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Ong HN, Chen IH, Hsieh YH, Hsu CH, Weng TI, Chang CC. Comparison of fatal traumatic medico-legal cases with postmortem computed tomography and autopsy: A pilot study in Taiwan. J Formos Med Assoc 2023; 122:351-354. [PMID: 36253239 DOI: 10.1016/j.jfma.2022.09.015] [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: 06/30/2022] [Revised: 09/27/2022] [Accepted: 09/28/2022] [Indexed: 11/07/2022] Open
Abstract
In order to determine the performance of postmortem computed tomography (PMCT) in identifying traumatic-relevant macroscopic findings in medico-legal cases, this retrospective observational pilot study involving nine trauma casualties who had received PMCT prior to autopsy. The comparison of these findings in six anatomical regions as dictated in Injury Severity Score (ISS) were performed. 104 traumatic-relevant findings were identified with achievement of 51% congruent findings. PMCT and autopsy had additionally found 22 and 29 findings respectively. PMCT had highest sensitivity for extremity injury (81.82%), followed by chest (73.91%), head, neck and face (71.43%), and abdomino-pelvic area (50%). It had excellent detection rate in abnormal air collection, fracture, foreign body localization, internal ballistic and intracranial pathology. However, the solid organ and vascular injuries as well as integumentary lesions were the major drawback. In conclusion, incorporation of PMCT to autopsy in medico-legal investigation helps to preserve the most abundant traumatic-relevant injuries compared to either modality.
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Affiliation(s)
- Hooi-Nee Ong
- Department of Emergency Medicine, National Taiwan University Hospital and National Taiwan, University College of Medicine, Taipei, Taiwan; Department and Graduate Institute of Forensic Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - I-Hung Chen
- Department of Forensic Pathology, Institute of Forensic Medicine, Ministry of Justice, New Taipei City, Taiwan
| | - Yu-Hsuan Hsieh
- Department and Graduate Institute of Forensic Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Cho-Hsien Hsu
- Department of Forensic Pathology, Institute of Forensic Medicine, Ministry of Justice, New Taipei City, Taiwan
| | - Te-I Weng
- Department of Emergency Medicine, National Taiwan University Hospital and National Taiwan, University College of Medicine, Taipei, Taiwan; Department and Graduate Institute of Forensic Medicine, National Taiwan University College of Medicine, Taipei, Taiwan.
| | - Chin-Chen Chang
- Department and Graduate Institute of Forensic Medicine, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Medical Imaging, National Taiwan University Hospital and National Taiwan, University College of Medicine, Taipei, Taiwan.
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Okumura S, Usui A, Kawasumi Y, Odagiri H, Funayama M, Kaneta T. Diagnostic Accuracy of Liver Damage Based on Postmortem Computed Tomography Findings in High-Energy Trauma. TOHOKU J EXP MED 2022; 257:327-332. [PMID: 35691914 DOI: 10.1620/tjem.2022.j046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Satsuki Okumura
- Department of Diagnostic Image Analysis, Tohoku University Graduate School of Medicine
| | - Akihito Usui
- Department of Diagnostic Image Analysis, Tohoku University Graduate School of Medicine
| | - Yusuke Kawasumi
- Department of Clinical Imaging, Tohoku University Graduate School of Medicine
| | - Hayato Odagiri
- Department of Diagnostic Image Analysis, Tohoku University Graduate School of Medicine
| | - Masato Funayama
- Department of Forensic Medicine, Tohoku University Graduate School of Medicine
| | - Tomohiro Kaneta
- Department of Diagnostic Image Analysis, Tohoku University Graduate School of Medicine
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3
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Richard ME, Delabarde T, Hmeydia G, Provost C, de Jong L, Hamza L, Meder JF, Oppenheim C, Ludes B, Benzakoun J. Validation of a post-mortem computed tomography method for age estimation based on the 4th rib in a French population. Int J Legal Med 2022; 136:833-839. [PMID: 35230486 DOI: 10.1007/s00414-022-02798-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 02/09/2022] [Indexed: 10/19/2022]
Abstract
Age estimation is a key factor for identification procedure in forensic context. Based on anthropological findings, degenerative changes of the sternal extremity of the 4th rib are currently used for age estimation. These have been adapted to post-mortem computed tomography (PMCT). The aim of this study was to validate a post-mortem computed tomography method based on a revision of the Iscan's method on a French sample. A total of 250 PMCT (aged from 18-98 years (IQR 36-68 years, median 51 years); 68 (27%) females) from the Medicolegal Institute of Paris (MLIP) were analyzed by two radiologists. The sternal extremity of 4th right rib was scored using method adapted from Iscan et al. Weighted κ was used to evaluate intra- and inter-observer reliability and Spearman correlation was performed to evaluate relationship between age and score. Confidence intervals for individual prediction of age based on 4th rib score and sex were computed with bootstrapping. The intra-observer reliability and inter-observer reliability were almost perfect (weighted κ = 0.85 [95%CI: 0.78-0.93] and 0.82 [95%CI 0.70-0.96] respectively). We confirmed a high correlation between the 4th rib score and subject age (rho = 0.72, p < 0.001), although the confidence intervals for individual age prediction were large, spanning over several decades. This study confirms the high reliability of Iscan method applied to PMCT for age estimation, although future multimodal age prediction techniques may help reducing the span of confidence intervals for individual age estimation.Trial registration: INDS 0,509,211,020, October 2020, retrospectively registered.
