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Hansen JP, Larsen ST, Jacobsen C. Diagnostic accuracy of post-mortem computed tomography for fractures of the hyoid-larynx complex. Int J Legal Med 2024:10.1007/s00414-024-03293-1. [PMID: 39014249 DOI: 10.1007/s00414-024-03293-1] [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: 04/17/2024] [Accepted: 07/09/2024] [Indexed: 07/18/2024]
Abstract
Post-mortem computed tomography (PMCT) is routinely used at many forensic institutions to guide the following autopsy and is especially useful for diagnosing fractures. This systematic review aims to investigate the sensitivity and specificity of a PMCT scan in fracture diagnosis of the hyoid-larynx complex (HLC) compared to traditional autopsy in cases involving traumatic neck injuries. We searched PubMed, SCOPUS and Web of Science and included papers with cases n ≥ 3 published between January 2000 and April 2023 reporting on PMCT and autopsy findings of fractures of the HLC. The search provided 259 results of which 10 were included. Overall sensitivity and specificity were 0.70 [0.59; 0.79] and 0.92 [0.80; 0.97] for hyoid bone fractures and 0.80 [0.62; 0.91] and 0.76 [0.63; 0.85] for the thyroid cartilage. The results show great variation, and a large range between studies. These results indicate that PMCT cannot replace autopsy in cases with HLC fractures. Future larger prospective studies are needed, examining fracture details, scan protocols and different slice thicknesses using uniform reporting.
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Affiliation(s)
- Josephine Ploug Hansen
- Department of Forensic Medicine, Section of Forensic Pathology, University of Copenhagen, Frederik V's Vej 11, Copenhagen, 2100, Denmark
| | - Sara Tangmose Larsen
- Department of Forensic Medicine, Section of Forensic Pathology, University of Copenhagen, Frederik V's Vej 11, Copenhagen, 2100, Denmark.
| | - Christina Jacobsen
- Department of Forensic Medicine, Section of Forensic Pathology, University of Copenhagen, Frederik V's Vej 11, Copenhagen, 2100, Denmark
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2
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Albano GD, Scalzo G, Malta G, Puntarello M, Alongi A, Piscionieri D, Lo Re GF, Salerno S, Zerbo S, Argo A. Useful Evidence by Post-Mortem CT and Stereomicroscopy in Bone Injury: A Case Series from Forensic Practice. Healthcare (Basel) 2023; 11:healthcare11040540. [PMID: 36833074 PMCID: PMC9956299 DOI: 10.3390/healthcare11040540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 02/07/2023] [Accepted: 02/08/2023] [Indexed: 02/16/2023] Open
Abstract
The investigation of bone injuries is an essential topic in forensics. We sometimes have to deal with charred or dismembered human remains that have lost soft tissue, making it difficult to diagnose the mechanisms of injury that led to death. Our contribution aims to share with the scientific community how we approached two cases of very different bone injuries and the techniques used to differentiate relevant pathology findings of bone fragments. Two cases are analyzed from the case history of the forensic medicine institute of Palermo. PMCT made it possible to differentiate heat bone lesions from traumatic lesions. The stereomicroscope was superior to PMCT in being able to better characterize and evaluate shear injuries, allowing a more accurate measurement of acute lesions. Injury to bone remains can be appropriately investigated with rapid techniques such as PMCT and stereomicroscopy. The presented methodology shows the importance of a multidisciplinary approach when dealing with bone injuries in forensics that could find further applications in other circumstances to answer forensic questions.
