1
|
Ishida M, Gonoi W, Abe H, Ushiku T, Abe O. Essence of postmortem computed tomography for in-hospital deaths: what clinical radiologists should know. Jpn J Radiol 2023; 41:1039-1050. [PMID: 37193920 PMCID: PMC10543514 DOI: 10.1007/s11604-023-01443-w] [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: 02/13/2023] [Accepted: 05/06/2023] [Indexed: 05/18/2023]
Abstract
Postmortem computed tomography (CT) is an essential tool for investigating the causes of death. Postmortem CT has characteristic imaging findings and should not be interpreted in the same manner as clinical antemortem images. In analyzing the cause of death in in-hospital death cases using postmortem images, it is crucial to understand early postmortem and post-resuscitation changes. In addition, it is essential to understand the limitations of diagnosing the cause of death or significant pathology relating to death on non-contrast-enhanced postmortem CT. In Japan, there has also been social demand to establish a system for postmortem imaging at the time of death. To facilitate such a system, clinical radiologists should be prepared to interpret postmortem images and assess the cause of death. This review article provides comprehensive information regarding unenhanced postmortem CT for in-hospital death cases in daily clinical practice in Japan.
Collapse
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
| | - 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
| |
Collapse
|
2
|
Fujimoto K, Gonoi W, Ishida M, Okimoto N, Nyunoya K, Abe H, Ushiku T, Abe O. Association between postmortem computed tomography value of cerebrospinal fluid and time after death: A longitudinal study of antemortem and postmortem computed tomography. J Forensic Leg Med 2023; 93:102461. [PMID: 36470057 DOI: 10.1016/j.jflm.2022.102461] [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: 08/18/2022] [Revised: 11/16/2022] [Accepted: 11/25/2022] [Indexed: 12/03/2022]
Abstract
This study was designed to examine the antemortem factors affecting cerebrospinal fluid (CSF) Hounsfield Units (HU) on postmortem computed tomography (PMCT) compared to the antemortem CT (AMCT). Fifty-five participants without brain lesions who died at a university hospital and underwent AMCT, PMCT, and an autopsy were enrolled. We recorded age, sex, time after death, the CSF HU on AMCT and PMCT at multiple measuring points, 4-point-scale brain atrophy grade on AMCT, and the cella media index. We tested the effects of CSF HU factors observed on PMCT. No significant differences were observed between CSF HUs at any of the PMCT measurement points. The average CSF HU on PMCT was positively correlated with the natural logarithm of the time after death (Pearson's correlation coefficient, 0.81; p < 0.001). No other factors showed correlative relationships. Up until approximately 12 h after death, the CSF HU on PMCT depended only on the time since death.
Collapse
Affiliation(s)
- Kotaro Fujimoto
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Wataru Gonoi
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
| | - Masanori Ishida
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Naomasa Okimoto
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Keisuke Nyunoya
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroyuki Abe
- Department of Pathology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Tetsuo Ushiku
- Department of Pathology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Osamu Abe
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| |
Collapse
|
3
|
Post mortem computed tomography meets radiomics: a case series on fractal analysis of post mortem changes in the brain. Int J Legal Med 2022; 136:719-727. [PMID: 35239030 PMCID: PMC9005394 DOI: 10.1007/s00414-022-02801-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 02/14/2022] [Indexed: 10/26/2022]
Abstract
Estimating the post-mortem interval is a fundamental, albeit challenging task in forensic sciences. To this aim, forensic practitioners need to assess post-mortem changes through a plethora of different methods, most of which are inherently qualitative, thus providing broad time intervals rather than precise determinations. This challenging problem is further complicated by the influence of environmental factors, which modify the temporal dynamics of post-mortem changes, sometimes in a rather unpredictable fashion. In this context, the search for quantitative and objective descriptors of post-mortem changes is highly demanded. In this study, we used computed tomography (CT) to assess the post-mortem anatomical modifications occurring in the time interval 0-4 days after death in the brain of four corpses. Our results show that fractal analysis of CT brain slices provides a set of quantitative descriptors able to map post-mortem changes over time throughout the whole brain. Although incapable of producing a direct estimation of the PMI, these descriptors could be used in combination with other more established methods to improve the accuracy and reliability of PMI determination.
Collapse
|
4
|
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.
