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Van Goethem A, Mankad K, Sudhakar S, De Temmerman G, Van Hoyweghen A, Volders W, Bracke P, Soerdjbalie-Maikoe V, D'Hondt D, Van Rafelghem B, Jacobs W. Added value of postmortem mri in sudden unexpected infant death cases. Forensic Sci Med Pathol 2024:10.1007/s12024-024-00850-3. [PMID: 38896346 DOI: 10.1007/s12024-024-00850-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2024] [Indexed: 06/21/2024]
Abstract
We aimed to investigate the potential added value of postmortem MRI (PMMRI) in sudden unexpected infant death (SUID) cases referred to our center between September 2020 and June 2023. Ultimately, 19 SUID cases underwent PMMRI alongside standard autopsy procedures, which included technical examinations such as postmortem CT (PMCT). Four radiologists, two with prior PMMRI experience, provided structured reports following consensus. For each case, the responsible forensic medicine specialist documented the cause of death before and after reviewing the PMMRI report. Additionally, they assessed the overall impact of the PMMRI report and had the opportunity to provide written comments. The results of our study indicate that none of the PMMRI reports altered the prior determined cause of death, which included cases of infection, asphyxia, and sudden infant death syndrome (SIDS). However, we observed a moderate impact in one case and a low impact in 10 cases. The moderate impact arose from the PMMRI report identifying hypoxic-ischemic changes, where histologic examination of the brain was perceived as normal. Conversely, in the 10 cases with a low impact, the PMMRI reports supported the autopsy findings, specifically indicating brain injury and intra-alveolar cellular infiltrates. In conclusion, our study suggests that while PMMRI may not be pivotal in determining the cause of death in SUID cases, it could aid in detecting hypoxic-ischemic changes and reinforcing brain and lung observations. However, distinguishing genuine lung pathology from postmortem changes using PMMRI remains challenging. Further research is warranted to clarify the role of PMMRI in forensic SUID investigations.
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Affiliation(s)
- Alexia Van Goethem
- Department of Forensic Medicine and Pathology, Antwerp University Hospital, Edegem, Belgium.
| | - Kshitij Mankad
- Department of Radiology, Great Ormond Street Hospital for Children, London, UK
| | - Sniya Sudhakar
- Department of Radiology, Great Ormond Street Hospital for Children, London, UK
| | | | - Astrid Van Hoyweghen
- Department of Radiology, Hospital Geel, Geel, Belgium
- AZ Turnhout, Department of Radiology, Turnhout, Belgium
| | - Wim Volders
- Department of Radiology, AZ KLINA, Brasschaat, Belgium
| | - Peter Bracke
- Department of Radiology, AZ KLINA, Brasschaat, Belgium
| | | | - Diona D'Hondt
- Department of Forensic Medicine and Pathology, Antwerp University Hospital, Edegem, Belgium
| | - Babette Van Rafelghem
- Department of Forensic Medicine and Pathology, Antwerp University Hospital, Edegem, Belgium
| | - Werner Jacobs
- Department of Forensic Medicine and Pathology, Antwerp University Hospital, Edegem, Belgium
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Castañeyra-Perdomo A, Gonzalez-Mora JL, Carmona-Calero EM, Makris N, Carrasco-Juan JL. A Narrative Review on the Clinical Relevance of Imaging the Circumventricular Brain Organs and Performing Their Anatomical and Histopathological Examination in Acute and Postacute COVID-19. Am J Forensic Med Pathol 2024; 45:151-156. [PMID: 38739896 DOI: 10.1097/paf.0000000000000939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
ABSTRACT Autopsy followed by histopathological examination is foundational in clinical and forensic medicine for discovering and understanding pathological changes in disease, their underlying processes, and cause of death. Imaging technology has become increasingly important for advancing clinical research and practice, given its noninvasive, in vivo and ex vivo applicability. Medical and forensic autopsy can benefit greatly from advances in imaging technology that lead toward minimally invasive, whole-brain virtual autopsy. Brain autopsy followed by histopathological examination is still the hallmark for understanding disease and a fundamental modus operandi in forensic pathology and forensic medicine, despite the fact that its practice has become progressively less frequent in medical settings. This situation is especially relevant with respect to new diseases such as COVID-19 caused by the SARS-CoV-2 virus, for which our neuroanatomical knowledge is sparse. In this narrative review, we show that ad hoc clinical autopsies and histopathological analyses combined with neuroimaging of the principal circumventricular organs are critical to gaining insight into the reconstruction of the pathophysiological mechanisms and the explanation of cause of death (ie, atrium mortis) related to the cardiovascular effects of SARS-CoV-2 infection in forensic and clinical medicine.
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Affiliation(s)
- Agustin Castañeyra-Perdomo
- From the Universidad de La Laguna, Área de Anatomía y Fisiología, Departamento de Ciencias Médicas Básicas, Facultad de Ciencias de la Salud, San Cristobal de la Laguna, Santa Cruz de Tenerife, Spain
| | - Jose Luis Gonzalez-Mora
- From the Universidad de La Laguna, Área de Anatomía y Fisiología, Departamento de Ciencias Médicas Básicas, Facultad de Ciencias de la Salud, San Cristobal de la Laguna, Santa Cruz de Tenerife, Spain
| | - Emilia Maria Carmona-Calero
- From the Universidad de La Laguna, Área de Anatomía y Fisiología, Departamento de Ciencias Médicas Básicas, Facultad de Ciencias de la Salud, San Cristobal de la Laguna, Santa Cruz de Tenerife, Spain
| | - Nikos Makris
- Center for Morphometric Analysis, Departments of Psychiatry and Neurology, A.A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Jose Luis Carrasco-Juan
- Universidad de La Laguna, Área de Histología, Departamento de Ciencias Médicas Básicas, Facultad de Ciencias de la Salud, San Cristobal de la Laguna, Santa Cruz de Tenerife, Spain
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Lemainque T, Pridöhl N, Huppertz M, Post M, Yüksel C, Siepmann R, Radke KL, Zhang S, Yoneyama M, Prescher A, Kuhl C, Truhn D, Nebelung S. Two for One-Combined Morphologic and Quantitative Knee Joint MRI Using a Versatile Turbo Spin-Echo Platform. Diagnostics (Basel) 2024; 14:978. [PMID: 38786276 PMCID: PMC11120432 DOI: 10.3390/diagnostics14100978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 04/25/2024] [Accepted: 05/03/2024] [Indexed: 05/25/2024] Open
Abstract
Quantitative MRI techniques such as T2 and T1ρ mapping are beneficial in evaluating knee joint pathologies; however, long acquisition times limit their clinical adoption. MIXTURE (Multi-Interleaved X-prepared Turbo Spin-Echo with IntUitive RElaxometry) provides a versatile turbo spin-echo (TSE) platform for simultaneous morphologic and quantitative joint imaging. Two MIXTURE sequences were designed along clinical requirements: "MIX1", combining proton density (PD)-weighted fat-saturated (FS) images and T2 mapping (acquisition time: 4:59 min), and "MIX2", combining T1-weighted images and T1ρ mapping (6:38 min). MIXTURE sequences and their reference 2D and 3D TSE counterparts were acquired from ten human cadaveric knee joints at 3.0 T. Contrast, contrast-to-noise ratios, and coefficients of variation were comparatively evaluated using parametric tests. Clinical radiologists (n = 3) assessed diagnostic quality as a function of sequence and anatomic structure using five-point Likert scales and ordinal regression, with a significance level of α = 0.01. MIX1 and MIX2 had at least equal diagnostic quality compared to reference sequences of the same image weighting. Contrast, contrast-to-noise ratios, and coefficients of variation were largely similar for the PD-weighted FS and T1-weighted images. In clinically feasible scan times, MIXTURE sequences yield morphologic, TSE-based images of diagnostic quality and quantitative parameter maps with additional insights on soft tissue composition and ultrastructure.
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Affiliation(s)
- Teresa Lemainque
- Department of Diagnostic and Interventional Radiology, Medical Faculty, RWTH Aachen University, 52074 Aachen, Germany (C.Y.); (R.S.); (S.N.)
| | - Nicola Pridöhl
- Department of Diagnostic and Interventional Radiology, Medical Faculty, RWTH Aachen University, 52074 Aachen, Germany (C.Y.); (R.S.); (S.N.)
| | - Marc Huppertz
- Department of Diagnostic and Interventional Radiology, Medical Faculty, RWTH Aachen University, 52074 Aachen, Germany (C.Y.); (R.S.); (S.N.)
| | - Manuel Post
- Department of Diagnostic and Interventional Radiology, Medical Faculty, RWTH Aachen University, 52074 Aachen, Germany (C.Y.); (R.S.); (S.N.)
| | - Can Yüksel
- Department of Diagnostic and Interventional Radiology, Medical Faculty, RWTH Aachen University, 52074 Aachen, Germany (C.Y.); (R.S.); (S.N.)
| | - Robert Siepmann
- Department of Diagnostic and Interventional Radiology, Medical Faculty, RWTH Aachen University, 52074 Aachen, Germany (C.Y.); (R.S.); (S.N.)
| | - Karl Ludger Radke
- Department of Diagnostic and Interventional Radiology, University Hospital Düsseldorf, University Dusseldorf, 40225 Düsseldorf, Germany
| | - Shuo Zhang
- Philips GmbH Market DACH, 22335 Hamburg, Germany
- Philips Healthcare, 5684 PZ Best, The Netherlands
| | | | - Andreas Prescher
- Institute of Molecular and Cellular Anatomy, Medical Faculty, RWTH Aachen University, 52074 Aachen, Germany
| | - Christiane Kuhl
- Department of Diagnostic and Interventional Radiology, Medical Faculty, RWTH Aachen University, 52074 Aachen, Germany (C.Y.); (R.S.); (S.N.)
| | - Daniel Truhn
- Department of Diagnostic and Interventional Radiology, Medical Faculty, RWTH Aachen University, 52074 Aachen, Germany (C.Y.); (R.S.); (S.N.)
| | - Sven Nebelung
- Department of Diagnostic and Interventional Radiology, Medical Faculty, RWTH Aachen University, 52074 Aachen, Germany (C.Y.); (R.S.); (S.N.)
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Davidson CL, de Klerk J, Matejovsky Z, Fabris-Rotelli I, Uys A. Metric evaluation of the anterior nasal spine to estimate sex and population group in South African individuals. Int J Legal Med 2024; 138:1117-1137. [PMID: 38010514 PMCID: PMC11003921 DOI: 10.1007/s00414-023-03130-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 11/12/2023] [Indexed: 11/29/2023]
Abstract
INTRODUCTION The anterior nasal spine is a pointed, midline projection of the maxilla. This bony structure dictates the overlying soft tissues providing the phenotypic features of the nose and upper lip and determines the differences in the mid-face morphology. Little data is available on the metric features of the Anterior nasal spine (ANS). This study aimed to perform metric evaluations of the ANS of white and black South African males and females to ascertain if morphological variations exist and if the differences are viable for the use in sex and population identification. MATERIALS AND METHODS The sample included 100 CBCT images for each population and sex group. Linear and angular measurements of the ANS were recorded in both the sagittal and axial planes. RESULTS Classification decision trees (pruned) were fitted to ascertain the relationship between population group, sex and the ANS measurements including and excluding age. For population group, all the ANS measurements were statistically significant for females but in males, all the ANS measurements were significant when performed individually. However, when fitted to the classification tree, Sagittal 2 did not show any statistical significance. When considering sex, only 2 of the ANS measurements (Sagittal 2 and Axial 1) were found to be significant. The results did not differ significantly when comparing the decision trees including and excluding age. CONCLUSIONS White South African individuals presented with a longer ANS that produced a more acute angle whereas black South African individuals presented with a shorter ANS and a more obtuse angle. Additionally, males presented with a longer ANS compared to females. ANS measurements were found to be more relevant for population discernment than for sex.
