Thomas D. Ruder

Suicide Announcement on Facebook

BACKGROUND The media and the Internet may be having an influence on suicidal behavior. Online social networks such as Facebook represent a new facet of global information transfer. The impact of these online social networks on suicidal behavior has not yet been evaluated. AIMS To discuss potential effects of suicide notes on Facebook on suicide prevention and copycat suicides, and to create awareness among health care professionals. METHODS We present a case involving a suicide note on Facebook and discuss potential consequences of this phenomenon based on literature found searching PubMed and Google. RESULTS There are numerous reports of suicide notes on Facebook in the popular press, but none in the professional literature. Online social network users attempted to prevent planned suicides in several reported cases. To date there is no documented evidence of a copycat suicide, directly emulating a suicide announced on Facebook. CONCLUSIONS Suicide notes on online social networks may allow for suicide prevention via the immediate intervention of other network users. But it is not yet clear to what extent suicide notes on online social networks actually induce copycat suicides. These effects deserve future evaluation and research.

Sudden Death after Chest Pain: Feasibility of Virtual Autopsy with Postmortem CT Angiography and Biopsy

PURPOSE To determine the potential of minimally invasive postmortem computed tomographic (CT) angiography combined with image-guided tissue biopsy of the myocardium and lungs in decedents who were thought to have died of acute chest disease and to compare this method with conventional autopsy as the reference standard. MATERIALS AND METHODS The responsible justice department and ethics committee approved this study. Twenty corpses (four female corpses and 16 male corpses; age range, 15-80 years), all of whom were reported to have had antemortem acute chest pain, were imaged with postmortem whole-body CT angiography and underwent standardized image-guided biopsy. The standard included three biopsies of the myocardium and a single biopsy of bilateral central lung tissue. Additional biopsies of pulmonary clots for differentiation of pulmonary embolism and postmortem organized thrombus were performed after initial analysis of the cross-sectional images. Subsequent traditional autopsy with sampling of histologic specimens was performed in all cases. Thereafter, conventional histologic and autopsy reports were compared with postmortem CT angiography and CT-guided biopsy findings. A Cohen κ coefficient analysis was performed to explore the effect of the clustered nature of the data. RESULTS In 19 of the 20 cadavers, findings at postmortem CT angiography in combination with CT-guided biopsy validated the cause of death found at traditional autopsy. In one cadaver, early myocardial infarction of the papillary muscles had been missed. The Cohen κ coefficient was 0.94. There were four instances of pulmonary embolism, three aortic dissections (Stanford type A), three myocardial infarctions, three instances of fresh coronary thrombosis, three cases of obstructive coronary artery disease, one ruptured ulcer of the ascending aorta, one ruptured aneurysm of the right subclavian artery, one case of myocarditis, and one pulmonary malignancy with pulmonary artery erosion. In seven of 20 cadavers, CT-guided biopsy provided additional histopathologic information that substantiated the final diagnosis of the cause of death. CONCLUSION Postmortem CT angiography combined with image-guided biopsy, because of their minimally invasive nature, have a potential role in the detection of the cause of death after acute chest pain.

Imaging in forensic radiology: an illustrated guide for postmortem computed tomography technique and protocols

Forensic radiology is a new subspecialty that has arisen worldwide in the field of forensic medicine. Postmortem computed tomography (PMCT) and, to a lesser extent, PMCT angiography (PMCTA), are established imaging methods that have replaced dated conventional X-ray images in morgues. However, these methods have not been standardized for postmortem imaging. Therefore, this article outlines the main approach for a recommended standard protocol for postmortem cross-sectional imaging that focuses on unenhanced PMCT and PMCTA. This review should facilitate the implementation of a high-quality protocol that enables standardized reporting in morgues, associated hospitals or private practices that perform forensic scans to provide the same quality that clinical scans provide in court.

The influence of body temperature on image contrast in post mortem MRI

OBJECTIVE To assess the temperature dependency of tissue contrast on post mortem magnetic resonance (PMMR) images both objectively and subjectively; and to visually demonstrate the changes of image contrast at various temperatures. MATERIALS AND METHODS The study was approved by the responsible justice department and the ethics committee. The contrast of water, fat, and muscle was measured using regions of interest (ROI) in the orbit of 41 human corpses to assess how body temperature (range 2.1-39.8 °C) relates to image contrast of T1-weighted (T1W) and T2-weighted (T2W) sequences on PMMR. Regressions were calculated using the method of least squares. Three readers judged visible changes of image contrast subjectively by consensus. RESULTS There was a positive relationship between temperature and contrast on T1-weighted (T1W) images and between temperature and the contrast of fat/muscle on T2-weighted (T2W) images. There was a negative relationship between temperature and the contrast of water/fat and water/muscle on T2W images. Subjectively, the influence of temperature became visible below 20 °C on T2W images, and below 10 °C on T1W images. CONCLUSION Image contrast on PMMR depends on the temperature of a corpse. Radiologists involved in post mortem imaging must be aware of temperature-related changes in MR image contrast. To preserve technical quality, scanning corpses below 10 °C should be avoided.

