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Makino Y, Kojima M, Inokuchi G, Motomura A, Arai N, Inoue H, Kabasawa H, Iwase H, Yajima D. Two medicolegal autopsy cases of multinodular and vacuolating neuronal tumor revealed by postmortem MRI. Leg Med (Tokyo) 2024; 69:102342. [PMID: 37914604 DOI: 10.1016/j.legalmed.2023.102342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 09/27/2023] [Accepted: 10/25/2023] [Indexed: 11/03/2023]
Abstract
The multinodular and vacuolating neuronal tumor (MVNT) is a recently recognized brain lesion. MVNT has a characteristic appearance in MRI images and is potentially epileptogenic. To the best of our knowledge, no report has yet described this pathological entity in the forensic medicine literature. We present two medicolegal autopsy cases where postmortem MRI (PMMR) was useful to detect this lesion. Case 1: a man in his 30s, with about a 7-year history of intractable epilepsy and known MVNT died suddenly. Although MVNT was not detected in the initial morphological evaluation during autopsy, PMMR of the formalin-fixed brain revealed the lesion in the left frontal lobe. Histopathology confirmed it as a MVNT. Case 2: a man in his 20s hanged himself to death. PMMR prior to autopsy revealed MVNT in his brain, and the diagnosis was confirmed by a detailed histopathological evaluation. In both cases, postmortem CT was not useful for evaluation. The cases suggested that MVNT can cause sudden, unexpected epileptic death, and pre- or post-autopsy PMMR may be useful to detect it.
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Affiliation(s)
- Yohsuke Makino
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan; Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Japan.
| | - Masatoshi Kojima
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Japan
| | - Go Inokuchi
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Japan
| | - Ayumi Motomura
- Department of Forensic Medicine, School of Medicine, International University of Health and Welfare, 4-3 Kozunomori, Narita, Japan
| | - Nobutaka Arai
- Tokyo Metropolitan Institute of Medical Science, 2-1-6 Kamikitazawa, Setagaya-ku, Tokyo, Japan
| | - Hiroyuki Inoue
- Department of Forensic Medicine, School of Medicine, International University of Health and Welfare, 4-3 Kozunomori, Narita, Japan
| | - Hiroyuki Kabasawa
- Department of Radiological Sciences, International University of Health and Welfare, 4-3 Kozunomori, Narita, Japan
| | - Hirotaro Iwase
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan; Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Japan
| | - Daisuke Yajima
- Department of Forensic Medicine, School of Medicine, International University of Health and Welfare, 4-3 Kozunomori, Narita, Japan
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Zoelch N, Heimer J, Richter H, Luechinger R, Archibald J, Thali MJ, Gascho D. In situ temperature determination using magnetic resonance spectroscopy thermometry for noninvasive postmortem examinations. NMR IN BIOMEDICINE 2024:e5171. [PMID: 38757603 DOI: 10.1002/nbm.5171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 03/28/2024] [Accepted: 04/18/2024] [Indexed: 05/18/2024]
Abstract
Magnetic resonance spectroscopy (MRS) thermometry offers a noninvasive, localized method for estimating temperature by leveraging the temperature-dependent chemical shift of water relative to a temperature-stable reference metabolite under suitable calibration. Consequentially, this technique has significant potential as a tool for postmortem MR examinations in forensic medicine and pathology. In these examinations, the deceased are examined at a wide range of body temperatures, and MRS thermometry may be used for the temperature adjustment of magnetic resonance imaging (MRI) protocols or for corrections in the analysis of MRI or MRS data. However, it is not yet clear to what extent postmortem changes may influence temperature estimation with MRS thermometry. In addition, N-acetylaspartate, which is commonly used as an in vivo reference metabolite, is known to decrease with increasing postmortem interval (PMI). This study shows that lactate, which is not only present in significant amounts postmortem but also has a temperature-stable chemical shift, can serve as a suitable reference metabolite for postmortem MRS thermometry. Using lactate, temperature estimation in postmortem brain tissue of severed sheep heads was accurate up to 60 h after death, with a mean absolute error of less than 0.5°C. For this purpose, published calibrations intended for in vivo measurements were used. Although postmortem decomposition resulted in severe metabolic changes, no consistent deviations were observed between measurements with an MR-compatible temperature probe and MRS thermometry with lactate as a reference metabolite. In addition, MRS thermometry was applied to 84 deceased who underwent a MR examination as part of the legal examination. MRS thermometry provided plausible results of brain temperature in comparison with rectal temperature. Even for deceased with a PMI well above 60 h, MRS thermometry still provided reliable readings. The results show a good suitability of MRS thermometry for postmortem examinations in forensic medicine.
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Affiliation(s)
- Niklaus Zoelch
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Zurich, Switzerland
- Department of Adult Psychiatry and Psychotherapy, Psychiatric University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Jakob Heimer
- 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
| | - Roger Luechinger
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
| | - Jessica Archibald
- Department of Radiology, Weill Cornell Medicine, New York, New York, USA
| | - Michael J Thali
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Zurich, Switzerland
| | - Dominic Gascho
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Zurich, Switzerland
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Cianci V, Forzese E, Sapienza D, Cianci A, Ieni A, Germanà A, Guerrera MC, Omero F, Speranza D, Cracò A, Asmundo A, Gualniera P, Mondello C. Arrhythmogenic Right Ventricular Cardiomyopathy Post-Mortem Assessment: A Systematic Review. Int J Mol Sci 2024; 25:2467. [PMID: 38473714 PMCID: PMC10931616 DOI: 10.3390/ijms25052467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Revised: 02/15/2024] [Accepted: 02/19/2024] [Indexed: 03/14/2024] Open
Abstract
Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a genetic disorder characterized by the progressive fibro-fatty replacement of the right ventricular myocardium, leading to myocardial atrophy. Although the structural changes usually affect the right ventricle, the pathology may also manifest with either isolated left ventricular myocardium or biventricular involvement. As ARVC shows an autosomal dominant pattern of inheritance with variable penetrance, the clinical presentation of the disease is highly heterogeneous, with different degrees of severity and patterns of myocardial involvement even in patients of the same familiar group with the same gene mutation: the pathology spectrum ranges from the absence of symptoms to sudden cardiac death (SCD) sustained by ventricular arrhythmias, which may, in some cases, be the first manifestation of an otherwise silent pathology. An evidence-based systematic review of the literature was conducted to evaluate the state of the art of the diagnostic techniques for the correct post-mortem identification of ARVC. The research was performed using the electronic databases PubMed and Scopus. A methodological approach to reach a correct post-mortem diagnosis of ARVC was described, analyzing the main post-mortem peculiar macroscopic, microscopic and radiological alterations. In addition, the importance of performing post-mortem genetic tests has been underlined, which may lead to the correct identification and characterization of the disease, especially in those ARVC forms where anatomopathological investigation does not show evident morphostructural damage. Furthermore, the usefulness of genetic testing is not exclusively limited to the correct diagnosis of the pathology, but is essential for promoting targeted screening programs to the deceased's family members. Nowadays, the post-mortem diagnosis of ARVC performed by forensic pathologist remains very challenging: therefore, the identification of a clear methodological approach may lead to both a reduction in under-diagnoses and to the improvement of knowledge on the disease.
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Affiliation(s)
- Vincenzo Cianci
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Section of Legal Medicine, University of Messina, Via Consolare Valeria, 1, 98125 Messina, Italy; (E.F.); (D.S.); (A.A.); (P.G.); (C.M.)
| | - Elena Forzese
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Section of Legal Medicine, University of Messina, Via Consolare Valeria, 1, 98125 Messina, Italy; (E.F.); (D.S.); (A.A.); (P.G.); (C.M.)
| | - Daniela Sapienza
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Section of Legal Medicine, University of Messina, Via Consolare Valeria, 1, 98125 Messina, Italy; (E.F.); (D.S.); (A.A.); (P.G.); (C.M.)
| | - Alessio Cianci
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Antonio Ieni
- Department of Human Pathology in Adult and Developmental Age “Gaetano Barresi”, Section of Pathology, University of Messina, 98125 Messina, Italy;
| | - Antonino Germanà
- Zebrafish Neuromorphology Lab, Department of Veterinary Sciences, Via Palatucci Snc, University of Messina, 98168 Messina, Italy; (A.G.); (M.C.G.)
| | - Maria Cristina Guerrera
- Zebrafish Neuromorphology Lab, Department of Veterinary Sciences, Via Palatucci Snc, University of Messina, 98168 Messina, Italy; (A.G.); (M.C.G.)
| | - Fausto Omero
- Medical Oncology Unit, Department of Human Pathology “G.Barresi”, University of Messina, 98125 Messina, Italy; (F.O.); (D.S.)
| | - Desirèe Speranza
- Medical Oncology Unit, Department of Human Pathology “G.Barresi”, University of Messina, 98125 Messina, Italy; (F.O.); (D.S.)
| | - Annalisa Cracò
- Department of Biomedical Sciences and Morphological and Functional Imaging, Diagnostic and Interventional Radiology Unit, University Hospital Messina, 98125 Messina, Italy;
| | - Alessio Asmundo
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Section of Legal Medicine, University of Messina, Via Consolare Valeria, 1, 98125 Messina, Italy; (E.F.); (D.S.); (A.A.); (P.G.); (C.M.)
| | - Patrizia Gualniera
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Section of Legal Medicine, University of Messina, Via Consolare Valeria, 1, 98125 Messina, Italy; (E.F.); (D.S.); (A.A.); (P.G.); (C.M.)
| | - Cristina Mondello
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Section of Legal Medicine, University of Messina, Via Consolare Valeria, 1, 98125 Messina, Italy; (E.F.); (D.S.); (A.A.); (P.G.); (C.M.)
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Wu ZX, Bu WQ, Tang Y, Guo YX, Guo YC, Wang F, Meng HT. Sex estimation using maxillary sinus volume for Chinese subjects based on cone-beam computed tomography. BMC Oral Health 2024; 24:253. [PMID: 38374033 PMCID: PMC10875788 DOI: 10.1186/s12903-024-04010-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 02/09/2024] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND Sex estimate is a key stage in forensic science for identifying individuals. Some anatomical structures may be useful for sex estimation since they retain their integrity even after highly severe events. However, few studies are focusing on the Chinese population. Some researchers used teeth for sex estimation, but comparison with maxillary sinus were lack. As a result, the objective of this research is to develop a sex estimation formula for the northwestern Chinese population by the volume of the maxillary sinus and compare with the accuracy of sex estimation based on teeth through cone-beam computed tomography (CBCT). METHODS CBCT images from 349 samples were used to establish and verify the formula. The volume of both the left and right maxillary sinuses was measured and examined for appropriate formula coefficients. To create the formula, we randomly picked 80% of the data as the training set and 20% of the samples as the testing set. Another set of samples, including 20 males and 20 females, were used to compare the accuracy of maxillary sinuses and teeth. RESULTS Overall, sex estimation accuracy by volume of the left maxillary sinus can reach 78.57%, while by the volume of the right maxillary sinus can reach 74.29%. The accuracy for females, which can reach 91.43% using the left maxillary sinus, was significantly higher than that for males, which was 65.71%. The result also shows that maxillary sinus volume was higher in males. The comparison with the available results using measurements of teeth for sex estimation performed by our group showed that the accuracy of sex estimation using canines volume was higher than the one using maxillary sinus volume, the accuracies based on mesiodistal diameter of canine and first molar were the same or lower than the volume of maxillary sinus. CONCLUSIONS The study demonstrates that measurement of maxillary sinus volume based on CBCT scans was an available and alternative method for sex estimation. And we established a method to accurately assess the sex of the northwest Chinese population. The comparison with the results of teeth measurements made the conclusion more reliable.