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Affiliation(s)
- Marie-Edith Richard
- Université de Paris, Paris, France.,Service de Neuroradiologie, GHU Paris Psychiatrie et Neurosciences, 1, Rue Cabanis, 75014, Paris, France
| | - Tania Delabarde
- Université de Paris, UMR8045 BABEL, CNRS, Paris, France.,Institut Médico-Légal de Paris, Paris, France.,Pôle Universitaire d'imagerie Post-Mortem, Université de Paris, Paris, France
| | - Ghazi Hmeydia
- Service de Neuroradiologie, GHU Paris Psychiatrie et Neurosciences, 1, Rue Cabanis, 75014, Paris, France.,Institut de Psychiatrie et de Neurosciences de Paris, INSERM UMR 1266, IMA-BRAIN, Paris, France
| | - Corentin Provost
- Université de Paris, Paris, France.,Service de Neuroradiologie, GHU Paris Psychiatrie et Neurosciences, 1, Rue Cabanis, 75014, Paris, France.,Institut de Psychiatrie et de Neurosciences de Paris, INSERM UMR 1266, IMA-BRAIN, Paris, France
| | - Laura de Jong
- Service de Neuroradiologie, GHU Paris Psychiatrie et Neurosciences, 1, Rue Cabanis, 75014, Paris, France.,Institut de Psychiatrie et de Neurosciences de Paris, INSERM UMR 1266, IMA-BRAIN, Paris, France
| | - Lilia Hamza
- Institut Médico-Légal de Paris, Paris, France.,Pôle Universitaire d'imagerie Post-Mortem, Université de Paris, Paris, France
| | - Jean-François Meder
- Université de Paris, Paris, France.,Service de Neuroradiologie, GHU Paris Psychiatrie et Neurosciences, 1, Rue Cabanis, 75014, Paris, France.,Institut de Psychiatrie et de Neurosciences de Paris, INSERM UMR 1266, IMA-BRAIN, Paris, France
| | - Catherine Oppenheim
- Université de Paris, Paris, France.,Service de Neuroradiologie, GHU Paris Psychiatrie et Neurosciences, 1, Rue Cabanis, 75014, Paris, France.,Institut de Psychiatrie et de Neurosciences de Paris, INSERM UMR 1266, IMA-BRAIN, Paris, France
| | - Bertrand Ludes
- Université de Paris, UMR8045 BABEL, CNRS, Paris, France.,Institut Médico-Légal de Paris, Paris, France.,Pôle Universitaire d'imagerie Post-Mortem, Université de Paris, Paris, France
| | - Joseph Benzakoun
- Université de Paris, Paris, France. .,Service de Neuroradiologie, GHU Paris Psychiatrie et Neurosciences, 1, Rue Cabanis, 75014, Paris, France. .,Institut de Psychiatrie et de Neurosciences de Paris, INSERM UMR 1266, IMA-BRAIN, Paris, France.
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Chatzaraki V, Thali MJ, Ampanozi G. Diagnostic accuracy of postmortem computed tomography for bleeding source determination in cases with hemoperitoneum. Int J Legal Med 2021; 135:593-603. [PMID: 33410928 PMCID: PMC7870604 DOI: 10.1007/s00414-020-02472-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 11/18/2020] [Indexed: 11/26/2022]
Abstract
Aim The aim of this retrospective study was to determine the accuracy of postmortem computed tomography and different radiological signs for the determination of the bleeding source in cases with hemoperitoneum confirmed at autopsy. Methods Postmortem computed tomography data of consecutive cases with hemoperitoneum confirmed at autopsy were reviewed by two raters, blinded to the autopsy findings. The determination of possible bleeding sources was based on the presence of the sentinel clot sign, blood or sedimented blood surrounding an organ, intraparenchymal abnormal gas distribution, and parenchymal disruption. The bleeding source and the cause of hemoperitoneum (traumatic, surgical, natural, or resuscitation) as reported in the autopsy report were noted. The survival intervals of the deceased were calculated when information about the time of an incident related to death was available in the autopsy reports. Results Eighty-five cases were included in the study. Postmortem computed tomography showed 79% sensitivity and 92.1% specificity for the detection of the bleeding source. The sentinel clot sign was associated with surgical or natural causes of hemoperitoneum and longer survival intervals. Sedimented blood around the bleeding source was associated with resuscitation. Abnormal gas distribution within organs and combination of multiple radiological signs provided higher sensitivity. Conclusion Postmortem computed tomography provides moderate sensitivity and high specificity for determining the bleeding source in cases with hemoperitoneum. Different PMCT signs are associated with different causes of hemoperitoneum and survival intervals.
