-020-00233-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2020] [Indexed: 11/26/2022]
Abstract
The purpose of this study was to evaluate the added value of postmortem magnetic resonance imaging (MRI) compared to postmortem computed tomography (CT) and autopsy in cases of fatal hanging. In addition, the study analyzed the strengths of each examination method regarding typical injuries in these cases. We investigated a cohort of 25 decedents who underwent CT, MRI and autopsy. Two radiologists assessed all MR images of the head and neck as well as the corresponding CT images. The results were compared to autopsy findings by retrospectively analyzing the autopsy reports. Postmortem MRI revealed intramuscular hemorrhages in a large number of cases, however, autopsy did not confirm all of the detected hemorrhages. CT and autopsy detected fractures in several cases, whereas MRI showed a fracture in just one single case. Other previously described vital signs and relevant findings, such as fracture-related gas bubbles, soft tissue emphysema or pneumomediastinum, were observed in only a few individual cases. MRI provided added diagnostic value in the detection of soft tissue injuries and lymph node swelling in fatal hangings. As an adjunct to autopsy, postmortem MRI may reveal additional hemorrhages, which might be missed at autopsy. Since standard MRI demonstrated low sensitivity for the detection of fractures, an additional imaging modality or autopsy is required to overcome this limitation.
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Affiliation(s)
- Eva Deininger-Czermak
- Department of Forensic Medicine and Imaging, Zurich Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse, 190/52, CH-8057, Zurich, Switzerland.
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland.
| | - Jakob Heimer
- Department of Forensic Medicine and Imaging, Zurich Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse, 190/52, CH-8057, Zurich, Switzerland
| | - Carlo Tappero
- Department of Forensic Medicine and Imaging, Zurich Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse, 190/52, CH-8057, Zurich, Switzerland
- Department of Radiology, Hôpital Fribourgeois, Fribourg, Switzerland
| | - Michael J Thali
- Department of Forensic Medicine and Imaging, Zurich Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse, 190/52, CH-8057, Zurich, Switzerland
| | - Dominic Gascho
- Department of Forensic Medicine and Imaging, Zurich Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse, 190/52, CH-8057, Zurich, Switzerland
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Gascho D, Marosi M, Thali MJ, Deininger-Czermak E. Postmortem Computed Tomography and Magnetic Resonance Imaging of Gunshot Wounds to the Neck. J Forensic Sci 2020; 65:1360-1364. [PMID: 32105348 DOI: 10.1111/1556-4029.14311] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 02/03/2020] [Accepted: 02/06/2020] [Indexed: 12/24/2022]
Abstract
Postmortem magnetic resonance imaging (MRI) is rarely used for the radiologic assessment of gunshot injuries, although it has clear advantages over postmortem computed tomography (CT) with regard to the imaging of soft tissue injuries. Another benefit in using MRI is that lodged projectiles composed of nonferromagnetic material such as lead present only marginal metal artifacts compared with severe artifacts on CT. This case report presents CT and MRI findings in a case with two gunshot wounds to the neck: a perforating wound and a nonperforating wound with a lead bullet lodged in the cervical spine. The decedent underwent CT and MRI before the scheduled autopsy. A ring of radiopaque material under the dermis in the fatty tissue was identified at both entrance wounds on CT, which was indicative of contact shots. The perforating gunshot was clearly indicated on CT by bullet fragments along the wound channel through the perforated 6th cervical vertebra and the fractured cricoid cartilage at the exit wound. The second trajectory, however, was only assumed based on the presence of gunshot residues at the entrance wound and the position of the lodged bullet. The radiologic assessment was severely impeded by the metal artifacts on CT. Barely noticeable metal artifacts on MRI allowed for clear visualization of the soft tissue injuries and the ruptured medulla oblongata. Only MRI clarified the soft tissue injuries of the brainstem noninvasively, which could provide specific and graphic information on the rapidity of death and the incapacitation of the victim.
