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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.
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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
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2
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Ikeda-Murakami K, Ikeda T, Watanabe M, Tani N, Ishikawa T. Central nervous system stimulants promote nerve cell death under continuous hypoxia. Hum Cell 2022; 35:1391-1407. [PMID: 35737220 DOI: 10.1007/s13577-022-00734-0] [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: 04/26/2022] [Accepted: 06/02/2022] [Indexed: 11/26/2022]
Abstract
Intake of central nervous system (CNS) stimulants causes hypoxia and brain edema, which results in nerve cell death. However, no study has yet investigated the direct and continuous effects on nerve cells of CNS stimulants under hypoxia. Thus, based on autopsy cases, the effects of CNS stimulant drugs on the CNS were examined. The pathological changes in cultured nerve cells when various CNS stimulants were added under a hypoxic condition were also investigated. Five groups (Group A, stimulants; Group B, stimulants with psychiatric drugs; Group C, caffeine; Group D, psychiatric drugs; and Group E, no drugs) according to the detected drugs in autopsy cases were compared, and brain edema was evaluated using morphological findings. Furthermore, the number of dead cultured nerve cells was counted after the addition of drugs (4-aminopyridine (4-AP), caffeine, and ephedrine) under hypoxia (3% O2). Staining with anti-receptor-interacting protein 3 (RIP3) and other associated stains was also performed to investigate the neuronal changes in the brain. Group A showed significantly more brain edema than the other groups. In the culture experiments, the ratio of nerve cell death after the addition of 4-AP was the highest in the hypoxic condition. Groups with stimulants detected were stained more strongly by RIP3 immunostaining than by other staining. Addition of stimulants to cultured nerve cells in a persistent hypoxic condition led to severe cytotoxicity and nerve cell death. These findings suggest that necroptosis is involved in nerve cell death due to the addition of CNS stimulants in the hypoxic condition.
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Affiliation(s)
- Kei Ikeda-Murakami
- Department of Legal Medicine, Osaka City University Medical School, 1-4-3 Asahi-machi, Abeno, Osaka, 545-8585, Japan.
| | - Tomoya Ikeda
- Department of Legal Medicine, Graduate School of Medicine, Osaka Metropolitan University, 1-4-3 Asahi-machi, Abeno, Osaka, 545-8585, Japan
- Forensic Autopsy Section, Medico-Legal Consultation and Postmortem Investigation Support Center, Department of Legal Medicine, Osaka Metropolitan University, 1-4-3 Asahi-machi, Abeno, Osaka, 545-8585, Japan
| | - Miho Watanabe
- Laboratory of Clinical Regenerative Medicine, Department of Neurosurgery, Faculty of Medicine, Health and Medical Science Innovation Laboratory 403, University of Tsukuba, Tsukuba City, Ibaraki, 305-8575, Japan
| | - Naoto Tani
- Department of Legal Medicine, Graduate School of Medicine, Osaka Metropolitan University, 1-4-3 Asahi-machi, Abeno, Osaka, 545-8585, Japan
- Forensic Autopsy Section, Medico-Legal Consultation and Postmortem Investigation Support Center, Department of Legal Medicine, Osaka Metropolitan University, 1-4-3 Asahi-machi, Abeno, Osaka, 545-8585, Japan
| | - Takaki Ishikawa
- Department of Legal Medicine, Graduate School of Medicine, Osaka Metropolitan University, 1-4-3 Asahi-machi, Abeno, Osaka, 545-8585, Japan
- Forensic Autopsy Section, Medico-Legal Consultation and Postmortem Investigation Support Center, Department of Legal Medicine, Osaka Metropolitan University, 1-4-3 Asahi-machi, Abeno, Osaka, 545-8585, Japan
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3
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Bauer M, Berger C, Gerlach K, Scheurer E, Lenz C. Post mortem evaluation of brain edema using quantitative MRI. Forensic Sci Int 2022; 337:111376. [DOI: 10.1016/j.forsciint.2022.111376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 05/30/2022] [Accepted: 06/26/2022] [Indexed: 11/30/2022]
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Shchegolev AI, Tumanova UN, Savva OV. [Postmortem assessment of cerebral edema]. Arkh Patol 2022; 84:74-80. [PMID: 36469722 DOI: 10.17116/patol20228406174] [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] [Indexed: 06/17/2023]
Abstract
An analysis of literature data on the methods of post-mortem assessment of cerebral edema is presented. Based on the mechanisms of development, two main types of cerebral edema are distinguished: cytotoxic (intracellular) and vasogenic (extracellular). To determine cerebral edema, a number of methods are used, both direct and indirect, invasive and non-invasive assessment. Direct methods for assessing cerebral edema are based on determining the amount of water in its tissue. Indirect methods include morphological and radiation studies. Traditionally, the most evidence-based criteria for the diagnosis of cerebral edema are macroscopic and microscopic changes determined at autopsy. Methods are also indicated for determining the content of water in brain tissue by comparing the mass of wet and dry brain, as well as estimating the specific density of brain tissue.
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Affiliation(s)
- A I Shchegolev
- National Medical Research Center for Obstetrics, Gynecology and Perinatology named after academician V.I. Kulakov, Moscow, Russia
| | - U N Tumanova
- National Medical Research Center for Obstetrics, Gynecology and Perinatology named after academician V.I. Kulakov, Moscow, Russia
| | - O V Savva
- National Medical Research Center for Obstetrics, Gynecology and Perinatology named after academician V.I. Kulakov, Moscow, Russia
- Bureau of Forensic Medicine named after D.I. Mastbaum, Ryazan, Russia
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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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Okimoto N, Ishida M, Abe H, Ikemura M, Fujimoto K, Kanemaru N, Ushiku T, Abe O, Gonoi W. Delayed cerebral enhancement on post-mortem computed tomography due to residual contrast medium administered shortly before death. Radiol Case Rep 2021; 16:2056-2060. [PMID: 34158893 PMCID: PMC8203565 DOI: 10.1016/j.radcr.2021.04.065] [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: 03/23/2021] [Revised: 04/20/2021] [Accepted: 04/21/2021] [Indexed: 12/05/2022] Open
Abstract
Postmortem computed tomography (CT) is currently a well-known procedure and helps in postmortem investigations. In this case report, we report a unique postmortem CT finding: delayed cerebral enhancement associated with the antemortem infusion of contrast medium. A 72-year-old female lost consciousness at a restaurant and was taken to a hospital in an ambulance. Despite resuscitation efforts, she died of hypoxic–ischemic encephalopathy caused by cardiac arrest. About 6 h before her death, she underwent enhanced antemortem CT of the head. No abnormal enhancement was observed in the cerebral parenchyma. Then, 11 h after her death, she underwent unenhanced postmortem CT, which showed bilateral hyperdense caudate nucleus and putamina, due to residual iodinated contrast medium, in addition to other characteristic findings of hypoxic–ischemic encephalopathy. The mechanism underlying this phenomenon could be the destruction of the blood–brain barrier, and/or selective vulnerability, due to hypoxic–ischemic changes in the gray matter. Enhancement of basal ganglia on postmortem CT due to antemortem infusion of iodinated contrast medium might suggest hypoxic–ischemic encephalopathy, which should be noted in postmortem CT interpretations.
