Danny Spendlove

Postmortem Whole-Body CT Angiography: Evaluation of Two Contrast Media Solutions

OBJECTIVE The objective of our study was to establish a standardized procedure for postmortem whole-body CT-based angiography with lipophilic and hydrophilic contrast media solutions and to compare the results of these two methods. MATERIALS AND METHODS Minimally invasive postmortem CT angiography was performed on 10 human cadavers via access to the femoral blood vessels. Separate perfusion of the arterial and venous systems was established with a modified heart-lung machine using a mixture of an oily contrast medium and paraffin (five cases) and a mixture of a water-soluble contrast medium with polyethylene glycol (PEG) 200 in the other five cases. Imaging was executed with an MDCT scanner. RESULTS The minimally invasive femoral approach to the vascular system provided a good depiction of lesions of the complete vascular system down to the level of the small supplying vessels. Because of the enhancement of well-vascularized tissues, angiography with the PEG-mixed contrast medium allowed the detection of tissue lesions and the depiction of vascular abnormalities such as pulmonary embolisms or ruptures of the vessel wall. CONCLUSION The angiographic method with a water-soluble contrast medium and PEG as a contrast-agent dissolver showed a clearly superior quality due to the lack of extravasation through the gastrointestinal vascular bed and the enhancement of soft tissues (cerebral cortex, myocardium, and parenchymal abdominal organs). The diagnostic possibilities of these findings in cases of antemortem ischemia of these tissues are not yet fully understood.

Gunshot injuries detected by post-mortem multislice computed tomography (MSCT): a feasibility study

Modern cross-sectional imaging techniques are being increasingly implemented in forensic pathology. These methods may serve as an adjuvant to classic forensic autopsies or even replace them altogether in the future. In order to assess the practicability of such a method, namely post-mortem multislice computed tomography (MSCT) in fatal gunshot injuries, 22 corpses underwent such an examination prior to forensic autopsy. The cardinal questions of the location of entrance and exit wounds, the detection of bullets and bullet fragments in the body, the bullet course, inflicted injuries and cause of death were addressed at MSCT and autopsy. The results of the two techniques revealed that post-mortem MSCT can answer these questions reliably and is therefore a useful tool in the assessment of such injuries.

Postmortem Imaging-Guided Biopsy as an Adjuvant to Minimally Invasive Autopsy With CT and Postmortem Angiography: A Feasibility Study

OBJECTIVE Although postmortem CT suffices for diagnosing most forms of traumatic death, the examination of natural death is, to date, very difficult and error prone. The introduction of postmortem angiography has led to improved radiologic diagnoses of natural deaths. Nevertheless, histologic changes to tissues, an important aspect in traditional examination procedures, remain obscure even with CT and CT angiography. For this reason, we examined the accuracy of a minimally invasive procedure (i.e., CT angiography combined with biopsy) in diagnosing major findings and the cause of death in natural deaths. MATERIALS AND METHODS We examined 20 bodies in a minimally invasive fashion-namely, native CT, CT angiography, and biopsy-and compared the results to those obtained at subsequent autopsy and histologic analysis. RESULTS Regarding the major findings and the cause of death, the minimally invasive examination showed almost identical results in 18 of 20 cases. In one case, the severity of a cardiac ischemia was underestimated; in another case, the iliopsoas muscles were not biopsied, thus missing the diagnosis of discoid muscle necrosis and therefore a death due to hypothermia. CONCLUSION In light of increasing objections of the next of kin toward an autopsy and the necessity for medical examiners to assess the manner and cause of death, we think that the minimally invasive procedure described here may present a viable compromise in selected cases.

Abdominal trauma--sensitivity and specificity of postmortem noncontrast imaging findings compared with autopsy findings.

OBJECTIVE The aim of the study was to determine the sensitivity and specificity for typical abdominal injuries after major blunt trauma in postmortem multislice computed tomography (MSCT) and magnetic resonance imaging (MRI). MATERIAL Thirty-four cases of accidental death underwent postmortem pre-autopsy MSCT and MRI. The imaging findings were correlated with the autopsy findings. RESULTS Sensitivity and specificity for liver injury in computed tomography (CT) alone were 53% and 84%. In MRI, a sensitivity of 58% and a specificity of 46% were found. CT and MRI together (when either one was positive, liver-injury was considered) had a sensitivity of 73% and a specificity of 63%. For major liver lacerations (grades II-VI) a slightly higher sensitivity of 81% and a better specificity of 100% were noted. CT and MRI together showed a sensitivity of 50% for injuries of the spleen, specificity was 89%. CT and MRI together had a sensitivity of only 25% for trauma of the kidney, but a specificity of 100%. CONCLUSION A lot of cases with small organ injuries (such as superficial liver-laceration) seemed that could not be found by MSCT or by MRI, leading to a rather low sensitivity. Nevertheless, most of the life-threatening liver injuries could be detected, which is essential in forensic pathology.

Injuries due to sharp trauma detected by post-mortem multislice computed tomography (MSCT): a feasibility study.