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Affiliation(s)
- Dominic Gascho
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, Zurich, 8057, Switzerland
| | - Mária Marosi
- Department of Radiology, University of Debrecen, Nagyerdei krt. 98, Debrecen, 4032, Hungary
| | - Michael J Thali
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, Zurich, 8057, Switzerland
| | - Eva Deininger-Czermak
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, Zurich, 8057, Switzerland
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Öhrström L, Tekin A, Biedermann P, Morozova I, Habicht M, Gascho D, Bode-Lesniewska B, Imhof A, Rühli F, Eppenberger P. Experimental mummification-In the tracks of the ancient Egyptians. Clin Anat 2020; 33:860-871. [PMID: 31943391 DOI: 10.1002/ca.23568] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 01/08/2020] [Accepted: 01/11/2020] [Indexed: 12/24/2022]
Abstract
Understanding natural and artificial postmortem alterations in different tissues of the human body is essential for bioarchaeology, paleogenetics, physical anthropology, forensic medicine, and many related disciplines. With this study, we tried to gain a better understanding of tissue alterations associated with the artificial mummification techniques of ancient Egypt, in particular for mummified visceral organs. We used several entire porcine organs and organ sections (liver, lung, stomach, ileum, and colon), which provided a close approximation to human organs. First, we dehydrated the specimens in artificial natron, before applying natural ointments, according to the ancient literary sources and recent publications. We periodically monitored the temperature, pH value, and weight of the specimens, in addition to radiodensity and volumetric measurements by clinical computed tomography and sampling for histological, bacteriological, and molecular analyses. After seven weeks, mummification was seen completed in all specimens. We observed a considerable loss of weight and volume, as well as similar courses in the decay of tissue architecture but varying levels of DNA degradation. Bacteriologically we did not detect any of the initially identified taxa in the samples by the end of the mummification process, nor any fungi. This feasibility study established an experimental protocol for future experiments modeling ancient Egyptian mummification of visceral organs using human specimens. Understanding desiccation and mummification processes in non-pathological tissues of specific visceral organs may help to identify and interpret disease-specific alterations in mummified tissues in ancient Egyptian canopic jars and organ packages contained in whole mummies.
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Affiliation(s)
- Lena Öhrström
- Institute of Evolutionary Medicine, University of Zurich, Zurich, Switzerland
| | - Ahmed Tekin
- Institute of Evolutionary Medicine, University of Zurich, Zurich, Switzerland
| | - Philipp Biedermann
- Institute of Evolutionary Medicine, University of Zurich, Zurich, Switzerland
| | - Irina Morozova
- Institute of Evolutionary Medicine, University of Zurich, Zurich, Switzerland
| | - Michael Habicht
- Institute of Evolutionary Medicine, University of Zurich, Zurich, Switzerland
| | - Dominic Gascho
- Institute of Forensic Medicine, University of Zurich, Zurich, Switzerland
| | - Beata Bode-Lesniewska
- Institute of Pathology and Molecular Pathology, University Hospital of Zurich, Zürich, Switzerland
| | - Alexander Imhof
- Microbiology Laboratory, Hospital of Langenthal, Langenthal, Switzerland
| | - Frank Rühli
- Institute of Evolutionary Medicine, University of Zurich, Zurich, Switzerland
| | - Patrick Eppenberger
- Institute of Evolutionary Medicine, University of Zurich, Zurich, Switzerland
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Gascho D, Zoelch N, Deininger-Czermak E, Tappero C, Buehlmann A, Wyss P, Thali MJ, Schaerli S. Visualization and material-based differentiation of lodged projectiles by extended CT scale and the dual-energy index. J Forensic Leg Med 2020; 70:101919. [DOI: 10.1016/j.jflm.2020.101919] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 01/24/2020] [Accepted: 02/01/2020] [Indexed: 02/07/2023]
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Gascho D, Richter H, Karampinos DC, Heimer J, Schaerli S, Thali MJ, Zoelch N. Noninvasive in situ proton MRS in muscle tissue and bone marrow as a novel approach to identify previous freezing in a completely thawed cadaver. NMR Biomed 2020; 33:e4220. [PMID: 31774230 DOI: 10.1002/nbm.4220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 10/02/2019] [Accepted: 10/22/2019] [Indexed: 06/10/2023]
Abstract
The temporary or permanent storage of human bodies in freezers following a homicide is a documented method for criminal disposal of human corpses. In these cases, the detection of characteristics which indicate that a thawed cadaver or body part was previously frozen provides crucial information for forensic casework. Previous histological and radiological approaches to detect characteristics of previous freezing are based on the formation of bubble-like gas patterns, which are difficult to distinguish from common postmortem gas formation in the course of decomposition. The objective of this study was to detect changes in the muscle tissue and in the bone marrow after freezing and thawing by means of in situ proton magnetic resonance spectroscopy (1 H-MRS) to provide a noninvasive approach to detect postfreezing alterations in human cadavers. In this experimental study, the hind legs of seven sheep were used as substitutes for human tissue. One hind leg underwent 1 H-MRS before and daily after storage in a deep freezer (-20°C) and complete thawing at room temperature (study group: n = 7). The opposite hind leg was kept at room temperature and was measured daily (control group: n = 7). Spectra and relaxation times were measured using single voxel measurements in the muscle tissue and in the bone marrow. 1 H-MRS revealed several changes in the muscle tissue and in the bone marrow after freezing and thawing. A strongly reduced peak area ratio (<20) between bulk methylene and olefinic and glycerol methine and a reduced T2 relaxation time for bulk methylene (<45 ms) measured in the bone marrow were found to be indicators that a sheep leg was previously frozen and thawed independent of the postmortem interval. Noninvasive in situ 1 H-MRS in the bone marrow potentially provides a new method for detecting previous freezing or extreme cooling in cadavers.