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Affiliation(s)
- Zi-Xuan Wu
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi'an Jiaotong University, 98 XiWu Road, Xi'an, 710004, Shaanxi, People's Republic of China
- Department of Orthodontics, Stomatological Hospital of Xi'an Jiaotong University, 98 XiWu Road, Xi'an, 710004, Shaanxi, People's Republic of China
| | - Wen-Qing Bu
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi'an Jiaotong University, 98 XiWu Road, Xi'an, 710004, Shaanxi, People's Republic of China
- Department of Orthodontics, Stomatological Hospital of Xi'an Jiaotong University, 98 XiWu Road, Xi'an, 710004, Shaanxi, People's Republic of China
| | - Yu Tang
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi'an Jiaotong University, 98 XiWu Road, Xi'an, 710004, Shaanxi, People's Republic of China
- Department of Orthodontics, Stomatological Hospital of Xi'an Jiaotong University, 98 XiWu Road, Xi'an, 710004, Shaanxi, People's Republic of China
| | - Yu-Xin Guo
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi'an Jiaotong University, 98 XiWu Road, Xi'an, 710004, Shaanxi, People's Republic of China
| | - Yu-Cheng Guo
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi'an Jiaotong University, 98 XiWu Road, Xi'an, 710004, Shaanxi, People's Republic of China
- Department of Orthodontics, Stomatological Hospital of Xi'an Jiaotong University, 98 XiWu Road, Xi'an, 710004, Shaanxi, People's Republic of China
- College of Medicine and Forensics, Xi'an Jiaotong University Health Science Center, 76 West Yanta Road, Xi'an, 710004, Shaanxi, People's Republic of China
| | - Fei Wang
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi'an Jiaotong University, 98 XiWu Road, Xi'an, 710004, Shaanxi, People's Republic of China.
- Department of Orthodontics, Stomatological Hospital of Xi'an Jiaotong University, 98 XiWu Road, Xi'an, 710004, Shaanxi, People's Republic of China.
| | - Hao-Tian Meng
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi'an Jiaotong University, 98 XiWu Road, Xi'an, 710004, Shaanxi, People's Republic of China.
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Di Fazio N, Scopetti M, Delogu G, Morena D, Santurro A, Cipolloni L, Serviddio G, Papi L, Frati P, Turillazzi E, Fineschi V. Fourteen Deaths from Suspected Heparin Overdose in an Italian Primary-Level Hospital. Diagnostics (Basel) 2023; 13:3361. [PMID: 37958256 PMCID: PMC10650777 DOI: 10.3390/diagnostics13213361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 10/08/2023] [Accepted: 10/26/2023] [Indexed: 11/15/2023] Open
Abstract
Healthcare-related homicidal cases are not novel within the medical-legal landscape, but investigations are often made difficult with the scarcity of material evidence related to the crime. For this reason, it is necessary to carefully analyze the clinical documentation and employ ancillary forensic resources such as radiology, histopathology, and toxicology. In the presented scenario, the observation of 14 deaths from abnormal bleeding in a First-Level Italian Hospital revealed the administration of massive doses of heparin by a nurse. On behalf of the Judicial Authority, a multidisciplinary medical team investigated the case through the following steps: a thorough review of the clinical documentation, exhumation of the bodies belonging to the deceased patients, performing PMCT and autopsy, and collecting tissue samples for histopathological, immunohistochemical, and toxicological investigations. All the analyzed cases have been characterized by the observation of fatal hemorrhagic episodes not explained with the clinical conditions of the patients, confirmed using autopsy observations and the histological demonstration of the vitality of the lesions. However, due to the limited availability of biological material for the toxicological analysis, the indirect evidence from hematological analyses in hospitalized patients was crucial in demonstrating heparin overdose and its link to the recorded deaths. The present scenario demonstrates the fundamental importance of a multidisciplinary approach to cases of judicial interest related to the healthcare context. Therefore, the illustrated methodologies can be interpreted as an operational framework for similar future cases.
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Affiliation(s)
- Nicola Di Fazio
- Department of Anatomical, Histological, Forensic and Orthopedic Science, Sapienza University of Rome, 00161 Rome, Italy; (N.D.F.); (M.S.); (G.D.); (D.M.); (A.S.); (P.F.)
| | - Matteo Scopetti
- Department of Anatomical, Histological, Forensic and Orthopedic Science, Sapienza University of Rome, 00161 Rome, Italy; (N.D.F.); (M.S.); (G.D.); (D.M.); (A.S.); (P.F.)
| | - Giuseppe Delogu
- Department of Anatomical, Histological, Forensic and Orthopedic Science, Sapienza University of Rome, 00161 Rome, Italy; (N.D.F.); (M.S.); (G.D.); (D.M.); (A.S.); (P.F.)
| | - Donato Morena
- Department of Anatomical, Histological, Forensic and Orthopedic Science, Sapienza University of Rome, 00161 Rome, Italy; (N.D.F.); (M.S.); (G.D.); (D.M.); (A.S.); (P.F.)
| | - Alessandro Santurro
- Department of Anatomical, Histological, Forensic and Orthopedic Science, Sapienza University of Rome, 00161 Rome, Italy; (N.D.F.); (M.S.); (G.D.); (D.M.); (A.S.); (P.F.)
| | - Luigi Cipolloni
- Department of Clinical and Experimental Medicine, University of Foggia, 71100 Foggia, Italy;
| | - Gaetano Serviddio
- Department of Medical and Surgical Sciences, University of Foggia, 71100 Foggia, Italy;
| | - Luigi Papi
- Department of Legal Medicine, University of Pisa, 56126 Pisa, Italy; (L.P.); (E.T.)
| | - Paola Frati
- Department of Anatomical, Histological, Forensic and Orthopedic Science, Sapienza University of Rome, 00161 Rome, Italy; (N.D.F.); (M.S.); (G.D.); (D.M.); (A.S.); (P.F.)
| | - Emanuela Turillazzi
- Department of Legal Medicine, University of Pisa, 56126 Pisa, Italy; (L.P.); (E.T.)
| | - Vittorio Fineschi
- Department of Anatomical, Histological, Forensic and Orthopedic Science, Sapienza University of Rome, 00161 Rome, Italy; (N.D.F.); (M.S.); (G.D.); (D.M.); (A.S.); (P.F.)
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Gibb I, Delaney R, Murphy D, Hunt N. Post-mortem computed tomography in the investigation of conflict and terrorist related deaths: UK military experience of developing a multidisciplinary service. Clin Radiol 2023; 78:804-811. [PMID: 36031431 DOI: 10.1016/j.crad.2022.07.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 07/01/2022] [Accepted: 07/04/2022] [Indexed: 11/21/2022]
Abstract
This paper discusses the introduction, development and utility of post-mortem imaging relating specifically to conflict-related and terrorist-related deaths and considers the use of computed tomography (CT) in the investigations. We demonstrate how a multi-disciplinary approach involving direct communication between forensic pathologist and radiologist can maximise evidential yield, reduce the need for unnecessary dissection and further our understanding of such injuries. This summarises our shared experience of hundreds of cases, each having been individually discussed and reviewed, and has helped shape our understanding of conflict injury as well as contributing to the development of mitigation strategies and adaptations to protective equipment. A series of clinical cases are presented to demonstrate some of the strengths and weaknesses of the process.
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Affiliation(s)
- I Gibb
- Centre for Blast Injury Studies, Imperial College London, London, UK; Centre for Defence Radiology, c/o HMS Nelson, Portsmouth, Hampshire, UK.
| | - R Delaney
- South West Forensic Pathology Group Practice
| | - D Murphy
- Metropolitan Police Force, New Scotland Yard, London, SW1A 2JL, UK
| | - N Hunt
- Home Office Registered Forensic Pathologist (Retired)
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Villa C, Lynnerup N, Jacobsen C. A Virtual, 3D Multimodal Approach to Victim and Crime Scene Reconstruction. Diagnostics (Basel) 2023; 13:2764. [PMID: 37685302 PMCID: PMC10486680 DOI: 10.3390/diagnostics13172764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 08/16/2023] [Accepted: 08/18/2023] [Indexed: 09/10/2023] Open
Abstract
In the last two decades, forensic pathology and crime scene investigations have seen a rapid increase in examination tools due to the implementation of several imaging techniques, e.g., CT and MR scanning, surface scanning and photogrammetry. These tools encompass relatively simple visualization tools to powerful instruments for performing virtual 3D crime scene reconstructions. A multi-modality and multiscale approach to a crime scene, where 3D models of victims and the crime scene are combined, offers several advantages. A permanent documentation of all evidence in a single 3D environment can be used during the investigation phases (e.g., for testing hypotheses) or during the court procedures (e.g., to visualize the scene and the victim in a more intuitive manner). Advanced computational approaches to understand what might have happened during a crime can also be applied by, e.g., performing a virtual animation of the victim in the actual context, which can provide important information about possible dynamics during the event. Here, we present an overview of the different techniques and modalities used in forensic pathology in conjunction with crime scene investigations. Based on our experiences, the advantages and challenges of an image-based multi-modality approach will be discussed, including how their use may introduce new visualization modalities in court, e.g., virtual reality (VR) and 3D printing. Finally, considerations about future directions in research will be mentioned.
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Affiliation(s)
- Chiara Villa
- Department of Forensic Medicine, University of Copenhagen, Frederik V’s Vej 11, DK-2100 Copenhagen, Denmark; (N.L.); (C.J.)
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Golomingi R, Dobay A, Franckenberg S, Ebert L, Sieberth T. Augmented reality in forensics and forensic medicine - Current status and future prospects. Sci Justice 2023; 63:451-455. [PMID: 37453776 DOI: 10.1016/j.scijus.2023.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 03/27/2023] [Accepted: 04/22/2023] [Indexed: 07/18/2023]
Abstract
Forensic investigations require a vast variety of knowledge and expertise of each specialist involved. With the increase in digitization and advanced technical possibilities, the traditional use of a computer with a screen for visualization and a mouse and keyboard for interactions has limitations, especially when visualizing the content in relation to the real world. Augmented reality (AR) can be used in such instances to support investigators in various tasks at the scene as well as later in the investigation process. In this article, we present current applications of AR in forensics and forensic medicine, the technological basics of AR, and the advantages that AR brings for forensic investigations. Furthermore, we will have a brief look at other fields of application and at future developments of AR in forensics.
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Affiliation(s)
- Raffael Golomingi
- 3D Center Zurich, Institute of Forensic Medicine, University of Zurich, 8057 Zurich, Switzerland.
| | - Akos Dobay
- 3D Center Zurich, Institute of Forensic Medicine, University of Zurich, 8057 Zurich, Switzerland.
| | - Sabine Franckenberg
- 3D Center Zurich, Institute of Forensic Medicine, University of Zurich, 8057 Zurich, Switzerland; Diagnostic and Interventional Radiology, University Hospital Zurich, 8091 Zurich, Switzerland.
| | - Lars Ebert
- 3D Center Zurich, Institute of Forensic Medicine, University of Zurich, 8057 Zurich, Switzerland.
| | - Till Sieberth
- 3D Center Zurich, Institute of Forensic Medicine, University of Zurich, 8057 Zurich, Switzerland.
