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Cianci V, Forzese E, Sapienza D, Cardia L, Cianci A, Germanà A, Tornese L, Ieni A, Gualniera P, Asmundo A, Mondello C. Morphological and Genetic Aspects for Post-Mortem Diagnosis of Hypertrophic Cardiomyopathy: A Systematic Review. Int J Mol Sci 2024; 25:1275. [PMID: 38279275 PMCID: PMC10816624 DOI: 10.3390/ijms25021275] [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: 12/19/2023] [Revised: 01/15/2024] [Accepted: 01/18/2024] [Indexed: 01/28/2024] Open
Abstract
Hypertrophic cardiomyopathy (HCM) is one of the most common genetic cardiovascular diseases, and it shows an autosomal dominant pattern of inheritance. HCM can be clinically silent, and sudden unexpected death due to malignant arrhythmias may be the first manifestation. Thus, the HCM diagnosis could be performed at a clinical and judicial autopsy and offer useful findings on morphological features; moreover, it could integrate the knowledge on the genetic aspect of the disease. This review aims to systematically analyze the literature on the main post-mortem investigations and the related findings of HCM to reach a well-characterized and stringent diagnosis; the review was performed using PubMed and Scopus databases. The articles on the post-mortem evaluation of HCM by gross and microscopic evaluation, imaging, and genetic test were selected; a total of 36 studies were included. HCM was described with a wide range of gross findings, and there were cases without morphological alterations. Myocyte hypertrophy, disarray, fibrosis, and small vessel disease were the main histological findings. The post-mortem genetic tests allowed the diagnosis to be reached in cases without morpho-structural abnormalities; clinical and forensic pathologists have a pivotal role in HCM diagnosis; they contribute to a better definition of the disease and also provide data on the genotype-phenotype correlation, which is useful for clinical research.
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Affiliation(s)
- Vincenzo Cianci
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy; (V.C.); (E.F.); (D.S.); (L.T.); (P.G.)
| | - Elena Forzese
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy; (V.C.); (E.F.); (D.S.); (L.T.); (P.G.)
| | - Daniela Sapienza
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy; (V.C.); (E.F.); (D.S.); (L.T.); (P.G.)
| | - Luigi Cardia
- Department of Human Pathology of Adult and Childhood “Gaetano Barresi”, University of Messina, Via C. Valeria 1, 98125 Messina, Italy; (L.C.); (A.I.)
| | - Alessio Cianci
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy;
| | - Antonino Germanà
- Zebrafish Neuromorphology Laboratory, Department of Veterinary Sciences, University of Messina, Via Palatucci snc, 98168 Messina, Italy;
| | - Lorenzo Tornese
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy; (V.C.); (E.F.); (D.S.); (L.T.); (P.G.)
| | - Antonio Ieni
- Department of Human Pathology of Adult and Childhood “Gaetano Barresi”, University of Messina, Via C. Valeria 1, 98125 Messina, Italy; (L.C.); (A.I.)
| | - Patrizia Gualniera
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy; (V.C.); (E.F.); (D.S.); (L.T.); (P.G.)
| | - Alessio Asmundo
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy; (V.C.); (E.F.); (D.S.); (L.T.); (P.G.)
| | - Cristina Mondello
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy; (V.C.); (E.F.); (D.S.); (L.T.); (P.G.)