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Affiliation(s)
- Naomasa Okimoto
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Masanori Ishida
- 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
| | - Masako Ikemura
- Department of Pathology, 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
| | - Noriko Kanemaru
- 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
| | - Wataru Gonoi
- 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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Alrayashi R, Braun RD, Muca A, Kühl A, Hali M, Holt AG. Postmortem neuroimaging: Temporal and spatial sensitivity of manganese-enhanced magnetic resonance imaging (MEMRI) and impact of Mn 2+ uptake. Hear Res 2021; 407:108276. [PMID: 34107410 DOI: 10.1016/j.heares.2021.108276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 04/20/2021] [Accepted: 05/08/2021] [Indexed: 11/29/2022]
Abstract
Magnetic resonance imaging data collection and analysis have been challenges in the field of auditory neuroscience. Recent studies have addressed these concerns by using manganese-enhanced magnetic resonance imaging (MEMRI). Basic challenges for in vivo application of MEMRI in rodents includes how to set inclusion criteria for adequate Mn2+ uptake and whether valid data can be collected from brains postmortem. Since brain Mn2+ uptake is complete within 2-4 h and clearance can take 2-4 weeks, one assumption has been that Mn2+-enhanced R1 values continue to reliably reflect the degree of Mn2+-uptake for some indeterminate time after death. To address these issues, the impact of death on R1 values was determined in rats administered Mn2+ and rats that were not. Images of auditory nuclei were collected at fixed intervals from rats before and after death for up to 10 h postmortem. By taking a ratio of pituitary and muscle T1-W intensities (P/M), a reliable quantitative method for assessing adequate brain Mn2+ uptake was created and suggest that P/M ratios should be adopted to objectively measure the quality of the Mn2+ injection. Postmortem R1 values decreased in all brain regions in both the After Mn2+ and No Mn2+ groups. However, the time-course of postmortem changes in R1 was dependent on brain region and degree of Mn2+ uptake. Thus, postmortem R1 values not only differ after death, but vary with time and across brain regions. Postmortem R1 values in unfixed brain tissue, including the auditory nuclei, should be interpreted with caution.
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Affiliation(s)
- Rasheed Alrayashi
- Department of Ophthalmology, Visual, and Anatomical Sciences, Wayne State University School of Medicine, Detroit, MI, USA
| | - Rod D Braun
- Department of Ophthalmology, Visual, and Anatomical Sciences, Wayne State University School of Medicine, Detroit, MI, USA
| | - Antonela Muca
- Department of Ophthalmology, Visual, and Anatomical Sciences, Wayne State University School of Medicine, Detroit, MI, USA
| | - André Kühl
- Department of Ophthalmology, Visual, and Anatomical Sciences, Wayne State University School of Medicine, Detroit, MI, USA
| | - Mirabela Hali
- Department of Ophthalmology, Visual, and Anatomical Sciences, Wayne State University School of Medicine, Detroit, MI, USA
| | - Avril Genene Holt
- Department of Ophthalmology, Visual, and Anatomical Sciences, Wayne State University School of Medicine, Detroit, MI, USA; John D. Dingell VAMC, Detroit, MI, USA.
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Bauer M, Deigendesch N, Wittig H, Scheurer E, Lenz C. Tissue sample analysis for post mortem determination of brain edema. Forensic Sci Int 2021; 323:110808. [PMID: 33971505 DOI: 10.1016/j.forsciint.2021.110808] [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: 01/11/2021] [Revised: 04/19/2021] [Accepted: 04/20/2021] [Indexed: 10/21/2022]
Abstract
The post mortem evaluation of a brain edema is routinely performed by pathologists based on the macroscopic signs during autopsy. This method represents the current gold standard, but is subjective and observer dependent. Therefore, three post mortem evaluation methods of brain samples were analyzed in this work: histology, wet-dry weight and normalized cerebral weight, which was described in 2020 by Bauer et al. Tissue samples from six different regions of 34 brains were collected and examined both by rating of histological slides and by measuring the water content by using a drying oven. The rating of the histological slides, stained with hematoxylin and eosin, was performed by two pathologists independently. For the water content, the wet weight and the dry weight of each sample were set in relation. The normalized cerebral weight was calculated by dividing the brain weight by the brain volume, which were both determined during autopsy and in computed tomography images, respectively. A fair to moderate interrater agreement was obtained for the histologic evaluation and a significant correlation was present between one rater and the wet-dry weight and the normalized cerebral weight method. When classifying according to the gold standard, a significant difference was detected between the edematous and nonedematous cases by using the wet-dry weight method in the cerebral cortex and by using the normalized cerebral weight method. However, the significant correlations and group differences were limited to the aforementioned results. In conclusion, both the histological and the wet-dry weight method show limited benefits for the classification of brain edema and the histology analysis is highly observer dependent. The normalized cerebral weight method, however, reveals a significant effect between the edematous and nonedematous cases when classifying according to the gold standard. Therefore, we suggest to apply this method for the assessment of brain edema since it is objective and rater independent. Nevertheless, the exact evaluation of brain edema remains a challenging task, especially due to the continuous transition between no edema and edema.
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Affiliation(s)
- Melanie Bauer
- Institute of Forensic Medicine, Department of Biomedical Engineering, University of Basel, Basel, Switzerland; Institute of Forensic Medicine, Health Department Basel-Stadt, Basel, Switzerland.
| | - Nikolaus Deigendesch
- Institute of Medical Genetics and Pathology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Holger Wittig
- Institute of Forensic Medicine, Department of Biomedical Engineering, University of Basel, Basel, Switzerland; Institute of Forensic Medicine, Health Department Basel-Stadt, Basel, Switzerland
| | - Eva Scheurer
- Institute of Forensic Medicine, Department of Biomedical Engineering, University of Basel, Basel, Switzerland; Institute of Forensic Medicine, Health Department Basel-Stadt, Basel, Switzerland
| | - Claudia Lenz
- Institute of Forensic Medicine, Department of Biomedical Engineering, University of Basel, Basel, Switzerland; Institute of Forensic Medicine, Health Department Basel-Stadt, Basel, Switzerland
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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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Deininger-Czermak E, Heimer J, Tappero C, Thali MJ, Gascho D. The added value of postmortem magnetic resonance imaging in cases of hanging compared to postmortem computed tomography and autopsy. Forensic Sci Med Pathol 2020; 16:234-242. [PMID: 32221850 DOI: 10.1007/s12024-020-00233-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2020] [Indexed: 11/26/2022]
Abstract
The purpose of this study was to evaluate the added value of postmortem magnetic resonance imaging (MRI) compared to postmortem computed tomography (CT) and autopsy in cases of fatal hanging. In addition, the study analyzed the strengths of each examination method regarding typical injuries in these cases. We investigated a cohort of 25 decedents who underwent CT, MRI and autopsy. Two radiologists assessed all MR images of the head and neck as well as the corresponding CT images. The results were compared to autopsy findings by retrospectively analyzing the autopsy reports. Postmortem MRI revealed intramuscular hemorrhages in a large number of cases, however, autopsy did not confirm all of the detected hemorrhages. CT and autopsy detected fractures in several cases, whereas MRI showed a fracture in just one single case. Other previously described vital signs and relevant findings, such as fracture-related gas bubbles, soft tissue emphysema or pneumomediastinum, were observed in only a few individual cases. MRI provided added diagnostic value in the detection of soft tissue injuries and lymph node swelling in fatal hangings. As an adjunct to autopsy, postmortem MRI may reveal additional hemorrhages, which might be missed at autopsy. Since standard MRI demonstrated low sensitivity for the detection of fractures, an additional imaging modality or autopsy is required to overcome this limitation.