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Yoshida M, Hoshioka Y, Makino Y, Yamagishi Y, Nagasawa S, Chiba F, Yamaguchi R, Inokuchi G, Iwase H. Fatal cocaine body packer syndrome depicted on antemortem and postmortem CT: A case report. FORENSIC IMAGING 2023. [DOI: 10.1016/j.fri.2023.200543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2023]
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10
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Franckenberg S, Sieberth T, Ptacek W, Fürst M, Colacicco G, Ebert L. Technical note: Semiautomated targeted postmortem computed tomography angiography of the pulmonary arteries using a robotic system. Forensic Sci Int 2023; 348:111712. [PMID: 37182280 DOI: 10.1016/j.forsciint.2023.111712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 04/20/2023] [Accepted: 04/27/2023] [Indexed: 05/16/2023]
Abstract
INTRODUCTION To better depict vascular lesions on postmortem computed tomography (PMCT), whole-body postmortem computed tomography angiography (PMCTA) can be used in forensic diagnostics. Targeted angiography, in which only a specific vessel is filled with contrast agent, might help in cases of traumatic changes that render whole-body PMCTA impossible. Moreover, in targeted PMCTA, the contrast agent does not affect the haptics of any other organs. In this article, we describe automated, CT-guided targeted angiography of the pulmonary artery (PA) using the Virtobot system. MATERIAL AND METHODS Our study group consisted of 8 deceased persons (3 males, 5 females). We first performed an unenhanced CT scan and used the data obtained to plan the needle trajectories with the Virtobot planning software. Then, the needle was fully automatically placed by the Virtobot system. Subsequently, 50 ml of contrast agent was injected manually, and the CT scan was repeated (targeted PMCTA). RESULTS AND DISCUSSION We tested a new method for performing semiautomated targeted postmortem angiography of the PAs using a robotic needle placement system (Virtobot). In 6 out of our 8 cases, the injection of contrast agent in the PA was successful. In five of the six successful cases, there was reflux of contrast agent to some extent, but the reflux did not affect the readout. In general, the procedure was easy to plan based on a PMCT data set, and the pulmonary trunk was easy to reach with a robotic needle placement system.
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Affiliation(s)
- Sabine Franckenberg
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Switzerland; Department of Diagnostic and Interventional Radiology, University Hospital Zurich, Switzerland.
| | - Till Sieberth
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Switzerland
| | - Wolfgang Ptacek
- Austrian Center for Medical Innovation and Technology (ACMIT GmbH), Wiener Neustadt, Austria
| | - Martin Fürst
- Austrian Center for Medical Innovation and Technology (ACMIT GmbH), Wiener Neustadt, Austria
| | | | - Lars Ebert
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Switzerland
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11
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Wang Y, Chen Q, Dang X, Lu W, Zhang X, Yan H, Niu S, Yan X, Yan J. A bibliometric analysis on traumatic brain injury in forensic medicine of a half-century (1972-2021). Front Neurol 2023; 14:913855. [PMID: 36816552 PMCID: PMC9932540 DOI: 10.3389/fneur.2023.913855] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 01/17/2023] [Indexed: 02/05/2023] Open
Abstract
Traumatic brain injury (TBI) is among the most common injuries in forensic medicine, the identification of which is of particular importance in forensic practice. To reveal the circumstances and trends of TBI in the forensic field, we used the Web of Science (WoS) database for comprehensive retrieval. We made a metrological analysis of 1,089 papers in the past 50 years (1972-2021). The United States and Germany have the most forensic research on TBI. Diffuse axonal injury (DAI) has been the focus of attention for many years, and much effort has been devoted to its diagnosis in forensic pathology. Infants and children are the subgroups of most concern, especially in infant and child abuse cases. Research on identifying shaken baby syndrome has received increasing attention in recent years. Overall, our study provides a comprehensive list and analysis of the articles regarding TBI in legal medicine, which may shed light on recognizing the trends and research hotspots in this field.
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Affiliation(s)
- Yufang Wang
- Department of Forensic Science, School of Basic Medical Science, Central South University, Changsha, Hunan, China
| | - Qianqian Chen
- Department of Forensic Science, School of Basic Medical Science, Central South University, Changsha, Hunan, China
| | - Xingxing Dang
- Department of Forensic Science, School of Basic Medical Science, Central South University, Changsha, Hunan, China
| | - Wanqing Lu
- Department of Forensic Science, School of Basic Medical Science, Central South University, Changsha, Hunan, China
| | - Xinran Zhang
- Department of Forensic Science, School of Basic Medical Science, Central South University, Changsha, Hunan, China
| | - He Yan
- Department of Forensic Science, School of Basic Medical Science, Central South University, Changsha, Hunan, China
| | - Shuliang Niu
- School of Basic Medical Science, Xinjiang Medical University, Urumqi, China
| | - Xisheng Yan
- Department of Cardiovascular Medicine, Wuhan Third Hospital, Tongren Hospital of Wuhan University, Wuhan, Hubei, China
| | - Jie Yan
- Department of Forensic Science, School of Basic Medical Science, Central South University, Changsha, Hunan, China,School of Basic Medical Science, Xinjiang Medical University, Urumqi, China,*Correspondence: Jie Yan ✉
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12
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The Role and Place of Thanatoradiological Studies in the Pathological Examination of Fetuses and Newborns. Bull Exp Biol Med 2022; 173:691-705. [DOI: 10.1007/s10517-022-05615-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Indexed: 11/06/2022]
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13
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Virtopsy visualisation: mixed data gradient model for more accurate thin bone visualization in 3D rendering. FORENSIC IMAGING 2022. [DOI: 10.1016/j.fri.2022.200529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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14
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Makino Y, Unuma K, Nolte KB, Adolphi NL. Accuracy of forensic pathologists in incorporating post-mortem CT (PMCT) in forensic death investigation. J Forensic Sci 2022; 67:2351-2359. [PMID: 36069005 DOI: 10.1111/1556-4029.15131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 08/21/2022] [Accepted: 08/25/2022] [Indexed: 11/28/2022]
Abstract
Post-mortem computed tomography (PMCT) is now performed routinely in some medical examiner's offices, and the images are typically interpreted by forensic pathologists. In this study, the question of whether pathologists appropriately identify significant PMCT findings and incorporate them into the death investigation report and the cause and manner of death (COD and MOD) statements was addressed. We retrospectively reviewed 200 cases where PMCT was performed. The cases were divided into four categories: (1) full autopsy without radiology consultation (n = 77), (2) external exam without radiology consultation (n = 79), (3) full autopsy with radiology consultation (n = 26), (4) external exam with radiology consultation (n = 18). A radiologist (not the consult radiologist) read the PMCT images, and a pathologist (not the case pathologist) reviewed the case pathologist's post-mortem examination report in tandem to determine any PMCT findings omitted from the report. Omitted findings were classified into error types according to a modified Goldman classification including Major 1: Unrecognized fatal injury or pathology that would change COD and/or MOD, and Major 2: Unrecognized fatal injury or pathology that would not change COD and/or MOD. A total of 13 Major errors were identified (6.5%), and none definitively changed the MOD. All four Major-1 errors which could change the COD were found in Category 2. Of 9 Major-2 errors, 2 occurred in Category 1, 6 occurred in Category 2, and 1 occurred in Category 4. In conclusion, forensic pathologists who routinely utilize computed tomography (CT) interpret CT images well enough to reliably certify the COD and MOD.
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Affiliation(s)
- Yohsuke Makino
- Department of Pathology, University of New Mexico, Albuquerque, New Mexico, USA.,Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kana Unuma
- Department of Pathology, University of New Mexico, Albuquerque, New Mexico, USA.,Department of Forensic Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Kurt B Nolte
- Department of Pathology, University of New Mexico, Albuquerque, New Mexico, USA.,Radiology-Pathology Center for Forensic Imaging, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| | - Natalie L Adolphi
- Department of Pathology, University of New Mexico, Albuquerque, New Mexico, USA.,Radiology-Pathology Center for Forensic Imaging, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
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15
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Health Technology Assessment (HTA) of virtual autopsy through PMCT with particular focus on Italy. FORENSIC IMAGING 2022. [DOI: 10.1016/j.fri.2022.200516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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16
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Kot BC, Ho HH, Leung EK, Chung TY, Tsui HC. Characterisation of Crassicauda fuelleborni nematode infection in Indo-Pacific finless porpoises (Neophocaena phocaenoides) using postmortem computed tomography. Int J Parasitol Parasites Wildl 2022; 18:68-75. [PMID: 35519505 PMCID: PMC9061254 DOI: 10.1016/j.ijppaw.2022.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 04/14/2022] [Accepted: 04/15/2022] [Indexed: 11/04/2022]
Abstract
Nematodes of the genus Crassicauda are parasites that infect various body tissues of cetaceans, including the mammary glands which can influence the reproductive output and hence threaten the survival of endangered cetacean populations. In this study, postmortem computed tomography (PMCT) was used to characterise lesions related to Crassicauda fuelleborni infections in stranded Indo-Pacific finless porpoises (Neophocaena phocaenoides) from Hong Kong waters. Using PMCT and subsequently verified by conventional necropsy, Crassicauda-related lesions were found in 52% of finless porpoises examined (n = 13/25), including both males and females. These parasitic lesions were mostly located in the ventral abdominal muscles in both sexes and situated in proximity to the mammary glands in females. C. fuelleborni infections were also found in the male reproductive organs, which to our knowledge have not been reported in this cetacean species previously. PMCT characteristics of the lesions were also correlated with the gross appearance observed at necropsy and the chronicity of the parasitic infections. In conclusion, this study established the use of virtopsy, particularly PMCT, to characterise C. fuelleborni infections in stranded finless porpoises for the first time, which is non-invasive and can be used prior to conventional necropsy to aid disease diagnosis and targeted sampling. This technique can be extended to other species of cetaceans and parasites, as well as being used in the retrospective analysis of past PMCT scans to deepen our understanding of the prevalence, health impacts, and ecological implications of parasitic infection in cetaceans. Computed tomography descriptions of cetacean mammary glands and adjacent musculature. Detection and characterisation of Crassicauda-related lesions using virtopsy. Crassicauda-related lesions found in 52% of finless porpoises examined in Hong Kong. Virtopsy features correlated with necropsy findings and chronicity of infection. Virtopsy can be used to study the prevalence and impact of parasitic infection in cetaceans.