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Affiliation(s)
- Dominic Gascho
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Zurich, Switzerland
| | - Henning Richter
- Clinic of Diagnostic Imaging, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Dimitrios C Karampinos
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, Munich, Germany
| | - Jakob Heimer
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Zurich, Switzerland
| | - Sarah Schaerli
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Zurich, Switzerland
| | - Michael J Thali
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Zurich, Switzerland
| | - Niklaus Zoelch
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Zurich, Switzerland
- Hospital of Psychiatry, Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland
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Klein WM, Sonnemans LJP, Franckenberg S, Fliss B, Gascho D, Prokop M, Lamers WH, Hikspoors JPJM, Thali MJ, Flach PM. Pseudolesion in the right parafissural liver parenchyma on CT: The base is found in embryology and collagen content. PLoS One 2020; 15:e0221544. [PMID: 31986149 PMCID: PMC6984698 DOI: 10.1371/journal.pone.0221544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 01/02/2020] [Indexed: 11/18/2022] Open
Abstract
Background Computed tomography (CT) images of livers may show a hypo-attenuated structure alongside the falciform ligament, which can be a focal fatty pseudolesion and can mimic a malignancy. The preferred location is on the right parafissural site, ventral in segment IVa/b. The etiology is not clear, nor is it known how the histology of this location develops. These are evaluated in this study. Methods 40 adult cadavers with autopsy and / or postmortem CT in a university hospital and a forensic center were included. Liver biopsies were taken at the left side of the falciform ligament as control, and at the right side as the possible precursor of a pseudolesion; these were examined for collagen and fat content. Cadavers with steatotic (>5% fat) or fibrotic (>2% collagen) control samples were excluded. Results Significantly more collagen was present in the right parafissural liver parenchyma: median 0.68% (IQR: 0.32–1.17%), compared to the left side 0.48% (IQR: 0.21–0.75%) (p 0.008), with equal fat content and CT attenuation values. The etiophysiology goes back to the demise of the umbilical venes in the early embryonic and neonatal period. Conclusions The right parafissural area contains more collagen and an equal amount of fat compared to the control left side. This supports the hypothesis of delayed, ‘third’ inflow: the postnatal change in blood supply from umbilical to portal leaves the downstream parafissural area hypoperfused leading to hypoxia which in turn results in collagen accumulation and the persistence of paraumbilical veins of Sappey.