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Affiliation(s)
- Giuseppe Davide Albano
- Section of Legal Medicine, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, I-90129 Palermo, Italy
- Correspondence:
| | - Giovanni Scalzo
- Section of Legal Medicine, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, I-90129 Palermo, Italy
| | - Ginevra Malta
- Section of Legal Medicine, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, I-90129 Palermo, Italy
| | - Maria Puntarello
- Section of Legal Medicine, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, I-90129 Palermo, Italy
| | - Alberto Alongi
- Section of Legal Medicine, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, I-90129 Palermo, Italy
| | - Donatella Piscionieri
- Section of Legal Medicine, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, I-90129 Palermo, Italy
| | - Giuseppe Francesco Lo Re
- Radiology Unit, Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, Via del Vespro 129, I-90127 Palermo, Italy
| | - Sergio Salerno
- Radiology Unit, Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, Via del Vespro 129, I-90127 Palermo, Italy
| | - Stefania Zerbo
- Section of Legal Medicine, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, I-90129 Palermo, Italy
| | - Antonina Argo
- Section of Legal Medicine, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, I-90129 Palermo, Italy
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Ebata K, Noriki S, Inai K, Kimura H. Changes in magnetic resonance imaging relaxation time on postmortem magnetic resonance imaging of formalin-fixed human normal heart tissue. BMC Med Imaging 2021; 21:134. [PMID: 34556039 PMCID: PMC8459544 DOI: 10.1186/s12880-021-00666-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 09/06/2021] [Indexed: 12/04/2022] Open
Abstract
Background Postmortem magnetic resonance imaging (MRI) has been used to investigate the cause of death, but due to time constraints, it is not widely applied to the heart. Therefore, MRI analysis of the heart after formalin fixation was previously performed. However, the changes in MRI signal values based on the fixation time of formalin were not investigated. The objective was to investigate changes over time in the T1- and T2-values of MRI signals in normal areas of hearts removed during autopsy, hearts subsequently fixed in formalin, and heart specimens sliced for the preparation of pathological specimens. Methods The study subjects were 21 autopsy cases in our hospital between May 26, 2019 and February 16, 2020 whose hearts were removed and scanned by MRI. The male:female ratio was 14:7, and their ages at death ranged from 9 to 92 years (mean age 65.0 ± 19.7 years). Postmortem (PM)-MRI was conducted with a 0.3-Tesla (0.3-T) scanner containing a permanent magnet. A 4-channel QD head coil was used as the receiver coil. Scans were performed immediately after removal, post-formalin fixation, and after slicing; 7 cases were scanned at all three time points. Results The T1- and T2-values were calculated from the MRI signals of each sample organ at each scanning stage. Specimens were sliced from removed organs after formalin fixation, and the changes in T1- and T2-values over time were graphed to obtain an approximate curve. The median T1-values at each measurement time point tended to decrease from immediately after removal. The T2-values showed the same tendency to decrease, but this tendency was more pronounced for the T1-values. Conclusion MRI signal changes in images of heart specimens were investigated. Formalin fixation shortened both T1- and T2-values over time, and approximation formulae were derived to show these decreases over time. The shortening of T1- and T2-values can be understood as commensurate with the reduction in the water content (water molecules) of the formalin-fixed heart. Supplementary Information The online version contains supplementary material available at 10.1186/s12880-021-00666-5.
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Affiliation(s)
- Kiyokadzu Ebata
- Integrated and Advanced Medical Course, Graduate School of Medical Sciences, University of Fukui, 23-3 Matsuoka Shimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan. .,Department of Radiology, University of Fukui Hospital, 23-3 Matsuoka Shimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan. .,Autopsy Imaging Division, Education and Research Center for Medical Imaging, School of Medical Sciences, University of Fukui, 23-3 Matsuoka Shimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan.
| | - Sakon Noriki
- Faculty of Nursing and Social Welfare Sciences, Fukui Prefectural University, 4-1-1 Kenjojima, Matsuoka, Eiheiji-cho, Yoshida-gun, Fukui, 910-1195, Japan.,Autopsy Imaging Division, Education and Research Center for Medical Imaging, School of Medical Sciences, University of Fukui, 23-3 Matsuoka Shimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan
| | - Kunihiro Inai
- Division of Molecular Pathology, Department of Pathological Sciences, School of Medical Sciences, University of Fukui, 23-3 Matsuoka Shimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan.,Autopsy Imaging Division, Education and Research Center for Medical Imaging, School of Medical Sciences, University of Fukui, 23-3 Matsuoka Shimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan
| | - Hirohiko Kimura
- Department of Radiology, Faculty of Medical Science, University of Fukui, 23-3 Matsuoka Shimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan.,Autopsy Imaging Division, Education and Research Center for Medical Imaging, School of Medical Sciences, University of Fukui, 23-3 Matsuoka Shimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan
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4
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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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Obertová Z, Leipner A, Messina C, Vanzulli A, Fliss B, Cattaneo C, Sconfienza LM. Postmortem imaging of perimortem skeletal trauma. Forensic Sci Int 2019; 302:109921. [DOI: 10.1016/j.forsciint.2019.109921] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 07/31/2019] [Accepted: 08/04/2019] [Indexed: 12/30/2022]
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Ampanozi G, Halbheer D, Ebert LC, Thali MJ, Held U. Postmortem imaging findings and cause of death determination compared with autopsy: a systematic review of diagnostic test accuracy and meta-analysis. Int J Legal Med 2019; 134:321-337. [PMID: 31455980 DOI: 10.1007/s00414-019-02140-y] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 08/06/2019] [Indexed: 01/06/2023]
Abstract