Terminology used in publications for post-mortem cross-sectional imaging

We write to you today to suggest the need for standardisation of terminology used in the forensic/autopsy journals in the ever increasing number of publications in the emerging field post-mortem cross-sectionalimaging.Inouropinion,thereare too many different terms used currently both as words and/or abbreviations and the time has come to propose within the forensic literature that common terminology be applied to this field. The introduction of standardised terminology is critical, not only for those endeavouring to write and publish their work but also for those attempting to find references by keyword searches. We suggest the following terminology be introduced to initiate the process of standardisation: 1. Currently, the two modalities emerging as dominant in post-mortem imaging are computed tomography and magnetic resonance imaging. We propose, as has been adopted within the UK, these be generically referred to as post-mortem cross-sectional imaging, so both modalities are covered by a single phrase. Authors could then go on to specify which of the two modalities, i.e. post-mortem computed tomography or postmortem magnetic resonance imaging or both, are referred to within their work. 2. In the case of post-mortem computed tomography, we propose the abbreviation PMCT be used. In the case of

Radiologic identification of disaster victims: A simple and reliable method using CT of the paranasal sinuses

OBJECTIVE To assess the reliability of radiologic identification using visual comparison of ante and post mortem paranasal sinus computed tomography (CT). SUBJECTS AND METHODS The study was approved by the responsible justice department and university ethics committee. Four blinded readers with varying radiological experience separately compared 100 post mortem to 25 ante mortem head CTs with the goal to identify as many matching pairs as possible (out of 23 possible matches). Sensitivity, specificity, positive and negative predictive values were calculated for all readers. The chi-square test was applied to establish if there was significant difference in sensitivity between radiologists and non-radiologists. RESULTS For all readers, sensitivity was 83.7%, specificity was 100.0%, negative predictive value (NPV) was 95.4%, positive predictive value (PPV) was 100.0%, and accuracy was 96.3%. For radiologists, sensitivity was 97.8%, NPV was 99.4%, and accuracy was 99.5%. For non-radiologists, average sensitivity was 69.6%, negative predictive value (NPV) was 91.7%, and accuracy was 93.0%. Radiologists achieved a significantly higher sensitivity (p < 0.01) than non-radiologists. CONCLUSIONS Visual comparison of ante mortem and post mortem CT of the head is a robust and reliable method for identifying unknown decedents, particularly in regard to positive matches. The sensitivity and NPV of the method depend on the readers experience.

A new approach in virtopsy: Postmortem ventilation in multislice computed tomography

Although postmortem imaging has gained prominence in the field of forensic medicine, evaluation of the postmortem lung remains problematic. Specifically, differentiation of normal postmortem changes and pathological pulmonary changes is challenging and at times impossible. In this study, five corpses were ventilated using a mechanical ventilator with a pressure of 40 mbar (40.8 cm H(2)O). The ventilation was performed via an endotracheal tube, a larynx mask or a continuous positive airway pressure mask. Postmortem computed tomographic images of the lungs before and with a ventilation of 40 mbar (40.8 cm H(2)O) were evaluated and the lung volumes were measured with segmentation software. Postmortem ventilation led to a clearly visible decrease of both the density in the dependant parts of the lungs and ground glass attenuation, whereas consolidated areas remained unchanged. Furthermore, a mean increase in the lung volume of 2.10 l was seen. Pathological changes such as septal thickening or pulmonary nodules in the lung parenchyma became more detectable with postmortem ventilation. Intracorporal postmortem mechanical ventilation of the lungs appears to be an effective method for enhancing detection of small pathologies of the lung parenchyma as well as for discriminating between consolidation, ground glass attenuation and position-dependent density.

CT based volume measurement and estimation in cases of pericardial effusion

The measurement of fluid volumes in cases of pericardial effusion is a necessary procedure during autopsy. With the increased use of virtual autopsy methods in forensics, the need for a quick volume measurement method on computed tomography (CT) data arises, especially since methods such as CT angiography can potentially alter the fluid content in the pericardium. We retrospectively selected 15 cases with hemopericardium, which underwent post-mortem imaging and autopsy. Based on CT data, the pericardial blood volume was estimated using segmentation techniques and downsampling of CT datasets. Additionally, a variety of measures (distances, areas and 3D approximations of the effusion) were examined to find a quick and easy way of estimating the effusion volume. Segmentation of CT images as shown in the present study is a feasible method to measure the pericardial fluid amount accurately. Downsampling of a dataset significantly increases the speed of segmentation without losing too much accuracy. Some of the other methods examined might be used to quickly estimate the severity of the effusion volumes.

Suicidal knife wound to the heart: Challenges in reconstructing wound channels with post mortem CT and CT-angiography

We present a case of an individual who stabbed himself through the heart with a large knife. Post mortem computed tomography (CT) and CT-angiography were used to assess the stab channel and to reconstruct the sequence of events. After penetrating injuries to the chest, both the intra-thoracic organs and the injury causing instrument may shift (e.g. from pnemothorax) and render forensic reconstructions more challenging. This case report illustrates the potentials and the pitfalls of CT for the reconstruction of penetrating injures to the chest.

Assessment of coronary artery disease by post-mortem cardiac MR

OBJECTIVES Minimally invasive or virtual autopsies are being advocated as alternative to traditional autopsy, but have limited abilities to detect coronary artery disease. It was the objective of this study to assess if the occurrence of chemical shift artifacts (CSA) along the coronary arteries on non-contrast, post-mortem cardiac MR may be used to investigate coronary artery disease. METHODS We retrospectively compared autopsy and CT findings of 30 cases with significant (≥75%), insignificant (<75%), or absent coronary artery stenosis to post-mortem cardiac MR findings. The chi-square test was used to investigate if the occurrence of CSA depends on the presence or absence of stenosis. Sensitivity, specificity and predictive values were calculated for each finding. RESULTS CSA indicates the absence of (significant) stenosis (p<0.001). The occurrence of paired dark bands in lieu of CSA on post-mortem cardiac MR suggests (significant) coronary arteries stenosis (p<0.001). Both findings have a high specificity but low sensitivity. CONCLUSIONS CSA is a marker of vessel patency. The presence of paired dark bands indicates stenosis. These criteria improve the ability of minimally invasive or virtual autopsy to detect coronary artery disease related deaths.