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Affiliation(s)
- Willemijn M. Klein
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
- * E-mail:
| | - Lianne J. P. Sonnemans
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Sabine Franckenberg
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zürich, Zürich, Switzerland
| | - Barbara Fliss
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zürich, Zürich, Switzerland
| | - Dominic Gascho
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zürich, Zürich, Switzerland
| | - Mathias Prokop
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Wouter H. Lamers
- Department of Anatomy and Embryology, Maastricht University, Maastricht, the Netherlands
| | | | - Michael J. Thali
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zürich, Zürich, Switzerland
| | - Patricia M. Flach
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zürich, Zürich, Switzerland
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Heimer J, Gascho D, Madea B, Steuer A, Martinez RM, Thali MJ, Zoelch N. Comparison of the beta-hydroxybutyrate, glucose, and lactate concentrations derived from postmortem proton magnetic resonance spectroscopy and biochemical analysis for the diagnosis of fatal metabolic disorders. Int J Legal Med 2020; 134:603-612. [DOI: 10.1007/s00414-019-02235-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 12/11/2019] [Indexed: 12/27/2022]
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41
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Morozova I, Öhrström LM, Eppenberger P, Bode-Lesniewska B, Gascho D, Haas C, Akgül G, Neukamm J, Röthlin KA, Imhof A, Shved N, Papageorgopoulou C, Rühli FJ. Ongoing tissue changes in an experimentally mummified human leg. Anat Rec (Hoboken) 2019; 303:3085-3095. [PMID: 31837087 DOI: 10.1002/ar.24333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 10/23/2019] [Accepted: 10/23/2019] [Indexed: 11/11/2022]
Abstract
Artificial mummification has been used since antiquity and is best known from ancient Egypt. Despite ancient Egyptian mummies being studied for several decades, the mummification techniques of that time are not well understood. Modern mummification experiments involving animal and human tissues have contributed additional insights relevant to a broad field of research. In the current study, we present follow-up results of an experiment on artificial mummification, which began in 2009. A human leg was artificially mummified and monitored for almost a year with histological, molecular, and radiological techniques. Since then, it has remained in a dry, natron salt blend for 9 years. The current analyses show further progression of dehydration and tissue alterations, as well as DNA degradation, suggesting an ongoing process. Our results add new insights into the mechanisms of tissue mummification. Taking into account that the process is still ongoing, further research is required, including a re-evaluation of the human leg in the future.
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Affiliation(s)
- Irina Morozova
- Institute of Evolutionary Medicine, Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Lena M Öhrström
- Institute of Evolutionary Medicine, Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Patrick Eppenberger
- Institute of Evolutionary Medicine, Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Beata Bode-Lesniewska
- Institute of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland
| | - Dominic Gascho
- Zurich Institute of Forensic Medicine, University of Zurich, Zurich, Switzerland
| | - Cordula Haas
- Zurich Institute of Forensic Medicine, University of Zurich, Zurich, Switzerland
| | - Gülfirde Akgül
- Institute of Evolutionary Medicine, Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Judith Neukamm
- Institute of Evolutionary Medicine, Faculty of Medicine, University of Zurich, Zurich, Switzerland.,Institute for Archaeological Sciences, University of Tübingen, Tübingen, Germany.,Center for Bioinformatics Tübingen, University of Tübingen, Tübingen, Germany
| | - Kim A Röthlin
- Institute of Medical Microbiology, Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Alexander Imhof
- SRO AG, Spital Langenthal, Department of Internal Medicine, Langenthal, Switzerland
| | - Natallia Shved
- Institute of Evolutionary Medicine, Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Christina Papageorgopoulou
- Laboratory of Physical Anthropology, Department of History and Ethnology, Democritus University of Thrace, Komotini, Greece
| | - Frank J Rühli
- Institute of Evolutionary Medicine, Faculty of Medicine, University of Zurich, Zurich, Switzerland
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42
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Gascho D, Thali MJ, Bolliger SA. Hidden shot pellets on postmortem computed tomography and their utilization for radiologic identification of decedents. Forensic Sci Med Pathol 2019; 16:340-344. [DOI: 10.1007/s12024-019-00213-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2019] [Indexed: 01/17/2023]
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43
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Gascho D, Zoelch N, Schaerli S. Explanation for the contradiction between the results of Diallo et al. (doi:10.1016/j.jofri.2018.10.001) and Winklhofer et al. (doi:10.1097/RLI.0000000000000032) in differentiating ferromagnetic from nonferromagnetic bullets by means of the dual-energy index. ACTA ACUST UNITED AC 2019. [DOI: 10.1016/j.jofri.2019.100351] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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44
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Heimer J, Gascho D, Tappero C, Thali MJ, Zoelch N. Noninvasive analysis and identification of an intramuscular fluid collection by postmortem 1H-MRS in a case of a fatal motor vehicle accident. Int J Legal Med 2019; 134:1167-1174. [PMID: 31713679 DOI: 10.1007/s00414-019-02190-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 10/17/2019] [Indexed: 10/25/2022]
Abstract
In a case of a fatal traffic accident, a suspicious finding was identified in the muscular tissue of the left thigh by whole-body postmortem computed tomography. To better interpret the finding, the lower extremities were investigated by magnetic resonance imaging (MRI) and proton magnetic resonance spectroscopy (1H-MRS). MRI revealed the presence of an evenly distributed intramuscular fluid and 1H-MRS of a volume within the fluid detected concentrations of acetate and lactate. The fluid was assumed to be an extravasation of an intraosseous infusion, erroneously administered to the intermediate vastus of the left thigh during resuscitation, which was later confirmed when access to resuscitation protocols was granted. Further ex situ 1H-MRS investigations of five different infusion fluids showed the possible discrimination of the fluids and further indicated the unknown fluid to be a Ringer's acetate solution. This paper presents the case-based application of postmortem intramuscular 1H-MRS and introduces the possibility of its use to differentiate exo- and endogenic fluids for forensic interpretation. Further research for this method regarding problems in forensic pathology is needed.
