1
|
Nakaki Y, Fukumoto W, Higashibori H, Kawashita I, Nakamura Y, Awai K. Performance of postmortem CT in the diagnosis of natural death from out-of-hospital cardiac arrest. Jpn J Radiol 2024:10.1007/s11604-024-01559-7. [PMID: 38625477 DOI: 10.1007/s11604-024-01559-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 03/14/2024] [Indexed: 04/17/2024]
Abstract
PURPOSE Postmortem CT (PMCT) is used widely to identify the cause of death. However, its diagnostic performance in cases of natural death from out-of-hospital cardiac arrest (OHCA) may be unsatisfactory because the cause tends to be cardiogenic and cannot be detected on PMCT images. We retrospectively investigated the diagnostic performance of PMCT in the diagnosis of natural death from OHCA and compared it to that of unnatural death. MATERIALS AND METHODS Our series included 450 cases; 336 were natural- and 114 were unnatural death cases. Between 2018 and 2022 all underwent non-contrast PMCT to identify the cause of death. Two radiologists reviewed the PMCT images and categorized them as diagnostic (PMCT alone sufficient to determine the cause of death), suggestive (the cause of death was suggested but additional information was needed), and non-diagnostic (the cause of death could not be determined on PMCT images). The diagnostic performance of PMCT was defined by the percentage of diagnosable and suggestive cases and compared between natural- and unnatural death cases. Interobserver agreement for the cause of death on PMCT images was also assessed with the Cohen kappa coefficient of concordance. RESULTS The diagnostic performance of PMCT for the cause of natural- and unnatural deaths from OHCA was 30.3% and 66.6%, respectively (p < 0.01). The interobserver agreement for the cause of natural- and unnatural deaths on PMCT images was very good with kappa value 0.92 and 0.96, respectively. CONCLUSION As PMCT identified the cause of natural death by OHCA in only 30% of cases, its diagnostic performance must be improved.
Collapse
Affiliation(s)
- Yu Nakaki
- Department of Diagnostic Radiology, Graduate School of Biomedical and Health Science, Hiroshima University, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8551, Japan
| | - Wataru Fukumoto
- Department of Diagnostic Radiology, Graduate School of Biomedical and Health Science, Hiroshima University, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8551, Japan.
- Center for Cause of Death Investigation Research, Graduate School of Biomedical and Health Science, Hiroshima University, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8551, Japan.
| | - Haruka Higashibori
- Department of Diagnostic Imaging, JA Hiroshima General Hospital, 1-3-3 Jigozen, Hatsukaichi-Shi, Hiroshima, 738-0042, Japan
| | - Ikuo Kawashita
- Department of Diagnostic Radiology, Graduate School of Biomedical and Health Science, Hiroshima University, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8551, Japan
| | - Yuko Nakamura
- Department of Diagnostic Radiology, Graduate School of Biomedical and Health Science, Hiroshima University, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8551, Japan
| | - Kazuo Awai
- Department of Diagnostic Radiology, Graduate School of Biomedical and Health Science, Hiroshima University, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8551, Japan
- Center for Cause of Death Investigation Research, Graduate School of Biomedical and Health Science, Hiroshima University, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8551, Japan
| |
Collapse
|
2
|
Nair G, Sun R, Merkle H, Hoskin K, Bree K, Dodd S, Koretsky A. Postmortem MRI of Tissue Frozen at Autopsy. bioRxiv 2024:2024.01.20.576456. [PMID: 38313300 PMCID: PMC10836069 DOI: 10.1101/2024.01.20.576456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2024]
Abstract
Introduction Postmortem MRI provides insight into location of pathology within tissue blocks, enabling efficient targeting of histopathological studies. While postmortem imaging of fixed tissue is gaining popularity, imaging tissue frozen at the time of extraction is significantly more challenging. Methods Tissue integrity was examined using RNA integrity number (RIN), in mouse brains placed between -20 °C and 20 °C for up to 24 hours, to determine the highest temperature that could potentially be used for imaging without tissue degeneration. Human tissue frozen at the time of autopsy was sealed in a tissue chamber filled with 2-methylbutane to prevent contamination of the MRI components. The tissue was cooled to a range of temperatures in a 9.4T MRI using a recirculating aqueous ethylene glycol solution. MRI was performed using a magnetization-prepared rapid gradient echo (MPRAGE) sequence with inversion time of 1400 ms to null the signal from 2-methylbutane bath, isotropic resolution between 0.3-0.4 mm, and scan time of about 4 hours was used to study the anatomical details of the tissue block. Results and Discussion A temperature of -7 °C was chosen for imaging as it was below the highest temperature that did not show significant RIN deterioration for over 12 hours, at the same time gave robust imaging signal and contrast between brain tissue types. Imaging performed on various human tissue blocks revealed good gray-white matter contrast and revealing subpial, subcortical, and deep white matter lesions typical of multiple sclerosis enabling further spatially targeted studies. Conclusion Here, we describe a new method to image cold tissue, while maintaining tissue integrity and biosafety during scanning. In addition to improving efficiency of downstream processes, imaging tissue at sub-zero temperatures may also improve our understanding of compartment specificity of MRI signal.