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Affiliation(s)
- Christy Lana Davidson
- Department of Oral and Maxillofacial Pathology, School of Dentistry, Faculty of Health Sciences, University of Pretoria, PO Box 1266, Pretoria, 0001, South Africa.
| | - Johan de Klerk
- Department of Oral and Maxillofacial Pathology, School of Dentistry, Faculty of Health Sciences, University of Pretoria, PO Box 1266, Pretoria, 0001, South Africa
| | - Zina Matejovsky
- Department of Oral and Maxillofacial Pathology, School of Dentistry, Faculty of Health Sciences, University of Pretoria, PO Box 1266, Pretoria, 0001, South Africa
| | - Inger Fabris-Rotelli
- Department of Statistics, Faculty of Natural and Agricultural Sciences, University of Pretoria, Pretoria, South Africa
| | - Andre Uys
- Department of Anatomy, School of Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
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Lombardo P, Lange-Herr N, Hoppe H, Schwendener N, Jackowski C, Klaus J, Zech WD. Diagnostic accuracy of coronary artery stenosis and thrombosis assessment using unenhanced multiplanar 3D post-mortem cardiac magnetic resonance imaging. Forensic Sci Int 2023; 353:111878. [PMID: 37980856 DOI: 10.1016/j.forsciint.2023.111878] [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: 06/23/2023] [Accepted: 10/18/2023] [Indexed: 11/21/2023]
Abstract
BACKGROUND A 3D sequence was introduced to unenhanced post-mortem cardiac magnetic resonance imaging (PMCMR) to enable multiplanar coronary artery image analysis and to investigate its diagnostic accuracy for the diagnosis of coronary artery stenosis and thrombosis. MATERIALS AND METHODS N = 200 forensic cases with suspected coronary artery pathology underwent 3 Tesla PMCMR (sequence used: T2 weighted transversal 3D turbo spin echo) before autopsy. Main coronary artery stenosis and thrombosis were assessed in PMCMR by multiplanar image analysis by two observers. Coronary artery histology was determined as the gold standard and compared to PMCMR. Sensitivity, specificity, negative (NPV) and positive predictive values (PPV) with 95% confidence intervals were calculated. RESULTS For all coronary arteries combined, sensitivity was 75% (PPV 73%) for the diagnosis of stenosis and 72% (PPV 71%) for the diagnosis of thrombosis. Specificity was 92% (NPV 90%) for correct diagnosis of non-existing stenosis and 97% (NPV 97%) for non-existing thrombosis. Sensitivity for correct diagnosis of different degrees of stenosis ranged between 67% and 80% (PPVs 67-82%); specificity ranged between 96% and 99% (NPVs 96-99%). CONCLUSION Multiplanar PMCMR coronary artery stenosis and thrombosis assessment based on an unenhanced T2 weighted 3D sequence provide moderate sensitivity and high specificity for the diagnosis of coronary artery stenosis and/or thrombosis. Hence, 3D T2w PMCMR cannot reliably detect existing coronary artery stenosis and thrombosis but may be particularly useful for the exclusion of stenosis or thrombosis of the main coronary arteries.
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Affiliation(s)
- Paolo Lombardo
- Institute of Forensic Medicine, University of Bern, Bern, Switzerland; Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Hanno Hoppe
- Department of Radiology, Lindenhofspital Bern, Bern, Switzerland; University of Bern, Bern, Switzerland; Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | | | | | - Jeremias Klaus
- Institute of Forensic Medicine, University of Bern, Bern, Switzerland; Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Wolf-Dieter Zech
- Institute of Forensic Medicine, University of Bern, Bern, Switzerland.
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Di Fazio N, Scopetti M, Delogu G, Morena D, Santurro A, Cipolloni L, Serviddio G, Papi L, Frati P, Turillazzi E, Fineschi V. Fourteen Deaths from Suspected Heparin Overdose in an Italian Primary-Level Hospital. Diagnostics (Basel) 2023; 13:3361. [PMID: 37958256 PMCID: PMC10650777 DOI: 10.3390/diagnostics13213361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 10/08/2023] [Accepted: 10/26/2023] [Indexed: 11/15/2023] Open
Abstract
Healthcare-related homicidal cases are not novel within the medical-legal landscape, but investigations are often made difficult with the scarcity of material evidence related to the crime. For this reason, it is necessary to carefully analyze the clinical documentation and employ ancillary forensic resources such as radiology, histopathology, and toxicology. In the presented scenario, the observation of 14 deaths from abnormal bleeding in a First-Level Italian Hospital revealed the administration of massive doses of heparin by a nurse. On behalf of the Judicial Authority, a multidisciplinary medical team investigated the case through the following steps: a thorough review of the clinical documentation, exhumation of the bodies belonging to the deceased patients, performing PMCT and autopsy, and collecting tissue samples for histopathological, immunohistochemical, and toxicological investigations. All the analyzed cases have been characterized by the observation of fatal hemorrhagic episodes not explained with the clinical conditions of the patients, confirmed using autopsy observations and the histological demonstration of the vitality of the lesions. However, due to the limited availability of biological material for the toxicological analysis, the indirect evidence from hematological analyses in hospitalized patients was crucial in demonstrating heparin overdose and its link to the recorded deaths. The present scenario demonstrates the fundamental importance of a multidisciplinary approach to cases of judicial interest related to the healthcare context. Therefore, the illustrated methodologies can be interpreted as an operational framework for similar future cases.
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Affiliation(s)
- Nicola Di Fazio
- Department of Anatomical, Histological, Forensic and Orthopedic Science, Sapienza University of Rome, 00161 Rome, Italy; (N.D.F.); (M.S.); (G.D.); (D.M.); (A.S.); (P.F.)
| | - Matteo Scopetti
- Department of Anatomical, Histological, Forensic and Orthopedic Science, Sapienza University of Rome, 00161 Rome, Italy; (N.D.F.); (M.S.); (G.D.); (D.M.); (A.S.); (P.F.)
| | - Giuseppe Delogu
- Department of Anatomical, Histological, Forensic and Orthopedic Science, Sapienza University of Rome, 00161 Rome, Italy; (N.D.F.); (M.S.); (G.D.); (D.M.); (A.S.); (P.F.)
| | - Donato Morena
- Department of Anatomical, Histological, Forensic and Orthopedic Science, Sapienza University of Rome, 00161 Rome, Italy; (N.D.F.); (M.S.); (G.D.); (D.M.); (A.S.); (P.F.)
| | - Alessandro Santurro
- Department of Anatomical, Histological, Forensic and Orthopedic Science, Sapienza University of Rome, 00161 Rome, Italy; (N.D.F.); (M.S.); (G.D.); (D.M.); (A.S.); (P.F.)
| | - Luigi Cipolloni
- Department of Clinical and Experimental Medicine, University of Foggia, 71100 Foggia, Italy;
| | - Gaetano Serviddio
- Department of Medical and Surgical Sciences, University of Foggia, 71100 Foggia, Italy;
| | - Luigi Papi
- Department of Legal Medicine, University of Pisa, 56126 Pisa, Italy; (L.P.); (E.T.)
| | - Paola Frati
- Department of Anatomical, Histological, Forensic and Orthopedic Science, Sapienza University of Rome, 00161 Rome, Italy; (N.D.F.); (M.S.); (G.D.); (D.M.); (A.S.); (P.F.)
| | - Emanuela Turillazzi
- Department of Legal Medicine, University of Pisa, 56126 Pisa, Italy; (L.P.); (E.T.)
| | - Vittorio Fineschi
- Department of Anatomical, Histological, Forensic and Orthopedic Science, Sapienza University of Rome, 00161 Rome, Italy; (N.D.F.); (M.S.); (G.D.); (D.M.); (A.S.); (P.F.)
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Villa C, Lynnerup N, Jacobsen C. A Virtual, 3D Multimodal Approach to Victim and Crime Scene Reconstruction. Diagnostics (Basel) 2023; 13:2764. [PMID: 37685302 PMCID: PMC10486680 DOI: 10.3390/diagnostics13172764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 08/16/2023] [Accepted: 08/18/2023] [Indexed: 09/10/2023] Open
Abstract
In the last two decades, forensic pathology and crime scene investigations have seen a rapid increase in examination tools due to the implementation of several imaging techniques, e.g., CT and MR scanning, surface scanning and photogrammetry. These tools encompass relatively simple visualization tools to powerful instruments for performing virtual 3D crime scene reconstructions. A multi-modality and multiscale approach to a crime scene, where 3D models of victims and the crime scene are combined, offers several advantages. A permanent documentation of all evidence in a single 3D environment can be used during the investigation phases (e.g., for testing hypotheses) or during the court procedures (e.g., to visualize the scene and the victim in a more intuitive manner). Advanced computational approaches to understand what might have happened during a crime can also be applied by, e.g., performing a virtual animation of the victim in the actual context, which can provide important information about possible dynamics during the event. Here, we present an overview of the different techniques and modalities used in forensic pathology in conjunction with crime scene investigations. Based on our experiences, the advantages and challenges of an image-based multi-modality approach will be discussed, including how their use may introduce new visualization modalities in court, e.g., virtual reality (VR) and 3D printing. Finally, considerations about future directions in research will be mentioned.
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Affiliation(s)
- Chiara Villa
- Department of Forensic Medicine, University of Copenhagen, Frederik V’s Vej 11, DK-2100 Copenhagen, Denmark; (N.L.); (C.J.)
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Golomingi R, Dobay A, Franckenberg S, Ebert L, Sieberth T. Augmented reality in forensics and forensic medicine - Current status and future prospects. Sci Justice 2023; 63:451-455. [PMID: 37453776 DOI: 10.1016/j.scijus.2023.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 03/27/2023] [Accepted: 04/22/2023] [Indexed: 07/18/2023]
Abstract
Forensic investigations require a vast variety of knowledge and expertise of each specialist involved. With the increase in digitization and advanced technical possibilities, the traditional use of a computer with a screen for visualization and a mouse and keyboard for interactions has limitations, especially when visualizing the content in relation to the real world. Augmented reality (AR) can be used in such instances to support investigators in various tasks at the scene as well as later in the investigation process. In this article, we present current applications of AR in forensics and forensic medicine, the technological basics of AR, and the advantages that AR brings for forensic investigations. Furthermore, we will have a brief look at other fields of application and at future developments of AR in forensics.
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Affiliation(s)
- Raffael Golomingi
- 3D Center Zurich, Institute of Forensic Medicine, University of Zurich, 8057 Zurich, Switzerland.
| | - Akos Dobay
- 3D Center Zurich, Institute of Forensic Medicine, University of Zurich, 8057 Zurich, Switzerland.
| | - Sabine Franckenberg
- 3D Center Zurich, Institute of Forensic Medicine, University of Zurich, 8057 Zurich, Switzerland; Diagnostic and Interventional Radiology, University Hospital Zurich, 8091 Zurich, Switzerland.
| | - Lars Ebert
- 3D Center Zurich, Institute of Forensic Medicine, University of Zurich, 8057 Zurich, Switzerland.
| | - Till Sieberth
- 3D Center Zurich, Institute of Forensic Medicine, University of Zurich, 8057 Zurich, Switzerland.
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Hansen RT, Chenu C, Sofat N, Pitsillides AA. Bone marrow lesions: plugging the holes in our knowledge using animal models. Nat Rev Rheumatol 2023; 19:429-445. [PMID: 37225964 DOI: 10.1038/s41584-023-00971-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2023] [Indexed: 05/26/2023]
Abstract
Bone marrow lesions (BMLs), which are early signs of osteoarthritis (OA) that are associated with the presence, onset and severity of pain, represent an emerging imaging biomarker and clinical target. Little is known, however, regarding their early spatial and temporal development, structural relationships or aetiopathogenesis, because of the sparsity of human early OA imaging and paucity of relevant tissue samples. The use of animal models is a logical approach to fill the gaps in our knowledge, and it can be informed by appraising models in which BMLs and closely related subchondral cysts have already been reported, including in spontaneous OA and pain models. The utility of these models in OA research, their relevance to clinical BMLs and practical considerations for their optimal deployment can also inform medical and veterinary clinicians and researchers alike.