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Affiliation(s)
- Jakob Heimer
- Institute of Forensic Medicine, Department of Forensic Medicine and Imaging, University of Zurich, Zurich, Switzerland.
| | - Dominic Gascho
- Institute of Forensic Medicine, Department of Forensic Medicine and Imaging, University of Zurich, Zurich, Switzerland
| | - Carlo Tappero
- Institute of Forensic Medicine, Department of Forensic Medicine and Imaging, University of Zurich, Zurich, Switzerland.,Department of Radiology, Hôpital Fribourgeois, Fribourg, Switzerland
| | - Michael J Thali
- Institute of Forensic Medicine, Department of Forensic Medicine and Imaging, University of Zurich, Zurich, Switzerland
| | - Niklaus Zoelch
- Institute of Forensic Medicine, Department of Forensic Medicine and Imaging, University of Zurich, Zurich, Switzerland.,Hospital of Psychiatry, Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland
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45
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Mauf S, Held U, Gascho D, Baumeister R, Flach P, Nguyen-Kim TDL, Thali MJ, Jentzsch T. Flat chest projection in the detection and visualization of rib fractures: A cross-sectional study comparing curved and multiplanar reformation of computed tomography images in different reader groups. Forensic Sci Int 2019; 303:109942. [DOI: 10.1016/j.forsciint.2019.109942] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 08/07/2019] [Accepted: 08/26/2019] [Indexed: 11/28/2022]
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46
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Zoelch N, Hock A, Steuer AE, Heimer J, Kraemer T, Thali MJ, Gascho D. In situ postmortem ethanol quantification in the cerebrospinal fluid by non-water-suppressed proton MRS. NMR Biomed 2019; 32:e4081. [PMID: 30835926 DOI: 10.1002/nbm.4081] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 01/16/2019] [Accepted: 01/17/2019] [Indexed: 06/09/2023]
Abstract
Determination of the ethanol concentration in corpses with MRS would allow a reproducible forensic assessment by which evidence is collected in a noninvasive manner. However, although MRS has been successfully used to detect ethanol in vivo, it has not been applied to postmortem ethanol quantification in situ. The present study examined the feasibility of the noninvasive measurement of the ethanol concentration in human corpses with MRS. A total of 15 corpses with suspected alcohol consumption before demise underwent examination in a 3 T whole body scanner. To address the partial overlap of the ethanol and lactate signal in the postmortem spectrum, non-water-suppressed single voxel spectra were recorded in the cerebrospinal fluid (CSF) of the left lateral ventricle via the metabolite cycling technique. The ethanol signals were quantified using the internal water as reference standard, as well as based on a reference signal acquired in a phantom. The measured values were compared with biochemically determined concentrations in the blood (BAC) and CSF (CSFAC). In 8 of the 15 corpses a BAC above zero was determined (range 0.03-1.68 g/kg). In all of these 8 corpses, ethanol was measured in CSF with the proposed MRS protocol. The two applied MRS calibration strategies resulted in similar concentrations. However, the MRS measurements generally overestimated the ethanol concentration by 0.09 g/kg (4%) to 0.72 g/kg (45%) as compared with the CSFAC value. The presented MRS protocol allows the measurement of ethanol in the CSF in human corpses and provides an estimation of the ethanol concentration prior to autopsy. Observed deviations from biochemically determined concentrations are mainly explained by the approximate correction of the relaxation attenuation of the ethanol signal.