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Kuijpers NW, van Schalkwijk L, IJsseldijk LL, Willems DS, Veraa S. Post-Mortem Computed Tomography Pulmonary Findings in Harbor Porpoises (Phocoena phocoena). Animals (Basel) 2022; 12:ani12111454. [PMID: 35681918 PMCID: PMC9179349 DOI: 10.3390/ani12111454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 06/01/2022] [Accepted: 06/02/2022] [Indexed: 02/04/2023] Open
Abstract
Simple Summary The use of cross-sectional imaging techniques to examine the cause of death and health status of deceased animals is increasing in both veterinary and wildlife conservation programs, including species of whales and dolphins. Lung disease is common in harbor porpoises (Phocoena phocoena), a small whale species that regularly washes up on the coast in North Sea-bordering countries. This study aimed to describe lung changes visible in computed tomographic (CT) images of recently deceased harbor porpoises before pathological dissection was performed, including comparison of these two examination methods. Despite frequently visible signs of body decomposition, several lung abnormalities (collapsed lung, fluid in the airways, lung mineralization) were more often seen on the CT images. In general, lung changes could be described in more detail compared to gross dissection. CT images of lungs of recently deceased harbor porpoises can therefore be used to guide gross dissection, leading to more specific findings and potentially a more complete understanding of the circumstances leading to the death of the porpoise, assessment of the population, and ultimately, ecosystem health. Abstract The application of whole-body post-mortem computed tomography (PMCT) in veterinary and wildlife post-mortem research programs is advancing. A high incidence of pulmonary pathology is reported in the harbor porpoise (Phocoena phocoena). In this study, the value of PMCT focused on pulmonary assessment is evaluated. The objectives of this study were to describe pulmonary changes as well as autolytic features detected by PMCT examination and to compare those findings with conventional necropsy. Retrospective evaluation of whole-body PMCT images of 46 relatively fresh harbor porpoises and corresponding conventional necropsy reports was carried out, with a special focus on the respiratory tract. Common pulmonary PMCT findings included: moderate (24/46) to severe (19/46) increased pulmonary soft tissue attenuation, severe parasite burden (17/46), bronchial wall thickening (30/46), and mild autolysis (26/46). Compared to conventional necropsy, PMCT more frequently identified pneumothorax (5/46 vs. none), tracheal content (26/46 vs. 7/46), and macroscopic pulmonary mineralization (23/46 vs. 11/46), and provided more information of the distribution of pulmonary changes. These results indicate that PMCT adds information on pulmonary assessment and is a promising complementary technique for necropsy, despite the frequent presence of mild autolytic features.
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Affiliation(s)
- Nienke W. Kuijpers
- Department of Clinical Sciences, Division of Integrating Disciplines, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 108, 3584 CM Utrecht, The Netherlands; (D.S.W.); (S.V.)
- Correspondence:
| | - Linde van Schalkwijk
- Department of Biomolecular Health Sciences, Division of Pathology, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 1, 3584 CL Utrecht, The Netherlands; (L.v.S.); (L.L.I.)
| | - Lonneke L. IJsseldijk
- Department of Biomolecular Health Sciences, Division of Pathology, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 1, 3584 CL Utrecht, The Netherlands; (L.v.S.); (L.L.I.)
| | - Dorien S. Willems
- Department of Clinical Sciences, Division of Integrating Disciplines, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 108, 3584 CM Utrecht, The Netherlands; (D.S.W.); (S.V.)
| | - Stefanie Veraa
- Department of Clinical Sciences, Division of Integrating Disciplines, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 108, 3584 CM Utrecht, The Netherlands; (D.S.W.); (S.V.)
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18
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Filograna L, Manenti G, Grassi S, Zedda M, Mecchia D, Briganti F, Ryan CP, Pascali VL, Floris R, Oliva A. Analysis of the role of PMCT during the COVID-19 pandemic: a systematic review. FORENSIC IMAGING 2022. [PMCID: PMC9134788 DOI: 10.1016/j.fri.2022.200505] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Objectives During COVID-19 pandemic PMCT has been proposed as a forensic investigation method. This systematic review is aimed to systematize evidence and peer-reviewed opinions reported during the first two years of pandemic, to evaluate the role of PMCT during the COVID-19 pandemic. Materials and methods An online literature search was performed to identify publications on PMCT during the COVID-19 pandemic between December 2019 and March 2022. For each publication included, the following data were collected: title and abstract, year of publication, type of article, number and type of individuals examined. The selected publications were also categorized based on PMCT findings, histopathological results, the comparison between PMCT and histopathological findings, cause of death and proposed role of PMCT during the pandemic. Results A total of 20 publications were included, mostly case reports (9/20). All cases examined included adults. The most frequent PMCT pattern in positive cases was diffuse mixed densities with prevalence of consolidations (pattern 1) (54%). In 97% of the cases where a comparison between PMCT and histological results was performed, a correspondence was found. In 82% of the cases the principal cause of death was COVID-19 pneumonia. PMCT has been proposed as a pre-autopsy screening tool in 62%, and as a method for augmenting post-mortem data in 50% of the papers reporting this issue. Conclusion This systematic review suggests that PMCT should be regarded as a highly valuable investigative technique for the forensic evaluation of deaths with ascertained or suspected COVID-19 pneumonia.
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Braun S, Indra L, Lösch S, Milella M. Perimortem Skeletal Sharp Force Trauma: Detection Reliability on CT Data, Demographics and Anatomical Patterns from a Forensic Dataset. BIOLOGY 2022; 11:biology11050666. [PMID: 35625394 PMCID: PMC9138488 DOI: 10.3390/biology11050666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/19/2022] [Accepted: 04/25/2022] [Indexed: 11/30/2022]
Abstract
Simple Summary The increased use of computed tomography images in forensic anthropology is easily explained with a variety of benefits: among other reasons they are digitally stored, they can easily be shared and they are non-invasive. However, it is not clear how suitable these images are for forensic anthropologists to detect sharp force trauma. Therefore, we analyzed computed tomography images, by observing digital images of 41 forensic cases in different viewing modalities. In addition, we looked for anatomical injury patterns in the soft- and hard-tissues and any significant correlations between the manner of death (suicide or homicide) with different parameters. Our findings indicated a superiority of viewing the images in 2D, but not all bone lesions were detected. The manner of death was significantly correlated to some of the parameters, which could be extrapolated to future forensic anthropological cases. We promote the inclusion of imaging training into the anthropological curricula. Abstract The increasing importance of trauma analysis by means of postmortem computed tomography (PMCT) is insufficiently reflected in forensic curricula, nor are best practice manuals available. We attempt to detect sharp force bone lesions on PMCT of closed forensic cases with the aims of assessing errors and pointing out patterns in anatomical location and manner of death (MOD). We investigated 41 closed sharp force fatality cases, with available PMCT and forensic reports. Two observers with different radiological training assessed the lesions on PMCT scans (2D and 3D) for comparison with the reports. Between 3% (suicides) and 15.3% (homicides) of sharp force injuries caused visible bone lesions. While our observations were repeatable, each forensic investigation left a similar number of bone lesions undetected. Injury patterns differed between MOD, with thoracic bone lesions being most frequent overall. Soft tissue injury location varied between the MOD. Associations between MOD and age as well as number of injuries were significant. The detection of bone lesions on PMCT for untrained forensic specialists is challenging, curricula and pertinent manuals are desirable. With the low frequency of bone lesions compared to soft tissue injuries, we should be aware when analyzing decomposed bodies.
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20
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Ursprung R, Eggert S, Ampanozi G, Gascho D, Thali M, Franckenberg S. Gunshot wounds to the head: a comparison of postmortem magnetic resonance imaging, computed tomography, and autopsy. Acta Radiol 2022; 63:513-519. [PMID: 33779322 DOI: 10.1177/0284185121999999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Postmortem imaging has become a powerful diagnostic tool in forensics. Postmortem computed tomography (PMCT) is often used currently to complement and sometimes even replace an autopsy. PURPOSE To compare PMCT, postmortem magnetic resonance imaging (PMMRI), and autopsy findings for gunshot wounds to the head. MATERIAL AND METHODS Cross-sectional study. We performed a retrospective analysis of 24 cases with gunshot wounds to the head that underwent both PMCT and PMMRI between 2011 and 2018 at the Institute of Forensic Medicine, University of Zurich (Switzerland). RESULTS Our study confirms that PMCT and, to a slightly lesser degree, PMMRI provide additional information that is valuable when combined with autopsy findings. Air embolism was solely detected in PMCT (67% vs. 0% at autopsy). A retained bullet or projectile and bone fragments were diagnosed more frequently with PMCT (42%, 67%, and 92%) than at autopsy (33%, 42%, and 46%). Soft tissue lesions were more often detected with PMMRI than with PMCT. With regard to autopsy, subdural hemorrhage and ventricular hemorrhage were slightly more frequently diagnosed with PMMRI (63% and 75% vs. 38% and 58% at autopsy). Intracerebral hemorrhage was by far most often diagnosed with PMMRI (92%) compared with both PMCT (38%) and autopsy (14%). CONCLUSION All three modalities should ideally be considered in cases of craniocerebral gunshot wounds. However, it might be conceivable that depending on the forensic query, PMCT and PMMRI may be an adequate replacement for an autopsy.
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Affiliation(s)
- Reto Ursprung
- Institute of Forensic Medicine and Imaging, University of Zürich, Zürich, Switzerland
| | - Sebastian Eggert
- Institute of Forensic Medicine and Imaging, University of Zürich, Zürich, Switzerland
| | - Garyfalia Ampanozi
- Institute of Forensic Medicine and Imaging, University of Zürich, Zürich, Switzerland
| | - Dominic Gascho
- Institute of Forensic Medicine and Imaging, University of Zürich, Zürich, Switzerland
| | - Michael Thali
- Institute of Forensic Medicine and Imaging, University of Zürich, Zürich, Switzerland
| | - Sabine Franckenberg
- Institute of Forensic Medicine and Imaging, University of Zürich, Zürich, Switzerland
- Institute of Diagnostic and Interventional Radiology, University Hospital of Zürich, Zürich, Switzerland
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21
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Spies AJ, Steyn M, Brits D. Diagnostic accuracies of CTs, X-rays and Lodox to detect blunt force trauma in adults, using a pig model. MEDICINE, SCIENCE, AND THE LAW 2022; 62:134-143. [PMID: 34825618 DOI: 10.1177/00258024211049591] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The accurate radiological detection of skeletal trauma is crucial for the investigation of blunt force trauma (BFT) cases. The sensitivities of CTs, X-rays and Lodox in identifying BFT fractures and minimum number of impacts in pigs, used as proxies for adult humans, were assessed. Ten human sized pig carcasses were struck with a mallet and scanned, after which the number of fractures and minimum number of impacts detected radiologically were recorded. Pig carcasses were then macerated, and the defleshed, skeletonized remains were considered the gold standard as far as number and location of fractures were concerned. CTs were most sensitive in identifying fractures and impacts in all body regions, with overall sensitivities of 55.4% and 71.5% respectively, while X-rays and Lodox had sensitivities of 25.8% and 29.3% for fractures, and 43.5% and 41.1% for impacts, respectively. All modalities were highly specific for identifying fractures (CT: 99.1%; X-ray: 98.9%; Lodox: 99.4%). CTs should be used to analyze blunt force trauma when a radiological assessment is required, but an examination of the defleshed bones remains the gold standard for the deceased whenever feasible. X-rays and Lodox have limited diagnostic value in these cases and relying on them to detect fractures may compromise the accurate forensic investigation of blunt trauma victims. However, the use of Lodox for initial screening of major trauma is still of value. Sensitivities are generally higher for detecting fractures in pigs compared to piglets, indicating that increased diagnostic value is achieved when imaging pigs compared to piglets.