Collapse
Affiliation(s)
- Govind Nair
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda
| | - Roy Sun
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda
| | - Hellmut Merkle
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda
| | - Kyra Hoskin
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda
| | - Kendyl Bree
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda
| | - Stephen Dodd
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda
| | - Alan Koretsky
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda
| |
Collapse
|
3
|
Takahashi Y, Fukuda H, Hayakawa A, Sano R, Kubo R, Kawabata-Iwakawa R, Nakajima T, Ishige T, Tokue H, Asano K, Seki T, Hsiao YY, Ishizawa F, Takei H, Kominato Y. Postmortem genetic analysis of 17 sudden cardiac deaths identified nonsense and frameshift variants in two cases of arrhythmogenic cardiomyopathy. Int J Legal Med 2023; 137:1927-1937. [PMID: 37328711 DOI: 10.1007/s00414-023-03037-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 06/01/2023] [Indexed: 06/18/2023]
Abstract
Sudden death, or unexpected natural death of a healthy individual, is a serious problem in all nations. Sudden cardiac death (SCD) mainly due to ischemic heart diseases is the top cause of sudden death. However, there are pathophysiological conditions, referred to as sudden arrhythmic death syndrome, in which no apparent lesion can be identified even after complete conventional or ordinary autopsy. While postmortem genetic analyses have accumulated evidence about underlying genetic abnormality in such cases, the precise relationships between genetic background and the phenotype have been largely elusive. In this study, a retrospective investigation of 17 autopsy cases in which lethal arrhythmia was suspected to be the cause of death was carried out. Genetic analysis focusing on 72 genes reported to be associated with cardiac dysfunctions was performed, in combination with detailed histopathological and postmortem imaging examination, and a family study. As a result, in two cases of suspected arrhythmogenic cardiomyopathy (ACM), we found a nonsense variant in PKP2 and frameshift variant in TRPM4 gene. In contrast, the other 15 cases showed no morphological changes in the heart despite the presence of a frameshift variant and several missense variants, leaving the clinical significance of these variants obscure. The findings of the present study suggest that nonsense and frameshift variants could be involved in the morphological abnormality in cases of SCD due to ACM, while missense variants alone rarely contribute to massive structural changes in the heart.
Collapse
Affiliation(s)
- Yoichiro Takahashi
- Department of Legal Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan.
- Department of Legal Medicine, Institute of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan.
| | - Haruki Fukuda
- Department of Legal Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Akira Hayakawa
- Department of Legal Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Rie Sano
- Department of Legal Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Rieko Kubo
- Department of Legal Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Reika Kawabata-Iwakawa
- Division of Integrated Oncology Research, Gunma University Initiative for Advanced Research, Gunma University, Maebashi, Japan
| | - Tadashi Nakajima
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Takashi Ishige
- Department of Pediatrics, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Hiroyuki Tokue
- Department of Diagnostic Radiology & Nuclear Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Kazuya Asano
- Department of Radiology, Gunma University Hospital, Maebashi, Japan
| | - Tomohiro Seki
- Department of Legal Medicine, Institute of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Yi-Yang Hsiao
- Department of Legal Medicine, Institute of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Fujio Ishizawa
- Department of Legal Medicine, Institute of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Hiroyuki Takei
- Department of Radiology, Gunma University Hospital, Maebashi, Japan
- Faculty of Health Sciences, Tsukuba International University, Tsuchiura, Japan
| | - Yoshihiko Kominato
- Department of Legal Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
| |
Collapse
|
4
|
Ishida M, Gonoi W, Abe H, Ushiku T, Abe O. Essence of postmortem computed tomography for in-hospital deaths: what clinical radiologists should know. Jpn J Radiol 2023; 41:1039-1050. [PMID: 37193920 PMCID: PMC10543514 DOI: 10.1007/s11604-023-01443-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 05/06/2023] [Indexed: 05/18/2023]
Abstract
Postmortem computed tomography (CT) is an essential tool for investigating the causes of death. Postmortem CT has characteristic imaging findings and should not be interpreted in the same manner as clinical antemortem images. In analyzing the cause of death in in-hospital death cases using postmortem images, it is crucial to understand early postmortem and post-resuscitation changes. In addition, it is essential to understand the limitations of diagnosing the cause of death or significant pathology relating to death on non-contrast-enhanced postmortem CT. In Japan, there has also been social demand to establish a system for postmortem imaging at the time of death. To facilitate such a system, clinical radiologists should be prepared to interpret postmortem images and assess the cause of death. This review article provides comprehensive information regarding unenhanced postmortem CT for in-hospital death cases in daily clinical practice in Japan.