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De Silva M, Bo P, Dora Genocchi E, Tagliavia C, Roccaro M, Grandis A, Baron Toaldo M. Radiographic and anatomical morphometric assessments of heart size in presumed healthy pet guinea pigs. Vet Radiol Ultrasound 2021; 63:8-17. [PMID: 34528738 PMCID: PMC9292407 DOI: 10.1111/vru.13020] [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: 01/16/2021] [Revised: 06/25/2021] [Accepted: 06/29/2021] [Indexed: 11/29/2022] Open
Abstract
Cardiac disease in guinea pigs has been reported in the literature; however, reference intervals for normal radiographic heart size obtained using objective measurement methods have not been provided for this species. The aim of this prospective, reference interval study was to describe cardiac dimensions in presumed healthy guinea pigs using the vertebral heart scale (VHS) from thoracic radiographs, as described for dogs and cats. Furthermore, an anatomical study was carried out to compare the radiographic and anatomical findings. Thoracic radiographs were acquired in right lateral recumbency for 30, client‐owned, conscious, presumed healthy guinea pigs and radiographs were acquired in left lateral recumbency for 10 presumed healthy guinea pigs as comparisons. The influence of sex, age, body weight (BW), and recumbency on the VHS and absolute cardiac measurements was investigated. The median (interquartile range; IQR) VHS was 7.4 (7.1‐7.6). No differences emerged between the VHS measured in right versus left lateral recumbency (P = .41) or between sexes (P = .16). The VHS values were not influenced by age (P = .53) or BW (P = .26). The anatomical study was carried out on 10 guinea pig cadavers, and in situ and ex situ cardiac measurements were taken using a caliper. A median (IQR) 7.5 (7.2‐8.0) VHS was assessed by this anatomical study. The reference intervals provided should be useful tools in the future for the radiographic interpretation of cardiac size in guinea pigs in clinical practice.
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Affiliation(s)
- Margherita De Silva
- Department of Veterinary Medical Sciences, University of Bologna, Ozzano dell'Emilia, Bologna, Italy
| | | | | | - Claudio Tagliavia
- Department of Veterinary Medical Sciences, University of Bologna, Ozzano dell'Emilia, Bologna, Italy
| | - Mariana Roccaro
- Department of Veterinary Medical Sciences, University of Bologna, Ozzano dell'Emilia, Bologna, Italy
| | - Annamaria Grandis
- Department of Veterinary Medical Sciences, University of Bologna, Ozzano dell'Emilia, Bologna, Italy
| | - Marco Baron Toaldo
- Department for Small Animals, Division of Cardiology, Clinic for Small Animal Internal Medicine, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
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Viani A, Mácová P, Machová D, Mali G. Technical Note: Post-burial alteration of bones: Quantitative characterization with solid-state 1H MAS NMR. Forensic Sci Int 2021; 323:110783. [PMID: 33878550 DOI: 10.1016/j.forsciint.2021.110783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 01/28/2021] [Accepted: 04/05/2021] [Indexed: 12/01/2022]
Abstract
The identification of markers of the modifications occurring in human bones after death and of the sedimentary and post-sedimentary processes affecting their state of preservation, is of interest for several scientific disciplines. A new index, obtained from spectral deconvolution of the 1H MAS NMR spectra of bones, relating the number of organic protons to the amount of hydrogen nuclei in the OH- groups of bioapatite, is proposed as indicator of the state of preservation of the organic fraction. In the osteological material from three different archaeological sites, this index resulted positively correlated with the extent of collagen loss derived from infrared spectroscopy. Its sensitivity to changes in the physical and chemical characteristics of bone allows to identify distinct diagenetic pathways specific to each site and to distinguish different trajectories within the same site.
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Affiliation(s)
- Alberto Viani
- Institute of Theoretical and Applied Mechanics of the Czech Academy of Sciences, Centre Telč, Prosecká 809/76, 190 00 Praha 9, Czech Republic.