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Affiliation(s)
- Amy Joy Spies
- Human Variation and Identification Research Unit (HVIRU), School of Anatomical Sciences, Faculty of Health Sciences, 37708University of the Witwatersrand, 7 York Road, Parktown, Johannesburg 2193, South Africa
| | - Maryna Steyn
- Human Variation and Identification Research Unit (HVIRU), School of Anatomical Sciences, Faculty of Health Sciences, 37708University of the Witwatersrand, 7 York Road, Parktown, Johannesburg 2193, South Africa
| | - Desiré Brits
- Human Variation and Identification Research Unit (HVIRU), School of Anatomical Sciences, Faculty of Health Sciences, 37708University of the Witwatersrand, 7 York Road, Parktown, Johannesburg 2193, South Africa
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Abstract
Forensic imaging is a non-invasive examination process during the forensic investigation. It is mainly used in forensic pathology as an adjunct to the traditional autopsy. In the past two decades, forensic imaging has been vigorously developed by forensic experts from computed tomography (CT) to multiple augmented techniques through CT and magnetic resonance imaging (MRI). The application field of forensic imaging has also been broadened as its advantages are recognised by more forensic practitioners. In addition to the forensic pathology, this technique has been used in other forensic disciplines, including forensic anthropology, forensic odontology, forensic ballistics and wildlife forensics, etc. This article reviews the development of forensic imaging as the practice and research development in different forensic disciplines based on the relevant literature analysis.
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Affiliation(s)
- Min Zhang
- Faculty of Forensic Investigation Department of Criminal Justice, Coppin State University, Baltimore, MD, USA
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23
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Filograna L, Manenti G, Ampanozi G, Calcagni A, Ryan CP, Floris R, Thali MJ. Potentials of post-mortem CT investigations during SARS-COV-2 pandemic: a narrative review. Radiol Med 2022; 127:383-390. [PMID: 35226246 PMCID: PMC8884096 DOI: 10.1007/s11547-022-01457-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 01/21/2022] [Indexed: 12/22/2022]
Abstract
In December 2019, a new coronavirus, SARS-COV-2, caused a cluster of cases of pneumonia in China, and rapidly spread across the globe. It was declared a pandemic by the World Health Organization on March 11th, 2020. Virtual autopsy by post-mortem CT (PMCT) and its ancillary techniques are currently applied in post-mortem examinations as minimally or non-invasive techniques with promising results. In this narrative review, we speculate on the potentials of PMCT and its ancillary techniques, as a viable investigation technique for analysis of suspected or confirmed SARS-COV-2 deaths. An online literature search was performed by using three prefix search terms (postmortem, post-mortem, post mortem) individually combined with the suffix radiology, imaging, computed tomography, CT and with the search terms ‘SARS-CoV-2’ and ‘COVID-19’ to identify papers about PMCT and its ancillary techniques in SARS-COV-2 positive cadavers. PMCT findings suggestive for pulmonary COVID-19 in deceased positive SARS-COV-2 infection are reported in the literature. PMCT ancillary techniques were never applied in such cases. PMCT imaging of the lungs has been proposed as a pre-autopsy screening method for SARS-COV-2 infection. Further studies are needed to ascertain the value of PMCT in determining COVID-19 as the cause of death without autopsy histopathological confirmation. We advocate the application of PMCT techniques in the study of ascertained or suspected SARS-COV-2 infected deceased individuals as a screening technique and as a method of post-mortem investigation, to augment the numbers of case examined and significantly reducing infection risk for the operators.
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Affiliation(s)
- Laura Filograna
- Department of Radiological Sciences, Fondazione PTV Policlinico Tor Vergata, Viale Oxford 81, 00133, Rome, Lazio, IT, Italy.
| | - Guglielmo Manenti
- Department of Radiological Sciences, Fondazione PTV Policlinico Tor Vergata, Viale Oxford 81, 00133, Rome, Lazio, IT, Italy
| | - Garyfalia Ampanozi
- Institute of Forensic Medicine, Department of Forensic Medicine and Imaging, University of Zurich, Winterthurerstrasse 190/52, CH-8057, Zurich, Switzerland
| | - Antonello Calcagni
- Department of Radiological Sciences, Fondazione PTV Policlinico Tor Vergata, Viale Oxford 81, 00133, Rome, Lazio, IT, Italy
| | - Colleen Patricia Ryan
- Department of Radiological Sciences, Fondazione PTV Policlinico Tor Vergata, Viale Oxford 81, 00133, Rome, Lazio, IT, Italy
| | - Roberto Floris
- Department of Radiological Sciences, Fondazione PTV Policlinico Tor Vergata, Viale Oxford 81, 00133, Rome, Lazio, IT, Italy
| | - Michael John Thali
- Institute of Forensic Medicine, Department of Forensic Medicine and Imaging, University of Zurich, Winterthurerstrasse 190/52, CH-8057, Zurich, Switzerland
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24
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Cao Y, Ma Y, Yang X, Xiong J, Wang Y, Zhang J, Qin Z, Chen Y, Vieira DN, Chen F, Zhang J, Huang P. Use of deep learning in forensic sex estimation of virtual pelvic models from the Han population. Forensic Sci Res 2022; 7:540-549. [PMID: 36353321 PMCID: PMC9639534 DOI: 10.1080/20961790.2021.2024369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Accurate sex estimation is crucial to determine the identity of human skeletal remains effectively. Here, we developed convolutional neural network (CNN) models for sex estimation on virtual hemi-pelvic regions, including the ventral pubis (VP), dorsal pubis (DP), greater sciatic notch (GSN), pelvic inlet (PI), ischium, and acetabulum from the Han population and compared these models with two experienced forensic anthropologists using morphological methods. A Computed Tomography (CT) dataset of 862 individuals was divided into the subgroups of training, validation, and testing, respectively. The CT-based virtual hemi-pelvises from the training and validation groups were used to calibrate sex estimation models; and then a testing dataset was used to evaluate the performance of the trained models and two human experts on the sex estimation of specific pelvic regions in terms of overall accuracy, sensitivity, specificity, F1 score, and receiver operating characteristic (ROC) curve. Except for the ischium and acetabulum, the CNN models trained with the VP, DP, GSN, and PI images achieved excellent results with all the prediction metrics over 0.9. All accuracies were superior to those of the two forensic anthropologists in the independent testing. Notably, the heatmap results confirmed that the trained CNN models were focused on traditional sexual anatomic traits for sex classification. This study demonstrates the potential of AI techniques based on the radiological dataset in sex estimation of virtual pelvic models. The excellent sex estimation performance obtained by the CNN models indicates that this method is valuable to proceed with in prospective forensic trials.
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Affiliation(s)
- Yongjie Cao
- Shanghai Key Laboratory of Forensic Medicine, Shanghai Forensic Service Platform, Academy of Forensic Science, Ministry of Justice, Shanghai, China
- Department of Forensic Medicine, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yonggang Ma
- Department of Medical Imaging, 3201 Hospital of Xi’an Jiaotong University Health Science Center, Hanzhong, Shannxi, China
| | - Xiaotong Yang
- Shanghai Key Laboratory of Forensic Medicine, Shanghai Forensic Service Platform, Academy of Forensic Science, Ministry of Justice, Shanghai, China
- Department of Forensic Pathology, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Jian Xiong
- Shanghai Key Laboratory of Forensic Medicine, Shanghai Forensic Service Platform, Academy of Forensic Science, Ministry of Justice, Shanghai, China
- Department of Forensic Medicine, Guizhou Medical University, Guiyang, Guizhou, China
| | - Yahui Wang
- Shanghai Key Laboratory of Forensic Medicine, Shanghai Forensic Service Platform, Academy of Forensic Science, Ministry of Justice, Shanghai, China
| | - Jianhua Zhang
- Shanghai Key Laboratory of Forensic Medicine, Shanghai Forensic Service Platform, Academy of Forensic Science, Ministry of Justice, Shanghai, China
| | - Zhiqiang Qin
- Shanghai Key Laboratory of Forensic Medicine, Shanghai Forensic Service Platform, Academy of Forensic Science, Ministry of Justice, Shanghai, China
| | - Yijiu Chen
- Shanghai Key Laboratory of Forensic Medicine, Shanghai Forensic Service Platform, Academy of Forensic Science, Ministry of Justice, Shanghai, China
| | - Duarte Nuno Vieira
- Institute of Legal Medicine, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Feng Chen
- Department of Forensic Medicine, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Ji Zhang
- Shanghai Key Laboratory of Forensic Medicine, Shanghai Forensic Service Platform, Academy of Forensic Science, Ministry of Justice, Shanghai, China
| | - Ping Huang
- Shanghai Key Laboratory of Forensic Medicine, Shanghai Forensic Service Platform, Academy of Forensic Science, Ministry of Justice, Shanghai, China
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Aljerian K. Saudi physicians’ perceptions of the validity of autopsy and its implications - Structural equation modeling. J Forensic Leg Med 2022; 86:102320. [DOI: 10.1016/j.jflm.2022.102320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 01/24/2022] [Accepted: 01/30/2022] [Indexed: 10/19/2022]
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Wan L, Song Y, Li Z, Wang M, Song F, Zhang J, Zou D, Liu N, Shi Y, Zhang Z. Detection of traumatic internal carotid artery pseudoaneurysm by postmortem imaging: A case report. Medicine (Baltimore) 2022; 101:e28544. [PMID: 35029212 PMCID: PMC8758031 DOI: 10.1097/md.0000000000028544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Accepted: 12/21/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Postmortem imaging (PMI), including computed tomography (PMCT), postmortem computed tomography angiography (PMCTA), and postmortem magnetic resonance imaging (PMMRI), is rapidly becoming effective and a practical method in forensic medicine. This study aimed to present a specific forensic case in which the PMI approach and its applications were used. PATIENT CONCERNS A 40-year-old male patient had moderate unilateral nose bleeding constantly 10 times after suffering from a head injury induced by a car accident. After a bilateral massive nose bleeding for the last time, he died from hemorrhagic shock. Traumatic internal carotid artery pseudoaneurysm (TICAP) was suspected in this patient. DIAGNOSIS, INTERVENTIONS, AND OUTCOMES A whole-body scanning was performed using PMCT and PMMRI. Then, PMCTA using left ventricular cardiac puncture was also implemented. A water-soluble contrast agent was injected into the left ventricle and pumped toward the intracranial, followed by a repeated whole-body PMCT scan. The PMCT/PMMRI detected a high-density/signal mass inside the left sphenoid sinus. The PMCTA detected a distinct leakage of the contrast agent into the left sphenoid sinus from an adjacent aneurysm of the C3 section of the left internal carotid artery. Autopsy and histology confirmed a TICAP inside the sphenoid sinus. LESSONS This case showed that the PMI was of great value for identifying the cause of death in special cases. When vascular lesions are suspected in the body, PMI and especially the PMCTA approach may be an effective detection method.