Collapse
Affiliation(s)
- Masanori Ishida
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - Wataru Gonoi
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan.
| | - Hiroyuki Abe
- Department of Pathology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - Tetsuo Ushiku
- Department of Pathology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - Osamu Abe
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
| |
Collapse
|
5
|
Takeuchi A, Hyodoh H, Jin S, Tanaka S, Murakami M, Minowa K, Matoba K. Objective Evaluation of Oral and Pharyngeal Areas in Autopsy Cases of Obstructive Sleep Apnea Syndrome via Postmortem CT. Curr Med Imaging 2023:CMIR-EPUB-130381. [PMID: 37018520 DOI: 10.2174/1573405620666230328082804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 01/07/2023] [Accepted: 01/25/2023] [Indexed: 04/07/2023]
Abstract
BACKGROUND Obstructive sleep apnea syndrome (OSAS) can cause sudden death during sleep. Previous findings have suggested that OSAS development is related to maxillofacial morphology. Evaluation of facial morphology can determine the risk of developing the disease, and establishing an objective method to assess the underlying etiology of OSAS-related death would be advantageous. OBJECTIVE The objective of this study is to determine the key features of obstructive sleep apnea syndrome (OSAS) using postmortem oral and pharyngeal computed tomography (CT). METHODS We retrospectively assessed autopsy cases of patients with (n=25) and without (n=25) OSAS-related death. We used oral and pharyngeal CT images to compare the oral and pharyngeal cavity volume (OPCV), oral and pharyngeal soft tissue volume (OPSV), oral and pharyngeal air space volume (OPAV), and OPAV to OPCV ratio (%air). Receiver operating curve (ROC) analysis was used to determine the accuracy of OSAS prediction. We assessed participants with body mass index (BMI) values within the normal range. RESULTS Among the 50 subjects, we observed significant between-group differences in OPSV, OPAV, and % air, whereas there were significant between-group differences in OPSV and %air among 28 subjects with normal BMI values. Both comparisons suggested that OSAS-related death was associated with low %air and high OPSV values. CONCLUSION The %air and OPSV are useful for assessing postmortem oropharyngeal CT images. OSAS-related sudden death is likely when %air and OPSV values are ≤20.1% and ≥127.2 ml, respectively. Among those with normal BMI values, % air and OPSV values of ≤22.8% and ≥111.5 ml, respectively, predict OSAS-related sudden death.
Collapse
Affiliation(s)
- Akiko Takeuchi
- Center for Cause of Death Investigation, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
- Department of Radiology, Faculty of Dental Medicine, Hokkaido University, Sapporo, Japan
| | - Hideki Hyodoh
- Department of Forensic Medicine, Graduate School of Medicine, Fukui University, Japan
| | - Shigeki Jin
- Center for Cause of Death Investigation, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Satoshi Tanaka
- Center for Cause of Death Investigation, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Manabu Murakami
- Hokkaido University Center for Medical Education and International Relations, Faculty of Medicine Sapporo Japan
| | - Kazuyuki Minowa
- Center for Cause of Death Investigation, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
- Department of Radiology, Faculty of Dental Medicine, Hokkaido University, Sapporo, Japan
| | - Kotaro Matoba
- Center for Cause of Death Investigation, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
- Department of Forensic Medicine, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| |
Collapse
|
6
|
Harty MP, Gould SW, Arthurs OJ, Miller E, Harcke HT; SPR Postmortem Imaging Committee. Current utilization of pediatric postmortem imaging in North America: a questionnaire-based survey. Pediatr Radiol 2023. [PMID: 36729184 DOI: 10.1007/s00247-023-05586-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 10/19/2022] [Accepted: 12/30/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Postmortem imaging is used more widely as the number of conventional autopsies has decreased over the last several decades. It is widely accepted in Europe, Asia and Oceania, but there has been a delay in acceptance in North America. Education, scanning protocols, resourcing and clinical incentives are needed to support this emerging field. OBJECTIVE To determine the use of postmortem imaging and define perceived barriers to its implementation with the goal of expanding postmortem imaging in the United States and Canada. MATERIALS AND METHODS We sent an online survey to active members of the Society for Pediatric Radiology (SPR) addressing the use of postmortem imaging, indications, readers, practical aspects, anticipated barriers and potential solutions to more widespread use. RESULTS More than 50% of the 50 institutions that returned surveys used postmortem computed tomography; 24% used postmortem magnetic resonance imaging. Most postmortem imaging cases were read by radiologists. Fewer than 50% had formal correlation with autopsy results or an established relationship with the local medical examiner. Seven institutions reported reimbursement for postmortem imaging. Major barriers to postmortem imaging included lack of funding and lack of interest among clinicians. Funding and education were seen as important issues requiring attention. CONCLUSION While most responding institutions provide pediatric postmortem imaging, the modalities, protocols, reporting procedures and clinical correlation vary widely. A lack of funding and few opportunities for education are limiting factors. Attention to these issues along with active support from the SPR are seen as potential solutions to recognize the value and promote widespread acceptance of postmortem imaging.