BACKGROUND The aim of this study was to evaluate the sensitivity of postmortem computed tomography (PMCT), postmortem magnetic resonance imaging (PMMR) and PMCT angiography (PMCTA) compared with autopsy in cases of adult death investigations. METHODS For this systematic review and meta-analysis, Embase, PubMed, Scopus, Web of Science and Medline were searched for eligible studies in October 2016; a follow-up literature search was conducted in March 2018. Studies referring to PMCT, PMCTA and/or PMMR of more than 3 cases with subsequent autopsy were included. Data were extracted from published texts in duplicate. The extracted outcomes were categorized as follows: soft tissue and organ findings, skeletal injuries, haemorrhages, abnormal gas accumulations and causes of death. The summary measure was sensitivity, if 3 or more studies were available. To combine studies, a random effects model was used. Variability and heterogeneity within the meta-analysis was assessed. RESULTS Of 1053 studies, 66 were eligible, encompassing a total of 4213 individuals. For soft tissue and organ findings, there was a high pooled sensitivity with PMCTA (0.91, 95% CI 0.81-0.96), without evidence for between-study variability (Cochrane's Q test p = 0.331, I2 = 24.5%). The pooled sensitivity of PMCT+PMMR was very high in skeletal injuries (0.97, CI 0.87-0.99), without evidence for variability (p = 0.857, I2 = 0.0%). In detecting haemorrhages, the pooled sensitivity for PMCT+PMMR was the highest (0.88, 95% CI 0.35-0.99), with strong evidence of heterogeneity (p < 0.05, I2 > 50%). Pooled sensitivity for the correct cause of death was the highest for PMCTA with 0.79 (95% CI 0.52-0.93), again with evidence of heterogeneity (p = 0.062, I2 > 50%). CONCLUSION Distinct postmortem imaging modalities can achieve high sensitivities for detecting various findings and causes of death. This knowledge should lead to a reasoned use of each modality. Both forensic evidence and in-hospital medical quality would be enhanced.
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Affiliation(s)
- Garyfalia Ampanozi
- Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, 8057, Zurich, Switzerland.
| | - Delaja Halbheer
- Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, 8057, Zurich, Switzerland
| | - Lars C Ebert
- Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, 8057, Zurich, Switzerland
| | - Michael J Thali
- Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, 8057, Zurich, Switzerland
| | - Ulrike Held
- Horten Centre, University of Zurich, Pestalozzistrasse 24, 8091, Zurich, Switzerland.,Epidemiology, Biostatistics and Prevention Institute, Department of Biostatistics, University of Zurich, Hirschengraben 84, 8001, Zurich, Switzerland
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8
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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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Cafarelli FP, Grilli G, Zizzo G, Bertozzi G, Giuliani N, Mahakkanukrauh P, Pinto A, Guglielmi G. Postmortem Imaging: An Update. Semin Ultrasound CT MR 2019; 40:86-93. [DOI: 10.1053/j.sult.2018.10.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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10
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Abstract
Autopsies are of key importance for the understanding of the anatomy, pathophysiology and pathomorphology. In forensic medicine, the virtual autopsy is a standard instrument in autopsy practice. The advantage of postmortem imaging is the generation of a three-dimensional pre-autopsy snapshot of the body from head to toe with excellent visualization of skeletal pathologies and air inclusions. When angiography is performed, pathologies of the cardiovascular system can additionally be evaluated. The shortcomings of postmortem imaging are the low soft tissue contrast with CT imaging, the lack of haptic, olfactory and color impressions. Another limitation is the access to CT and particularly to magnetic resonance imaging (MRI) facilities and the necessary experience with the peculiarities of postmortem imaging. To date, postmortem imaging can supplement but not replace the traditional autopsy. Nevertheless, postmortem imaging adds valuable technical capabilities to the traditional autopsy. The ability to achieve valid results for the cause of death and additional diagnoses must be evaluated systematically for postmortem imaging, in particular in addition to CT or MR guided biopsies. This article gives an overview of the current state of the technology and encourages its development for application in pathology departments.
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11
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Ben Taher M, Pearson J, Cohen M, Offiah AC. Acceptability of post-mortem imaging among Muslim and non-Muslim communities. Br J Radiol 2018; 91:20180295. [PMID: 30059236 DOI: 10.1259/bjr.20180295] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE: People's views regarding autopsy vary according to their cultural and religious beliefs. This paper aims to determine the opinions towards this procedure among Muslims resident in Libya and Muslims and non-Muslims resident in the UK. Our long-term goal is to improve autopsy rates; whether conventional or through the use of post-mortem imaging. METHODS: 400 questionnaires were distributed to the three communities, interrogating belief about post-mortem investigations. Descriptive statistics and non-parametric statistics were used to analyse the data. RESULTS: Of the 400 distributed questionnaires, there was a high return rate of 320 (80%). All groups felt that children should be buried sooner than adults(p < 0.001), but 77% of Libyan Muslims thought that children should be buried within 12 h of death compared to 16% of UK Muslims and only 7% of UK non-Muslims (p < 0.001). More non-Muslims were unconcerned about a negative impact of traditional autopsy on the dignity of the corpse than Muslims (p < 0.001) and more Muslims responded that autopsy has a negative emotional effect on the family (p < 0.001). Type of death altered what sort of investigations were desired. In the case of homicide, Libyan Muslims were less likely to prefer CT (p < 0.001) or MRI (p = 0.001). Sex had no effect on the results of the survey. CONCLUSION: Post-mortem imaging is acceptable to both Muslims and non-Muslims in Libya and the UK, but Muslims have a significant preference for post-mortem imaging compared to autopsy, except in homicidal cases. ADVANCES IN KNOWLEDGE: (1) The ability of post-mortem imaging to preserve the dignity of the corpse is independent of religion, however, significantly more Muslims feel that autopsy has a negative emotional effect on the family of the deceased. (2) A significant majority of Muslims in Libya prefer to bury children within 12 h of death, while a delay of up to a week is acceptable in UK. (3) Muslims resident in UK have an attitude closer to that of the indigenous (non-Muslim) population and therefore, educational programmes may be successful in changing attitudes of Muslims in Libya and other predominantly Muslim countries.