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Affiliation(s)
- Eva Deininger-Czermak
- Department of Forensic Medicine and Imaging, Zurich Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse, 190/52, CH-8057, Zurich, Switzerland.
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland.
| | - Jakob Heimer
- Department of Forensic Medicine and Imaging, Zurich Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse, 190/52, CH-8057, Zurich, Switzerland
| | - Carlo Tappero
- Department of Forensic Medicine and Imaging, Zurich Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse, 190/52, CH-8057, Zurich, Switzerland
- Department of Radiology, Hôpital Fribourgeois, Fribourg, Switzerland
| | - Michael J Thali
- Department of Forensic Medicine and Imaging, Zurich Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse, 190/52, CH-8057, Zurich, Switzerland
| | - Dominic Gascho
- Department of Forensic Medicine and Imaging, Zurich Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse, 190/52, CH-8057, Zurich, Switzerland
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Takahashi N, Yajima K, Otaki M, Yoshikawa Y, Ishihara A, Sato Y, Higuchi T, Takatsuka H. Postmortem volume change of the spleen and kidney on early postmortem computed tomography: comparison with antemortem computed tomography. Jpn J Radiol 2019; 37:534-542. [PMID: 31069621 DOI: 10.1007/s11604-019-00841-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 04/22/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE To clarify an early postmortem change, we investigated the volume changes of the spleen and kidney on postmortem CT compared with antemortem CT in the same patients. MATERIALS AND METHODS We retrospectively evaluated the volumes of 56 spleens (56 cases) and 50 kidneys (25 cases) using antemortem and postmortem CT, which were performed within 168 min after death. We divided the cases of spleen analysis into a hemorrhagic group (n = 12) and a non-hemorrhagic group (n = 44). RESULTS The volumes of the organs before and after death were 101.0 ± 70.9 (cm3, mean ± standard deviation) and 81.1 ± 57.8 in spleens, 120.3 ± 49.2 and 109.2 ± 39.2 in kidneys, respectively. Both spleens and kidneys shrank after death (p < 0.05). The volumes of spleens before and after death were 111 ± 66.5 and 67.5 ± 27.7 in the hemorrhagic group, and 98.2 ± 72.5 and 84.9 ± 63.3 in the non-hemorrhagic group, respectively. The median value of the ratio of postmortem splenic volume to antemortem volume in the hemorrhagic group (65.0%) was smaller than the one in the non-hemorrhagic group (90.5%) (p < 0.05). CONCLUSION We demonstrated that spleens and kidneys significantly reduced in size after death. The rate of shrinkage of spleens in the hemorrhagic group significantly became larger than the one in the non-hemorrhagic group.
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Affiliation(s)
- Naoya Takahashi
- Department of Radiological Technology, Graduate School of Health Sciences, Niigata University, 2-746 Asahimachi-dori, Chuoku, Niigata, Niigata, 951-8518, Japan. .,Department of Diagnostic Radiology, Niigata City General Hospital, 463-7 Shumoku, Chuoku, Niigata, Niigata, 950-1197, Japan. .,Center for Cause of Death Investigation, Niigata University, 1-757 Asahimachi-dori, Chuoku, Niigata, Niigata, 951-8510, Japan.
| | - Keisuke Yajima
- Department of Radiological Technology, Graduate School of Health Sciences, Niigata University, 2-746 Asahimachi-dori, Chuoku, Niigata, Niigata, 951-8518, Japan.,Department of Radiological Technology, NTT Medical Center Tokyo, 5-9-22 Higashi-Gotanda, Shinagawa-ku, Tokyo, 141-8625, Japan
| | - Madoka Otaki
- Department of Radiological Technology, School of Health Sciences, Faculty of Medicine, Niigata University, 2-746 Asahimachi-dori, Chuoku, Niigata, Niigata, 951-8518, Japan.,Department of Radiological Technology, Niigata City General Hospital, 463-7 Shumoku, Chuoku, Niigata, Niigata, 950-1197, Japan
| | - Yurina Yoshikawa
- Department of Radiological Technology, School of Health Sciences, Faculty of Medicine, Niigata University, 2-746 Asahimachi-dori, Chuoku, Niigata, Niigata, 951-8518, Japan.,Department of Radiological Technology, St. Marianna University Yokohama City Seibu Hospital, 1197-1 Yasashicho, Asahiku, Yokohama, Kanagawa, 241-0811, Japan
| | - Ayumi Ishihara
- Department of Radiological Technology, School of Health Sciences, Faculty of Medicine, Niigata University, 2-746 Asahimachi-dori, Chuoku, Niigata, Niigata, 951-8518, Japan.,Department of Radiological Technology, University of Yamanashi Hospital, 1110, Shimokato, Chuo City, Yamanashi, 409-3898, Japan
| | - Yuki Sato
- Department of Radiological Technology, School of Health Sciences, Faculty of Medicine, Niigata University, 2-746 Asahimachi-dori, Chuoku, Niigata, Niigata, 951-8518, Japan.,Department of Radiological Technology, Fukushima Medical University Hospital, 1, Hikarigaoka, Fukushima, Fukushima, 960-1295, Japan
| | - Takeshi Higuchi
- Department of Diagnostic Radiology, Niigata City General Hospital, 463-7 Shumoku, Chuoku, Niigata, Niigata, 950-1197, Japan
| | - Hisakazu Takatsuka
- Center for Cause of Death Investigation, Niigata University, 1-757 Asahimachi-dori, Chuoku, Niigata, Niigata, 951-8510, Japan
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12
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Nishikimi M, Ogura T, Matsui K, Takahashi K, Fukaya K, Liu K, Morita H, Nakamura M, Matsui S, Matsuda N. Accuracy of the first interpretation of early brain CT images for predicting the prognosis of post-cardiac arrest syndrome patients at the emergency department. J Intensive Care 2018; 6:26. [PMID: 29721320 PMCID: PMC5918845 DOI: 10.1186/s40560-018-0296-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 04/16/2018] [Indexed: 11/10/2022] Open
Abstract
Background Early brain CT is one of the most useful tools for estimating the prognosis in patients with post-cardiac arrest syndrome (PCAS) at the emergency department (ED). The aim of this study was to evaluate the prognosis-prediction accuracy of the emergency physicians' interpretation of the findings on early brain CT in PCAS patients treated by targeted temperature management (TTM). Methods This was a double-center, retrospective, observational study. Eligible subjects were cardiac arrest patients admitted to the intensive care unit (ICU) for TTM between April 2011 and March 2017. We performed the McNemar test to compare the predictive accuracies of the interpretation by emergency physicians and radiologists and calculated the kappa statistic for determining the concordance rate between the interpretations by these two groups. Results Of the 122 eligible patients, 106 met the inclusion criteria for this study. The predictive accuracies (sensitivity, specificity) of the interpretations by the emergency physicians and radiologists were (0.34, 1.00) and (0.41, 0.93), respectively, with no significant difference in either the sensitivity or specificity as assessed by the McNemar test. The kappa statistic calculated to determine the concordance between the two interpretations was 0.66 (0.48-0.83), which showed a good conformity. Conclusions The emergency physicians' interpretation of the early brain CT findings in PCAS patients treated by TTM was as reliable as that of radiologists, in terms of prediction of the prognosis.