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Affiliation(s)
- Rebecca T Hansen
- Skeletal Biology Group, Comparative Biomedical Sciences, Royal Veterinary College, London, UK
| | - Chantal Chenu
- Skeletal Biology Group, Comparative Biomedical Sciences, Royal Veterinary College, London, UK
| | - Nidhi Sofat
- Institute for Infection and Immunity, St George's, University of London, London, UK
- Department of Rheumatology, St George's, University Hospitals NHS Foundation Trust, London, UK
| | - Andrew A Pitsillides
- Skeletal Biology Group, Comparative Biomedical Sciences, Royal Veterinary College, London, UK.
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Michaud K, Jacobsen C, Basso C, Banner J, Blokker BM, de Boer HH, Dedouit F, O'Donnell C, Giordano C, Magnin V, Grabherr S, Suvarna SK, Wozniak K, Parsons S, van der Wal AC. Application of postmortem imaging modalities in cases of sudden death due to cardiovascular diseases-current achievements and limitations from a pathology perspective : Endorsed by the Association for European Cardiovascular Pathology and by the International Society of Forensic Radiology and Imaging. Virchows Arch 2023; 482:385-406. [PMID: 36565335 PMCID: PMC9931788 DOI: 10.1007/s00428-022-03458-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 11/11/2022] [Accepted: 11/15/2022] [Indexed: 12/25/2022]
Abstract
Postmortem imaging (PMI) is increasingly used in postmortem practice and is considered a potential alternative to a conventional autopsy, particularly in case of sudden cardiac deaths (SCD). In 2017, the Association for European Cardiovascular Pathology (AECVP) published guidelines on how to perform an autopsy in such cases, which is still considered the gold standard, but the diagnostic value of PMI herein was not analyzed in detail. At present, significant progress has been made in the PMI diagnosis of acute ischemic heart disease, the most important cause of SCD, while the introduction of postmortem CT angiography (PMCTA) has improved the visualization of several parameters of coronary artery pathology that can support a diagnosis of SCD. Postmortem magnetic resonance (PMMR) allows the detection of acute myocardial injury-related edema. However, PMI has limitations when compared to clinical imaging, which severely impacts the postmortem diagnosis of myocardial injuries (ischemic versus non-ischemic), the age-dating of coronary occlusion (acute versus old), other potentially SCD-related cardiac lesions (e.g., the distinctive morphologies of cardiomyopathies), aortic diseases underlying dissection or rupture, or pulmonary embolism. In these instances, PMI cannot replace a histopathological examination for a final diagnosis. Emerging minimally invasive techniques at PMI such as image-guided biopsies of the myocardium or the aorta, provide promising results that warrant further investigations. The rapid developments in the field of postmortem imaging imply that the diagnosis of sudden death due to cardiovascular diseases will soon require detailed knowledge of both postmortem radiology and of pathology.
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Affiliation(s)
- Katarzyna Michaud
- University Center of Legal Medicine Lausanne - Geneva, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
| | - Christina Jacobsen
- Section of Forensic Pathology, Department of Forensic Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Cristina Basso
- Cardiovascular Pathology Unit, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Jytte Banner
- Section of Forensic Pathology, Department of Forensic Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | - Hans H de Boer
- Department of Forensic Medicine, Victorian Institute of Forensic Medicine, Monash University, Melbourne, Australia
| | - Fabrice Dedouit
- GRAVIT, Groupe de Recherche en Autopsie Virtuelle et Imagerie Thanatologique, Forensic Department, University Hospital, Rangueil, Toulouse, France
| | - Chris O'Donnell
- Department of Forensic Medicine, Victorian Institute of Forensic Medicine, Monash University, Melbourne, Australia
| | - Carla Giordano
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Virginie Magnin
- University Center of Legal Medicine Lausanne - Geneva, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Geneva University Hospital, University of Geneva, Geneva, Switzerland
| | - Silke Grabherr
- University Center of Legal Medicine Lausanne - Geneva, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Geneva University Hospital, University of Geneva, Geneva, Switzerland
| | - S Kim Suvarna
- Department of Histopathology, Northern General Hospital, The University of Sheffield, Sheffield, UK
| | - Krzysztof Wozniak
- Department of Forensic Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Sarah Parsons
- Department of Forensic Medicine, Victorian Institute of Forensic Medicine, Monash University, Melbourne, Australia
| | - Allard C van der Wal
- Department of Pathology, Amsterdam UMC, Academic Medical Center, Amsterdam, The Netherlands.
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11
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Application of postmortem MRI for identification of medulla oblongata contusion as a cause of death: a case report. Int J Legal Med 2023; 137:115-121. [PMID: 36303078 DOI: 10.1007/s00414-022-02909-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 10/19/2022] [Indexed: 01/10/2023]
Abstract
Whiplash injury is common in traffic accidents, and severe whiplash is characterized by cervical spinal cord injuries with cervical dislocation or fracture, that can be diagnosed by postmortem computed tomography (PMCT), postmortem magnetic resonance (PMMR), or conventional autopsy. However, for cervical spinal cord injury without fracture and dislocation, PMMR can be more informative because it provides higher resolution of soft tissues. We report the case of a 29-year-old male who died immediately following a traffic accident, in which the vehicle hit an obstacle at a high speed, causing deformation of the bumper and severe damage of the vehicle body. PMCT indicated no significant injuries or diseases related to death, but PMMR showed patchy abnormal signals in the medulla oblongata, and the lower edge of the cerebellar tonsil was herniated out of the foramen magnum. The subsequent pathological and histological results confirmed that death was caused by medulla oblongata contusion combined with cerebellar tonsillar herniation. Our description of this case of a rare but fatal whiplash injury in which there was no fracture or dislocation provides a better understanding of the potentially fatal consequences of cervical spinal cord whiplash injury without fracture or dislocation and of the underlying lethal mechanisms. Compared with PMCT, PMMR provides important diagnostic information in forensic practice for the identification of soft tissue injuries, and is therefore an important imaging modality for diagnosis of whiplash injury when there is no fracture or dislocation.
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12
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Porzionato A, Macchi V, Stecco C, Boscolo-Berto R, Loukas M, Tubbs RS, De Caro R. Clinical Anatomy and Medical Malpractice-A Narrative Review with Methodological Implications. Healthcare (Basel) 2022; 10:1915. [PMID: 36292362 PMCID: PMC9601975 DOI: 10.3390/healthcare10101915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 09/25/2022] [Accepted: 09/27/2022] [Indexed: 11/04/2022] Open
Abstract
Anatomical issues are intrinsically included in medico-legal methodology, however, higher awareness would be needed about the relevance of anatomy in addressing medico-legal questions in clinical/surgical contexts. Forensic Clinical Anatomy has been defined as "the practical application of Clinical Anatomy to the ascertainment and evaluation of medico-legal problems". The so-called individual anatomy (normal anatomy, anatomical variations, or anatomical modifications due to development, aging, para-physiological conditions, diseases, or surgery) may acquire specific relevance in medico-legal ascertainment and evaluation of cases of supposed medical malpractice. Here, we reviewed the literature on the relationships between anatomy, clinics/surgery, and legal medicine. Some methodological considerations were also proposed concerning the following issues: (1) relevant aspects of individual anatomy may arise from the application of methods of ascertainment, and they may be furtherly ascertained through specific anatomical methodology; (2) data about individual anatomy may help in the objective application of the criteria of evaluation (physio-pathological pathway, identification-evaluation of errors, causal value, damage estimation) and in final judgment about medical responsibility/liability. Awareness of the relevance of individual anatomy (risk of iatrogenic lesions, need for preoperative diagnostic procedures) should be one of the principles guiding the clinician; medico-legal analyses can also take advantage of its contribution in terms of ascertainment/evaluation.
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Affiliation(s)
- Andrea Porzionato
- Section of Anatomy, Department of Neuroscience, University of Padova, Via Gabelli, 65, 35127 Padova, Italy
| | - Veronica Macchi
- Section of Anatomy, Department of Neuroscience, University of Padova, Via Gabelli, 65, 35127 Padova, Italy
| | - Carla Stecco
- Section of Anatomy, Department of Neuroscience, University of Padova, Via Gabelli, 65, 35127 Padova, Italy
| | - Rafael Boscolo-Berto
- Section of Anatomy, Department of Neuroscience, University of Padova, Via Gabelli, 65, 35127 Padova, Italy
| | - Marios Loukas
- Department of Anatomical Sciences, True Blue Campus, St. George’s University, St. George 1473, Grenada
| | - Ronald Shane Tubbs
- Department of Anatomical Sciences, True Blue Campus, St. George’s University, St. George 1473, Grenada
- Department of Neurosurgery, Tulane University, New Orleans, LA 70112, USA
| | - Raffaele De Caro
- Section of Anatomy, Department of Neuroscience, University of Padova, Via Gabelli, 65, 35127 Padova, Italy
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13
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Tijssen MPM, Hofman PAM, Robben SGF. Postmortem Fetal Temperature Estimation with Magnetic Resonance Imaging: Apparent Diffusion Coefficient Measurements in the Vitreous Body and Cerebrospinal Fluid. Top Magn Reson Imaging 2022; 31:25-30. [PMID: 36269228 DOI: 10.1097/rmr.0000000000000295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
OBJECTIVES Magnetic resonance imaging (MRI) is increasingly used in postmortem fetal imaging. Several factors influence the quality of MRI in this setting, such as small size, autolytic and maceration changes, and temperature. Knowing the fetal temperature at the time of scanning can improve the MRI interpretation. Temperature can be calculated using diffusion-weighted imaging with measurements of the apparent diffusion coefficient (ADC) in the cerebrospinal fluid (CSF). However, this is complicated by small ventricle size and hemorrhage and, therefore, may be unreliable in postmortem imaging. The current study evaluated the feasibility and reliability of using the ADC for temperature measurements of the vitreous body compared to that of CSF. MATERIALS AND METHODS Two lambs were scanned postmortem at five different time points over 28 hours. Furthermore, 10 stillborn fetuses were scanned once, at 4 to 62 hours after birth. The temperature was measured with a digital thermometer and calculated using the ADCs of the vitreous body (lambs and fetuses) and CSF (fetuses). RESULTS There was an excellent correlation between measured and calculated temperatures in vitreous bodies of lambs (r = 0.997, P < 0.001) and fetuses (r = 0.970, P < 0.001). The correlation between measured and calculated temperatures in the CSF was poor (r = 0.522, P = 0.122). CONCLUSION The calculation of the temperature based on the ADC of the vitreous body is feasible and reliable for postmortem fetal imaging.
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Affiliation(s)
- Maud P M Tijssen
- Department of Radiology, Maastricht University Medical Center, Maastricht, The Netherlands
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14
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Bertozzi G, Cafarelli FP, Ferrara M, Di Fazio N, Guglielmi G, Cipolloni L, Manetti F, La Russa R, Fineschi V. Sudden Cardiac Death and Ex-Situ Post-Mortem Cardiac Magnetic Resonance Imaging: A Morphological Study Based on Diagnostic Correlation Methodology. Diagnostics (Basel) 2022; 12:diagnostics12010218. [PMID: 35054385 PMCID: PMC8774558 DOI: 10.3390/diagnostics12010218] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 01/07/2022] [Accepted: 01/12/2022] [Indexed: 02/01/2023] Open
Abstract
During the last years, post-mortem imaging has gradually been assumed within research in the field of forensic pathology. This role appears to be clearly and simply applied in the trauma field with the use of conventional radiography or Post Mortem Computed Tomography (PMCT). Recently, particular attention was paid to cardiovascular imaging using Post Mortem Magnetic Resonance Imaging (PMMRI). The present experimental study aims to: (i) confirm the efficacy of a Post Mortem Cardiac Resonance Imaging (PMCRI) study protocol for the study of human hearts collected during the autopsy; (ii) apply the defined protocol on subjects who died of “SCD (sudden cardiac death)”, to identify alterations that could guide subsequent sampling. Two hearts of healthy subjects (A: male 22 years; B: female 26 years), who died from causes other than SCD were collected and compared to hearts that belonged to SCD individuals (C: male, 47 years old; D: female, 44 years old; E: male; 72 years old). The exams were performed on a 1.5 T scanner (Philips Intera Achieva, Best, the Netherlands) on hearts collected during autopsy and after a 30-day formalin fixation. Two readers analyzed the obtained images blindly and after randomization. From the comparison between the data from imaging and the macroscopic and histological investigations carried out, the present study proved the effectiveness of a PMMRI protocol to study ex-situ hearts. Moreover, it suggested the following semeiology in post-mortem SCD cases: the hyperintense area with indistinct margins in the Short Tau Inversion Recovery (STIR) sequence was linked to edema or area of pathological fibers, whereas the hypointense area in the T2-FFE sequences was linked to fibrosis. PMMRI can provide a valuable benefit to post-mortem investigations, helping to distinctly improve the success rate of histological sampling and investigations, which remains the gold standard in the diagnosis of sudden death.