| | - Petra Mácová
- Institute of Theoretical and Applied Mechanics of the Czech Academy of Sciences, Centre Telč, Prosecká 809/76, 190 00 Praha 9, Czech Republic
| | - Dita Machová
- Institute of Theoretical and Applied Mechanics of the Czech Academy of Sciences, Centre Telč, Prosecká 809/76, 190 00 Praha 9, Czech Republic
| | - Gregor Mali
- National Institute of Chemistry, Hajdrihova 19, SI-1001 Ljubljana, Slovenia
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De Silva M, Tagliavia C, Galiazzo G, Gifuni G, Caiazza M, Chiocchetti R, Grandis A. Morphological variability of the atrioventricular valve cusps in the equine heart. Equine Vet J 2021; 54:167-175. [PMID: 33555625 DOI: 10.1111/evj.13434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 01/28/2021] [Accepted: 02/03/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND The morphometric studies of the atrioventricular valves are still limited in the horse. OBJECTIVES To investigate the anatomy of the atrioventricular valves in the horse, focusing on the morphometric features of the valvular leaflets and the tendinous cords. We hypothesised that accessory leaflets occur commonly and exist as independent structures in the atrioventricular valves of the horse. STUDY DESIGN Descriptive anatomical study. METHODS Twenty normal hearts from slaughtered half-bred horses were used. The cardiac weight and circumference were recorded. The atrioventricular valves were exposed by excision of the atria, and the tricuspid and mitral annular diameters and circumferences were measured; the number of leaflets and tendinous cords for each atrioventricular ostium were then counted. The atrioventricular valves were isolated and the width, height and thickness of each leaflet were measured. RESULTS In addition to the principal leaflets, accessory leaflets were identified in 39 of 40 cardiac valves, 2 to 6 accessory leaflets for the mitral valve and 1 to 4 for the tricuspid valve. All the accessory leaflets were separated from the adjacent leaflets at their insertion. They were narrower and thinner than the principal leaflets, and were attached to a single papillary muscle; 95% of the accessory leaflets had two tendinous cords shared with the adjacent leaflets while a minority (34%) had their own specific tendinous cord. MAIN LIMITATIONS Lack of signalment data from the study population. CONCLUSIONS Supernumerary leaflets occurred commonly in the atrioventricular valves of the horse and appeared as independent structures. The clinical relevance of increased numbers of commissures that result from accessory leaflets and their relationship with valvular regurgitation are currently unknown.
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Affiliation(s)
- Margherita De Silva
- Department of Veterinary Medical Sciences, University of Bologna, Bologna, Italy
| | - Claudio Tagliavia
- Department of Veterinary Medical Sciences, University of Bologna, Bologna, Italy
| | - Giorgia Galiazzo
- Department of Veterinary Medical Sciences, University of Bologna, Bologna, Italy
| | | | | | - Roberto Chiocchetti
- Department of Veterinary Medical Sciences, University of Bologna, Bologna, Italy
| | - Annamaria Grandis
- Department of Veterinary Medical Sciences, University of Bologna, Bologna, Italy
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Post-Mortem Cardiac Magnetic Resonance for the Diagnosis of Hypertrophic Cardiomyopathy. Diagnostics (Basel) 2020; 10:diagnostics10110981. [PMID: 33233445 PMCID: PMC7700290 DOI: 10.3390/diagnostics10110981] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 11/19/2020] [Accepted: 11/20/2020] [Indexed: 12/04/2022] Open
Abstract
Background: Post-mortem cardiac magnetic resonance (PMCMR) is an emerging tool supporting forensic medicine for the identification of the causes of cardiac death, such as hypertrophic cardiomyopathy (HCM). We proposed a new method of PMCMR to diagnose HCM despite myocardial rigor mortis. Methods: We performed CMR in 49 HCM patients, 30 non-HCM hypertrophy, and 32 healthy controls. In cine images, rigor mortis was simulated by the analysis of the cardiac phase corresponding to 25% of diastole. Left ventricular mass, mean, and standard deviation (SD) of WT, maximal WT, minimal WT, and their difference were compared for the identification of HCM. These parameters were validated at PMCMR, evaluating eight hearts with HCM, 10 with coronary artery disease, and 10 with non-cardiac death. Results: The SD of WT with a cut-off of > 2.4 had the highest accuracy to identify HCM (AUC 0.95, 95% CI = 0.89–0.98). This was particularly evident in the female population of HCM (AUC=0.998), with 100% specificity (95% CI = 85–100%) and 96% sensitivity (95% CI = 79–99%). Using this parameter, at PMCMR, all of the eight patients with HCM were correctly identified with no false positives. Conclusions: PMCMR allows identification of HCM as the cause of sudden death using the SD of WT > 2.4 as the diagnostic parameter.