Collapse
|
7
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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.
| |
Collapse
|
8
|
Ali Z, Mourtzinos N. Postmortem Imaging of an Unusual Case of Fatal Heart and Lung Perforation Due to Self-Treatment. Acad Forensic Pathol 2022; 12:75-79. [PMID: 35799997 DOI: 10.1177/19253621221102045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 04/08/2022] [Indexed: 11/17/2022]
Abstract
Intentional or accidental cardiothoracic injuries caused by needles and pins are rare and commonly reported in individuals with psychiatric conditions or intravenous drug users. Although rare, these cases could result in serious injury during the performance of an autopsy and highlight the importance of post-mortem radiology. Therapeutic complications with cardiac perforation have been reported due to pericardiocentesis and acupuncture. The majority of reported cases were not fatal and some had a prolonged asymptomatic period of weeks or even years after insertion. Needles or other sharp objects can reach the cardiovascular system directly through the chest wall, indirectly from any segment of the gastrointestinal tract after swallowing needles, or through migration of broken needles from distant injection sites in intravenous drug users. We report a case of rapidly fatal cardiopulmonary injuries following "self-treatment" to "pop" a cyst with a piercing needle. The scene, autopsy, computed tomography, and digital x-ray findings of this unique case are discussed with a review of selective literature. In this case, the right lung and heart showed multiple perforations, possibly resulting from heartbeats or respirations pushing the organs against the needle. To our knowledge, perforations in this setting of "self-treatment" have not been previously reported in the literature.
Collapse
|
9
|
Melvinsdottir I, Solomon N, Wadia R, Muniraj T, Huber S, Sinusas AJ. Massive Air Embolism Following Necrotizing Pancreatitis and COVID-19 Infection-The Role of Postmortem Computed Tomography. Acad Forensic Pathol 2022; 12:31-38. [PMID: 35694008 PMCID: PMC9178998 DOI: 10.1177/19253621211073284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 11/02/2021] [Indexed: 02/04/2023]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that caused the COVID-19 pandemic raised important questions about workplace exposures to the virus, including postmortem exposures. The complexity of COVID-19 disease and its numerous unanticipated complications made autopsy even more vital in determining the pathophysiology of the disease. Performing traditional autopsy, however, carries risk of exposure. The following report describes an unusual case in which a patient diagnosed with COVID-19 and necrotizing pancreatitis underwent postmortem computed tomography (PMCT) prior to limited traditional autopsy and was unexpectedly found via PMCT to have large and diffuse venous air emboli and a new peripancreatic hematoma. In this case, not only did PMCT play a crucial role in determining the cause of death but also it allowed for a limited autopsy, thereby reducing the exposure to SARS-CoV-2 and associated risk to the autopsy staff and pathologists.
Collapse
Affiliation(s)
| | | | | | | | | | - Albert J. Sinusas
- Albert J. Sinusas, MD, Medicine and Radiology & Biomedical Imaging and Biomedical Engineering; Yale Translational Research Imaging Center (Y-TRIC), Yale University School of Medicine, Section Cardiovascular Medicine, DANA3, P.O. Box 208017, New Haven, CT 06520,
| |
Collapse
|
10
|
Hussein MN, Heinemann A, Shokry DA, Elgebely M, Pueschel K, Hassan FM. Postmortem computed tomography differentiation between intraperitoneal decomposition gas and pneumoperitoneum. Int J Legal Med 2021; 136:229-235. [PMID: 34708283 DOI: 10.1007/s00414-021-02732-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 10/18/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE The aim of this study is to investigate the ability of postmortem computed tomography (PMCT) to distinguish intraperitoneal decomposition gas from pneumoperitoneum due to intestinal perforation. METHODS This retrospective study investigated the factors affecting intraperitoneal gas in two groups of 14 decedents as detected by postmortem CT performed in the Department of Legal Medicine of Hamburg University. The first group died with a cause of death associated with intestinal perforation, and the second group with other different natural causes of death. These factors include postmortem interval, gas volume, gas distribution, radiology alteration index (RAI), and pneumoperitoneum-associated pathology. RESULTS The findings of this study showed the appearance of specific gas distribution patterns and a significant increase in gas volumes in the cases of intestinal perforation. Moreover, postmortem interval and the pneumoperitoneum-associated pathology could help distinguish postmortem-generated gas from pneumoperitoneum. CONCLUSION Based on the findings of this study, we propose that these findings can improve the proper detection of intestinal perforation cases in the future.