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Affiliation(s)
- Mohamed Ben Taher
- 1 Department of Oncology and Metabolism, University of Sheffield , Sheffield , UK
| | - Jean Pearson
- 2 Corporate Information and Computing Services, University of Sheffield , Sheffield , UK
| | - Marta Cohen
- 3 Department of Pathology, Sheffield Children's NHS Foundation Trust, Western Bank , Sheffield , UK
| | - Amaka C Offiah
- 1 Department of Oncology and Metabolism, University of Sheffield , Sheffield , UK.,4 Department of Radiology, Sheffield Children's NHS Foundation Trust, Western Bank , Sheffield , UK
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Bornik A, Urschler M, Schmalstieg D, Bischof H, Krauskopf A, Schwark T, Scheurer E, Yen K. Integrated computer-aided forensic case analysis, presentation, and documentation based on multimodal 3D data. Forensic Sci Int 2018; 287:12-24. [DOI: 10.1016/j.forsciint.2018.03.031] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 03/13/2018] [Accepted: 03/15/2018] [Indexed: 11/24/2022]
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13
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Joshi M, Mishra B, Lalwani S, Kumar A, Kumar A, Kumar S, Gupta A, Sagar S, Singhal M, Panda A, Rattan A. A comparative analysis of the findings of postmortem computed tomography scan and traditional autopsy in traumatic deaths: Is technology mutually complementing or exclusive? ARCHIVES OF TRAUMA RESEARCH 2018. [DOI: 10.4103/atr.atr_55_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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14
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Ahmad MU, Sharif KA, Qayyum H, Ehsanullah B, Balyasnikova S, Wale A, Shanmuganandan A, Siddiqui MRS, Athanasiou T, Kemp GJ. Assessing the use of magnetic resonance imaging virtopsy as an alternative to autopsy: a systematic review and meta-analysis. Postgrad Med J 2017; 93:671-678. [DOI: 10.1136/postgradmedj-2017-134945] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 05/03/2017] [Accepted: 05/08/2017] [Indexed: 12/26/2022]
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15
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Chen Y. State of the art in post-mortem forensic imaging in China. Forensic Sci Res 2017; 2:75-84. [PMID: 30483623 PMCID: PMC6197115 DOI: 10.1080/20961790.2017.1337501] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 05/30/2017] [Indexed: 10/26/2022] Open
Abstract
The autopsy and histopathologic examination are traditional and classic approaches in forensic pathology. In recent years, with the tremendous progresses of computer technology and medical imaging technology, the developed post-mortem computer tomography, post-mortem magnetic resonance imaging and other new methods provide non-invasive, intuitive, high-precision examining methods and research tools for the forensic pathology. As a result, the reconstruction of the injury as well as the analysis of injury mechanism has been essentially achieved. Such methods have become popular in the research field of forensic science and related work has also been carried out in China. This paper reviews the development and application of abovementioned post-mortem forensic imaging methods in China based on the relevant literature.