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Affiliation(s)
- Niklaus Zoelch
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Switzerland
- Department of Psychiatry, Psychotherapy and Psychosomatics, Zurich University Hospital for Psychiatry, Switzerland
| | - Andreas Hock
- Department of Psychiatry, Psychotherapy and Psychosomatics, Zurich University Hospital for Psychiatry, Switzerland
- Institute for Biomedical Engineering, University and ETH Zurich, Switzerland
- Philips Healthcare Deutschland, Hamburg, Germany
| | - Andrea E Steuer
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Switzerland
| | - Jakob Heimer
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Switzerland
| | - Thomas Kraemer
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Switzerland
| | - Michael J Thali
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Switzerland
| | - Dominic Gascho
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Switzerland
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47
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Seiler R, Öhrström LM, Eppenberger P, Gascho D, Rühli FJ, Galassi FM. The earliest known case of frontal sinus osteoma in man. Clin Anat 2019; 32:105-109. [PMID: 30324624 DOI: 10.1002/ca.23301] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 09/30/2018] [Accepted: 10/11/2018] [Indexed: 11/08/2022]
Abstract
Frontal sinus osteoma is a relatively common finding in the modern clinical setting. Although, its paleopathological record is not in dispute, its presence in Ancient Egypt has never been clarified. The aim of this article is to contribute to the debate. An Egyptian mummy head from the Musée d'Éthnographie de Neuchâtel (Switzerland) was studied radiologically and the obtained evidence was contextualized in the wider frame of multidisciplinary paleopathology. A 128-slice CT scanner was used for further investigation; datasets were processed with OsiriX-64 bit (version 5.8.5), and multiplanar (MPR) and volumetric reconstructions were performed. A small hyperdense and well-defined structure, most likely an osteoma, was identified in the right frontal sinus. Frontal sinus osteoma definitely existed in Ancient Egypt. Finally, this represents the oldest case in anatomically modern humans so far reported. Clin. Anat.32:105-109, 2019. © 2018 Wiley Periodicals, Inc.
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Affiliation(s)
- Roger Seiler
- Institute of Evolutionary Medicine, University of Zurich, Zurich 8057, Switzerland
| | - Lena M Öhrström
- Institute of Evolutionary Medicine, University of Zurich, Zurich 8057, Switzerland
| | - Patrick Eppenberger
- Institute of Evolutionary Medicine, University of Zurich, Zurich 8057, Switzerland
| | - Dominic Gascho
- Institute of Forensic Medicine, University of Zurich, Zurich 8057, Switzerland
| | - Frank J Rühli
- Institute of Evolutionary Medicine, University of Zurich, Zurich 8057, Switzerland
| | - Francesco M Galassi
- Institute of Evolutionary Medicine, University of Zurich, Zurich 8057, Switzerland
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48
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Kottner S, Schaerli S, Fürst M, Ptacek W, Thali M, Gascho D. VirtoScan-on-Rails - an automated 3D imaging system for fast post-mortem whole-body surface documentation at autopsy tables. Forensic Sci Med Pathol 2019; 15:198-212. [PMID: 30850988 DOI: 10.1007/s12024-019-00095-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2019] [Indexed: 10/27/2022]
Abstract
Two-dimensional photographic documentation is a substantial part of post-mortem examinations for legal investigations. Additional three-dimensional surface documentation has been shown to assist in the visualization of findings and contribute to the reconstruction of the sequence of events. However, 2D photo documentation and, especially, 3D surface documentation, are time-consuming procedures that require specially trained personnel. In this study a 3D imaging system, called VirtoScan-on-Rails, was developed to automate and facilitate 3D surface documentation for photo documentation in autopsy suites. The imaging system was built to quickly acquire photogrammetric image sets of whole bodies during different stages of external and internal examinations. VirtoScan-on-Rails was set up in the autopsy suite of the Zurich Institute of Forensic Medicine at the University of Zurich (Zurich, Switzerland). The imaging system is based on a movable frame that carries a multi-camera array. Data quality and the applicability of the system were analyzed and evaluated within two test series. Up to 200 overlapping photographic images were acquired at consecutive image-capturing positions over a distance of approximately 2000 mm. The image-capturing process took 1 min and 23 s to acquire a set of 200 images for one side of the body. During test series one and two, 53 photogrammetric image sets taken from 31 forensic cases were successfully reconstructed. VirtoScan-on-Rails is an automated, fast and easy-to-use 3D imaging setup for autopsy suits. It facilitates documenting bodies during different stages of forensic examinations and allows standardizing the procedure of photo documentation.