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Affiliation(s)
- Mitsuaki Nishikimi
- 1Department of Emergency and Critical Care, Nagoya University Graduate School of Medicine, Tsurumai-cho 64, Syowa-ku, Nagoya, Aichi 466-8560 Japan
| | - Takayuki Ogura
- Advanced Medical Emergency Department and Critical Care Center, Japan Red Cross Maebashi Hospital, Maebashi, Japan
| | - Kota Matsui
- 3Department of Biostatistics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kunihiko Takahashi
- 3Department of Biostatistics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kenji Fukaya
- 1Department of Emergency and Critical Care, Nagoya University Graduate School of Medicine, Tsurumai-cho 64, Syowa-ku, Nagoya, Aichi 466-8560 Japan
| | - Keibun Liu
- Advanced Medical Emergency Department and Critical Care Center, Japan Red Cross Maebashi Hospital, Maebashi, Japan
| | - Hideo Morita
- Department of Diagnostic Radiology, Japan Red Cross Maebashi Hospital, Maebashi, Japan
| | - Mitsunobu Nakamura
- Advanced Medical Emergency Department and Critical Care Center, Japan Red Cross Maebashi Hospital, Maebashi, Japan
| | - Shigeyuki Matsui
- 3Department of Biostatistics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Naoyuki Matsuda
- 1Department of Emergency and Critical Care, Nagoya University Graduate School of Medicine, Tsurumai-cho 64, Syowa-ku, Nagoya, Aichi 466-8560 Japan
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13
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Wagensveld IM, Blokker BM, Wielopolski PA, Renken NS, Krestin GP, Hunink MG, Oosterhuis JW, Weustink AC. Total-body CT and MR features of postmortem change in in-hospital deaths. PLoS One 2017; 12:e0185115. [PMID: 28953923 PMCID: PMC5617178 DOI: 10.1371/journal.pone.0185115] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 09/05/2017] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To evaluate the frequency of total-body CT and MR features of postmortem change in in-hospital deaths. MATERIALS AND METHODS In this prospective blinded cross-sectional study, in-hospital deceased adult patients underwent total-body postmortem CT and MR followed by image-guided biopsies. The presence of PMCT and PMMR features related to postmortem change was scored retrospectively and correlated with postmortem time interval, post-resuscitation status and intensive care unit (ICU) admittance. RESULTS Intravascular air, pleural effusion, periportal edema, and distended intestines occurred more frequently in patients who were resuscitated compared to those who were not. Postmortem clotting was seen less often in resuscitated patients (p = 0.002). Distended intestines and loss of grey-white matter differentiation in the brain showed a significant correlation with postmortem time interval (p = 0.001, p<0.001). Hyperdense cerebral vessels, intravenous clotting, subcutaneous edema, fluid in the abdomen and internal livores of the liver were seen more in ICU patients. Longer postmortem time interval led to a significant increase in decomposition related changes (p = 0.026). CONCLUSIONS There is a wide variety of imaging features of postmortem change in in-hospital deaths. These imaging features vary among clinical conditions, increase with longer postmortem time interval and must be distinguished from pathologic changes.
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Affiliation(s)
- Ivo M. Wagensveld
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Centre, Rotterdam, Zuid-Holland, The Netherlands
- Department of Pathology, Erasmus University Medical Centre, Rotterdam, Zuid-Holland, The Netherlands
- * E-mail:
| | - Britt M. Blokker
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Centre, Rotterdam, Zuid-Holland, The Netherlands
- Department of Pathology, Erasmus University Medical Centre, Rotterdam, Zuid-Holland, The Netherlands
| | - Piotr A. Wielopolski
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Centre, Rotterdam, Zuid-Holland, The Netherlands
| | - Nomdo S. Renken
- Department of Radiology, Reinier de Graaf Gasthuis, Delft, Zuid-Holland, The Netherlands
| | - Gabriel P. Krestin
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Centre, Rotterdam, Zuid-Holland, The Netherlands
| | - Myriam G. Hunink
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Centre, Rotterdam, Zuid-Holland, The Netherlands
- Centre for Health Decision Science, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, United States of America
| | - J. Wolter Oosterhuis
- Department of Pathology, Erasmus University Medical Centre, Rotterdam, Zuid-Holland, The Netherlands
| | - Annick C. Weustink
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Centre, Rotterdam, Zuid-Holland, The Netherlands
- Department of Pathology, Erasmus University Medical Centre, Rotterdam, Zuid-Holland, The Netherlands
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14
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Prognostic Utility of Computed Tomography Histogram Analysis in Patients With Post-Cardiac Arrest Syndrome: Evaluation Using an Automated Whole-Brain Extraction Algorithm. J Comput Assist Tomogr 2017; 40:612-6. [PMID: 26953771 DOI: 10.1097/rct.0000000000000396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The aim of the study was to evaluate the prognostic utility of computed tomography (CT) histogram analysis with an automated whole-brain extraction algorithm in patients with post-cardiac arrest syndrome (PCAS). METHODS Computed tomography data from consecutive patients between January 2009 and February 2012 were obtained and retrospectively analyzed. All CT images were obtained using a 64-detector-row CT scanner with a slice thickness of 4.0 mm. A brain region was extracted from the whole-brain CT images using our original automated algorithm and used for the subsequent histogram analysis. The obtained histogram statistics (mean brain tissue CT value, kurtosis, and skewness), as well as clinical parameters, were compared between the good and poor outcome groups using the Student t test. In addition, receiver operating characteristic curve analysis was performed for the discrimination between the 2 groups for each parameter. RESULTS One hundred thirty-eight consecutive PCAS patients were enrolled. The patients were classified into good (n = 47) and poor (n = 91) outcome groups. The mean brain tissue CT value was significantly higher in the good outcome group than in the poor outcome group (P < 0.05). Kurtosis, skewness, and age were significantly lower in the good outcome group than in the poor outcome group (P < 0.0001, P < 0.05, and P < 0.05, respectively). The area-under-the-curve values for kurtosis, mean brain tissue CT value, skewness, and age were 0.751, 0.639, 0.623, and 0.626, respectively. A combination of the 4 parameters increased the diagnostic performance (area under the curve = 0.814). CONCLUSIONS Histogram analysis of whole-brain CT images with our automated extraction algorithm is useful for assessing the outcome of PCAS patients.