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Affiliation(s)
- Lei Wan
- Department of Radiology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Forensic Medicine, Key Laboratory of Forensic Science, Ministry of Justice, Shanghai Forensic Service Platform, Academy of Forensic Science, Shanghai, China
| | - Yanxiang Song
- Institute for Regenerative Medicine, Shanghai East Hospital, School of Life Sciences and Technology, Tongji University, Shanghai, China
| | - Zhengdong Li
- Shanghai Key Laboratory of Forensic Medicine, Key Laboratory of Forensic Science, Ministry of Justice, Shanghai Forensic Service Platform, Academy of Forensic Science, Shanghai, China
| | - Maowen Wang
- Shanghai Key Laboratory of Forensic Medicine, Key Laboratory of Forensic Science, Ministry of Justice, Shanghai Forensic Service Platform, Academy of Forensic Science, Shanghai, China
| | - Fengxiang Song
- Department of Radiology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Jianhua Zhang
- Shanghai Key Laboratory of Forensic Medicine, Key Laboratory of Forensic Science, Ministry of Justice, Shanghai Forensic Service Platform, Academy of Forensic Science, Shanghai, China
| | - Donghua Zou
- Shanghai Key Laboratory of Forensic Medicine, Key Laboratory of Forensic Science, Ministry of Justice, Shanghai Forensic Service Platform, Academy of Forensic Science, Shanghai, China
| | - Ningguo Liu
- Shanghai Key Laboratory of Forensic Medicine, Key Laboratory of Forensic Science, Ministry of Justice, Shanghai Forensic Service Platform, Academy of Forensic Science, Shanghai, China
| | - Yuxin Shi
- Department of Radiology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Zhiyong Zhang
- Department of Radiology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
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Dedouit F, Grabherr S, Heinze S, Scheurer E, Yen K. Forensic Imaging: A New Subspeciality of Radiology. FORENSIC IMAGING 2022. [DOI: 10.1007/978-3-030-83352-7_1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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Rodríguez Almada H, Borches Duhalde F. Historical autopsy: A contribution to the investigation of State terrorism crimes in Uruguay. FORENSIC SCIENCE INTERNATIONAL: REPORTS 2021. [DOI: 10.1016/j.fsir.2021.100242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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De-Giorgio F, Ciasca G, Fecondo G, Mazzini A, De Spirito M, Pascali VL. Estimation of the time of death by measuring the variation of lateral cerebral ventricle volume and cerebrospinal fluid radiodensity using postmortem computed tomography. Int J Legal Med 2021; 135:2615-2623. [PMID: 34562107 PMCID: PMC8523388 DOI: 10.1007/s00414-021-02698-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 08/27/2021] [Indexed: 12/21/2022]
Abstract
Using postmortem CT (PMCT), changes in the volume of the lateral cerebral ventricles (LCVs) and modifications of the radiodensity of cerebrospinal fluid (CSF) have been examined to identify a possible relationship between these changes and the time of death. Subsequent periodical CT scans termed "sequential scans" for ten corpses at known time of death were obtained, and a 3D segmentation of the entire LCV was carried out to measure its volume and radiodensity over time from ~ 5.5- h up to 273-h postmortem. A linear decrease of the LCV volume for all the cases was observed in the investigated time range, together with an overall logarithmic increase of radiodensity. Although a larger sampling should be performed to improve the result reliability, our finding suggests that the postmortem variation of CSF radiodensity can be a potentially useful tool in determining postmortem interval, a finding that is worthy of further investigation.
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Affiliation(s)
- Fabio De-Giorgio
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
- Department of Healthcare Surveillance and Bioethics, Section of Legal Medicine, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Gabriele Ciasca
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Neuroscience Department, Section of Physics, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gennaro Fecondo
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Department of Healthcare Surveillance and Bioethics, Section of Legal Medicine, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alberto Mazzini
- Neuroscience Department, Section of Physics, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Marco De Spirito
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Neuroscience Department, Section of Physics, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Vincenzo L Pascali
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Department of Healthcare Surveillance and Bioethics, Section of Legal Medicine, Università Cattolica del Sacro Cuore, Rome, Italy
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Yoshida M, Makino Y, Hoshioka Y, Saito N, Yamaguchi R, Chiba F, Inokuchi G, Iwase H. Technical and interpretive pitfalls of postmortem CT: Five examples of errors revealed by autopsy. J Forensic Sci 2021; 67:395-403. [PMID: 34491573 DOI: 10.1111/1556-4029.14883] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 08/01/2021] [Accepted: 08/17/2021] [Indexed: 11/30/2022]
Abstract
Image acquisition of dead bodies, particularly using postmortem computed tomography (PMCT), has become common in forensic investigations worldwide. Meanwhile, in countries such as Japan which have an extremely low rate of autopsy, PMCT is being increasingly used in the clinical field to certify the cause of death (COD) without performing an autopsy or toxicological tests, even in cases of unnatural death. Additionally, these PMCT images are predominantly interpreted by clinical personnel such as emergency physicians or clinicians who are not trained in PMCT interpretation and who work for the police, that is, the so-called police doctors. Many potential pitfalls associated with the use of PMCT have been previously described in textbooks and published papers, including the pitfalls of not performing a complete forensic pathology investigation, and the use of physicians without appropriate PMCT training to interpret PMCT and direct death investigation and certification. We describe five examples in which apparent misdiagnosis of COD based on PMCT misinterpretation was revealed by autopsy. Here are the five examples of errors: (1) Postmortem changes were misinterpreted as COD, (2) resuscitation effects were misinterpreted as COD, (3) COD was determined after an incomplete examination, (4) fatal findings caused by external origin were wrongly interpreted as 'of internal origin' based on PMCT, and (5) non-fatal findings on PMCT were wrongly interpreted as fatal. Interpretation of PMCT by appropriately trained physicians and an accompanying complete forensic investigation, including autopsy when indicated, is necessary to prevent significant errors in COD determination and related potential adverse medicolegal consequences.
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Affiliation(s)
- Maiko Yoshida
- Chiba University Center for Education and Research in Legal Medicine, Chiba, Japan.,Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
| | - Yohsuke Makino
- Chiba University Center for Education and Research in Legal Medicine, Chiba, Japan.,Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yumi Hoshioka
- Chiba University Center for Education and Research in Legal Medicine, Chiba, Japan
| | - Naoki Saito
- Chiba University Center for Education and Research in Legal Medicine, Chiba, Japan
| | - Rutsuko Yamaguchi
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Fumiko Chiba
- Chiba University Center for Education and Research in Legal Medicine, Chiba, Japan
| | - Go Inokuchi
- Chiba University Center for Education and Research in Legal Medicine, Chiba, Japan
| | - Hirotaro Iwase
- Chiba University Center for Education and Research in Legal Medicine, Chiba, Japan.,Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Nuzzolese E. VIRDENTOPSY: Virtual Dental Autopsy and Remote Forensic Odontology Evaluation. Dent J (Basel) 2021; 9:102. [PMID: 34562976 PMCID: PMC8468385 DOI: 10.3390/dj9090102] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 08/26/2021] [Accepted: 09/02/2021] [Indexed: 12/04/2022] Open
Abstract
The identification of human remains relies on the comparison of post-mortem data, collected during the autopsy, with the ante-mortem data gathered from the missing persons' reports. DNA, fingerprints, and dental data are considered primary identifiers and are usually collected during any human identification process. Post-mortem dental data should be collected and analyzed by forensic odontologists, as a dental autopsy must not be confused with a dental examination. The virdentopsy project was inaugurated in 2020, during the COVID-19 pandemic, to allow the correct process of human remains by collecting dental data from teeth and jaws, which was then transmitted to forensic odontologists remotely for an expert opinion to achieve a generic profile of the unidentified human remains. The post-mortem dental biography is paramount to narrow the search for compatible missing persons but requires knowledge and experience of forensic odontologists. The virdentopsy process uses radiographic imaging (periapical X-rays, CT scans, panoramics), 2D/3D photos and video recording, photogrammetry documentation, 3D scanning, and live streaming where possible. This registered term was created by merging the terms "virtual" and "dental autopsy" but with no commercial benefits. The proposed process combines research topics under the field of the human rights of the dead and humanitarian forensic odontology services. It should enhance and accelerate the human identification process of the deceased, age estimation of the living, analysis of panoramic X-ray images, and be an educational tool for remote live training in forensic odontology and anatomy of skulls. This paper presents an overview of the virdentopsy process in the field of forensic odontology as a remote consultation as well as an educational tool for undergraduates and postgraduates.
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Affiliation(s)
- Emilio Nuzzolese
- Human Identification Laboratory, Section of Legal Medicine, University of Turin, 10124 Torino, Italy
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Henningsen MJ, Khatam-Lashgari A, Olsen KB, Jacobsen C, Brøchner CB, Banner J. Translational deep phenotyping of deaths related to the COVID-19 pandemic: protocol for a prospective observational autopsy study. BMJ Open 2021; 11:e049083. [PMID: 34452963 PMCID: PMC8406463 DOI: 10.1136/bmjopen-2021-049083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 07/28/2021] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION The COVID-19 pandemic is an international emergency with an extreme socioeconomic impact and a high mortality and disease burden. The COVID-19 outbreak is neither fully understood nor fully pictured. Autopsy studies can help understand the pathogenesis of COVID-19 and has already resulted in better treatment of patients. Structured and systematic autopsy of COVID-19-related deaths will enhance the mapping of pathophysiological pathways, not possible in the living. Furthermore, it provides an opportunity to envision factors translationally for the purpose of disease prevention in this and future pandemics. This is the protocol for an autopsy study that offers an umbrella for deep and diverse investigations of COVID-19-related deaths, including a systematic investigation of 'long' COVID-19 by means of extensive and systematic tissue sampling. METHODS AND ANALYSIS A COVID-19-specific autopsy algorithm has been created to cover all cases undergoing clinical or forensic autopsy in Denmark. The algorithm describes advanced tissue sampling and a translational analytical follow-up for deep phenotyping. The translational approach covers registry data, postmortem imaging, gross autopsy findings, microscopic organ changes, postmortem toxicology, postmortem biochemical investigation, microbiological profiling and immunological status at the time of death, and future research projects covering genetics and epigenetics on an organ level. ETHICS AND DISSEMINATION This study has been approved by the Regional Ethics Committee of the Region of Greater Copenhagen (No: H-20078436) and the Danish Data Protection Agency (No: 2002-54-1080). Next of kin gave informed consent to research. The study results will be published in peer-reviewed journals. TRIAL REGISTRATION NUMBER This study is purely observational and, as such, does not meet the criteria of the International Committee of Medical Journal Editors for clinical trials; thus, there is no need for registration in a database of research trials, such as clinical trials. To facilitate cooperation in research, provide transparency on case recruitment for publications to come and to avoid unnecessary duplicate work, we nevertheless wish to publish our protocol.
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Affiliation(s)
- Mikkel Jon Henningsen
- Section of Forensic Pathology, Department of Forensic Medicine, University of Copenhagen Faculty of Health and Medical Sciences, Copenhagen, Denmark
| | - Apameh Khatam-Lashgari
- Section of Forensic Pathology, Department of Forensic Medicine, University of Copenhagen Faculty of Health and Medical Sciences, Copenhagen, Denmark
| | - Kristine Boisen Olsen
- Section of Forensic Pathology, Department of Forensic Medicine, University of Copenhagen Faculty of Health and Medical Sciences, Copenhagen, Denmark
| | - Christina Jacobsen
- Section of Forensic Pathology, Department of Forensic Medicine, University of Copenhagen Faculty of Health and Medical Sciences, Copenhagen, Denmark
| | | | - Jytte Banner
- Section of Forensic Pathology, Department of Forensic Medicine, University of Copenhagen Faculty of Health and Medical Sciences, Copenhagen, Denmark
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35
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Russo A, Reginelli A, Pignatiello M, Montella M, Toni G, Cappabianca S, Grassi R. Sirenomelia: The role of post - Mortem diagnostic imaging. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2021. [DOI: 10.1016/j.epsc.2021.101921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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37
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Harty MP, Gould SW, Harcke HT. Navigating the perils and pitfalls of pediatric forensic postmortem imaging in the United States. Pediatr Radiol 2021; 51:1051-1060. [PMID: 33999245 DOI: 10.1007/s00247-020-04833-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 05/28/2020] [Accepted: 08/27/2020] [Indexed: 02/06/2023]
Abstract
Postmortem CT is widely used in the general adult and military populations. It is used extensively in pediatric death investigations in Europe and Asia, but distinctive challenges are encountered when launching a postmortem imaging program in the United States. We describe the issues we have encountered specific to establishing a pediatric postmortem imaging service in this country and propose potential solutions.