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Saitou H, Shiotani S, Kobayashi T, Hayakawa H. Approaching the forensic significance of possible PMMR correlates in a case of assumed cardiac rigor mortis. FORENSIC IMAGING 2020. [DOI: 10.1016/j.fri.2020.200374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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The Accuracy of Left Ventricular and Left Atrial Volumetry Using 64-Slice Computed Tomography: In Vitro Validation Study With Human Cardiac Cadaveric Casts. J Comput Assist Tomogr 2018; 42:754-759. [PMID: 30015798 DOI: 10.1097/rct.0000000000000773] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE We aimed to validate the accuracy of imaging of left atrial and ventricular volumes using cardiac cadaveric silicone casts. METHODS Left atrial (n = 14) and ventricular (n = 15) casts were imaged using 64-slice computed tomography (CT). Water displacement (WD) of cardiac casts was used as the gold standard for volume measurements. RESULTS Compared with WD, CT resulted in slightly higher left atrial and ventricular volumes (54 ± 25 vs 56 ± 26 mL [P = 0.003] and 57 ± 47 vs 66 ± 47 mL [P = 0.0001]). Variability between left atrial and ventricular volumes by CT and WD was low (coefficients of variation [CVs], 4% [intraclass correlation coefficient {ICC}, 0.99] and 12% [ICC, 0.97]). Intraobserver variability of CT was low for both the left atrium and the left ventricle (CVs, 1% [ICC, 1.00] and 4% [ICC, 1.00]). CONCLUSIONS Cardiac CT is both accurate and reproducible in assessment of left ventricular and atrial chamber volumes.
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Henes FO, Regier M, Bannas P, Henker M, Heinemann A, Sperhake J, Begemann PGC, Adam G, Groth M. Early time-related course of image findings in postmortem MRI: Typical findings and observer agreement in a porcine model. Leg Med (Tokyo) 2017; 28:15-21. [PMID: 28738216 DOI: 10.1016/j.legalmed.2017.07.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 06/23/2017] [Accepted: 07/14/2017] [Indexed: 11/25/2022]
Abstract
PURPOSE To assess early time-related image findings in postmortem magnetic resonance imaging (MRI) and to evaluate observer agreement in a porcine model. MATERIAL AND METHODS Three pigs were examined by MRI at 15 different time points in the first 36h after death. Two observers independently recorded the postmortem interval (PMI) to the appearance of fluid collection (pleural space, interlobar and interlobular pulmonary fissures and hepatic interlobar fissures), gas accumulation (intrahepatic and intracardial) and blood clotting (aorta and intrahepatic venous vessels). Cohen's Kappa statistics and intraclass correlation coefficient (ICC) were used to evaluate intra- and interobserver agreement. RESULTS Intrahepatic gas was evident after 12, 17 and 30h. Also, intracardiac gas was present in all animals. However, no chronological appearance has been observed. Blood clotting in the hepatic vein was observed within 3min, aortic clotting with a delay of 2-12h after death. Interlobular pulmonary fluid (median PMI: 2h, range 2-2h), pleural effusion (median PMI: 10.5h, range 9-12h) and hepatic interlobar fissure fluid (median PMI: 11.5h, range 11-12h) displayed a chronological appearance pattern. Qualitative and quantitative detection of most postmortem findings showed excellent intra- and interobserver agreement with Kappa values>0.8 or ICC>0.75. CONCLUSION Pulmonary and hepatic fissural fluid collection as well as intravasal gas accumulation are early time-related image findings in postmortem MRI. The chronological appearance of these findings can be assessed with excellent observer agreement in a porcine model.