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Affiliation(s)
- Yijiu Chen
- Institute of Forensic Science, Ministry of Justice, PRC, Shanghai, China
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16
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Sifaoui I, Nedelcu C, Beltran G, Dupont V, Lebigot J, Gaudin A, Ridereau Zins C, Rouge Maillard C, Aubé C. Evaluation of unenhanced post-mortem computed tomography to detect chest injuries in violent death. Diagn Interv Imaging 2017; 98:393-400. [DOI: 10.1016/j.diii.2016.08.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 08/25/2016] [Accepted: 08/29/2016] [Indexed: 11/16/2022]
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17
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Watson E, Heng HG. FORENSIC RADIOLOGY AND IMAGING FOR VETERINARY RADIOLOGISTS. Vet Radiol Ultrasound 2017; 58:245-258. [PMID: 28233422 DOI: 10.1111/vru.12484] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Revised: 01/19/2017] [Accepted: 01/19/2017] [Indexed: 12/12/2022] Open
Abstract
Imaging studies are often of evidentiary value in medicolegal investigations involving animals and the role of the veterinary radiologist is to interpret those images for courts as an expert or opinion witness. With progressing interest in prosecuting animal crimes and strengthening of penalties for crimes against animals, the participation of veterinary radiologists in medicolegal investigations is expected to increase. Veterinary radiologists who are aware of radiographic and imaging signs that result in animal suffering, abuse, or neglect; knowledgeable in ways radiology and imaging may support cause of death determinations; conversant in postmortem imaging; comfortable discussing mechanisms and timing of blunt or sharp force and projectile trauma in imaging; and prepared to identify mimics of abuse can assist court participants in understanding imaging evidence. The goal of this commentary review is to familiarize veterinary radiologists with the forensic radiology and imaging literature and with the advantages and disadvantages of various imaging modalities utilized in forensic investigations. Another goal is to provide background information for future research studies in veterinary forensic radiology and imaging.
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Affiliation(s)
- Elizabeth Watson
- Department of Pathology, Immunology, and Laboratory Medicine, Veterinary Forensic Sciences, University of Florida College of Medicine, Gainesville, FL, 32610
| | - Hock Gan Heng
- Department of Veterinary Clinical Sciences, Purdue University, 625 Harrison Street, West Lafayette, IN, 47907
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Bolliger SA, Thali MJ. Imaging and virtual autopsy: looking back and forward. Philos Trans R Soc Lond B Biol Sci 2016; 370:rstb.2014.0253. [PMID: 26101279 DOI: 10.1098/rstb.2014.0253] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
In order to create a three-dimensional (3D) documentation of findings which can be reassessed if necessary by other experts, the research project 'Virtopsy®' was launched in the late 1990s. This project combined autopsy results with forensic imaging in the form of computed tomography, magnetic resonance tomography and 3D surface scanning. The success of this project eventually succeeded in convincing the courts in Switzerland to accept these novel methods as evidence. As opposition towards autopsies has grown over the last decades, Virtopsy also strives to find and elaborate additional methods which can answer the main forensic questions without autopsy. These methods comprise post-mortem angiography for illustration of the vascular bed and image-guided tissue and fluid sampling for histological, toxicological and microbiological examinations. Based on the promising results, post-mortem imaging, especially with 3D surface scanning, has meanwhile also been applied to living victims of assault, who have suffered patterned injuries due to bites, blows with objects, etc. In our opinion, forensic imaging is an objective method which offers the possibility for a reassessment of the findings by other experts, even after burial or cremation of the corpse, or healing of the injuries in living victims, thus leading to a greater security in court.
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Affiliation(s)
- Stephan A Bolliger
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Wintherthurerstrasse 190/52, Zurich 8057, Switzerland
| | - Michael J Thali
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Wintherthurerstrasse 190/52, Zurich 8057, Switzerland
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19
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Deep Into the Fibers! Postmortem Diffusion Tensor Imaging in Forensic Radiology. Am J Forensic Med Pathol 2015; 36:153-61. [DOI: 10.1097/paf.0000000000000177] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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20
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Goo HW. Whole-Body MRI in Children: Current Imaging Techniques and Clinical Applications. Korean J Radiol 2015; 16:973-85. [PMID: 26355493 PMCID: PMC4559794 DOI: 10.3348/kjr.2015.16.5.973] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2015] [Accepted: 05/19/2015] [Indexed: 11/22/2022] Open
Abstract
Whole-body magnetic resonance imaging (MRI) is increasingly used in children to evaluate the extent and distribution of various neoplastic and non-neoplastic diseases. Not using ionizing radiation is a major advantage of pediatric whole-body MRI. Coronal and sagittal short tau inversion recovery imaging is most commonly used as the fundamental whole-body MRI protocol. Diffusion-weighted imaging and Dixon-based imaging, which has been recently incorporated into whole-body MRI, are promising pulse sequences, particularly for pediatric oncology. Other pulse sequences may be added to increase diagnostic capability of whole-body MRI. Of importance, the overall whole-body MRI examination time should be less than 30-60 minutes in children, regardless of the imaging protocol. Established and potentially useful clinical applications of pediatric whole-body MRI are described.