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15
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Whole brain analysis of postmortem density changes of grey and white matter on computed tomography by statistical parametric mapping. Eur Radiol 2016; 27:2317-2325. [DOI: 10.1007/s00330-016-4633-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 08/17/2016] [Accepted: 10/03/2016] [Indexed: 10/20/2022]
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16
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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]
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17
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Papilledema as a Diagnostic Sign of Cerebral Edema on Postmortem Magnetic Resonance Imaging. Am J Forensic Med Pathol 2016; 37:264-269. [PMID: 27571174 DOI: 10.1097/paf.0000000000000265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The purpose of this study was to investigate papilledema (PA) as a diagnostic criterion for the presence of antemortem or agonal cerebral edema despite normal postmortem brain swelling on postmortem magnetic resonance imaging (PMMR) in comparison with conventional autopsy.One hundred subjects with head PMMR and autopsy were included in this study. The sensitivities, spec icities, positive predictive values (PPVs), negative predictive values (NPVs), and accuracies were calculated in terms of the PA, PMMR, and cerebral edema on autopsy. Spearman r tests were used to analyze the linear correlations of PA and the radiological and autoptic determination of cerebral edema.In autopsy, the sensitivity regarding the presence of PA and cerebral edema was 66.2% (PPV, 70.5%), and specificity was 48.6% (NPV, 28.3%), with an overall accuracy of 60%. On PMMR, the sensitivity was 86.6% (PPV, 95%). The specificity was 90.9% (NPV, 34%), with an overall accuracy of 88%. The Spearman correlation revealed a statistically significant result (P < 0.001), which indicated a strong linear correlation of the presence of PA and cerebral edema with the autopsy results and the PMMR results.The presence of PA may aid in the diagnoses of cerebral edema despite normal postmortem brain swelling based on PMMR.
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18
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Fetisov VA, Kuprina TA, Sinitsyn VE, Dubrova SE, Filimonov BA. [The foreign experience with the application of the modern radiodiagnostic methods for the estimation of prescription of death coming and time of infliction of injury]. Sud Med Ekspert 2016; 59:47-54. [PMID: 27358930 DOI: 10.17116/sudmed201659247-54] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
We undertook the analysis of the foreign publications concerning the application of the modern radiodiagnostic methods (including MSCT- and MRI-visualization) with reference to the solution of the traditional problems facing forensic medical expertise, such as the estimation of prescription of death coming and time of infliction of injury in the dead bodies. Both advantages and disadvantages of postmortem visualization of the corpses of adult subjects are discussed taking into consideration the period of time that elapsed between the death and the onset of the study as well as the character of the injuries. It was shown that the examination of the corpses using the up-to-date methods of radiodiagnostics prior to autopsy makes it possible for morphologists, jointly with radiologists, to identify, to see in the new light, and to evaluate the number of charges in the dead body, such as the alteration of the blood cell sedimentation rate, the formation of postmortem hypostases in the internal organs, the hardening of the walls of aorta and major blood vessels, right heart dilatation, gradual smoothing of the borderline between grey and white matter of the brain. Virtual autopsy can be useful , even for the study of such long-term processes in the corpses as putrefaction, saponification, mummification, and peat tanning. Moreover, this technique may be instrumental in the elucidation of the specific features of topographic-anatomical relationships between individual 'tissues and organs, detection of the concealed lesions, and a variety of pathological changes. Postmortem visualization allows for the quantitative evaluation of the severity of these transformations and the preliminary estimation of prescription of death coming. Also, radiodiagnostic methods can be employed to reliably visualize and measure various hemorrhagic events (from the density of such ones as liquid and clotted blood) in the tissues surrounding the fractures, in body cavities, and internal organs as well as to establish the facts of inter-vital aspiration of blood, alimentary masses, liquid and solid foreign bodies penetrating into the upper sections of the respiratory and gastrointestinal tracts as the consequence f an injury. It is concluded that the postmortem visualization techniques employed to estimate prescription of death coming and time of infliction of injury as well as other complicated problems facing forensic medical expertize need the further scientifically based development.
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Affiliation(s)
- V A Fetisov
- Federal state budgetary institution 'Russian Centre of Forensic Medical Expertise', Russian Ministry of Health, Moscow, Russia, 125284
| | - T A Kuprina
- Federal state budgetary institution 'Russian Centre of Forensic Medical Expertise', Russian Ministry of Health, Moscow, Russia, 125284
| | - V E Sinitsyn
- Therapeutic and Rehabilitative Centre of the Russian Ministry of Health, Moscow, Russia, 125367
| | - S E Dubrova
- M.F. Vladimirsky Moscow Regional Research Clinical Institute, Moscow, Russia, 129110
| | - B A Filimonov
- I.M. Sechenov Moscow First State Medical University, Moscow, Russia, 119991
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Shirota G, Ishida M, Shintani Y, Abe H, Ikemura M, Fukayama M, Gonoi W. Can postmortem computed tomography detect antemortem hypoxic-ischemic encephalopathy? Forensic Sci Med Pathol 2016; 12:267-75. [PMID: 27342771 DOI: 10.1007/s12024-016-9787-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2016] [Indexed: 10/21/2022]
Abstract
The purpose of this study was to evaluate the usefulness of brain postmortem computed tomography (PMCT) findings for the detection of global hypoxia or hypoperfusion leading to hypoxic-ischemic encephalopathy (HIE) prior to death. Cadavers of individuals who died from non-traumatic causes were subjected to PMCT and pathological autopsy. Cases with an episode of cardiopulmonary arrest, hypoxia, or hypoperfusion that required intensive respiratory management at least 24 h before death and exhibited findings of HIE in conventional autopsy (HIE group, n = 6) were compared with those without such episodes prior to death (control group; overall, n = 37; age-matched, n = 8) with regard to four parameters: (1) width of the central sulcus (CS), (2) attenuation difference at the basal ganglia (BG) level, (3) attenuation difference between cerebral gray matter (GM) and cerebral white matter (WM), and (4) attenuation difference between cerebellar GM and cerebral GM. The results revealed significant differences in the width of the CS (P < 0.001), attenuation difference at the BG level (P < 0.001), and attenuation difference between cerebral GM and cerebral WM (P = 0.009) between the HIE group and the overall control group. When the age-matched control group and the HIE group were compared, there was a significant difference in the width of the CS (P = 0.026) and attenuation difference at the BG level (P < 0.001). Our results suggest that effacement of the sulcus of the cerebral hemisphere and the loss of contrast at the BG level on brain PMCT indicate the existence of HIE prior to death.