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Affiliation(s)
- Vasiliki Chatzaraki
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, CH-8057, Zurich, Switzerland.
- Department of Radiology, Kantonsspital Baden AG, Im Ergel 1, CH-5404, Baden, Switzerland.
| | - Michael J Thali
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, CH-8057, Zurich, Switzerland
| | - Garyfalia Ampanozi
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, CH-8057, Zurich, Switzerland
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Ampanozi G, Halbheer D, Ebert LC, Thali MJ, Held U. Postmortem imaging findings and cause of death determination compared with autopsy: a systematic review of diagnostic test accuracy and meta-analysis. Int J Legal Med 2019; 134:321-337. [PMID: 31455980 DOI: 10.1007/s00414-019-02140-y] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 08/06/2019] [Indexed: 01/06/2023]
Abstract
BACKGROUND The aim of this study was to evaluate the sensitivity of postmortem computed tomography (PMCT), postmortem magnetic resonance imaging (PMMR) and PMCT angiography (PMCTA) compared with autopsy in cases of adult death investigations. METHODS For this systematic review and meta-analysis, Embase, PubMed, Scopus, Web of Science and Medline were searched for eligible studies in October 2016; a follow-up literature search was conducted in March 2018. Studies referring to PMCT, PMCTA and/or PMMR of more than 3 cases with subsequent autopsy were included. Data were extracted from published texts in duplicate. The extracted outcomes were categorized as follows: soft tissue and organ findings, skeletal injuries, haemorrhages, abnormal gas accumulations and causes of death. The summary measure was sensitivity, if 3 or more studies were available. To combine studies, a random effects model was used. Variability and heterogeneity within the meta-analysis was assessed. RESULTS Of 1053 studies, 66 were eligible, encompassing a total of 4213 individuals. For soft tissue and organ findings, there was a high pooled sensitivity with PMCTA (0.91, 95% CI 0.81-0.96), without evidence for between-study variability (Cochrane's Q test p = 0.331, I2 = 24.5%). The pooled sensitivity of PMCT+PMMR was very high in skeletal injuries (0.97, CI 0.87-0.99), without evidence for variability (p = 0.857, I2 = 0.0%). In detecting haemorrhages, the pooled sensitivity for PMCT+PMMR was the highest (0.88, 95% CI 0.35-0.99), with strong evidence of heterogeneity (p < 0.05, I2 > 50%). Pooled sensitivity for the correct cause of death was the highest for PMCTA with 0.79 (95% CI 0.52-0.93), again with evidence of heterogeneity (p = 0.062, I2 > 50%). CONCLUSION Distinct postmortem imaging modalities can achieve high sensitivities for detecting various findings and causes of death. This knowledge should lead to a reasoned use of each modality. Both forensic evidence and in-hospital medical quality would be enhanced.
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Affiliation(s)
- Garyfalia Ampanozi
- Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, 8057, Zurich, Switzerland.
| | - Delaja Halbheer
- Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, 8057, Zurich, Switzerland
| | - Lars C Ebert
- Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, 8057, Zurich, Switzerland
| | - Michael J Thali
- Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, 8057, Zurich, Switzerland
| | - Ulrike Held
- Horten Centre, University of Zurich, Pestalozzistrasse 24, 8091, Zurich, Switzerland.,Epidemiology, Biostatistics and Prevention Institute, Department of Biostatistics, University of Zurich, Hirschengraben 84, 8001, Zurich, Switzerland
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State of the art in post-mortem computed tomography: a review of current literature. Virchows Arch 2019; 475:139-150. [PMID: 30937612 DOI: 10.1007/s00428-019-02562-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 02/06/2019] [Accepted: 03/12/2019] [Indexed: 12/14/2022]
Abstract
Computed tomography (CT) and other advanced diagnostic imaging techniques are gaining popularity in forensic pathology. This paper aims to define and offer complete and easily accessible "state of the art" for post-mortem computed tomography (PMCT), by reviewing the latest international literature. The proposed format answers the "five Ws" that follows: (1) What: We report the different kinds of CT scan and settings generally used in post-mortem imaging. The machine most employed is a 8/16-slice spiral CT, usually without contrast enhancement. The introduction of some variables, such as CT-guided biopsies, post-mortem ventilation, and PMCT angiography is becoming increasingly useful. (2) Why: Literature highlights the many advantages of PMCT. Limitations can be partly overcome by modern imaging techniques and combined evaluation with traditional autopsy. (3) Who: Most authors agree that collaboration between different specialists, i.e., radiologists and pathologists, is the best scenario, since radiologic, anatomic, and forensic skills are needed simultaneously. The most important human factor is "teamwork". (4) When: Literature provides no absolute limits for performing PMCT. Some authors have tested PMCT as a replacement for conventional autopsy but found some limitations. Others evaluated PMCT as a guide or screening tool for traditional autopsy. (5) Where: Many research groups around the world have performed studies on the use of PMCT. Although few countries adopt PMCT in routine practice, its use is rapidly spreading.
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