Collapse
Affiliation(s)
- Maged Nabil Hussein
- Forensic Medicine Authority, Ministry of Justice, 14 Berium Eltonsy Street, Elsayda Zainb, Cairo, Egypt.
| | - Axel Heinemann
- Department of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg University, Butenfeld 34, 22529, Hamburg, Germany
| | - Dina Ali Shokry
- Forensic Medicine & Clinical Toxicology Department, Faculty of Medicine, Cairo University, kasr Alainy Street, Cairo, 11562, Egypt
| | - Mohamed Elgebely
- Lecturer of Forensic Medicine & Clinical Toxicology Department, Faculty of Medicine, Suez University, Cairo-suez road, 41522, Al-salam city, Egypt
| | - Klaus Pueschel
- Department of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg University, Butenfeld 34, 22529, Hamburg, Germany
| | - Fatma Mohamed Hassan
- Forensic Medicine & Clinical Toxicology Department, Faculty of Medicine, Cairo University, kasr Alainy Street, Cairo, 11562, Egypt
| |
Collapse
|
11
|
Michaud K, Magnin V, Faouzi M, Fracasso T, Aguiar D, Dedouit F, Grabherr S. Postmortem coronary artery calcium score in cases of myocardial infarction. Int J Legal Med 2021; 135:1829-1836. [PMID: 33847801 PMCID: PMC8354952 DOI: 10.1007/s00414-021-02586-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 03/24/2021] [Indexed: 12/19/2022]
Abstract
Sudden cardiac death (SCD) related to atherosclerotic coronary artery disease (ACAD) resulting in myocardial infarction is the most prevalent cause of death in western countries. In clinical practice, coronary artery calcium score (CACS) is considered an independent predictor of coronary events, closely related to atherosclerotic burden and is quantified radiologically by the Agatston score being calculated through computed tomography. Postmortem computed tomography (PMCT) allows the visualization and quantification of coronary calcifications before the autopsy. However, it was reported that some patients who died from severe ACAD had a zero CACS in PMCT. In this study, a retrospective evaluation of CACS in adult's myocardial infarction cases related to ACAD, with available CACS and histological slides of coronary arteries, was performed in order to gain a deeper understanding of coronary calcifications and their role in myocardial infarction cases. The CACS was calculated by using the software Smartscore 4.0 after the radiological examination on a 64-row CT unit using a specific cardiac protocol. Thirty-six cases were identified out of 582 autopsies, recorded during a 2-year study period (29 men, 7 women; age 56.3 ± 11.7). CACS was 0-10 in 5 cases (5 men, 44.8 ± 13.7), 11-100 in 8 cases (6 men, 2 women, 53.1 ± 7.7), 101-400 in 13 cases (11 men, 2 women, 57.4 ± 9.6), and > 400 in 10 cases (9 men, 1 woman, 63.1 ± 11.9). Coronary thrombosis was found in 28 cases, histologically identified as plaque erosions in 6 cases and as plaque ruptures in 22 cases. Statistical analyses showed that CACS increases significantly with age (p-value < 0.05) and does not show significant correlation with gender, body weight, body mass index, and heart weight. CACS was significantly higher in plaque ruptures than in plaque erosions (p-value < 0.01). Zero or low CACS on unenhanced PMCT cannot exclude the presence of myocardial infarction related to ACAD. This paradoxical discrepancy between imaging and autopsy findings can be explained considering the histological aspect of fatal coronary plaques.
Collapse
Affiliation(s)
- Katarzyna Michaud
- University Center of Legal Medicine Lausanne-Geneva, Chemin de la Vulliette 4, CH - 1000, Lausanne 25, Switzerland.
- Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland.