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Affiliation(s)
- Go Shirota
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Masanori Ishida
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.,Department of Radiology, Mutual Aid Association for Tokyo Metropolitan Teachers and Officials, Sanraku Hospital, 2-5 Kandasurugadai, Chiyoda-ku, Tokyo, 101-8326, Japan
| | - Yukako Shintani
- Department of Pathology, 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
| | - Masako Ikemura
- Department of Pathology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Masashi Fukayama
- Department of Pathology, 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.
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Hasegawa I, Shimizu A, Saito A, Suzuki H, Vogel H, Püschel K, Heinemann A. Evaluation of post-mortem lateral cerebral ventricle changes using sequential scans during post-mortem computed tomography. Int J Legal Med 2016; 130:1323-8. [PMID: 27048214 PMCID: PMC4976059 DOI: 10.1007/s00414-016-1327-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 02/03/2016] [Indexed: 11/21/2022]
Abstract
In the present study, we evaluated post-mortem lateral cerebral ventricle (LCV) changes using computed tomography (CT). Subsequent periodical CT scans termed “sequential scans” were obtained for three cadavers. The first scan was performed immediately after the body was transferred from the emergency room to the institute of legal medicine. Sequential scans were obtained and evaluated for 24 h at maximum. The time of death had been determined in the emergency room. The sequential scans enabled us to observe periodical post-mortem changes in CT images. The series of continuous LCV images obtained up to 24 h (two cases)/16 h (1 case) after death was evaluated. The average Hounsfield units (HU) within the LCVs progressively increased, and LCV volume progressively decreased over time. The HU in the cerebrospinal fluid (CSF) increased at an individual rate proportional to the post-mortem interval (PMI). Thus, an early longitudinal radiodensity change in the CSF could be potential indicator of post-mortem interval (PMI). Sequential imaging scans reveal post-mortem changes in the CSF space which may reflect post-mortem brain alterations. Further studies are needed to evaluate the proposed CSF change markers in correlation with other validated PMI indicators.
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Affiliation(s)
- Iwao Hasegawa
- Department of Legal Medicine, University Medical Center Hamburg-Eppendorf, Butenfeld 34, Hamburg, 22529, Germany. .,Department of Forensic Medicine, School of Medicine, Tokai University, Shimokasuya 143, Isehara, Kanagawa, 259-1193, Japan. .,Tokyo Medical Examiner's Office, Otsuka 4-21-18, Bunkyo, Tokyo, 112-0012, Japan.
| | - Akinobu Shimizu
- Institute of Engineering, Tokyo University of Agriculture and Technology, Naka-cho 2-24-16, Koganei, Tokyo, 184-0012, Japan
| | - Atsushi Saito
- Institute of Engineering, Tokyo University of Agriculture and Technology, Naka-cho 2-24-16, Koganei, Tokyo, 184-0012, Japan
| | - Hideto Suzuki
- Tokyo Medical Examiner's Office, Otsuka 4-21-18, Bunkyo, Tokyo, 112-0012, Japan
| | - Hermann Vogel
- Department of Legal Medicine, University Medical Center Hamburg-Eppendorf, Butenfeld 34, Hamburg, 22529, Germany
| | - Klaus Püschel
- Department of Legal Medicine, University Medical Center Hamburg-Eppendorf, Butenfeld 34, Hamburg, 22529, Germany
| | - Axel Heinemann
- Department of Legal Medicine, University Medical Center Hamburg-Eppendorf, Butenfeld 34, Hamburg, 22529, Germany
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21
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Klein W, Kunz T, Hermans K, Bayat A, Koopmanschap D. The common pattern of postmortem changes on whole body CT scans. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.jofri.2015.11.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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22
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Kondo M, Yamashita K, Yoshiura T, Hiwatash A, Shirasaka T, Arimura H, Nakamura Y, Honda H. Histogram analysis with automated extraction of brain-tissue region from whole-brain CT images. SPRINGERPLUS 2015; 4:788. [PMID: 26702377 PMCID: PMC4684555 DOI: 10.1186/s40064-015-1587-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2015] [Accepted: 12/04/2015] [Indexed: 11/24/2022]
Abstract
To determine whether an automated extraction of the brain-tissue region from CT images is useful for the histogram analysis of the brain-tissue region was studied. We used the CT images of 11 patients. We developed an automatic brain-tissue extraction algorithm. We evaluated the similarity index of this automated extraction method relative to manual extraction, and we compared the mean CT number of all extracted pixels and the kurtosis and skewness of the distribution of CT numbers of all extracted pixels from the automated and manual extractions. The similarity index was 0.93. The mean CT number and the kurtosis and skewness from the automated extraction were 35.0 Hounsfield units, 0.63, and 0.51, respectively, and were equivalent to those from the manual extraction (35.4 Hounsfield units, 0.59, and 0.46, respectively). The automated extraction of the brain-tissue region from whole-brain CT images was useful for histogram analysis of the brain-tissue region.
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Affiliation(s)
- Masatoshi Kondo
- Department of Medical Technology, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582 Japan ; Graduate School of Health Sciences, Kumamoto University, 4-24-1 Kuhonji, Kumamoto, 862-0976 Japan
| | - Koji Yamashita
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582 Japan
| | - Takashi Yoshiura
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582 Japan ; Department of Radiology, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8544 Japan
| | - Akio Hiwatash
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582 Japan
| | - Takashi Shirasaka
- Department of Medical Technology, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582 Japan ; Department of Radiological Technology, Kumamoto University Hospital, 1-1-1 Honjyo, Kumamoto, 860-8556 Japan
| | - Hisao Arimura
- Department of Medical Technology, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582 Japan
| | - Yasuhiko Nakamura
- Department of Medical Technology, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582 Japan
| | - Hiroshi Honda
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582 Japan
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Brain Swelling and Loss of Gray and White Matter Differentiation in Human Postmortem Cases by Computed Tomography. PLoS One 2015; 10:e0143848. [PMID: 26618492 PMCID: PMC4664263 DOI: 10.1371/journal.pone.0143848] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 11/09/2015] [Indexed: 12/02/2022] Open
Abstract
The purpose of this study was to evaluate the brain by postmortem computed tomography (PMCT) versus antemortem computed tomography (AMCT) using brains from the same patients. We studied 36 nontraumatic subjects who underwent AMCT, PMCT, and pathological autopsy in our hospital between April 2009 and December 2013. PMCT was performed within 20 h after death, followed by pathological autopsy including the brain. Autopsy confirmed the absence of intracranial disorders that might be related to the cause of death or might affect measurements in our study. Width of the third ventricle, width of the central sulcus, and attenuation in gray matter (GM) and white matter (WM) from the same area of the basal ganglia, centrum semiovale, and high convexity were statistically compared between AMCT and PMCT. Both the width of the third ventricle and the central sulcus were significantly shorter in PMCT than in AMCT (P < 0.0001). GM attenuation increased after death at the level of the centrum semiovale and high convexity, but the differences were not statistically significant considering the differences in attenuation among the different computed tomography scanners. WM attenuation significantly increased after death at all levels (P<0.0001). The differences were larger than the differences in scanners. GM/WM ratio of attenuation was significantly lower by PMCT than by AMCT at all levels (P<0.0001). PMCT showed an increase in WM attenuation, loss of GM–WM differentiation, and brain swelling, evidenced by a decrease in the size of ventricles and sulci.