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Affiliation(s)
- Hyun Woo Goo
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea
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21
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Jalalzadeh H, Giannakopoulos GF, Berger FH, Fronczek J, van de Goot FRW, Reijnders UJ, Zuidema WP. Post-mortem imaging compared with autopsy in trauma victims--A systematic review. Forensic Sci Int 2015; 257:29-48. [PMID: 26284976 DOI: 10.1016/j.forsciint.2015.07.026] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 06/25/2015] [Accepted: 07/13/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Post-mortem imaging or virtual autopsy is a rapidly advancing field of post-mortem investigations of trauma victims. In this review we evaluate the feasibility of complementation or replacement of conventional autopsy by post-mortem imaging in trauma victims. MATERIALS AND METHODS A systematic review was performed in compliance with the PRISMA guidelines. MEDLINE, Embase and Cochrane databases were systematically searched for studies published between January 2008 and January 2014, in which post-mortem imaging was compared to conventional autopsy in trauma victims. Studies were included when two or more trauma victims were investigated. RESULTS Twenty-six studies were included, with a total number of 563 trauma victims. Post-mortem computer tomography (PMCT) was performed in 22 studies, post-mortem magnetic resonance imaging (PMMRI) in five studies and conventional radiography in two studies. PMCT and PMMRI both demonstrate moderate to high-grade injuries and cause of death accurately. PMCT is more sensitive than conventional autopsy or PMMRI in detecting skeletal injuries. For detecting minor organ and soft tissue injuries, autopsy remains superior to imaging. Aortic injuries are missed frequently by PMCT and PMMRI and form their main limitation. CONCLUSION PMCT should be considered as an essential supplement to conventional autopsy in trauma victims since it detects many additional injuries. Despite some major limitations, PMCT could be used as an alternative for conventional autopsy in situations where conventional autopsy is rejected or unavailable.
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Affiliation(s)
- Hamid Jalalzadeh
- Department of Trauma Surgery, VU University Medical Centre, De Boelelaan 1117, 1081 HZ Amsterdam, The Netherlands; Department of General Surgery, Slotervaartziekenhuis, Louwesweg 6, 1066 EC Amsterdam, The Netherlands.
| | - Georgios F Giannakopoulos
- Department of Trauma Surgery, VU University Medical Centre, De Boelelaan 1117, 1081 HZ Amsterdam, The Netherlands; Department of General Surgery, Slotervaartziekenhuis, Louwesweg 6, 1066 EC Amsterdam, The Netherlands
| | - Ferco H Berger
- Department of Radiology and Nuclear Medicine, VU University Medical Centre, De Boelelaan 1117, 1081 HZ Amsterdam, The Netherlands
| | - Judith Fronczek
- Department of Pathology, VU University Medical Centre, De Boelelaan 1117, 1081 HZ Amsterdam, The Netherlands; Department of Pathology, Symbiant, Medisch Centrum Alkmaar, Wilhelminalaan 12, 1815 JD Alkmaar, The Netherlands
| | - Frank R W van de Goot
- Department of Pathology, VU University Medical Centre, De Boelelaan 1117, 1081 HZ Amsterdam, The Netherlands; Department of Pathology, Symbiant, Medisch Centrum Alkmaar, Wilhelminalaan 12, 1815 JD Alkmaar, The Netherlands
| | - Udo J Reijnders
- Department of Forensic Medicine, Public Health Service, P.O. Box 2200, 1000 CE Amsterdam, The Netherlands
| | - Wietse P Zuidema
- Department of Trauma Surgery, VU University Medical Centre, De Boelelaan 1117, 1081 HZ Amsterdam, The Netherlands
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22
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Fairly direct hit! Advances in imaging of shotgun projectiles in MRI. Eur Radiol 2015; 25:2745-53. [PMID: 25708963 PMCID: PMC4529452 DOI: 10.1007/s00330-015-3646-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Revised: 12/22/2014] [Accepted: 01/30/2015] [Indexed: 11/02/2022]
Abstract
OBJECTIVES To investigate the magnetic properties of different types of projectiles and qualify the metal artefact reduction technique for diagnostic and/or forensic MRI. MATERIALS AND METHODS Ten different projectiles embedded in ordnance gelatine blocks underwent an in vitro 1.5-T MR study with seven sequences including a recently developed metal artefact reduction sequence (Advanced WARP) combining VAT (view-angle-tilting) and SEMAC (slice-encoding metal-artefact-correction). Resulting image quality (five-point scale: 1=best; 5=worst) was scored. Quantifiable magnetic characteristics were correlated with qualitative rating of the MR sequences and torque dislodgment. RESULTS Metal artefact reduction sequence (median: 2.5) significantly (p < 0.001) improves depiction of projectiles in comparison to all other MR pulse sequences (median: 4.75). Images from diamagnetic composed bullets (median: 2) are much less disturbed compared to magnetic attracted ones (median: 5). Correlation (0.623) between deflection angle measurement (ferromagnetic mean 84.2°; paramagnetic 62°; diamagnetic mean 0°) and median qualitative image quality was highly significant (p = 0.027). Torque dislodgement was distinct for elongated magnetic attracted projectiles. CONCLUSIONS Significant improvement of MR imaging of projectiles using metal artefact reduction techniques has important implications for diagnostic/forensic work-up. The correlations between magnetic attraction force, deflection-angle results and image properties demonstrate that the MR safety of projectiles can be estimated with one of these methods. KEY POINTS • Metal artefact reduction sequence improves overall image quality of bullets (p < 0.001). • Deflection angle assessment significantly predicts image quality of bullets (p = 0.027). • Classification of projectiles' magnetic properties based on artefacts' characteristics is possible. • Classifying of bullets has important implications in diagnostic and forensic imaging. • Identification of projectiles' magnetic attributes improves estimation of patients' injury risk.