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Affiliation(s)
- Mary P Harty
- Department of Medical Imaging, Nemours/Alfred I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE, 19803, USA.
| | - Sharon W Gould
- Department of Medical Imaging, Nemours/Alfred I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE, 19803, USA
| | - Howard T Harcke
- Department of Medical Imaging, Nemours/Alfred I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE, 19803, USA
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Grassi S, Campuzano O, Coll M, Cazzato F, Sarquella-Brugada G, Rossi R, Arena V, Brugada J, Brugada R, Oliva A. Update on the Diagnostic Pitfalls of Autopsy and Post-Mortem Genetic Testing in Cardiomyopathies. Int J Mol Sci 2021; 22:ijms22084124. [PMID: 33923560 PMCID: PMC8074148 DOI: 10.3390/ijms22084124] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 04/04/2021] [Accepted: 04/14/2021] [Indexed: 02/08/2023] Open
Abstract
Inherited cardiomyopathies are frequent causes of sudden cardiac death (SCD), especially in young patients. Despite at the autopsy they usually have distinctive microscopic and/or macroscopic diagnostic features, their phenotypes may be mild or ambiguous, possibly leading to misdiagnoses or missed diagnoses. In this review, the main differential diagnoses of hypertrophic cardiomyopathy (e.g., athlete's heart, idiopathic left ventricular hypertrophy), arrhythmogenic cardiomyopathy (e.g., adipositas cordis, myocarditis) and dilated cardiomyopathy (e.g., acquired forms of dilated cardiomyopathy, left ventricular noncompaction) are discussed. Moreover, the diagnostic issues in SCD victims affected by phenotype-negative hypertrophic cardiomyopathy and the relationship between myocardial bridging and hypertrophic cardiomyopathy are analyzed. Finally, the applications/limits of virtopsy and post-mortem genetic testing in this field are discussed, with particular attention to the issues related to the assessment of the significance of the genetic variants.
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Affiliation(s)
- Simone Grassi
- Department of Health Surveillance and Bioethics, Section of Legal Medicine, Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (F.C.); (R.R.); (A.O.)
- Correspondence:
| | - Oscar Campuzano
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain; (O.C.); (M.C.); (J.B.); (R.B.)
- Cardiovascular Genetics Center, Institut d’Investigació Biomèdica Girona (IDIBGI), University of Girona, 17190 Girona, Spain
- Medical Science Department, School of Medicine, University of Girona, 17003 Girona, Spain;
| | - Mònica Coll
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain; (O.C.); (M.C.); (J.B.); (R.B.)
- Cardiovascular Genetics Center, Institut d’Investigació Biomèdica Girona (IDIBGI), University of Girona, 17190 Girona, Spain
- Medical Science Department, School of Medicine, University of Girona, 17003 Girona, Spain;
| | - Francesca Cazzato
- Department of Health Surveillance and Bioethics, Section of Legal Medicine, Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (F.C.); (R.R.); (A.O.)
| | - Georgia Sarquella-Brugada
- Medical Science Department, School of Medicine, University of Girona, 17003 Girona, Spain;
- Arrhythmias Unit, Hospital Sant Joan de Déu, University of Barcelona, 08950 Barcelona, Spain
| | - Riccardo Rossi
- Department of Health Surveillance and Bioethics, Section of Legal Medicine, Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (F.C.); (R.R.); (A.O.)
| | - Vincenzo Arena
- Area of Pathology, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00147 Rome, Italy;
- Istituto di Anatomia Patologica, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Josep Brugada
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain; (O.C.); (M.C.); (J.B.); (R.B.)
- Arrhythmias Unit, Hospital Sant Joan de Déu, University of Barcelona, 08950 Barcelona, Spain
- Institut Clínic Cardiovascular (ICCV), Hospital Clínic, Universitat de Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
| | - Ramon Brugada
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain; (O.C.); (M.C.); (J.B.); (R.B.)
- Cardiovascular Genetics Center, Institut d’Investigació Biomèdica Girona (IDIBGI), University of Girona, 17190 Girona, Spain
- Medical Science Department, School of Medicine, University of Girona, 17003 Girona, Spain;
| | - Antonio Oliva
- Department of Health Surveillance and Bioethics, Section of Legal Medicine, Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (F.C.); (R.R.); (A.O.)
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Spies AJ, Steyn M, Prince DN, Brits D. Can forensic anthropologists accurately detect skeletal trauma using radiological imaging? FORENSIC IMAGING 2021. [DOI: 10.1016/j.fri.2020.200424] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Ishida M, Gonoi W, Abe H, Shirota G, Fujimoto K, Okimoto N, Ushiku T, Abe O. Longitudinal comparison of ascites attenuation between antemortem and postmortem computed tomography. Forensic Sci Int 2021; 321:110727. [PMID: 33636473 DOI: 10.1016/j.forsciint.2021.110727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 01/02/2021] [Accepted: 02/15/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To investigate the changes in ascites attenuation between antemortem (AMCT) and postmortem computed tomography (PMCT) analyses of the same subjects. METHODS Thirty-five subjects who underwent unenhanced or enhanced AMCT within 7 days before death, unenhanced PMCT, and autopsy were evaluated. In each subject, ascites attenuation was measured at similar sites on AMCT and PMCT. Attenuation changes were evaluated in 42 unenhanced AMCT/PMCT site pairs (23 subjects) and 20 enhanced AMCT/PMCT site pairs (12 subjects). Factors contributing to CT attenuation changes were also assessed, including the time interval between AMCT and PMCT, serum albumin level, estimated glomerular filtration rate, and ascites volume. RESULTS Significantly elevated CT attenuation was observed between enhanced AMCT and PMCT (12.2 ± 6.3 vs. 18.7 ± 10.4 Hounsfield units; paired t-test, p = 0.006), but not between unenhanced AMCT and PMCT (13.5 ± 8.9 vs. 13.4 ± 9.3; p = 0.554). A significant inverse association was observed between the degree of CT attenuation change and the time interval between enhanced AMCT and PMCT (Spearman's rank correlation coefficient, r = -0.56, p = 0.01). CONCLUSIONS We confirmed an elevated level of ascites attenuation on PMCT relative to AMCT in subjects who underwent enhanced AMCT shortly before death.
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Affiliation(s)
- Masanori Ishida
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
| | - Wataru Gonoi
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Hiroyuki Abe
- Department of Pathology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Go Shirota
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Kotaro Fujimoto
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Naomasa Okimoto
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Tetsuo Ushiku
- Department of Pathology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Osamu Abe
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
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Eliasova H, Dostalova T, Prochazka A, Sediva E, Horacek M, Urbanova P, Hlinakova P. Comparison of 2D OPG image versus orthopantomogram from 3D CBCT from the forensic point of view. Leg Med (Tokyo) 2021; 48:101802. [PMID: 33478657 DOI: 10.1016/j.legalmed.2020.101802] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 09/18/2020] [Accepted: 10/11/2020] [Indexed: 12/01/2022]
Abstract
Forensic dental identification has employed traditionally 2D digital radiological imaging techniques. More recently, 3D cone beam computer tomography (CBCT) data, widely applied in clinical dentistry, have been gradually used. The purpose of this study was to compare the precision and quality of 2D digital orthopantomogram (OPG) and 2D OPG images generated from cone beam computed tomography (CBCT). The study sample consisted of 50 patients with archived conventional 2D OPG and 3D CBCT images. Patients signed an informed consent form to take part in our study. Measurements of the mandible, teeth and dental restorations were taken by two observers on calibrated 2D OPG and 3D CBCT-to-OPG images using measurement functionalities of DOPLHIN software. Acquired dimensions were compared side by side and images of fillings were superimposed. For better visual comparison and more efficient image registration, the methods of spline interpolation were used. The pairs of absolute measurements obtained from conventional OPG and CBCT-to-OPG-converted images were highly correlated (p < 0.05). However, larger, and horizontally measured distances were revealed to be more affected than shorter vertically taken measurements. In relative terms, CBCT-generated width/length indices of the canines and the first molars ranged from 84% to 99.8% of those acquired from traditional OPGs. In addition, corresponding points on the teeth and fillings were compared side by side and in superimposition. The average coincidence of images was 6.1%. The results revealed that for selected metric variables 2D OPGs and 3D CBCT-generated OPGs were complementary and could be used for forensic comparisons.
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Affiliation(s)
- Hana Eliasova
- Institute of Criminalistics, Police of the Czech Republic, Strojnická 27, 170 89 Prague, Czech Republic.
| | - Tatjana Dostalova
- Department of Stomatology, Charles University, 2nd Medical Faculty and Motol University Hospital, V Uvalu 84, 150 06 Prague, Czech Republic.
| | - Ales Prochazka
- University of Chemistry and Technology Prague, Department of Computing and Control Engineering, Technicka 5, 166 28 Prague 6, Czech Republic.
| | - Eliska Sediva
- Department of Stomatology, Charles University, 2nd Medical Faculty and Motol University Hospital, V Uvalu 84, 150 06 Prague, Czech Republic.
| | - Martin Horacek
- Department of Stomatology, Charles University, 2nd Medical Faculty and Motol University Hospital, V Uvalu 84, 150 06 Prague, Czech Republic.
| | - Petra Urbanova
- Masaryk University, Faculty of Science, Department of Anthropology, Kotlarska 2, 611 37 Brno, Czech Republic.
| | - Petra Hlinakova
- Department of Stomatology, Charles University, 2nd Medical Faculty and Motol University Hospital, V Uvalu 84, 150 06 Prague, Czech Republic.
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Franckenberg S, Sieberth T, Frauenfelder T, Thali MJ, Ebert LC. Semiautomated robotic, CT-guided needle placement for postmortem CSF sampling – a Novel application of the Virtobot. ALL LIFE 2021. [DOI: 10.1080/26895293.2021.1875056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Affiliation(s)
- Sabine Franckenberg
- Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich Switzerland
- Institute of Forensic Medicine, University of Zurich, Zurich Switzerland
| | - Till Sieberth
- Institute of Forensic Medicine, University of Zurich, Zurich Switzerland
| | - Thomas Frauenfelder
- Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich Switzerland
| | - Michael J. Thali
- Institute of Forensic Medicine, University of Zurich, Zurich Switzerland
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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] [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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Tumanova UN, Shchegolev AI, Kovalev AV. [Organization of postmortem radiological examination in the structure of pathological departments and forensic bureaus]. Sud Med Ekspert 2021; 64:57-63. [PMID: 33511837 DOI: 10.17116/sudmed20216401157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The purpose of this work is to develop an optimal scheme for organizing and conducting postmortem radiation studies in the Russian Federation based on literature data and our own results. One of the primary points in organizing virtopsiy is to determine the place where radiation examinations of deceased patients will be performed. The absence or presence of the equipment and capabilities available in the institution, i.e., the department of radiation diagnostics with functioning CT and MRI devices and software, determines the volume of economic costs. The analysis of the results of radiation research methods should be carried out by a highly qualified radiologist who has both general knowledge of radiation diagnostics and information about the radiation pattern of nonspecific postmortem changes. Based on our own experience in organizing postmortem radiation examinations, we consider it optimal to conduct postmortem CT and/or MRI scans by an X-ray technician in the radiation diagnostics department and to introduce a separate radiologist in the staffing of the pathology department or forensic medical examination bureau. In our opinion, an examination of the corpse by a radiologist in conjunction with a forensic expert is required to determine the most important areas of interest, tactics and methodology of radiation research. The final conclusion of the radiologist should be formed after consultation and agreement of the identified changes with a pathologist or forensic expert. Virtopsy is a highly effective objective method for examining a corpse. This dictates the need for its widespread introduction into the practice of the forensic medical examination bureaus and pathological and anatomical departments.