Collapse
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
| |
Collapse
|
5
|
The role of PMCT for the assessment of the cause of death in natural disaster (landslide and flood): a Sicilian experience. Int J Legal Med 2021; 136:237-244. [PMID: 34476607 PMCID: PMC8813687 DOI: 10.1007/s00414-021-02683-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 08/09/2021] [Indexed: 11/12/2022]
Abstract
In this report, the authors provide a contribution of PMCT in assessing the cause of death due to natural disasters. Here, the PMCT findings of 43 subjects who died during both landslide and flood were described. The post-mortem imaging revealed, clearly, traumatic injuries and/or the presence of foreign material in airways allowing to assess the cause of death of each subject, together with external inspection and the collected circumstantial data. Particularly, the PMCT has been helpful for characterization and localization of the clogging substance in airways providing findings on bronchial branches involvement. Moreover, the investigation offered detailed data on skeletal injuries in all anatomic districts and put in evidence both the precise fracturing site and the characteristics of fracture stubs for each bone fracture. This report supports the recommendation of the virtual autopsy in a case with several victims, as in natural disasters, and its role as an alternative diagnostic investigation when the standard autopsy is not feasible.
Collapse
|
6
|
Yu K, Yi M, Cui R, Gong T, Dong C, Gao X, Zhao J, Li M. Computed Tomography Measurement and Evaluation of the Subarachnoid Space Over Cerebral Convexities in Infants Aged 1-24 Months. J Child Neurol 2021; 36:447-452. [PMID: 33331188 DOI: 10.1177/0883073820977998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A widened subarachnoid space might be pathologic, potentially pathologic, or simply a normal developmental variant. However, the definition of a normal subarachnoid space width in infants remains unclear, especially on computed tomography (CT) images. To determine the physiological subarachnoid space width among infants aged 1-24 months, its upper limit, and changes with age, we measured the cerebrospinal fluid width on 538 CT images. Measurements were obtained at fixed planes and fixed positions to prevent variance and increase comparability between patients. We observed an asymmetry in the cerebrospinal fluid width of the temporal region. The width increased in all positions until 4-6 months of age, after which it began to decrease, reaching a relatively stable range in infants aged 13-24 months. We suggest considering the 95th percentile of the cerebrospinal fluid width as the upper limit. The correlation between age and the subarachnoid space width should be considered during clinical diagnosing.
Collapse
Affiliation(s)
- Ke Yu
- Department of Radiology, Jinan Children's Hospital, Jinan, Shandong, China
| | - Minggang Yi
- Department of Radiology, Jinan Children's Hospital, Jinan, Shandong, China
| | - Ruodi Cui
- Department of Radiology, Jinan Children's Hospital, Jinan, Shandong, China
| | - Tao Gong
- 159394Shandong Medical Imaging Research Institute, Jinan, Shandong, China
| | - Chunhua Dong
- Department of Radiology, Jinan Children's Hospital, Jinan, Shandong, China
| | - Xin Gao
- Department of Radiology, Jinan Children's Hospital, Jinan, Shandong, China
| | - Jianshe Zhao
- Department of Radiology, Jinan Children's Hospital, Jinan, Shandong, China
| | - Min Li
- Department of Nuclear Medicine, 205371960th Hospital of PLA, Jinan, Shandong, China
| |
Collapse
|
7
|
Automated liver segmentation from a postmortem CT scan based on a statistical shape model. Int J Comput Assist Radiol Surg 2016; 12:205-221. [PMID: 27659283 DOI: 10.1007/s11548-016-1481-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 08/31/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE Automated liver segmentation from a postmortem computed tomography (PMCT) volume is a challenging problem owing to the large deformation and intensity changes caused by severe pathology and/or postmortem changes. This paper addresses this problem by a novel segmentation algorithm using a statistical shape model (SSM) for a postmortem liver. METHODS The location and shape parameters of a liver are directly estimated from a given volume by the proposed SSM-guided expectation-maximization (EM) algorithm without any spatial standardization that might fail owing to the large deformation and intensity changes. The estimated location and shape parameters are then used as a constraint of the subsequent fine segmentation process based on graph cuts. Algorithms with eight different SSMs were trained using 144 in vivo and 32 postmortem livers, and the segmentation algorithm was tested on 32 postmortem livers in a twofold cross validation manner. The segmentation performance is measured by the Jaccard index (JI) between the segmentation result and the true liver label. RESULTS The average JI of the segmentation result with the best SSM was 0.8501, which was better compared with the results obtained using conventional SSMs and the results of the previous postmortem liver segmentation with statistically significant difference. CONCLUSIONS We proposed an algorithm for automated liver segmentation from a PMCT volume, in which an SSM-guided EM algorithm estimated the location and shape parameters of a liver in a given volume accurately. We demonstrated the effectiveness of the proposed algorithm using actual postmortem CT volumes.
Collapse
|
8
|
Morikawa K, Hyodoh H, Matoba K, Mizuo K, Okazaki S, Watanabe S. Time-related change evaluation of the cerebrospinal fluid using postmortem CT. Leg Med (Tokyo) 2016; 22:30-5. [DOI: 10.1016/j.legalmed.2016.07.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 07/29/2016] [Accepted: 07/31/2016] [Indexed: 10/21/2022]
|