| | - Virginie Magnin
- University Center of Legal Medicine Lausanne-Geneva, Chemin de la Vulliette 4, CH - 1000, Lausanne 25, Switzerland
- Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Mohamed Faouzi
- Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
- Division of Biostatistics, Center for Primary Care and Public Health (Unisanté), Lausanne, Switzerland
| | - Tony Fracasso
- University Center of Legal Medicine Lausanne-Geneva, Chemin de la Vulliette 4, CH - 1000, Lausanne 25, Switzerland
- Geneva University Hospital, University of Geneva, Geneva, Switzerland
| | - Diego Aguiar
- University Center of Legal Medicine Lausanne-Geneva, Chemin de la Vulliette 4, CH - 1000, Lausanne 25, Switzerland
- Geneva University Hospital, University of Geneva, Geneva, Switzerland
| | - Fabrice Dedouit
- Department of Forensic Pathology, Rangueil University Hospital, Toulouse, France
| | - Silke Grabherr
- University Center of Legal Medicine Lausanne-Geneva, Chemin de la Vulliette 4, CH - 1000, Lausanne 25, Switzerland
- Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
- Geneva University Hospital, University of Geneva, Geneva, Switzerland
| |
Collapse
|
12
|
Ducloyer M, David A, Dautreme B, Tournel G, Vincent F, Clement R, Tuchtan L, Delteil C, Gorincour G, Dedouit F. Pictorial review of the postmortem computed tomography in neonaticide cases. Int J Legal Med 2021; 135:2395-2408. [PMID: 34383117 DOI: 10.1007/s00414-021-02677-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 07/26/2021] [Indexed: 11/24/2022]
Abstract
Neonaticide is defined by the deliberate killing or homicide of a child within 24 h of its birth. In this context, three fundamental questions are generally asked of the forensic pathologist: what is the cause of death of the neonate? Was the child viable (i.e., what is the gestational age of the neonate)? Finally, was the neonate stillborn or liveborn?Postmortem imaging can help answer these questions by conducting (1) a complete lesional analysis of the body and the placenta, (2) an estimation of the gestational age by measuring the lengths of the diaphyseal long bones, and (3) an analysis of the aeration of the lungs and intestines. Using the details of 18 cases, we illustrate aspects of neonaticide cases in postmortem computed tomography (PMCT), offering detailed examples of notable postmortem changes and abnormalities, especially in the analysis of the pulmonary parenchyma. This article presents a useful iconography for the radiologist confronted with this rare yet complex forensic situation.
Collapse
Affiliation(s)
- Mathilde Ducloyer
- Forensic Department, University Hospital, 30 Boulevard Jean Monnet, 44000, Nantes, France. .,Department of Radiology, Hotel Dieu, University Hospital, Nantes, France. .,GRAVIT, Groupe de Recherche en Autopsie Virtuelle Et Imagerie Thanatologique, Forensic Department, University Hospital, Rangueil, Toulouse, France.
| | - Arthur David
- Department of Radiology, Hotel Dieu, University Hospital, Nantes, France
| | - Bérengère Dautreme
- Forensic Department, University Hospital, Rouen, France.,UTMLA 7367, University of Lille, Lille, France
| | - Gilles Tournel
- Forensic Department, University Hospital, Rouen, France.,EA 4651 ABTE, University of Rouen, Rouen, France
| | | | - Renaud Clement
- Forensic Department, University Hospital, 30 Boulevard Jean Monnet, 44000, Nantes, France
| | - Lucile Tuchtan
- CNRS, EFS, ADES, Aix Marseille Univ, 27 Avenue Jean Moulin, 13385, Marseille, France.,Forensic Department, APHM, La Timone, 264 Rue St Pierre, 13385, Marseille Cedex 05, France
| | - Clémence Delteil
- Forensic Department, APHM, La Timone, 264 Rue St Pierre, 13385, Marseille Cedex 05, France
| | - Guillaume Gorincour
- GRAVIT, Groupe de Recherche en Autopsie Virtuelle Et Imagerie Thanatologique, Forensic Department, University Hospital, Rangueil, Toulouse, France.,Elsan, Clinique Bouchard, Marseille, France
| | - Fabrice Dedouit
- GRAVIT, Groupe de Recherche en Autopsie Virtuelle Et Imagerie Thanatologique, Forensic Department, University Hospital, Rangueil, Toulouse, France.,Forensic Department, University Hospital, Rangueil, Toulouse, France
| |
Collapse
|
13
|
Möbius D, Fitzek A, Hammer N, Heinemann A, Ron A, Schädler J, Zwirner J, Ondruschka B. Ultrasound in legal medicine-a missed opportunity or simply too late? A narrative review of ultrasonic applications in forensic contexts. Int J Legal Med 2021; 135:2363-2383. [PMID: 34292383 PMCID: PMC8295453 DOI: 10.1007/s00414-021-02661-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 07/02/2021] [Indexed: 01/15/2023]
Abstract
Objectives Conventional autopsies remain the gold standard of postmortem healthcare quality assurance and help gathering extended knowledge on diseases. In answer to constantly declining autopsy rates non- or minimally invasive autopsy methods were introduced. Ultrasound is a well-established tool for imaging commonly used in clinical practice. This narrative review aims to summarize the current literature regarding the feasibility and validity of ultrasound in a forensic context. Material and methods A PubMed database search was carried out. Abstracts were scanned for pre-defined ex- and inclusion criteria, followed by a snowball search procedure applied to the primarily included articles. Results Forty-five publications met our inclusion criteria. The selected articles concern the feasibility of ultrasound in pre- or postmortem settings, forensic age estimation, and minimally invasive approaches. For imaging, ultrasound was deemed a reliable tool for the examination of epiphyses und superficial wounds, with limitations regarding internal organs and image quality due to postmortem changes. Ultrasound-guided minimally invasive approaches yielded higher success rates for adequate tissue sampling. Many investigations were carried out in low- and middle-income countries focusing on infectious diseases. Conclusion Ultrasound seems a promising but underutilized imaging tool in legal medicine to date. Promising approaches on its feasibility have been conducted. Especially for minimally invasive methods, ultrasound offered significant improvements on qualified biopsy sampling and thus appropriate diagnostics. Moreover, ultrasonic evaluation of epiphyses for age estimation offered valuable results. Nevertheless, further assessment of ultrasonic feasibility in forensic contexts is needed.