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Affiliation(s)
- U N Tumanova
- National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov, Moscow, Russia
| | - A I Shchegolev
- National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov, Moscow, Russia
| | - A V Kovalev
- Russian Medical Academy of continuing professional education, Moscow, Russia
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Takahashi Y, Sano R, Hayakawa A, Fukuda H, Kubo R, Okawa T, Tokue H, Takei H, Kominato Y. Superimposed CT imaging using fusion function to visualize the relationship between the knife and the wound path in a stabbing victim. J Forensic Sci 2020; 66:1148-1153. [PMID: 33320985 DOI: 10.1111/1556-4029.14653] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 11/13/2020] [Accepted: 11/30/2020] [Indexed: 11/29/2022]
Abstract
With the increasing use of postmortem computed tomography (PMCT) in medicolegal autopsies, three-dimensional (3D) models of injured areas can now be generated from multislice computed tomography images. However, since PMCT has low sensitivity for detecting injuries in solid organs in the absence of contrast administration, it has been difficult to demonstrate the tracks of stab wounds leading to solid organ injury using 3D reconstruction. Here, we report one homicide case with two stab wounds. On the skin surface, the stab wounds were located on the neck and anterior chest wall. A medicolegal autopsy revealed that one stab wound in the neck had penetrated the wall of the right pleural cavity and the upper portion of the right lung whereas the other stab wound in the anterior chest wall had penetrated the right diaphragm and the heart. To illustrate the tracks of the stab wounds, superimposed CT images of the body, the excised organ, and a knife model were constructed to obtain a 3D model. This allowed clear and concise visualization of the complex relationship of the knife to the heart incision and the stab wound on the chest surface.
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Affiliation(s)
- Yoichiro Takahashi
- Department of Legal Medicine, Graduate School of Medicine, Gunma University, Maebashi, Japan
| | - Rie Sano
- Department of Legal Medicine, Graduate School of Medicine, Gunma University, Maebashi, Japan
| | - Akira Hayakawa
- Department of Legal Medicine, Graduate School of Medicine, Gunma University, Maebashi, Japan
| | - Haruki Fukuda
- Department of Legal Medicine, Graduate School of Medicine, Gunma University, Maebashi, Japan
| | - Rieko Kubo
- Department of Legal Medicine, Graduate School of Medicine, Gunma University, Maebashi, Japan
| | - Takafumi Okawa
- Department of Legal Medicine, Graduate School of Medicine, Gunma University, Maebashi, Japan
| | - Hiroyuki Tokue
- Department of Diagnostic Radiology & Nuclear Medicine, Graduate School of Medicine, Gunma University, Maebashi, Japan
| | - Hiroyuki Takei
- Department of Radiology, Gunma University Hospital, Maebashi, Japan
| | - Yoshihiko Kominato
- Department of Legal Medicine, Graduate School of Medicine, Gunma University, Maebashi, Japan
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Kranioti EF, Nathena D, Spanakis K, Karantanas A, Bouhaidar R, McLaughlin S, Thali MJ, Ampanozi G. Unenhanced PMCT in the diagnosis of fatal traumatic brain injury in a charred body. J Forensic Leg Med 2020; 77:102093. [PMID: 33316735 DOI: 10.1016/j.jflm.2020.102093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 11/18/2020] [Accepted: 12/03/2020] [Indexed: 10/22/2022]
Abstract
Traffic incidents are one of the most frequent causes of death in young adults worldwide. Depending on the location of the incident, the velocity of the vehicle(s), the weather condition, traffic incidents are often complicated making the investigation of the circumstances difficult. Here we report a case of an incinerated body involved in a vehicle incident. Differential diagnosis included natural cause of death during driving, fatal traumatic injuries, death due to fire and positional asphyxia. The body was submitted to PMCT prior to autopsy as part of a research protocol (N. 1388/2016) at the Department of Medical Imaging of the University Hospital of Heraklion in Crete, Greece. Unenhanced PMCT revealed craniofacial fractures, a thin film of subdural haemorrhage and an epidural fluid collection. The findings were interpreted as consistent with an impact to the face, causing craniofacial fractures mainly on the right side, and an acute subdural hematoma. Autopsy findings corroborated the diagnosis. The epidural hematoma was deemed to be post-mortem heat-induced. This case is an excellent example of the diagnostic value of PMCT in the medicolegal investigation of death.
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Affiliation(s)
- Elena F Kranioti
- Forensic Medicine Unit, Department of Forensic Sciences, Medical School, University of Crete, Heraklion, Greece; Edinburgh Forensic Radiology and Anthropology Imaging Centre, Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh, UK.
| | - Despoina Nathena
- Forensic Medicine Unit, Department of Forensic Sciences, Medical School, University of Crete, Heraklion, Greece.
| | | | - Apostolos Karantanas
- Department of Medical Imaging, Heraklion University Hospital, Heraklion, Greece.
| | - Ralph Bouhaidar
- Division of Forensic Pathology, Medical School, University of Edinburgh, UK; Edinburgh Forensic Radiology and Anthropology Imaging Centre, Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh, UK.
| | - Siobhan McLaughlin
- Edinburgh Forensic Radiology and Anthropology Imaging Centre, Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh, UK.
| | - Michael J Thali
- Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, 8057, Zurich, Switzerland.
| | - Garyfalia Ampanozi
- Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, 8057, Zurich, Switzerland.
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Ribas LM, Massad MRR, Pinto ACBCF, Heng HG, Tremori TM, Reis STJ, Baroni CO, Massad E, Rocha NS. Post-mortem CT vs necropsy in feline medicine. J Feline Med Surg 2020; 22:1206-1213. [PMID: 32436802 PMCID: PMC10814360 DOI: 10.1177/1098612x20919310] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVES The aim of this study was to compare post-mortem CT findings with necropsy findings in domestic cats. METHODS Post-mortem CT and necropsies were performed in 20 cadavers of domestic cats. The sensitivity, specificity and agreement between the post-mortem CT and necropsy findings were determined. RESULTS There were a total of 315 post-mortem findings; 183 were identified by post-mortem CT and 132 were identified by necropsy. Post-mortem CT demonstrated a higher sensitivity to identify the findings mainly in bones. The higher indices of agreement between post-mortem CT and necropsy were related to abnormalities of pleural space, bones and joints. CONCLUSIONS AND RELEVANCE This study demonstrated that post-mortem CT and necropsy provided different information. Thus, their use in conjunction with each other might improve the understanding of the cause of death and the identification of post-mortem lesions.
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Affiliation(s)
- Laila M Ribas
- Department of Veterinary Clinical Sciences, School of Veterinary Medicine and Animal Science, São Paulo State University, Botucatu, Brazil
| | - Mara RR Massad
- Department of Veterinary Clinical Sciences, School of Veterinary Medicine and Animal Science, São Paulo State University, Botucatu, Brazil
| | - Ana CBCF Pinto
- Surgery Department, School of Veterinary Medicine and Animal Science, University of São Paulo, São Paulo, Brazil
| | - Hock Gan Heng
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, IN, USA
| | - Tália M Tremori
- Department of Veterinary Clinical Sciences, School of Veterinary Medicine and Animal Science, São Paulo State University, Botucatu, Brazil
| | - Sérvio TJ Reis
- Department of Veterinary Clinical Sciences, School of Veterinary Medicine and Animal Science, São Paulo State University, Botucatu, Brazil
| | - Carina O Baroni
- Surgery Department, School of Veterinary Medicine and Animal Science, University of São Paulo, São Paulo, Brazil
| | - Eduardo Massad
- School of Applied Mathematics of the Fundação Getulio Vargas, Rio de Janeiro, Brazil
| | - Noeme S Rocha
- Department of Veterinary Clinical Sciences, School of Veterinary Medicine and Animal Science, São Paulo State University, Botucatu, Brazil
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48
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Mamabolo B, Alblas A, Brits D. Modern imaging modalities in forensic anthropology and the potential of low-dose X-rays. FORENSIC IMAGING 2020. [DOI: 10.1016/j.fri.2020.200406] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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49
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Kondou H, Tsuboi H, Takazakura R, Nakamura M, Bandou R, Ichioka H, Idota N, Ikegaya H. Diagnosis of sudden death using postmortem CT. FORENSIC IMAGING 2020. [DOI: 10.1016/j.fri.2020.200411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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50
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Hueck U, Muggenthaler H, Hubig M, Heinrich A, Güttler F, Wagner R, Mall G, Teichgräber U. Forensic postmortem computed tomography in suspected unnatural adult deaths. Eur J Radiol 2020; 132:109297. [PMID: 33035918 DOI: 10.1016/j.ejrad.2020.109297] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 09/04/2020] [Accepted: 09/18/2020] [Indexed: 01/16/2023]
Abstract
PURPOSE Our study sought to evaluate validity of forensic postmortem CT in establishing cause of death (COD) in suspected unnatural adult death based on the reference standard of autopsy. METHODS In our prospective, single-center study, 64 of 94 consecutive corpses (70.7 % male, mean age: 47.4 years) who underwent CT and autopsy between November 2013 and April 2019 were included in the analysis. Primary objective was agreement between CT and autopsy on primary COD using kappa statistics. Secondary objectives were competing COD and specific pathological findings. RESULTS Agreement on primary COD between forensic CT and autopsy without or in consideration of toxicological and histological findings was strong (85.9 % [55 of 64 corpses]; κ = 0.83 [95 %CI: 0.74 to 0.93] and 95.3 % [61 of 64 corpses]; κ = 0.94 [95 %CI: 0.84-1.04], respectively, McNemar p = 0.03). Sensitivity and specificity of CT in identification of acute heart failure, intracranial bleeding, burns and heat shocks, gunshot wounds, polytrauma, cranio-cerebral trauma, and strangulation or hanging was 100 %, each. Acute respiratory failure was detected with a sensitivity and specificity of 100 % and 96.8 %, cuts and stab wounds with 95.2 % and 100 %, and intoxication, pneumonia, or gastrointestinal bleeding with 60.0 % and 100 %, respectively. Agreement on competing COD was moderate (51.6 %, [33 of 64 corpses]; κ = 0.47 [95 %CI: 0.40 to 0.53], p < 0.001). CONCLUSIONS Forensic postmortem CT, complemented by external, toxicological, and histological examination was sufficiently valid to assess primary COD in the majority of suspected unnatural deaths with few restrictions.
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Affiliation(s)
- U Hueck
- Department of Radiology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - H Muggenthaler
- Department of Forensic Medicine, Jena University Hospital, Jena, Am Klinikum 1, 07747, Jena, Germany
| | - M Hubig
- Department of Forensic Medicine, Jena University Hospital, Jena, Am Klinikum 1, 07747, Jena, Germany
| | - A Heinrich
- Department of Radiology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - F Güttler
- Department of Radiology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - R Wagner
- Department of Forensic Medicine, Jena University Hospital, Jena, Am Klinikum 1, 07747, Jena, Germany
| | - G Mall
- Department of Forensic Medicine, Jena University Hospital, Jena, Am Klinikum 1, 07747, Jena, Germany
| | - U Teichgräber
- Department of Radiology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany.
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