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Morgan B, Adlam D, Robinson C, Pakkal M, Rutty GN. Adult post-mortem imaging in traumatic and cardiorespiratory death and its relation to clinical radiological imaging. Br J Radiol 2014; 87:20130662. [PMID: 24338941 DOI: 10.1259/bjr.20130662] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
The use of post-mortem imaging is expanding throughout the world with increasing use of advanced imaging techniques, such as contrast-enhanced CT and MRI. The questions asked of post-mortem imaging are complex and can be very different, for example for natural sudden death investigation will focus on the cause, whereas for trauma the cause of death is often clear, but injury patterns may be very revealing in investigating the background to the incident. Post-mortem imaging is different to clinical imaging regarding both the appearance of pathology and the information required, but there is much to learn from many years of clinical research in the use of these techniques. Furthermore, it is possible that post-mortem imaging research could be used not only for investigating the cause of death but also as a model to conduct clinically relevant research. This article reviews challenges to the development of post-mortem imaging for trauma, identification and cardiorespiratory death, and how they may be influenced by current clinical thinking and practice.
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Affiliation(s)
- B Morgan
- Imaging Department, University Hospitals of Leicester, Leicester Royal Infirmary, Leicester, UK
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Ruder TD, Thali MJ, Hatch GM. Essentials of forensic post-mortem MR imaging in adults. Br J Radiol 2014; 87:20130567. [PMID: 24191122 DOI: 10.1259/bjr.20130567] [Citation(s) in RCA: 92] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Post-mortem MR (PMMR) imaging is a powerful diagnostic tool with a wide scope in forensic radiology. In the past 20 years, PMMR has been used as both an adjunct and an alternative to autopsy. The role of PMMR in forensic death investigations largely depends on the rules and habits of local jurisdictions, availability of experts, financial resources, and individual case circumstances. PMMR images are affected by post-mortem changes, including position-dependent sedimentation, variable body temperature and decomposition. Investigators must be familiar with the appearance of normal findings on PMMR to distinguish them from disease or injury. Coronal whole-body images provide a comprehensive overview. Notably, short tau inversion-recovery (STIR) images enable investigators to screen for pathological fluid accumulation, to which we refer as "forensic sentinel sign". If scan time is short, subsequent PMMR imaging may be focussed on regions with a positive forensic sentinel sign. PMMR offers excellent anatomical detail and is especially useful to visualize pathologies of the brain, heart, subcutaneous fat tissue and abdominal organs. PMMR may also be used to document skeletal injury. Cardiovascular imaging is a core area of PMMR imaging and growing evidence indicates that PMMR is able to detect ischaemic injury at an earlier stage than traditional autopsy and routine histology. The aim of this review is to present an overview of normal findings on forensic PMMR, provide general advice on the application of PMMR and summarise the current literature on PMMR imaging of the head and neck, cardiovascular system, abdomen and musculoskeletal system.
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Affiliation(s)
- T D Ruder
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Zurich, Switzerland
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25
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Orasanu E, Melbourne A, Cardoso MJ, Modat M, Taylor AM, Thayyil S, Ourselin S. Brain volume estimation from post-mortem newborn and fetal MRI. NEUROIMAGE-CLINICAL 2014; 6:438-44. [PMID: 25379457 PMCID: PMC4218943 DOI: 10.1016/j.nicl.2014.10.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Revised: 09/30/2014] [Accepted: 10/15/2014] [Indexed: 11/25/2022]
Abstract
Objective Minimally invasive autopsy using post-mortem magnetic resonance imaging (MRI) is a valid alternative to conventional autopsy in fetuses and infants. Estimation of brain weight is an integral part of autopsy, but manual segmentation of organ volumes on MRI is labor intensive and prone to errors, therefore unsuitable for routine clinical practice. In this paper we aim to show that volumetric measurements of the post-mortem fetal and neonatal brain can be accurately estimated using semi-automatic techniques and a high correlation can be found with the weights measured from conventional autopsy results. Methods The brains of 17 newborn subjects, part of Magnetic Resonance Imaging Autopsy Study (MaRIAS), were segmented from post-mortem MR images into cerebrum, cerebellum and brainstem using a publicly available neonate brain atlas and semi-automatic segmentation algorithm. The results of the segmentation were averaged to create a new atlas, which was then used for the automated atlas-based segmentation of 17 MaRIAS fetus subjects. As validation, we manually segmented the MR images from 8 subjects of each cohort and compared them with the automatic ones. The semi-automatic estimation of cerebrum weight was compared with the results of the conventional autopsy. Results The Dice overlaps between the manual and automatic segmentations are 0.991 and 0.992 for cerebrum, 0.873 and 0.888 for cerebellum and 0.819 and 0.815 for brainstem, for newborns and fetuses, respectively. Excellent agreement was obtained between the estimated MR weights and autopsy gold standard ones: mean absolute difference of 5 g and 2% maximum error for the fetus cohort and mean absolute difference of 20 g and 11% maximum error for the newborn one. Conclusions The high correlation between the obtained segmentation and autopsy weights strengthens the idea of using post-mortem MRI as an alternative for conventional autopsy of the brain. We segment the cerebrum of 17 newborns and 17 fetuses from postmortem MR. There is high correlation between the autopsy and MR segmentation brain volumes. Postmortem MR can be a non-invasive alternative to conventional autopsy of infants.