Collapse
Affiliation(s)
- Dustin Möbius
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Antonia Fitzek
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Niels Hammer
- Institute of Macroscopic and Clinical Anatomy, University of Graz, Graz, Austria.,Department of Orthopedic and Trauma Surgery, University of Leipzig, Leipzig, Germany.,Fraunhofer IWU, Dresden, Germany
| | - Axel Heinemann
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alexandra Ron
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Julia Schädler
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Johann Zwirner
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Anatomy, University of Otago, Dunedin, New Zealand
| | - Benjamin Ondruschka
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| |
Collapse
|
14
|
Barszcz M, Woźniak K. Complete sagittal suture closure evaluation based on post mortem computed tomography. Leg Med (Tokyo) 2021; 52:101907. [PMID: 34034066 DOI: 10.1016/j.legalmed.2021.101907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 05/07/2021] [Accepted: 05/11/2021] [Indexed: 11/21/2022]
Abstract
Age assessment at the time of death is of great importance when an unidentified skeleton or corpse is found. Obliteration of cranial sutures has been used for age assessment regarding anthropology as non - metrical method of direct bone inspection. The aim of our study was to assess sagittal suture closure in the contemporary population of Polish men using postmortem computed tomography. A total of 255 male skulls were analyzed with the use of multiplanar reconstruction (MPR) and volume rendering technique (VRT) images, which were based on whole-body postmortem computed tomography scans. The individuals of Polish origin were of precisely known metrical age. The sagittal sutures were analyzed across their entire thickness (including both the outer and inner aspect of bone) and along their entire length via frontal sections, using the sagittal suture division into 4 segments. This study showed that the earliest signs of suture closure occur in S4 on the inner side of the calvaria at a mean age of 50.48 years, but the youngest person with starting obliteration process was 13.37 years. This is prove that exist variability which must be count during biological age estimation. Additionally, VRT visualisation shows that the fourth state of obliteration does not mean that obliteration was ended. Further analyses of cranial suture closure are needed to obtain reliable methods for postmortem estimation of the age at the time of death in contemporary populations. The use of postmortem computed tomography may offer additional opportunities for contemporary analysis of skeletal material.
Collapse
|
15
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| |
Collapse
|
16
|
Ishida M, Gonoi W, Abe H, Shirota G, Fujimoto K, Okimoto N, Ushiku T, Abe O. Longitudinal comparison of ascites attenuation between antemortem and postmortem computed tomography. Forensic Sci Int 2021; 321:110727. [PMID: 33636473 DOI: 10.1016/j.forsciint.2021.110727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 01/02/2021] [Accepted: 02/15/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To investigate the changes in ascites attenuation between antemortem (AMCT) and postmortem computed tomography (PMCT) analyses of the same subjects. METHODS Thirty-five subjects who underwent unenhanced or enhanced AMCT within 7 days before death, unenhanced PMCT, and autopsy were evaluated. In each subject, ascites attenuation was measured at similar sites on AMCT and PMCT. Attenuation changes were evaluated in 42 unenhanced AMCT/PMCT site pairs (23 subjects) and 20 enhanced AMCT/PMCT site pairs (12 subjects). Factors contributing to CT attenuation changes were also assessed, including the time interval between AMCT and PMCT, serum albumin level, estimated glomerular filtration rate, and ascites volume. RESULTS Significantly elevated CT attenuation was observed between enhanced AMCT and PMCT (12.2 ± 6.3 vs. 18.7 ± 10.4 Hounsfield units; paired t-test, p = 0.006), but not between unenhanced AMCT and PMCT (13.5 ± 8.9 vs. 13.4 ± 9.3; p = 0.554). A significant inverse association was observed between the degree of CT attenuation change and the time interval between enhanced AMCT and PMCT (Spearman's rank correlation coefficient, r = -0.56, p = 0.01). CONCLUSIONS We confirmed an elevated level of ascites attenuation on PMCT relative to AMCT in subjects who underwent enhanced AMCT shortly before death.