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Hyodoh H, Shimizu J, Watanabe S, Okazaki S, Mizuo K, Inoue H. Time-related course of pleural space fluid collection and pulmonary aeration on postmortem computed tomography (PMCT). Leg Med (Tokyo) 2015; 17:221-5. [DOI: 10.1016/j.legalmed.2015.01.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 01/07/2015] [Accepted: 01/07/2015] [Indexed: 10/24/2022]
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Ishida M, Gonoi W, Okuma H, Shirota G, Shintani Y, Abe H, Takazawa Y, Fukayama M, Ohtomo K. Common Postmortem Computed Tomography Findings Following Atraumatic Death: Differentiation between Normal Postmortem Changes and Pathologic Lesions. Korean J Radiol 2015; 16:798-809. [PMID: 26175579 PMCID: PMC4499544 DOI: 10.3348/kjr.2015.16.4.798] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 03/16/2015] [Indexed: 11/25/2022] Open
Abstract
Computed tomography (CT) is widely used in postmortem investigations as an adjunct to the traditional autopsy in forensic medicine. To date, several studies have described postmortem CT findings as being caused by normal postmortem changes. However, on interpretation, postmortem CT findings that are seemingly due to normal postmortem changes initially, may not have been mere postmortem artifacts. In this pictorial essay, we describe the common postmortem CT findings in cases of atraumatic in-hospital death and describe the diagnostic pitfalls of normal postmortem changes that can mimic real pathologic lesions.
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Affiliation(s)
- Masanori Ishida
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
- Department of Radiology, Mutual Aid Association for Tokyo Metropolitan Teachers and Officials, Sanraku Hospital, Tokyo 101-8326, Japan
| | - Wataru Gonoi
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
| | - Hidemi Okuma
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
| | - Go Shirota
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
| | - Yukako Shintani
- Department of Pathology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
| | - Hiroyuki Abe
- Department of Pathology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
| | - Yutaka Takazawa
- Department of Pathology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
| | - Masashi Fukayama
- Department of Pathology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
| | - Kuni Ohtomo
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
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Racking the brain: Detection of cerebral edema on postmortem computed tomography compared with forensic autopsy. Eur J Radiol 2015; 84:643-51. [DOI: 10.1016/j.ejrad.2014.12.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2014] [Revised: 12/11/2014] [Accepted: 12/15/2014] [Indexed: 11/19/2022]
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Czyz M, Tabakow P, Hernandez-Sanchez I, Jarmundowicz W, Raisman G. Obtaining the olfactory bulb as a source of olfactory ensheathing cells with the use of minimally invasive neuroendoscopy-assisted supraorbital keyhole approach—cadaveric feasibility study. Br J Neurosurg 2015; 29:362-70. [DOI: 10.3109/02688697.2015.1006170] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Winklhofer S, Surer E, Ampanozi G, Ruder T, Stolzmann P, Elliott M, Oestreich A, Kraemer T, Thali M, Alkadhi H, Schweitzer W. Post-mortem whole body computed tomography of opioid (heroin and methadone) fatalities: frequent findings and comparison to autopsy. Eur Radiol 2014; 24:1276-82. [DOI: 10.1007/s00330-014-3128-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Revised: 02/07/2014] [Accepted: 02/12/2014] [Indexed: 11/30/2022]
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Batista EL, Moreira CC, Batista FC, de Oliveira RR, Pereira KKY. Altered passive eruption diagnosis and treatment: a cone beam computed tomography-based reappraisal of the condition. J Clin Periodontol 2012; 39:1089-96. [DOI: 10.1111/j.1600-051x.2012.01940.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2012] [Indexed: 11/29/2022]
Affiliation(s)
- Eraldo L. Batista
- Department of Periodontology and Graduate Program in Periodontics; School of Dentistry; Pontifícia Universidade Católica do Rio Grande do Sul-PUCRS; Porto Alegre; Brazil
| | - Carla C. Moreira
- Private Practice in Oral Surgery and Instituto do Cancer Infantil-ICI; Porto Alegre; Brazil
| | - Felipe C. Batista
- Department of Oral and Maxillofacial Surgery; Universidade Luterana do Brasil - ULBRA; Canoas; Brazil
| | - Rafael R. de Oliveira
- Department of Periodontology and Graduate Program in Periodontics; School of Dentistry; Pontifícia Universidade Católica do Rio Grande do Sul-PUCRS; Porto Alegre; Brazil
| | - Karina K. Y. Pereira
- Graduate Program in Periodontics; School of Dental Medicine; Pontifícia Universidade Católica do Rio Grande do Sul-PUCRS; Porto Alegre; Brazil
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Inokuchi G, Yajima D, Hayakawa M, Motomura A, Chiba F, Makino Y, Iwase H. Is acute subdural hematoma reduced during the agonal stage and postmortem? Int J Legal Med 2012; 127:263-6. [PMID: 22669325 DOI: 10.1007/s00414-012-0723-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Accepted: 05/25/2012] [Indexed: 11/29/2022]
Abstract
The issue of proper use of postmortem computed tomography (PMCT) in forensic fields is currently being actively discussed. The PMCT image has specific findings that differ from the antemortem image, and it is essential to understand and interpret postmortem changes in order to utilize PMCT properly. In this article, we present two cases of acute subdural hematoma (ASDH) in which images were obtained both ante- and postmortem. These images showed marked reduction of hematoma and diminishing midline shift between the agonal and postmortem periods, without evacuation of the hematoma. Attention should be paid to this phenomenon because key findings in determining cause of death could disappear if investigating the cause of death takes too long in cases that prove to be ASDH. In other words, this phenomenon potentially becomes a risk for misdiagnosis when we decide the cause of death without knowing the details of the circumstances of death.
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Affiliation(s)
- Go Inokuchi
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan.