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Affiliation(s)
- Eliza Orasanu
- Translational Imaging Group, Centre for Medical Image Computing (CMIC), University College London, UK
| | - Andrew Melbourne
- Translational Imaging Group, Centre for Medical Image Computing (CMIC), University College London, UK
| | - M Jorge Cardoso
- Translational Imaging Group, Centre for Medical Image Computing (CMIC), University College London, UK
| | - Marc Modat
- Translational Imaging Group, Centre for Medical Image Computing (CMIC), University College London, UK
| | - Andrew M Taylor
- Centre for Cardiovascular Imaging, Institute of Cardiovascular Science, University College London, UK
| | - Sudhin Thayyil
- Perinatal Neurology and Neonatology, Imperial College London, UK
| | - Sebastien Ourselin
- Translational Imaging Group, Centre for Medical Image Computing (CMIC), University College London, UK
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26
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Times have changed! Forensic radiology--a new challenge for radiology and forensic pathology. AJR Am J Roentgenol 2014; 202:W325-34. [PMID: 24660730 DOI: 10.2214/ajr.12.10283] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The ongoing development of imaging and the recent integration of cross-sectional imaging methods into the medicolegal workflow have resulted in an increasing number of forensic institutes acquiring dedicated CT and MRI scanners. The purpose of this article is to evaluate the different aspects of postmortem imaging and to detail the necessary cooperation between radiologists and forensic pathologists for mutual learning and accurate science to form a new subspecialty: forensic radiology. CONCLUSION; Forensic radiology must integrate the expertise of forensic pathologists and radiologists. The challenge is to unite these two disciplines first by direct and intense communications and second by a basic understanding of forensic pathology by radiologists as well as a foundational knowledge of postmortem imaging by forensic pathologists, in combination with the establishment of educational and reporting guidelines.
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27
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Flach PM, Gascho D, Schweitzer W, Ruder TD, Berger N, Ross SG, Thali MJ, Ampanozi G. Imaging in forensic radiology: an illustrated guide for postmortem computed tomography technique and protocols. Forensic Sci Med Pathol 2014; 10:583-606. [DOI: 10.1007/s12024-014-9555-6] [Citation(s) in RCA: 131] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2014] [Indexed: 11/30/2022]
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28
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Simons D, Sassenberg A, Schlemmer HP, Yen K. Forensic imaging for causal investigation of death. Korean J Radiol 2014; 15:205-9. [PMID: 24644410 PMCID: PMC3955786 DOI: 10.3348/kjr.2014.15.2.205] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2013] [Accepted: 12/19/2013] [Indexed: 12/02/2022] Open
Abstract
A 63-year-old man was found in the street after overrun by a car. Postmortem CT revealed multiple bone fractures, but surprisingly all without any relevant hemorrhage which would have been expected under such circumstances. A round radiopaque formation was found in the duodenum, which was reminiscent of ingested tablets. The toxicological analysis revealed high concentrations of zopiclone and alcohol. By combining radiologic and forensic results, zopiclone and alcohol intoxication were concluded as the cause of death, followed by a postmortem overrun accident.
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Affiliation(s)
- David Simons
- Department of Radiology (E010), German Cancer Research Center (DKFZ), Heidelberg 69120, Germany
| | - Alina Sassenberg
- Institute of Forensic Medicine, University of Heidelberg, Heidelberg 69115, Germany
| | - Heinz-Peter Schlemmer
- Department of Radiology (E010), German Cancer Research Center (DKFZ), Heidelberg 69120, Germany
| | - Kathrin Yen
- Institute of Forensic Medicine, University of Heidelberg, Heidelberg 69115, Germany
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