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Affiliation(s)
- Giuseppe Bertozzi
- Department of Clinical and Experimental Medicine, University of Foggia, 71100 Foggia, Italy; (G.B.); (F.P.C.); (G.G.); (L.C.); (R.L.R.)
| | - Francesco Pio Cafarelli
- Department of Clinical and Experimental Medicine, University of Foggia, 71100 Foggia, Italy; (G.B.); (F.P.C.); (G.G.); (L.C.); (R.L.R.)
| | - Michela Ferrara
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, 00185 Rome, Italy; (M.F.); (N.D.F.); (F.M.)
| | - Nicola Di Fazio
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, 00185 Rome, Italy; (M.F.); (N.D.F.); (F.M.)
| | - Giuseppe Guglielmi
- Department of Clinical and Experimental Medicine, University of Foggia, 71100 Foggia, Italy; (G.B.); (F.P.C.); (G.G.); (L.C.); (R.L.R.)
| | - Luigi Cipolloni
- Department of Clinical and Experimental Medicine, University of Foggia, 71100 Foggia, Italy; (G.B.); (F.P.C.); (G.G.); (L.C.); (R.L.R.)
| | - Federico Manetti
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, 00185 Rome, Italy; (M.F.); (N.D.F.); (F.M.)
| | - Raffaele La Russa
- Department of Clinical and Experimental Medicine, University of Foggia, 71100 Foggia, Italy; (G.B.); (F.P.C.); (G.G.); (L.C.); (R.L.R.)
| | - Vittorio Fineschi
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, 00185 Rome, Italy; (M.F.); (N.D.F.); (F.M.)
- Correspondence: ; Tel.: +39-06-4991-2722
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15
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Asphyxia. FORENSIC IMAGING 2022. [DOI: 10.1007/978-3-030-83352-7_8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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16
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Arnold I, Schwendener N, Lombardo P, Jackowski C, Zech WD. 3Tesla post-mortem MRI quantification of anatomical brain structures. Forensic Sci Int 2021; 327:110984. [PMID: 34482282 DOI: 10.1016/j.forsciint.2021.110984] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 03/04/2021] [Accepted: 08/17/2021] [Indexed: 01/31/2023]
Abstract
Quantitative post-mortem magnetic resonance imaging (PMMR) allows for measurement of T1 and T2 relaxation times and proton density (PD) of brain tissue. Quantitative PMMR values may be used for advanced post-mortem neuro-imaging diagnostics such as computer aided diagnosis. So far, the quantitative T1, T2 and PD post-mortem values of regular anatomical brain structures were unknown for a 3 Tesla PMMR application. The goal of this basic research study was to evaluate the quantitative values of post-mortem brain structures for a 3 T post-mortem magnetic resonance application with regard to various corpse temperatures. In 50 forensic cases, a quantitative PMMR brain sequence was applied prior to autopsy. Measurements of T1 (in ms), T2 (in ms), and PD (in %) values of cerebrum (Group 1: frontal grey matter, frontal white matter, thalamus, caudate nucleus, globus pallidus, putamen, internal capsule) brainstem and cerebellum (Group 2: cerebral peduncle, substantia nigra, red nucleus, pons, middle cerebellar peduncle, cerebellar hemisphere, medulla oblongata) were conducted in synthetically calculated axial PMMR brain images. Assessed quantitative values were corrected for corpse temperature. Temperature dependence was observed mainly for T1 values. ANOVA testing resulted in significant differences of quantitative values between the investigated anatomical brain structures in both groups. It can be concluded that temperature corrected 3 Tesla PMMR T1, T2 and PD values are feasible for characterization and discrimination of regular anatomical brain structures. This may provide a base for future advanced diagnostics of forensically relevant brain lesions and pathology.
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Affiliation(s)
- Isabel Arnold
- Institute of Forensic Medicine, University of Bern, Switzerland
| | | | - Paolo Lombardo
- Institute of Forensic Medicine, University of Bern, Switzerland; Department of Diagnostic, Interventional and Pediatric Radiology, University of Bern, Inselspital Bern, Switzerland
| | | | - Wolf-Dieter Zech
- Institute of Forensic Medicine, University of Bern, Switzerland.
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17
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18
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Sessa F, Esposito M, Messina G, Di Mizio G, Di Nunno N, Salerno M. Sudden Death in Adults: A Practical Flow Chart for Pathologist Guidance. Healthcare (Basel) 2021; 9:870. [PMID: 34356248 PMCID: PMC8307931 DOI: 10.3390/healthcare9070870] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 07/06/2021] [Accepted: 07/08/2021] [Indexed: 12/27/2022] Open
Abstract
The medico-legal term "sudden death (SD)" refers to those deaths that are not preceded by significant symptoms. SD in apparently healthy individuals (newborn through to adults) represents a challenge for medical examiners, law enforcement officers, and society as a whole. This review aims to introduce a useful flowchart that should be applied in all cases of SD. Particularly, this flowchart mixes the data obtained through an up-to-date literature review and a revision of the latest version of guidelines for autopsy investigation of sudden cardiac death (SCD) in order to support medico-legal investigation. In light of this review, following the suggested flowchart step-by-step, the forensic pathologist will be able to apply all the indications of the scientific community to real cases. Moreover, it will be possible to answer all questions relative to SD, such as: death may be attributable to cardiac disease or to other causes, the nature of the cardiac disease (defining whether the mechanism was arrhythmic or mechanical), whether the condition causing SD may be inherited (with subsequent genetic counseling), the assumption of toxic or illicit drugs, traumas, and other unnatural causes.
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Affiliation(s)
- Francesco Sessa
- Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy;
| | - Massimiliano Esposito
- Department of Medical, Surgical and Advanced Technologies “G.F. Ingrassia”, University of Catania, 95121 Catania, Italy; (M.E.); (M.S.)
| | - Giovanni Messina
- Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy;
| | - Giulio Di Mizio
- Forensic Medicine, Department of Law, Economy and Sociology, Campus “S. Venuta”, Magna Graecia University, 88100 Catanzaro, Italy;
| | - Nunzio Di Nunno
- Department of History, Society and Studies on Humanity, University of Salento, 73100 Lecce, Italy;
| | - Monica Salerno
- Department of Medical, Surgical and Advanced Technologies “G.F. Ingrassia”, University of Catania, 95121 Catania, Italy; (M.E.); (M.S.)
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19
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Ex situ heart magnetic resonance imaging and angiography: feasibility study for forensic purposes. FORENSIC IMAGING 2021. [DOI: 10.1016/j.fri.2021.200442] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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20
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Harty MP, Gould SW, Harcke HT. Navigating the perils and pitfalls of pediatric forensic postmortem imaging in the United States. Pediatr Radiol 2021; 51:1051-1060. [PMID: 33999245 DOI: 10.1007/s00247-020-04833-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 05/28/2020] [Accepted: 08/27/2020] [Indexed: 02/06/2023]
Abstract
Postmortem CT is widely used in the general adult and military populations. It is used extensively in pediatric death investigations in Europe and Asia, but distinctive challenges are encountered when launching a postmortem imaging program in the United States. We describe the issues we have encountered specific to establishing a pediatric postmortem imaging service in this country and propose potential solutions.
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Affiliation(s)
- Mary P Harty
- Department of Medical Imaging, Nemours/Alfred I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE, 19803, USA.
| | - Sharon W Gould
- Department of Medical Imaging, Nemours/Alfred I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE, 19803, USA
| | - Howard T Harcke
- Department of Medical Imaging, Nemours/Alfred I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE, 19803, USA
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21
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Femia G, Langlois N, Raleigh J, Gray B, Othman F, Perumal SR, Semsarian C, Puranik R. Comparison of conventional autopsy with post-mortem magnetic resonance, computed tomography in determining the cause of unexplained death. Forensic Sci Med Pathol 2021; 17:10-18. [PMID: 33464532 DOI: 10.1007/s12024-020-00343-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2020] [Indexed: 11/26/2022]
Abstract
Conventional autopsy is the gold standard for identifying unexplained death but due to declines in referrals, there is an emerging role for post-mortem imaging. We evaluated whether post-mortem magnetic resonance (PMMR) and computed tomography (PMCT) are inferior to conventional autopsy. Deceased individuals ≥ 2 years old with unexplained death referred for coronial investigation between October 2014 to December 2016 underwent PMCT and PMMR prior to conventional autopsy. Images were reported separately and then compared to the autopsy findings by independent and blinded investigators. Outcomes included the accuracy of imaging modalities to identify an organ system cause of death and other significant abnormalities. Sixty-nine individuals underwent post-mortem scanning and autopsy (50 males; 73%) with a median age of 61 years (IQR 50-73) and median time from death to imaging of 2 days (IQR 2-3). With autopsy, 48 (70%) had an organ system cause of death and were included in assessing primary outcome while the remaining 21 (30%) were only included in assessing secondary outcome; 12 (17%) had a non-structural cause and 9 (13%) had no identifiable cause. PMMR and PMCT identified the cause of death in 58% (28/48) of cases; 50% (24/48) for PMMR and 35% (17/48) for PMCT. The sensitivity and specificity were 57% and 57% for PMMR and 38% and 73% for PMCT. Both PMMR and PMCT identified 61% (57/94) of other significant abnormalities. Post-mortem imaging is inferior to autopsy but when reported by experienced clinicians, PMMR provides important information for cardiac and neurological deaths while PMCT is beneficial for neurological, traumatic and gastrointestinal deaths.
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Affiliation(s)
- Giuseppe Femia
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, NSW, 2050, Camperdown, Australia.
- Department of Cardiology, Royal Prince Alfred Hospital, NSW, Camperdown, Australia.
| | - Neil Langlois
- Forensic Science South Australia, SA, Adelaide, Australia
- School of Medical and Health Sciences, University of Adelaide, SA, Adelaide, Australia
| | - Jim Raleigh
- Department of Radiology, Royal Prince Alfred Hospital, NSW, Camperdown, Australia
| | - Belinda Gray
- Department of Cardiology, Royal Prince Alfred Hospital, NSW, Camperdown, Australia
| | - Farrah Othman
- Department of Cardiology, Royal Prince Alfred Hospital, NSW, Camperdown, Australia
| | - Sunthara Rajan Perumal
- South Australia Health & Medical Research Institute, Preclinical, Imaging & Research Laboratories, Adelaide, Australia
| | - Christopher Semsarian
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, NSW, 2050, Camperdown, Australia
- Department of Cardiology, Royal Prince Alfred Hospital, NSW, Camperdown, Australia
- Agnes Ginges Centre for Molecular Cardiology Centenary Institute, The University of Sydney, Sydney, Australia
| | - Rajesh Puranik
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, NSW, 2050, Camperdown, Australia
- Department of Cardiology, Royal Prince Alfred Hospital, NSW, Camperdown, Australia
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22
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Tsuneya S, Makino Y, Chiba F, Kojima M, Yoshida M, Kishimoto T, Mukai H, Hattori S, Iwase H. Postmortem magnetic resonance imaging revealed bilateral globi pallidi lesions in a death associated with prolonged carbon monoxide poisoning: a case report. Int J Legal Med 2021; 135:921-928. [PMID: 33447889 DOI: 10.1007/s00414-021-02506-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 01/08/2021] [Indexed: 11/28/2022]
Abstract
A man and a woman were found dead in the same car with a burned coal briquette. The cause of death of the woman was assigned to acute carbon monoxide (CO) poisoning without difficulty based on typical findings associated with this condition, including elevation of carboxyhaemoglobin (COHb). However, the man had an unremarkable elevation of COHb and a higher rectal temperature compared to that of the woman. Postmortem computed tomography (PMCT) revealed ambiguous low-density areas in the bilateral globi pallidi. Further analysis by postmortem magnetic resonance (PMMR) imaging showed these lesions more clearly; the lesions appeared as marked high signal intensity areas on both the T2-weighted images and the fluid-attenuated inversion recovery sequences. A subsequent autopsy revealed signs of pneumonia, dehydration, starvation, and hypothermia, suggesting that the man died from prolonged CO poisoning. Both globi pallidi contained grossly ambiguous lesions, and a detailed neuropathologic investigation revealed these lesions to be coagulative necrotic areas; this finding was compatible with a diagnosis of prolonged CO poisoning. This case report shows that postmortem imaging, especially PMMR, is useful for detecting necrotic lesions associated with prolonged CO poisoning. This report further exemplifies the utility of PMMR for detecting brain lesions, which may be difficult to detect by macroscopic analysis.