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Takahashi N, Higuchi T, Hirose Y, Yamanouchi H, Takatsuka H, Funayama K. Changes in aortic shape and diameters after death: comparison of early postmortem computed tomography with antemortem computed tomography. Forensic Sci Int 2012; 225:27-31. [PMID: 22656269 DOI: 10.1016/j.forsciint.2012.04.037] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2012] [Revised: 04/17/2012] [Accepted: 04/30/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE The purpose of this study is to evaluate the postmortem deformation of the aorta on postmortem computed tomography (CT) by comparison with the antemortem CT in the same patient. MATERIALS AND METHODS A total of 58 non-traumatic patients without hemorrhagic events who underwent torso CT before and shortly after death were enrolled. Antemortem chest and abdominal CT were obtained in 44 cases and in 57 cases, respectively. The lengths of the major and minor axes of the ascending and descending thoracic aorta and the abdominal aorta were measured on both antemortem and postmortem CT in the same patient. To evaluate the shape of the aorta, the major axis-minor axis ratio (Ma-MiR) was calculated. Mean values of the diameters of the aorta and Ma-MiRs on postmortem CT were compared with those on antemortem CT using the Wilcoxon signed-rank test. We also evaluated the major and minor axes and Ma-MiRs on both antemortem and postmortem CT in two age groups: 65 years and under (n=13) and over 65 years (n=45). RESULTS At each level tested, the aorta significantly shrank after death (p<0.001) (ascending thoracic aorta, descending thoracic aorta, and abdominal aorta: 38.5 mm × 33.5 mm, 28.0 mm × 25.9 mm, and 24.4 mm × 21.8 mm on antemortem CT, 30.0 mm × 26.2 mm, 24.4 mm × 20.7 mm, and 21.5 mm × 14.5 mm on postmortem CT, respectively). The postmortem Ma-MiRs significantly increased at the descending thoracic aorta and the abdominal aorta (p<0.001). The diameters of the aorta are longer in older cases at all levels on both antemortem and postmortem CT. The reduction rates were larger in younger cases than older cases at all levels. CONCLUSIONS After death, the aorta shrunk at all levels, and became oval in shape in descending thoracic and abdominal aorta. The contraction was greater in younger cases than older cases. Investigators who interpret postmortem imaging should be aware of the postmortem deformation of the aorta.
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Affiliation(s)
- Naoya Takahashi
- Department of Diagnostic Radiology, Niigata City General Hospital, Chuo-ku, Niigata, Japan.
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Background and current status of postmortem imaging in Japan: short history of "Autopsy imaging (Ai)". Forensic Sci Int 2012; 225:3-8. [PMID: 22480884 DOI: 10.1016/j.forsciint.2012.03.010] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2012] [Revised: 03/02/2012] [Accepted: 03/06/2012] [Indexed: 11/24/2022]
Abstract
There is a low autopsy rate and wide distribution of computed tomography (CT) and magnetic resonance imaging (MRI) scanners in Japan. Therefore, many Japanese hospitals, including 36% of the hospitals with in-patient facilities and 89% of large hospitals with ER facilities conduct postmortem imaging (PMI), use clinical scanners to screen for causes in unusual deaths as an alternative to an autopsy or to determine whether an autopsy is needed. The Japanese PMI examination procedure is generally referred to as "autopsy imaging" (Ai) and the term "Ai" is now commonly used by the Japanese government. Currently, 26 of 47 Japanese prefectures have at least one Ai Center with scanners that are dedicated for PMI. Here, we briefly review the history of Japanese PMI (Ai) from 1985 to the present.
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Effectiveness of a worksheet for diagnosing postmortem computed tomography in emergency departments. Jpn J Radiol 2011; 29:701-6. [DOI: 10.1007/s11604-011-0618-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2011] [Accepted: 06/09/2011] [Indexed: 10/16/2022]
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Quantitative analysis of intracranial hypostasis: comparison of early postmortem and antemortem CT findings. AJR Am J Roentgenol 2011; 195:W388-93. [PMID: 21098169 DOI: 10.2214/ajr.10.4442] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study was to quantitatively analyze postmortem hypostasis in the intracranial venous sinus on head CT scans compared with the antemortem CT findings in the same patients with the aim of evaluating sedimentation in the heart and great vessels. MATERIALS AND METHODS A total of 50 patients on whom head CT was performed before and after death were enrolled. Attenuation in the dorsal part of the superior sagittal sinus was measured at the level of the basal ganglia on both antemortem and postmortem CT scans. Increased attenuation in the transverse sinus and cerebellar tentorium and sedimentation in the heart and great vessels were evaluated visually. RESULTS Attenuation in the dorsal part of the superior sagittal sinus increased significantly (p < 0.0001) between antemortem (42.77 ± 6.23 HU) and postmortem (49.72 ± 10.58 HU) CT in 80% of cases. Increased attenuation of the transverse sinus or cerebellar tentorium was observed in 48% of cases and sedimentation in the heart or great vessels in 62% of cases. Increased attenuation in the superior sagittal sinus was clearly evident in patients with sedimentation in the heart or great vessels (antemortem, 43.81 ± 6.17 HU; postmortem, 54.65 ± 8.51 HU) compared with the patients without evidence of sedimentation (antemortem, 41.06 ± 6.10 HU; postmortem, 41.66 ± 8.57 HU) (p < 0.0001). CONCLUSION Intracranial hypostasis is a common postmortem CT finding. Radiologists and physicians who interpret postmortem neurologic images should be aware of intracranial hypostasis and differentiate this phenomenon from intracranial hemorrhage.
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Kant IJ, de Jong LC, van Rijssen-Moll M, Borm PJ. A survey of static and dynamic work postures of operating room staff. Int Arch Occup Environ Health 1992; 37:1182-91. [PMID: 21544692 PMCID: PMC3127009 DOI: 10.1007/s00134-011-2232-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2010] [Accepted: 02/18/2011] [Indexed: 01/01/2023]
Abstract
Purpose To determine reciprocal and synergistic effects of acute intracranial hypertension and ARDS on neuronal and pulmonary damage and to define possible mechanisms. Methods Twenty-eight mechanically ventilated pigs were randomized to four groups of seven each: control; acute intracranial hypertension (AICH); acute respiratory distress syndrome (ARDS); acute respiratory distress syndrome in combination with acute intracranial hypertension (ARDS + AICH). AICH was induced with an intracranial balloon catheter and the inflation volume was adjusted to keep intracranial pressure (ICP) at 30–40 cmH2O. ARDS was induced by oleic acid infusion. Respiratory function, hemodynamics, extravascular lung water index (ELWI), lung and brain computed tomography (CT) scans, as well as inflammatory mediators, S100B, and neuronal serum enolase (NSE) were measured over a 4-h period. Lung and brain tissue were collected and examined at the end of the experiment. Results In both healthy and injured lungs, AICH caused increases in NSE and TNF-alpha plasma concentrations, extravascular lung water, and lung density in CT, the extent of poorly aerated (dystelectatic) and atelectatic lung regions, and an increase in the brain tissue water content. ARDS and AICH in combination induced damage in the hippocampus and decreased density in brain CT. Conclusions AICH induces lung injury and also exacerbates pre-existing damage. Increased extravascular lung water is an early marker. ARDS has a detrimental effect on the brain and acts synergistically with intracranial hypertension to cause histological hippocampal damage. Electronic supplementary material The online version of this article (doi:10.1007/s00134-011-2232-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- I J Kant
- Department of Occupational and Environmental Medicine and Toxicology, State University of Limburg, Maastricht, The Netherlands
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