Modern cross-sectional imaging techniques are being increasingly implemented in forensic pathology. In order to assess the practicability of such a method, namely post-mortem multislice computed tomography (MSCT) in cases of fatal cut and stab injuries, 12 corpses underwent such an examination prior to forensic autopsy. The questions regarding detection of foreign bodies, wound channels, skeletal and organ injuries, as well as the cause of death were addressed at MSCT and autopsy. The results of the two techniques revealed that post-mortem MSCT a useful tool in the assessment of such injuries.

Postmortem Whole-Body Computed Tomography Angiography Visualizing Vascular Rupture in a Case of Fatal Car Crash

In addition to the increasingly significant role of multislice computed tomography in forensic pathology, the performance of whole-body computed tomography angiography provides outstanding results. In this case, we were able to detect multiple injuries of the parenchymal organs in the upper abdomen as well as lesions of the brain parenchyma and vasculature of the neck. The radiologic findings showed complete concordance with the autopsy and even supplemented the autopsy findings in areas that are difficult to access via a manual dissection (such as the vasculature of the neck). This case shows how minimally invasive computed tomography angiography can serve as an invaluable adjunct to the classic autopsy procedure.

Life-threatening versus non-life-threatening manual strangulation: are there appropriate criteria for MR imaging of the neck?

The aim of the study was to determine objective radiological signs of danger to life in survivors of manual strangulation and to establish a radiological scoring system for the differentiation between life-threatening and non-life-threatening strangulation by dividing the cross section of the neck into three zones (superficial, middle and deep zone). Forensic pathologists classified 56 survivors of strangulation into life-threatening and non-life-threatening cases by history and clinical examination alone, and two blinded radiologists evaluated the MRIs of the neck. In 15 cases, strangulation was life-threatening (27%), compared with 41 cases in which strangulation was non-life-threatening (73%). The best radiological signs on MRI to differentiate between the two groups were intramuscular haemorrhage/oedema, swelling of platysma and intracutaneous bleeding (all p = 0.02) followed by subcutaneous bleeding (p = 0.034) and haemorrhagic lymph nodes (p = 0.04), all indicating life-threatening strangulation. The radiological scoring system showed a sensitivity and specificity of ≈70% for life-threatening strangulation, when at least two neck zones were affected. MRI is not only helpful in assessing the severity of strangulation, but is also an excellent documentation tool that is even admissible in court.

Post-mortem imaging of laryngohyoid fractures in strangulation incidents: First results

Fractures and soft-tissue injuries of the neck are of great importance in forensic pathology, as they help in assessing whether strangulation took place, and if so, how severely. In this study, we examined the usefulness of post-mortem imaging with multislice computed tomography (MSCT) in detecting lesions of the laryngohyoid structures and the surrounding soft-tissues. For this purpose, we examined MSCT images of the neck of eight deceased persons who had suffered different types of strangulation and compared the findings with those obtained at the subsequent forensic autopsy. In six of the eight cases (75%), the fracture findings at autopsy were concordant with those found with MSCT. In the two non-congruent cases, MSCT revealed fractures, which were not discovered at autopsy. Soft-tissue haemorrhages were detected by autopsy in five cases, but only in one case with MSCT. MSCT does not suffice in detecting soft-tissue injuries. These preliminary results are promising regarding the detection of fractures in strangulation cases. If these results can be confirmed in larger studies, we believe that post-mortem MSCT may serve - in combination with a thorough external examination and a profound incident-scene investigation - as a useful decision-making tool regarding the necessity of further examinations, i.e. autopsy.

Is differentiation of frequently encountered foreign bodies in corpses possible by Hounsfield density measurement

Abstract:  The radiological determination of foreign objects in corpses can be difficult if they are fragmented or deformed. With multislice computed tomography, radiodensities—referred to as Hounsfield units (HU)—can be measured. We examined the possibility of differentiating 21 frequently occurring foreign bodies, such as metals, rocks, and different manmade materials by virtue of their HU values. Gold, steel, and brass showed mean HU values of 30671–30710 (upper measurable limit), mean HU values for steel, silver, copper, and limestone were 20346, 16949, 14033, and 2765, respectively. The group consisting of objects, such as aluminum, tarmac, car front‐window glass, and other rocks, displayed mean HU values of 2329–2131 HU. The mean HU value of bottle glass and car side‐window glass was 2088, whereas windowpane glass was 493. HU value determination may therefore help in preautopsy differentiation between case‐relevant and irrelevant foreign bodies and thus be useful for autopsy planning and extraction of the objects in question.

Can MRI of the neck compete with clinical findings in assessing danger to life for survivors of manual strangulation? A statistical analysis

OBJECTIVE The aim of the study was to examine the clinical forensic findings of strangulation according to their ability to differentiate between life-threatening and non-life-threatening strangulation, compare clinical and MRI findings of the neck and discuss a simple score for life-threatening strangulation (SLS). MATERIALS AND METHODS Forensic pathologists classified a continuous sample of 56 survivors of strangulation into life-threatening cases by clinical history and examination alone. Subjective, objective and radiological signs were evaluated for discriminating the two groups. RESULTS In 27% of the cases life was in danger. The most significant signs of danger to life were congestive petechial hemorrhage in the face (eyes); hematoma of the neck and loss of consciousness. The radiological score could compete with the clinical scores. CONCLUSION Clinical forensic findings differ significantly in non-life-threatening and life-threatening manual strangulation. Thanks to MRI a rather objective test for life-threatening strangulation can be added to a SLS.