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Affiliation(s)
- Shigeki Tsuneya
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.,Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Yohsuke Makino
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan. .,Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan.
| | - Fumiko Chiba
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.,Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Masatoshi Kojima
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Maiko Yoshida
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Takashi Kishimoto
- Department of Molecular Pathology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8677, Japan
| | - Hiroki Mukai
- Department of Radiology, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8677, Japan
| | - Shinya Hattori
- Department of Radiology, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8677, Japan
| | - Hirotaro Iwase
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.,Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
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23
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Kobayashi T, Shiotani S, Muranaka H, Saitou H, Tashiro K, Someya S, Yoshida M, Kaga K, Miyamoto K, Hayakawa H, Homma K. Skin temperature increase after whole body postmortem magnetic resonance imaging. FORENSIC IMAGING 2020. [DOI: 10.1016/j.fri.2020.200405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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24
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Baier W, Norman DG, Donnelly MJ, Williams MA. Forensic 3D printing from micro-CT for court use- process validation. Forensic Sci Int 2020; 318:110560. [PMID: 33183864 DOI: 10.1016/j.forsciint.2020.110560] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 09/17/2020] [Accepted: 10/19/2020] [Indexed: 11/25/2022]
Abstract
Forensic application of 3D scanning and printing technology is gaining momentum with 3D printed evidence starting to be produced for court. However, the processes for creating these forensic 3D models requires still rigorous assessment to ensure they adhere to the relevant legal standards. Although, previous work has examined the accuracy of 3D prints created from medical grade Computed Tomography (CT), no such assessment has been carried out for Micro Computed Tomography (micro-CT) which offers superior resolution and the ability to capture forensically relevant injuries. This study aimed to quantify the error rates associated with forensic 3D printed models and toolmarks, created using three different printing technologies, based on micro-CT data. Overall, 3D printed models, based on micro-CT scans, replicate bone surface geometry to sub-millimetre accuracy (<0.62mm for overall shape and <0.36mm for toolmarks). However, there were significant differences between the printing technology employed (mean errors of -0.3%, -0.8%, and 0.7% for shape geometry and -0.8%, 14.1%, and 0.7% for toolmark geometry for Printers 1-3 respectively). Where possible, the authors recommend micro-CT imaging for producing forensic 3D printed bone models particularly when injuries are present.
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25
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Tunariu N, Blackledge M, Messiou C, Petralia G, Padhani A, Curcean S, Curcean A, Koh DM. What's New for Clinical Whole-body MRI (WB-MRI) in the 21st Century. Br J Radiol 2020; 93:20200562. [PMID: 32822545 DOI: 10.1259/bjr.20200562] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Whole-body MRI (WB-MRI) has evolved since its first introduction in the 1970s as an imaging technique to detect and survey disease across multiple sites and organ systems in the body. The development of diffusion-weighted MRI (DWI) has added a new dimension to the implementation of WB-MRI on modern scanners, offering excellent lesion-to-background contrast, while achieving acceptable spatial resolution to detect focal lesions 5 to 10 mm in size. MRI hardware and software advances have reduced acquisition times, with studies taking 40-50 min to complete.The rising awareness of medical radiation exposure coupled with the advantages of MRI has resulted in increased utilization of WB-MRI in oncology, paediatrics, rheumatological and musculoskeletal conditions and more recently in population screening. There is recognition that WB-MRI can be used to track disease evolution and monitor response heterogeneity in patients with cancer. There are also opportunities to combine WB-MRI with molecular imaging on PET-MRI systems to harness the strengths of hybrid imaging. The advent of artificial intelligence and machine learning will shorten image acquisition times and image analyses, making the technique more competitive against other imaging technologies.
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Affiliation(s)
- Nina Tunariu
- Department of Radiology, Royal Marsden Hospital, Downs Road, Sutton, London, UK.,Drug Development Unit, The Institute of Cancer Research, 15 Cotswold Road, Sutton, London, UK
| | - Matthew Blackledge
- Department of Radiotherapy, The Institute of Cancer Research, 15 Cotswold Road, Sutton, London, UK
| | - Christina Messiou
- Department of Radiology, Royal Marsden Hospital, Downs Road, Sutton, London, UK
| | - Giuseppe Petralia
- Department of Radiology, European Institute of Oncology, Via Ripamonti, 435 - 20141 Milan, Italy
| | - Anwar Padhani
- Mount Vernon Hospital, The Paul Strickland Scanner Centre, Rickmansworth Road, Northwood, Middlesex, UK
| | - Sebastian Curcean
- Department of Radiology, Royal Marsden Hospital, Downs Road, Sutton, London, UK
| | - Andra Curcean
- Department of Radiology, Royal Marsden Hospital, Downs Road, Sutton, London, UK.,Drug Development Unit, The Institute of Cancer Research, 15 Cotswold Road, Sutton, London, UK
| | - Dow-Mu Koh
- Drug Development Unit, The Institute of Cancer Research, 15 Cotswold Road, Sutton, London, UK
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Tashiro K, Kobayashi T, Shiotani S, Saitou H, Kaga K, Someya S, Yoshida M, Yamamori M, Kamimura Y, Kuramochi R, Miyamoto K, Hayakawa H, Muranaka H, Homma K. Skeletal muscular relaxation time from postmortem MR imaging of adult humans. FORENSIC IMAGING 2020. [DOI: 10.1016/j.fri.2020.200399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Herr N, Lombardo P, Jackowski C, Zech WD. Diagnosis of pulmonary infarction in post-mortem computed tomography and post-mortem magnetic resonance imaging-a technical note. Int J Legal Med 2020; 134:1817-1821. [PMID: 32239316 DOI: 10.1007/s00414-020-02273-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 03/12/2020] [Indexed: 12/22/2022]
Abstract
Pulmonary thromboembolism may be accompanied by pulmonary infarction. Even though pulmonary thromboembolism (PTE) is a frequently found cause of death at autopsy, pulmonary infarction accompanying PTE is a less common finding and may therefore easily be misinterpreted as infectious or cancerous lung disease. Appearance of pulmonary infarction in post-mortem imaging and acquisition parameters helping to identify pulmonary infarctions are not described yet. Based on a case of a 50-year-old man who died due to PTE and presented pulmonary infarction, we suggest using a pulmonary algorithm in post-mortem computed tomography combined with post-mortem magnetic resonance imaging of the lungs using conventional T1- and T2-weighted sequences.
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Affiliation(s)
- Nicolas Herr
- Institute of Forensic Medicine, University of Bern, Bühlstrasse 20, 3012, Bern, Switzerland
| | - Paolo Lombardo
- Institute of Forensic Medicine, University of Bern, Bühlstrasse 20, 3012, Bern, Switzerland.,Department of Diagnostic, Interventional and Pediatric Radiology, University of Bern, Inselspital, Freiburgstrasse 10, 3010, Bern, Switzerland
| | - Christian Jackowski
- Institute of Forensic Medicine, University of Bern, Bühlstrasse 20, 3012, Bern, Switzerland
| | - Wolf Dieter Zech
- Institute of Forensic Medicine, University of Bern, Bühlstrasse 20, 3012, Bern, Switzerland.
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Xia ZY, Bruguier C, Dedouit F, Grabherr S, Augsburger M, Liu BB. Oleic Acid (OA), A Potential Dual Contrast Agent for Postmortem MR Angiography (PMMRA): A Pilot Study. Curr Med Sci 2020; 40:786-794. [PMID: 32862391 DOI: 10.1007/s11596-020-2244-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 05/19/2020] [Indexed: 01/31/2023]
Abstract
Choosing proper perfusates as contrast agents is an important aspect for postmortem magnetic resonance angiography (PMMRA). However, in this emerging field, the number of suitable kinds of liquid is still very limited. The objective of this research is to compare MR images of oleic acid (OA) with paraffin oil (PO) in vitro and in ex situ animal hearts, in order to evaluate the feasibility to use OA as a novel contrast agent for PMMRA. In vitro, OA, PO and water (control) were introduced into three tubes separately and T1weighted-spin echo (T1w-SE) and T2w-SE images were acquired on a 1.5T MR scanner. In the second experiment, OA and PO were injected into left coronary artery (LCA) and left ventricle (LV) of ex situ bovine hearts and their T1w-SE, T2w-SE, T1w-multipoint Dixon (T1w-mDixon) and 3DT2w-mDixon images were acquired. The overall results indicate that OA may have a potential to be used as a dual (T1 and T2 based) contrast agent for PMMRA when proper sequence parameters are utilized. However, as the pilot study was based on limited number of animal hearts, more researches using OA in cadavers are needed to validate our findings.
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Affiliation(s)
- Zhi-Yuan Xia
- Institute of Evidence Law and Forensic Science, China University of Political Science and Law (CUPL), Key Laboratory of Evidence Law and Forensic Science, Ministry of Education, Beijing, 100088, China.
| | - Christine Bruguier
- University Center of Legal Medicine, Lausanne-Geneva (CURML), Lausanne, CH1000, Switzerland
| | - Fabrice Dedouit
- Service de Médecine Légale, Hôpital de Rangueil, Toulouse, 50032, France
| | - Silke Grabherr
- University Center of Legal Medicine, Lausanne-Geneva (CURML), Lausanne, CH1000, Switzerland
| | - Marc Augsburger
- University Center of Legal Medicine, Lausanne-Geneva (CURML), Lausanne, CH1000, Switzerland
| | - Bei-Bei Liu
- Dian Research Center for Postmortem Imaging & Angiography, Beijing, 100192, China
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Daghighi MH, Pourisa M, Javanpour-Heravi H, Ghojazadeh M, Mirza-Aghazadeh-Attari M, Daghighi S, Jabbari Khamnei H, Zarrintan A. Application of knee MRI in forensic age estimation: A retrospective cohort. Radiography (Lond) 2020; 27:108-114. [PMID: 32674920 DOI: 10.1016/j.radi.2020.06.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 06/23/2020] [Accepted: 06/24/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Forensic age estimation is performed via clinical examination and utilizing various imaging modalities. Currently, radiography and CT are used. In this study we aim to evaluate if magnetic resonance imaging (MRI) can be used to determine stages of fusion in the epiphysis of the tibia and femur, and if these stages are significantly different regarding the mean age of subjects classified in each one. METHODS A total of 193 subjects were included in the study. Knee MR imaging was performed on all of the patients, and the patients were categorized based on imaging findings of the tibial and femoral epiphysis. Tukey multiple comparison test and analysis of variance were used to assess if the difference in the mean age of the groups were significantly different. RESULTS Analysis of variance revealed that the mean of the five groups, both in tibia and femur imaging were significantly different. Analysis of variance showed that in most of the cases, the groups mean age significantly differed from the other groups. Tukey multiple comparison tests showed that although the differences between stages I-III could not be regarded as significant, MR imaging was suitable in distinguishing stages IV-V from stages I-III. CONCLUSION MR imaging of the knee may be a suitable imaging modality to assess an individual's age, does not involve ionizing radiation, and that with imaging a single anatomical location, at least two epiphyses could be used to determine the age. IMPLICATIONS FOR PRACTICE Utilization of knee MRI by clinicians as a safe and practical age estimation method.