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Affiliation(s)
- Frank Oliver Henes
- Center for Radiology and Endoscopy, Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany.
| | - Marc Regier
- Center for Radiology and Endoscopy, Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Peter Bannas
- Center for Radiology and Endoscopy, Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Marlen Henker
- Center for Radiology and Endoscopy, Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Axel Heinemann
- Department of Legal Medicine University Medical Center Hamburg-Eppendorf, Butenfeld 34, Hamburg 22529, Germany
| | - Jan Sperhake
- Department of Legal Medicine University Medical Center Hamburg-Eppendorf, Butenfeld 34, Hamburg 22529, Germany
| | - Philipp G C Begemann
- Center for Radiology and Endoscopy, Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Gerhard Adam
- Center for Radiology and Endoscopy, Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Michael Groth
- Center for Radiology and Endoscopy, Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
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Crostack C, Sehner S, Raupach T, Anders S. Re-establishment of rigor mortis: evidence for a considerably longer post-mortem time span. Int J Legal Med 2017; 131:1039-1042. [DOI: 10.1007/s00414-017-1558-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 02/09/2017] [Indexed: 10/20/2022]
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Schwendener N, Jackowski C, Persson A, Warntjes MJ, Schuster F, Riva F, Zech WD. Detection and differentiation of early acute and following age stages of myocardial infarction with quantitative post-mortem cardiac 1.5T MR. Forensic Sci Int 2016; 270:248-254. [PMID: 27836412 DOI: 10.1016/j.forsciint.2016.10.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Revised: 09/26/2016] [Accepted: 10/16/2016] [Indexed: 11/25/2022]
Abstract
Recently, quantitative MR sequences have started being used in post-mortem imaging. The goal of the present study was to evaluate if early acute and following age stages of myocardial infarction can be detected and discerned by quantitative 1.5T post-mortem cardiac magnetic resonance (PMCMR) based on quantitative T1, T2 and PD values. In 80 deceased individuals (25 female, 55 male), a cardiac MR quantification sequence was performed prior to cardiac dissection at autopsy in a prospective study. Focal myocardial signal alterations detected in synthetically generated MR images were MR quantified for their T1, T2 and PD values. The locations of signal alteration measurements in PMCMR were targeted at autopsy heart dissection and cardiac tissue specimens were taken for histologic examinations. Quantified signal alterations in PMCMR were correlated to their according histologic age stage of myocardial infarction. In PMCMR seventy-three focal myocardial signal alterations were detected in 49 of 80 investigated hearts. These signal alterations were diagnosed histologically as early acute (n=39), acute (n=14), subacute (n=10) and chronic (n=10) age stages of myocardial infarction. Statistical analysis revealed that based on their quantitative T1, T2 and PD values, a significant difference between all defined age groups of myocardial infarction can be determined. It can be concluded that quantitative 1.5T PMCMR quantification based on quantitative T1, T2 and PD values is feasible for characterization and differentiation of early acute and following age stages of myocardial infarction.
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Affiliation(s)
- Nicole Schwendener
- Institute of Forensic Medicine, University of Bern, Buehlstrasse 20, 3012 Bern, Switzerland
| | - Christian Jackowski
- Institute of Forensic Medicine, University of Bern, Buehlstrasse 20, 3012 Bern, Switzerland
| | - Anders Persson
- Center for Medical Image Science and Visualization, CMIV, Linköping University, SE-58183 Linköping, Sweden; Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Marcel J Warntjes
- Center for Medical Image Science and Visualization, CMIV, Linköping University, SE-58183 Linköping, Sweden; Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Frederick Schuster
- Institute of Forensic Medicine, University of Bern, Buehlstrasse 20, 3012 Bern, Switzerland; Department of Diagnostic, Interventional and Pediatric Radiology, Hospital and University of Bern Inselspital, Freiburgstrasse 10, Bern CH-3010, Switzerland
| | - Fabiano Riva
- Institute of Forensic Medicine, University of Bern, Buehlstrasse 20, 3012 Bern, Switzerland
| | - Wolf-Dieter Zech
- Institute of Forensic Medicine, University of Bern, Buehlstrasse 20, 3012 Bern, Switzerland; Center for Medical Image Science and Visualization, CMIV, Linköping University, SE-58183 Linköping, Sweden; Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
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