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Affiliation(s)
- Sören Kottner
- Zurich Institute of Forensic Medicine, University of Zurich, Zurich, Switzerland.
| | - Sarah Schaerli
- Zurich Institute of Forensic Medicine, University of Zurich, Zurich, Switzerland
| | - Martin Fürst
- Austrian Center for Medical Innovation and Technology, ACMIT Gmbh, Wiener Neustadt, Austria
| | - Wolfgang Ptacek
- Austrian Center for Medical Innovation and Technology, ACMIT Gmbh, Wiener Neustadt, Austria
| | - Michael Thali
- Zurich Institute of Forensic Medicine, University of Zurich, Zurich, Switzerland
| | - Dominic Gascho
- Zurich Institute of Forensic Medicine, University of Zurich, Zurich, Switzerland
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49
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Heimer J, Tappero C, Gascho D, Flach P, Ruder TD, Thali MJ, Franckenberg S. Value of 3T craniocervical magnetic resonance imaging following nonfatal strangulation. Eur Radiol 2019; 29:3458-3466. [DOI: 10.1007/s00330-019-06033-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 12/14/2018] [Accepted: 01/22/2019] [Indexed: 11/28/2022]
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50
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Brockbals L, Staeheli SN, Gascho D, Ebert LC, Kraemer T, Steuer AE. Time-Dependent Postmortem Redistribution of Opioids in Blood and Alternative Matrices. J Anal Toxicol 2019; 42:365-374. [PMID: 29579266 DOI: 10.1093/jat/bky017] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 02/12/2018] [Indexed: 12/20/2022] Open
Abstract
Forensic postmortem case interpretation can be challenging, in particular due to postmortem redistribution (PMR) phenomena. Recent studies have shown that computed tomography (CT)-guided collection of biopsy samples using a robotic arm (virtobot) provides a valuable tool for systematic studies on time-dependent PMR. Utilizing this strategy, several cases involving opioid use such as methadone, fentanyl, tramadol, codeine, oxycodone and hydrocodone were evaluated for time-dependent concentration changes and potential redistribution mechanisms. Upon admission to the institute (t1), blood (femoral and right ventricle heart blood) and tissue biopsy samples (lung, kidney, liver, spleen, thigh muscle and adipose tissue) were collected utilizing CT-guided biopsy. Approximately 24 h later (t2; mean 28 ± 15 h), during the autopsy, samples from the same body regions were collected manually and in addition brain tissue, gastric content, urine and left ventricle heart blood. Analysis was conducted with liquid chromatography tandem mass spectrometry. Significant time-dependent methadone concentration increases in femoral blood (pB) indicate the occurrence of PMR, however, ultimately not relevant for forensic interpretation. The main metabolite of methadone, 2-ethylidene-1,5-dimethyl-3,3-diphenylpyrrolidine (EDDP), showed a less significant trend for PMR. Redistribution by passive diffusion along the muscle-to-pB concentration gradient seems likely for methadone, but not for EDDP. Results for fentanyl suggest extensive PMR. Other opioids such as tramadol, codeine, hydrocodone and oxycodone showed no consistent trend for significant PMR. Overall, CT-guided biopsy sampling proved to be a valuable tool for the investigation of PMR mechanisms.
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Affiliation(s)
- Lana Brockbals
- Department of Forensic Pharmacology and Toxicology, Zurich Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, Zurich, Switzerland
| | - Sandra N Staeheli
- Department of Forensic Pharmacology and Toxicology, Zurich Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, Zurich, Switzerland
| | - Dominic Gascho
- Department of Forensic Medicine and Imaging, Zurich Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, Zurich, Switzerland
| | - Lars C Ebert
- Department of Forensic Medicine and Imaging, Zurich Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, Zurich, Switzerland
| | - Thomas Kraemer
- Department of Forensic Pharmacology and Toxicology, Zurich Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, Zurich, Switzerland
| | - Andrea E Steuer
- Department of Forensic Pharmacology and Toxicology, Zurich Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, Zurich, Switzerland
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