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Affiliation(s)
- M H Daghighi
- Department of Radiology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - M Pourisa
- Department of Radiology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - H Javanpour-Heravi
- Department of Radiology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - M Ghojazadeh
- Research Center for Evidence Based Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - S Daghighi
- University of California San Diego, San Diego, United States
| | - H Jabbari Khamnei
- Department of Statistics, Faculty of Medicine, Tabriz University, Iran
| | - A Zarrintan
- Department of Radiology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.
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Oetelaar G, Heng HG, Lim CK, Cox A, Weng HY. Differentiation of Antemortem and Postmortem Appendicular Fractures Using Magnetic Resonance Imaging Signal Intensity Changes in Bone and Soft Tissues. J Forensic Sci 2020; 65:1524-1529. [PMID: 32525570 DOI: 10.1111/1556-4029.14475] [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: 04/20/2020] [Revised: 05/18/2020] [Accepted: 05/19/2020] [Indexed: 11/28/2022]
Abstract
Intraosseous T1-weighted (T1W) and short-tau inversion recovery (STIR) magnetic resonance imaging (MRI) signal intensity changes-so-called bone marrow edema-may be able to differentiate antemortem and postmortem fractures in human forensic imaging. The primary objective of this study was to investigate this hypothesis using an animal model. Three juvenile Landrace pigs were anesthetized and underwent MRI of both tibiae and both radii using a 1.5 T magnet. T1W, T2-weighted (T2W), STIR, and T2* sequences were included. Antemortem fractures were induced in both tibiae and postmortem fractures in both radii, and MRI was repeated. Two board-certified radiologists blinded to fracture group jointly evaluated the images for intraosseous and soft tissue signal intensity changes. Sensitivity (Se) and specificity (Sp) in identifying antemortem fractures were calculated based on intraosseous, soft tissue, and combined intraosseous and soft tissue signal intensity changes. Intraosseous and soft tissue signal intensity changes, when present, were hyperintense in all sequences. Intraosseous hyperintensity in T1W and T2W sequences yielded Sp of 100% for antemortem fractures. Regardless of sequence, soft tissue hyperintensity was comparatively more sensitive than intraosseous hyperintensity. Sensitivity for each sequence could be maximized by assessment of soft tissue and intraosseous hyperintense signals together; for the T1W sequence, such assessment optimized diagnostic utility yielding a Se of 100% and Sp of 83%. In summary, MRI-particularly the T1W sequence-can differentiate antemortem and postmortem fractures and may be a useful adjunct to the forensic analyses of fractures.
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Affiliation(s)
- Garrett Oetelaar
- Department of Veterinary Clinical Sciences, Purdue University College of Veterinary Medicine, West Lafayette, IN, 47907
| | - Hock Gan Heng
- Department of Veterinary Clinical Sciences, Purdue University College of Veterinary Medicine, West Lafayette, IN, 47907
| | - Chee Kin Lim
- Department of Veterinary Clinical Sciences, Purdue University College of Veterinary Medicine, West Lafayette, IN, 47907
| | - Abigail Cox
- Department of Comparative Pathobiology, Purdue University College of Veterinary Medicine, West Lafayette, IN, 47907
| | - Hsin-Yi Weng
- Department of Comparative Pathobiology, Purdue University College of Veterinary Medicine, West Lafayette, IN, 47907
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31
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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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32
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Heimer J, Gascho D, Odermatt R, Zoelch N, Kottner S, Thali M, Chatzaraki V. Full virtual autopsy in a case of a suicidal transthoracic gunshot injury. FORENSIC IMAGING 2020. [DOI: 10.1016/j.fri.2020.200368] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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33
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Mirza-Aghazadeh-Attari M, Ekrami EM, Aghdas SAM, Mihanfar A, Hallaj S, Yousefi B, Safa A, Majidinia M. Targeting PI3K/Akt/mTOR signaling pathway by polyphenols: Implication for cancer therapy. Life Sci 2020; 255:117481. [PMID: 32135183 DOI: 10.1016/j.lfs.2020.117481] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 02/20/2020] [Accepted: 02/28/2020] [Indexed: 02/07/2023]
Abstract
Cancer is one of the biggest challenges facing medicine and its cure is regarded to be the Holy Grail of medicine. Therapy in cancer is consisted as various artificial cytotoxic agents and radiotherapy, and recently immunotherapy. Recently much attention has been directed to the use of natural occurring agents in cancer therapy. One of the main group of agents utilized in this regard is polyphenols which are found abundantly in berries, fruits and vegetables. Polyphenols show to exert direct and indirect effects in progression of cancer, angiogenesis, proliferation and enhancing resistance to treatment. One of the cellular pathways commonly affected by polyphenols is PI3K/Akt/mTOR pathway, which has far ranging effects on multiple key aspects of cellular growth, metabolism and death. In this review article, evidence regarding the biology of polyphenols in cancer via PI3K/Akt/mTOR pathway is discussed and their application on cancer pathophysiology in various types of human malignancies is shown.
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Affiliation(s)
- Mohammad Mirza-Aghazadeh-Attari
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran; Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Elyad Mohammadi Ekrami
- Department of Anesthesiology & Critical Care Medicine, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Seyyed Ali Mousavi Aghdas
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran; Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ainaz Mihanfar
- Department of Biochemistry, Faculty of Medicine, Urmia University of Medical Sciences, Urmia, Iran
| | - Shahin Hallaj
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran; Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Bahman Yousefi
- Molecular Medicine Research Center, Tabriz University of Medical Sciences, Tabriz, Iran; Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Amin Safa
- Institute of Research and Development, Duy Tan University, Da Nang, Viet Nam; Department of Immunology, Ophthalmology and ENT, School of Medicine, Complutense University, Madrid, Spain
| | - Maryam Majidinia
- Solid Tumor Research Center, Urmia University of Medical Sciences, Urmia, Iran.
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Gascho D, Marosi M, Thali MJ, Deininger-Czermak E. Postmortem Computed Tomography and Magnetic Resonance Imaging of Gunshot Wounds to the Neck. J Forensic Sci 2020; 65:1360-1364. [PMID: 32105348 DOI: 10.1111/1556-4029.14311] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 02/03/2020] [Accepted: 02/06/2020] [Indexed: 12/24/2022]
Abstract
Postmortem magnetic resonance imaging (MRI) is rarely used for the radiologic assessment of gunshot injuries, although it has clear advantages over postmortem computed tomography (CT) with regard to the imaging of soft tissue injuries. Another benefit in using MRI is that lodged projectiles composed of nonferromagnetic material such as lead present only marginal metal artifacts compared with severe artifacts on CT. This case report presents CT and MRI findings in a case with two gunshot wounds to the neck: a perforating wound and a nonperforating wound with a lead bullet lodged in the cervical spine. The decedent underwent CT and MRI before the scheduled autopsy. A ring of radiopaque material under the dermis in the fatty tissue was identified at both entrance wounds on CT, which was indicative of contact shots. The perforating gunshot was clearly indicated on CT by bullet fragments along the wound channel through the perforated 6th cervical vertebra and the fractured cricoid cartilage at the exit wound. The second trajectory, however, was only assumed based on the presence of gunshot residues at the entrance wound and the position of the lodged bullet. The radiologic assessment was severely impeded by the metal artifacts on CT. Barely noticeable metal artifacts on MRI allowed for clear visualization of the soft tissue injuries and the ruptured medulla oblongata. Only MRI clarified the soft tissue injuries of the brainstem noninvasively, which could provide specific and graphic information on the rapidity of death and the incapacitation of the victim.
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Affiliation(s)
- Dominic Gascho
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, Zurich, 8057, Switzerland
| | - Mária Marosi
- Department of Radiology, University of Debrecen, Nagyerdei krt. 98, Debrecen, 4032, Hungary
| | - Michael J Thali
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, Zurich, 8057, Switzerland
| | - Eva Deininger-Czermak
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, Zurich, 8057, Switzerland
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Sapienza D, Asmundo A, Silipigni S, Barbaro U, Cinquegrani A, Granata F, Barresi V, Gualniera P, Bottari A, Gaeta M. Feasibility Study of MRI Muscles Molecular Imaging in Evaluation of Early Post-Mortem Interval. Sci Rep 2020; 10:392. [PMID: 31942017 PMCID: PMC6962370 DOI: 10.1038/s41598-019-57357-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 12/29/2019] [Indexed: 11/26/2022] Open
Abstract
Estimating early postmortem interval (EPI) is a difficult task in daily forensic activity due to limitations of accurate and reliable methods. The aim of the present work is to describe a novel approach in the estimation of EPI based on quantitative magnetic resonance molecular imaging (qMRMI) using a pig phantom since post-mortem degradation of pig meat is similar to that of human muscles. On a pig phantom maintained at 20° degree, using a 1.5 T MRI scanner we performed 10 scans (every 4 hours) monitoring apparent diffusion coefficient (ADC), fractional anisotropy (FA) magnetization transfer ration (MTR), tractography and susceptibility weighted changes in muscles until 36 hours after death. Cooling of the phantom during the experiment was recorded. Histology was also obtained. Pearson’s Test was carried out for time correlation between post-mortem interval and MRI data. We found a significative inverse correlation between ADC, FA, MT values and PMI. Our preliminary data shows that post-mortem qMRMI is a potential powerful tool in accurately determining EPI and is worth of further investigation.
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Affiliation(s)
- Daniela Sapienza
- Department of Biomedical and Dental Sciences,and of Morphological and Functional Images, Section of Legal Medicine, University of Messina, Via Consolare Valeria 1, 98125, Messina, Italy.
| | - Alessio Asmundo
- Department of Biomedical and Dental Sciences,and of Morphological and Functional Images, Section of Legal Medicine, University of Messina, Via Consolare Valeria 1, 98125, Messina, Italy
| | - Salvatore Silipigni
- Department of Biomedical and Dental Sciences,and of Morphological and Functional Images, Section of Radiological Sciences, University of Messina, Messina, Italy
| | - Ugo Barbaro
- Department of Biomedical and Dental Sciences,and of Morphological and Functional Images, Section of Radiological Sciences, University of Messina, Messina, Italy
| | - Antonella Cinquegrani
- Department of Biomedical and Dental Sciences,and of Morphological and Functional Images, Section of Radiological Sciences, University of Messina, Messina, Italy
| | - Francesca Granata
- Department of Biomedical and Dental Sciences,and of Morphological and Functional Images, Section of Radiological Sciences, University of Messina, Messina, Italy
| | - Valeria Barresi
- Department of Human Pathology in Adulthood and Evolutive Age, University of Messina, Messina, Italy
| | - Patrizia Gualniera
- Department of Biomedical and Dental Sciences,and of Morphological and Functional Images, Section of Legal Medicine, University of Messina, Via Consolare Valeria 1, 98125, Messina, Italy
| | - Antonio Bottari
- Department of Biomedical and Dental Sciences,and of Morphological and Functional Images, Section of Radiological Sciences, University of Messina, Messina, Italy
| | - Michele Gaeta
- Department of Biomedical and Dental Sciences,and of Morphological and Functional Images, Section of Radiological Sciences, University of Messina, Messina, Italy
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Influence of sex and body mass index on facial soft tissue thickness measurements in an adult population of southwest of Iran. Surg Radiol Anat 2020; 42:627-633. [PMID: 31907581 DOI: 10.1007/s00276-019-02409-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 12/23/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE Facial soft tissues have different thicknesses among different genders and ethnicities. This study was aimed to investigate the association of sex, ethnicity and body mass index (BMI) with facial soft tissue thickness measurements using magnetic resonance imaging to make a database for the Iranian southwest population (for Lur and Arab populations). METHODS In this analytical cross-sectional study, measurements of superficial soft tissues were taken at nine points of midline including glabella (GB), nasion (NA), end of nasals (END), mid-philtrum (MID), upper lip margin (UL), lower lip margin (LL), chin-lip fold (CLF), mental eminence (ME) and beneath chin (BC), eight points of axial sections including frontal tubers (FT), supraorbital margin (SO), external orbital margin (EX) and zygomatic arch (ZY) on both sides, and also two points of coronal section including both sides of the masseteric region (MST). RESULTS For association of sex with the measurements, NA, MID, UL, LL and BC were significantly higher in men (Pc < 0.05). The most accurate measurement was MID with area under curve (AUC) = 85.03%, followed by UL (81.21%), NA (72.18%), LL (71.19%) and BC (68.10%). For association of ethnicity with BMI and measurements, higher amounts of GB and MID were associated in Arab patients. CONCLUSION This study showed significant association of soft tissue thickness measurements with sex, BMI and ethnicities of southwest of Iran. MID had the most diagnostic value for male sex. The results of this study can be used in forensic medicine to diagnose the legal and biological identity of the corpse.
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Bertozzi G, Maglietta F, Sessa F, Scoto E, Cipolloni L, Di Mizio G, Salerno M, Pomara C. Traumatic Brain Injury: A Forensic Approach: A Literature Review. Curr Neuropharmacol 2020; 18:538-550. [PMID: 31686630 PMCID: PMC7457403 DOI: 10.2174/1570159x17666191101123145] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 08/27/2019] [Accepted: 10/31/2019] [Indexed: 12/11/2022] Open
Abstract
Traumatic brain injury (TBI) is the principal cause of invalidity and death in the population under 45 years of age worldwide. This mini-review aims to systematize the forensic approach in neuropathological studies, highlighting the proper elements to be noted during external, radiological, autoptical, and histological examinations with particular attention paid to immunohistochemistry and molecular biology. In the light of the results of this mini-review, an accurate forensic approach can be considered mandatory in the examination of suspected TBI with medico-legal importance, in order to gather all the possible evidence to corroborate the diagnosis of a lesion that may have caused, or contributed to, death. From this point of view, only the use of an evidence-based protocol can reach a suitable diagnosis, especially in those cases in which there are other neuropathological conditions (ischemia, neurodegeneration, neuro-inflammation, dementia) that may have played a role in death. This is even more relevant when corpses, in an advanced state of decomposition, are studied, where the radiological, macroscopic and histological analyses fail to give meaningful answers. In these cases, immune-histochemical and molecular biology diagnostics are of fundamental importance and a forensic neuropathologist has to know them. Particularly, MiRNAs are promising biomarkers for TBI both for brain damage identification and for medico-legal aspects, even if further investigations are required to validate the first experimental studies. In the same way, the genetic substrate should be examined during any forensic examination, considering its importance in the outcome of TBI.
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Affiliation(s)
| | | | | | | | | | | | | | - Cristoforo Pomara
- Address correspondence to this author at the Department of Medical and Surgical Sciences and Advanced Technologies GF Ingrassia, University of Catania, Catania, Italy; Via S. Sofia 78, 95123 Catania, Italy; Tel: (39) 095.3782153; E-mail:
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Webb B, Manninger M, Leoni M, Widek T, Dobrovnik M, Scherr D, Stollberger R, Schwark T. T 2 and T 2∗ mapping in ex situ porcine myocardium: myocardial intravariability, temporal stability and the effects of complete coronary occlusion. Int J Legal Med 2019; 134:679-690. [PMID: 31848700 DOI: 10.1007/s00414-019-02211-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 11/13/2019] [Indexed: 11/25/2022]
Abstract
Diagnosis of ischaemia-related sudden cardiac death in the absence of microscopic and macroscopic ischaemic lesions remains a challenge for medical examiners. Medical imaging techniques increasingly provide support in post-mortem examinations by detecting and documenting internal findings prior to autopsy. Previous studies have characterised MR relaxation times to investigate post-mortem signs of myocardial infarction in forensic cohorts. In this prospective study based on an ex situ porcine heart model, we report fundamental findings related to intramyocardial variability and temporal stability of T2 as well as the effects of permanent coronary occlusion on T2 and T2∗ relaxation in post-mortem myocardium. The ex situ porcine hearts included in this study (n= 19) were examined in two groups (Ss, n= 11 and Si, n= 8). All magnetic resonance imaging (MRI) examinations were performed ex situ, at room temperature and at 3 T. In the Ss group, T2 mapping was performed on slaughterhouse porcine hearts at different post-mortem intervals (PMI) between 7 and 26 h. Regarding the intramyocardial variability, no statistically significant differences in T2 were observed between myocardial segments (p= 0.167). Assessment of temporal stability indicated a weak negative correlation (r=- 0.21) between myocardial T2 and PMI. In the Si group, animals underwent ethanol-induced complete occlusion of the left anterior descending artery. T2 and T2∗ mapping were performed within 3 h of death. Differences between the expected ischaemic and remote regions were statistically significant for T2 (p= 0.007), however not for T2∗ (p= 0.062). Our results provide important information for future assessment of the diagnostic potential of quantitative MRI in the post-mortem detection of early acute myocardial infarction.
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Affiliation(s)
- Bridgette Webb
- Ludwig Boltzmann Institute for Clinical Forensic Imaging, Graz, Austria.
- BioTechMed, Graz, Austria.
| | - Martin Manninger
- Division of Cardiology, Department of Medicine, Medical University of Graz, Graz, Austria
| | - Marlene Leoni
- Institute of Pathology, Medical University of Graz, Graz, Austria
| | - Thomas Widek
- Ludwig Boltzmann Institute for Clinical Forensic Imaging, Graz, Austria
- BioTechMed, Graz, Austria
| | - Martin Dobrovnik
- Division of Cardiology, Department of Medicine, Medical University of Graz, Graz, Austria
| | - Daniel Scherr
- Division of Cardiology, Department of Medicine, Medical University of Graz, Graz, Austria
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands
| | - Rudolf Stollberger
- BioTechMed, Graz, Austria
- Institute of Medical Engineering, Graz University of Technology, Graz, Austria
| | - Thorsten Schwark
- Ludwig Boltzmann Institute for Clinical Forensic Imaging, Graz, Austria
- Institute of Forensic Medicine, Medical University Graz, Graz, Austria
- Laboratoire National de Santé, Dudelange, Luxembourg
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Audenaert EA, Khanduja V, Bauwens C, Van Hoof T, Pattyn C, Steenackers G. A discrete element model to predict anatomy of the psoas muscle and path of the tendon: Design implications for total hip arthroplasty. Clin Biomech (Bristol, Avon) 2019; 70:186-191. [PMID: 31526958 DOI: 10.1016/j.clinbiomech.2019.09.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 09/05/2019] [Accepted: 09/08/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND The accurate estimation of a muscle's line of action is a fundamental requirement in computational modelling. We present a novel anatomical muscle wrapping technique and demonstrate its clinical use on the evaluation of the Psoas muscle mechanics in hip arthroplasty. METHODS A volume preserving, spring model to parameterize muscle anatomy changes during motion is presented. Validation was performed by a CT scan of a cadaver model in multiple positions. The predicted psoas musculotendinous path was compared with the actual imaging findings. In a second stage, psoas kinetics were compared between a conventional versus a resurfacing hip arthroplasty during gait. FINDINGS Anatomy prediction error was found to be 2.12 mm on average (SD 1.34 mm). When applied to psoas mechanics during walking, the muscle was found to wrap predominantly around the femoral head providing a biomechanically efficient and nearly constant moment arm for flexion during the entire gait cycle. However, this advantage was found to be lost in small diameter hip arthroplasty designs resulting in an important mechanical disadvantage. The moment arm for flexion, was on average 36% (SD 0.03%) lower in the small diameter conventional hip arthroplasty as compared to the large diameter head of the hip resurfacing and this difference was highly significant. (p < 0.001). INTERPRETATION Despite the shortcomings of an "in silico" and cadaveric study, our findings are in accordance with previous clinical and gait studies. Furthermore, the findings are strongly in favour of large diameter implant designs, warranting their further development and optimisation.
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Affiliation(s)
- E A Audenaert
- Department of Orthopedic Surgery and Traumatology, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium; Department of Trauma and Orthopedics, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge CB2 0QQ, UK; Department of Electromechanics, Op3Mech research group, University of Antwerp, Groenenborgerlaan 171, 2020 Antwerp, Belgium; Department of Human Structure and Repair, Ghent University, Corneel Heymanslaan 10, 9000 Ghent, Belgium.
| | - V Khanduja
- Department of Trauma and Orthopedics, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge CB2 0QQ, UK
| | - C Bauwens
- Department of Human Structure and Repair, Ghent University, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - T Van Hoof
- Department of Human Structure and Repair, Ghent University, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - C Pattyn
- Department of Human Structure and Repair, Ghent University, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - G Steenackers
- Department of Electromechanics, Op3Mech research group, University of Antwerp, Groenenborgerlaan 171, 2020 Antwerp, Belgium
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Michaud K, Genet P, Sabatasso S, Grabherr S. Postmortem imaging as a complementary tool for the investigation of cardiac death. Forensic Sci Res 2019; 4:211-222. [PMID: 31489387 PMCID: PMC6713140 DOI: 10.1080/20961790.2019.1630944] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 06/06/2019] [Accepted: 06/10/2019] [Indexed: 12/26/2022] Open
Abstract
In the past 2 decades, modern radiological methods, such as multiple detector computed tomography (MDCT), MDCT-angiography, and cardiac magnetic resonance imaging (MRI) were introduced into postmortem practice for investigation of sudden death (SD), including cases of sudden cardiac death (SCD). In forensic cases, the underlying cause of SD is most frequently cardiovascular with coronary atherosclerotic disease as the leading cause. There are many controversies about the role of postmortem imaging in establishing the cause of death and especially the value of minimally invasive autopsy techniques. This paper discusses the state of the art for postmortem radiological evaluation of the heart compared to classical postmortem examination, especially in cases of SCD. In SCD cases, postmortem CT is helpful to estimate the heart size and to visualize haemopericardium and calcified plaques and valves, as well as to identify and locate cardiovascular devices. Angiographic methods are useful to provide a detailed view of the coronary arteries and to analyse them, especially regarding the extent and location of stenosis and obstruction. In postsurgical cases, it allows verification and documentation of the patency of stents and bypass grafts before opening the body. Postmortem MRI is used to investigate soft tissues such as the myocardium, but images are susceptible to postmortem changes and further work is necessary to increase the understanding of these radiological aspects, especially of the ischemic myocardium. In postsurgery cases, the value of postmortem imaging of the heart is reportedly for the diagnostic and documentation purposes. The implementation of new imaging methods into routine postmortem practice is challenging, as it requires not only an investment in equipment but, more importantly, investment in the expertise of interpreting the images. Once those requirements are implemented, however, they bring great advantages in investigating cases of SCD, as they allow documentation of the body, orientation of sampling for further analyses and gathering of other information that cannot be obtained by conventional autopsy such as a complete visualization of the vascular system using postmortem angiography.Key pointsThere are no established guidelines for the interpretation of postmortem imaging examination of the heartAt present, postmortem imaging methods are considered as less accurate than the autopsy for cardiac deathsPostmortem imaging is useful as a complementary tool for cardiac deathsThere is still a need to validate postmortem imaging in cardiac deaths by comparing with autopsy findings.
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Affiliation(s)
- Katarzyna Michaud
- Lausanne University Hospital and University of Lausanne, University Center of Legal Medicine Lausanne-Geneva, Lausanne, Switzerland
| | - Pia Genet
- Lausanne University Hospital and University of Lausanne, University Center of Legal Medicine Lausanne-Geneva, Lausanne, Switzerland.,Geneva University Hospital, University Center of Legal Medicine Lausanne-Geneva, Geneva, Switzerland
| | - Sara Sabatasso
- Geneva University Hospital, University Center of Legal Medicine Lausanne-Geneva, Geneva, Switzerland
| | - Silke Grabherr
- Lausanne University Hospital and University of Lausanne, University Center of Legal Medicine Lausanne-Geneva, Lausanne, Switzerland.,Geneva University Hospital, University Center of Legal Medicine Lausanne-Geneva, Geneva, Switzerland
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Comparing dental identifier charting in cone beam computed tomography scans and panoramic radiographs using INTERPOL coding for human identification. Forensic Sci Int 2019; 302:109860. [PMID: 31310942 DOI: 10.1016/j.forsciint.2019.06.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 04/02/2019] [Accepted: 06/13/2019] [Indexed: 11/24/2022]
Abstract
According to INTERPOL, the comparison of antemortem and postmortem dental identifiers is a scientifically reliable approach for human identification. This study aimed to quantify the prevalence of corresponding INTERPOL coded dental identifiers in cone beam computed tomography (CBCT) scans and panoramic radiographs (PR). The sample consisted of 100 CBCT scans and 100 PR taken the same day from the same patients (35 males and 65 females). Randomly and independently, forty-one INTERPOL coded dental identifiers were searched in each image. Wilcoxon test compared the prevalence of codes in CBCT scans and PR, Chi-square tested the dependence between codes and teeth; and multiple correspondence analyses (MCA) explored the association between codes and teeth in color maps for CBCT scans and PR. No statistically significant differences between the prevalence of identifiers in CBCT scans and PR were detected (p=0.693). In CBCT scans and PR, dependence between teeth and codes was detected (p<0.05). In the study sample, the strongest associations were found between the codes unerupted (UNE), partially erupted (ERU) and impacted (IMV) and third molars, both in CBCT scans and PR. INTERPOL coded dental identifiers registered on CBCT scans and PR can be exchanged during human identification.
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Lorenzen J, Schenzer-Hoffmann E, Braun C, Lorenzen M, Anders S, Adam G, Püschel K. Todesursachenbestimmung mit verblindeter koronaler Ganzkörper-MRT im Vergleich zur rechtsmedizinischen Untersuchung. Rechtsmedizin (Berl) 2019. [DOI: 10.1007/s00194-019-0329-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Yamashiro A, Kobayashi M, Saito T. Cerebrospinal fluid T1 value phantom reproduction at scan room temperature. J Appl Clin Med Phys 2019; 20:166-175. [PMID: 31179645 PMCID: PMC6612700 DOI: 10.1002/acm2.12659] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 05/16/2019] [Accepted: 05/21/2019] [Indexed: 01/05/2023] Open
Abstract
The T1 value of pure water, which is often used as a phantom to simulate cerebrospinal fluid, is significantly different from that of in-vivo cerebrospinal fluid. The purpose of this study was to develop a phantom with a T1 value equivalent to that of in-vivo cerebrospinal fluid under examination room temperature (23°C-25°C). In this study, 1.5 and 3.0 T magnetic resonance imaging scanners were used. We examined the signal intensity change in relation to pure water temperature, the T1 values of acetone-diluted solutions (0-100 v/v%, in 10 steps), and the correlation coefficients obtained from volunteers and the prepared phantoms. The T1 value was close to the value reported in the literature for cerebrospinal fluid when the acetone-diluted solution was 70 v/v% or higher at scan room temperature. The value at that time was 3532.81-4704.57 ms at 1.5 T and it ranged from 4052.41 to 5701.61 ms at 3.0 T. The highest correlation with the values obtained from the volunteers was r = 0.993 with pure acetone at 1.5 T and r = 0.991 with acetone 90 v/v% at 3.0 T. The relative error of the best phantom-volunteer match was 32.61 (%) ± 6.71 at 1.5 T and 46.67 (%) ± 4.31 at 3.0 T. The T1 value measured by the null point method did not detect a significant difference between in vivo CSF and acetone 100 v/v% at 1.5 T and acetone 90 v/v% at 3.0 T. The T1 value of cerebrospinal fluid in the living body at scan room temperature was reproduced with acetone. The optimum concentration of acetone for cerebrospinal-fluid reproduction was pure acetone at 1.5 T and 90 v/v% at 3.0 T.
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Affiliation(s)
- Akihiro Yamashiro
- Department of Radiology, Nagano Red Cross Hospital, Nagano-City, Nagano-ken, Japan
| | - Masato Kobayashi
- Department of Radiology, Shinano Town Shin-Etsu Hospital, Kamiminochi-gun, Nagano-ken, Japan
| | - Takaaki Saito
- Department of Radiology, Iiyama Red Cross Hospital, Iiyama-City, Nagano-ken, Japan
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Forensic Radiology: A Primer. Acad Radiol 2019; 26:820-830. [PMID: 31005405 DOI: 10.1016/j.acra.2019.03.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 03/05/2019] [Accepted: 03/08/2019] [Indexed: 11/21/2022]
Abstract
RATIONALE AND OBJECTIVE Forensic radiology is a relatively unknown subspecialty which is becoming increasingly more important. The field incorporates antemortem and postmortem imaging for the detection and documentation of various pathologies for medicolegal purposes. Postmortem imaging is increasingly used in conjunction with the traditional autopsy in a process called a "virtual" autopsy. Radiography has been a staple of forensic investigations for over a century, first used in 1896. Advanced imaging techniques such as postmortem computed tomography and postmortem magnetic resonance imaging have only recently gained acceptance in the forensic science community. Postmortem computed tomography and postmortem magnetic resonance imaging methods are now widely used in some parts of the world, while other countries including the United States have been slower to adopt these methods into their daily practice. Advanced forensic imaging is increasingly used in the courts where juries have responded positively to such presentation of forensic data. For these reasons, advanced postmortem imaging is becoming a regular part of forensic investigations. The increase in the use of forensic imaging presents a unique opportunity for radiologists to collaborate with pathologists and law enforcement officials. This paper provides an overview of forensic radiology and identifies potential challenges and opportunities.
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Hynes JP, Hughes N, Cunningham P, Kavanagh EC, Eustace SJ. Whole‐body MRI of bone marrow: A review. J Magn Reson Imaging 2019; 50:1687-1701. [DOI: 10.1002/jmri.26759] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 03/28/2019] [Accepted: 03/28/2019] [Indexed: 12/16/2022] Open
Affiliation(s)
- John P. Hynes
- Mater Misericordiae University Hospital Dublin Republic of Ireland
- National Orthopaedic Hospital of Ireland Cappagh, Dublin Republic of Ireland
| | - Nicola Hughes
- National Orthopaedic Hospital of Ireland Cappagh, Dublin Republic of Ireland
| | | | - Eoin C. Kavanagh
- Mater Misericordiae University Hospital Dublin Republic of Ireland
- National Orthopaedic Hospital of Ireland Cappagh, Dublin Republic of Ireland
| | - Stephen J. Eustace
- Mater Misericordiae University Hospital Dublin Republic of Ireland
- National Orthopaedic Hospital of Ireland Cappagh, Dublin Republic of Ireland
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Abstract
Postmortem imaging is increasingly used in forensic practice as good complementary tool to conventional autopsy investigations. Over the last decade, postmortem cardiac magnetic resonance (PMCMR) imaging was introduced in forensic investigations of natural deaths related to cardiovascular diseases, which represent the most common causes of death in developed countries. Postmortem CMR application has yielded interesting results in ischemic myocardium injury investigations and in visualizing other pathological findings in the heart. This review presents the actual state of postmortem imaging for cardiovascular pathologies in cases of sudden cardiac death (SCD), taking into consideration both the advantages and limitations of PMCMR application.
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Post-mortem MRI-based volumetry of the hippocampus in forensic cases of decedents with severe mental illness. Forensic Sci Med Pathol 2019; 15:213-217. [PMID: 30828766 DOI: 10.1007/s12024-019-00101-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2019] [Indexed: 10/27/2022]
Abstract
A decrease in the volume of the hippocampus is associated with severe mental illness, especially schizophrenia, and has been studied extensively in the living using magnetic resonance imaging. Autopsy cohorts also represent a valuable data source for imaging studies. However, post-mortem magnetic resonance imaging (PMMRI) is subject to unique challenges, such as the lower core temperature of scanned subjects and the influence of decomposition processes. This study aimed to determine if results from in vivo studies could be replicated on a post-mortem cohort of decedents who suffered from severe mental illness. We included 96 decedents with either schizophrenia (n = 34), depressive disorder (n = 17), or no known psychiatric diagnosis (n = 45) from April 2015 to January 2017. All cases underwent a T2-weighted cerebral MRI less than 24 h before autopsy. We used a manual segmentation algorithm to define the hippocampus on coronal images and subsequently estimate the volume of the region. The group with schizophrenia had a statistically significant 9.5% decrease in mean hippocampal volume compared with control subjects, while the group with depression trended towards a reduced volume, but this difference was not statistically significant. Thus we were able to replicate previous results from in vivo studies. PMMRI has unique potential for research in that it can be combined with procedures possible only in the research fields of clinical pathology and forensic science, e.g. histopathological sampling.
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Dusek P, Madai VI, Huelnhagen T, Bahn E, Matej R, Sobesky J, Niendorf T, Acosta-Cabronero J, Wuerfel J. The choice of embedding media affects image quality, tissue R 2 * , and susceptibility behaviors in post-mortem brain MR microscopy at 7.0T. Magn Reson Med 2018; 81:2688-2701. [PMID: 30506939 DOI: 10.1002/mrm.27595] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 09/19/2018] [Accepted: 10/14/2018] [Indexed: 12/22/2022]
Abstract
PURPOSE The quality and precision of post-mortem MRI microscopy may vary depending on the embedding medium used. To investigate this, our study evaluated the impact of 5 widely used media on: (1) image quality, (2) contrast of high spatial resolution gradient-echo (T1 and T2 * -weighted) MR images, (3) effective transverse relaxation rate (R2 * ), and (4) quantitative susceptibility measurements (QSM) of post-mortem brain specimens. METHODS Five formaldehyde-fixed brain slices were scanned using 7.0T MRI in: (1) formaldehyde solution (formalin), (2) phosphate-buffered saline (PBS), (3) deuterium oxide (D2 O), (4) perfluoropolyether (Galden), and (5) agarose gel. SNR and contrast-to-noise ratii (SNR/CNR) were calculated for cortex/white matter (WM) and basal ganglia/WM regions. In addition, median R2 * and QSM values were extracted from caudate nucleus, putamen, globus pallidus, WM, and cortical regions. RESULTS PBS, Galden, and agarose returned higher SNR/CNR compared to formalin and D2 O. Formalin fixation, and its use as embedding medium for scanning, increased tissue R2 * . Imaging with agarose, D2 O, and Galden returned lower R2 * values than PBS (and formalin). No major QSM offsets were observed, although spatial variance was increased (with respect to R2 * behaviors) for formalin and agarose. CONCLUSIONS Embedding media affect gradient-echo image quality, R2 * , and QSM in differing ways. In this study, PBS embedding was identified as the most stable experimental setup, although by a small margin. Agarose and Galden were preferred to formalin or D2 O embedding. Formalin significantly increased R2 * causing noisier data and increased QSM variance.
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Affiliation(s)
- Petr Dusek
- Department of Neurology, Charles University, 1st Faculty of Medicine and General University Hospital in Prague, Praha, Czech Republic.,Department of Radiology, Charles University, 1st Faculty of Medicine and General University Hospital in Prague, Praha, Czech Republic
| | - Vince Istvan Madai
- Department of Neurology and Center for Stroke Research Berlin (CSB), Charité-Universitaetsmedizin, Berlin, Germany
| | - Till Huelnhagen
- Berlin Ultrahigh Field Facility (B.U.F.F.), Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
| | - Erik Bahn
- Institute of Neuropathology, University Medicine Göttingen, Göttingen, Germany
| | - Radoslav Matej
- Department of Pathology and Molecular Medicine, Thomayer Hospital, Praha, Czech Republic.,Department of Pathology, Charles University, 1st Faculty of Medicine and General University Hospital in Prague, Praha, Czech Republic
| | - Jan Sobesky
- Department of Neurology and Center for Stroke Research Berlin (CSB), Charité-Universitaetsmedizin, Berlin, Germany.,Experimental and Clinical Research Center (ECRC), Charité-Universitaetsmedizin and Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
| | - Thoralf Niendorf
- Berlin Ultrahigh Field Facility (B.U.F.F.), Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany.,Experimental and Clinical Research Center (ECRC), Charité-Universitaetsmedizin and Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
| | - Julio Acosta-Cabronero
- Wellcome Centre for Human Neuroimaging, UCL Institute of Neurology, University College London, London, United Kingdom.,German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany
| | - Jens Wuerfel
- NeuroCure Clinical Research Center, Charité-Universitaetsmedizin, Berlin, Germany.,Medical Imaging Analysis Center AG, Basel, Switzerland.,Department of Biomedical Engineering, University Basel, Switzerland
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