Collapse
Affiliation(s)
- Masanori Ishida
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
| | - Wataru Gonoi
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Hiroyuki Abe
- Department of Pathology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Go Shirota
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Kotaro Fujimoto
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Naomasa Okimoto
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Tetsuo Ushiku
- Department of Pathology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Osamu Abe
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| |
Collapse
|
17
|
Thomsen T, Dietrich CF. [Postmortem sonography helpful in death of unknown origin]. Med Klin Intensivmed Notfmed 2021; 116:254-258. [PMID: 33559701 DOI: 10.1007/s00063-021-00784-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 11/19/2020] [Accepted: 12/24/2020] [Indexed: 10/22/2022]
Abstract
Postmortem imaging has been used primarily in forensic medicine since 1895. Conventional x‑ray, computed tomography (CT), and magnetic resonance imaging (MRI) are used. In studies, sonography is not considered to be of particular value, especially because of postmortem gas formation in adults. We report three cases in which postmortem sonography within three hours of death allowed clarification of a previously unclear cause of death.
Collapse
Affiliation(s)
- T Thomsen
- Klinik für Innere Medizin, Westküstenkliniken, Brunsbüttel, Deutschland
| | - C F Dietrich
- Department Allgemeine Innere Medizin, Kliniken Hirslanden, Beau Site, Salem und Permanence, Schänzlihalde 11, 3013, Bern, Schweiz.
| |
Collapse
|
18
|
Torimitsu S, Abe H, Makino Y, Yamaguchi R, Motomura A, Hoshioka Y, Iwase H. Streptococcal toxic shock syndrome with fatal outcome: Report on four forensic autopsy cases. Leg Med (Tokyo) 2021; 50:101851. [PMID: 33578046 DOI: 10.1016/j.legalmed.2021.101851] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 01/28/2021] [Accepted: 01/29/2021] [Indexed: 12/01/2022]
Abstract
Streptococcal toxic shock syndrome (STSS) is a severe infection most commonly caused by group A streptococcus. It is clinically characterized by rapidly progressive multiple organ failure and septic shock. This report presents four fatal cases associated with STSS. In two cases (cases 2 and 3), the portals of entry may be ulcer and mucosa at the surgical site; the initial symptoms in these cases included fever. In the other cases, the portal of entry was unknown; the initial symptom was pain. In two cases (cases 1 and 3), malpractice was suspected before autopsy. At autopsy, blood culture was positive for group A streptococcus in all of the present cases. Although C-reactive protein levels were increased, procalcitonin levels were not markedly elevated. This is the first report of autopsy cases associated with STSS in which postmortem computed tomography was performed; the swelling of muscles and increased concentrations of peripheral subcutaneous tissue without gas may be characteristic findings. Histology revealed extensive bacterial colonies and necrosis with mild neutrophilic reaction in two cases (cases 3 and 4), and hemophagocytosis in two cases (cases 1 and 4). It is essential to perform appropriate examinations and make a proper diagnosis because STSS still has a high fatality rate and medical malpractice is often suspected. In addition, it is important to evaluate STSS again for the reduction of the fatal cases associated with STSS.
Collapse
Affiliation(s)
- Suguru Torimitsu
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan; Education and Research Center of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan.
| | - Hiroyuki Abe
- Department of Pathology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, 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; Education and Research Center of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan
| | - Rutsuko Yamaguchi
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan; Education and Research Center of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan
| | - Ayumi Motomura
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan; Education and Research Center of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan; Department of Forensic Medicine, School of Medicine, International University of Health and Welfare, 4-3 Kozunomori, Narita, Chiba 286-8686, Japan
| | - Yumi Hoshioka
- Education and Research Center of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, 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; Education and Research Center of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan
| |
Collapse
|
19
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| |
Collapse
|
20
|
Gascho D, Hetzel U, Schmid N, Martinez RM, Thali MJ, Richter H. Virtopsy of a gravid Boa constrictor using computed tomography and magnetic resonance imaging. Vet Anim Sci 2020; 10:100150. [PMID: 33089008 PMCID: PMC7566950 DOI: 10.1016/j.vas.2020.100150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 05/29/2020] [Accepted: 10/01/2020] [Indexed: 11/18/2022] Open
Abstract
This article presents radiologic examinations of a deeply sedated Boa constrictor with boid inclusion body disease (BIBD) as an adjunction to the subsequent necropsy. This method is known as virtopsy. The Boa constrictor in the present case was gravid. Computed tomography (CT) allowed for the detailed depiction of a fetal skeleton at the rear end of the adult snake. Furthermore, tiny gas formation was detected inside the cranium of the fetus, which was deemed a radiologic sign for decomposition. Magnetic resonance imaging (MRI) delineated the soft tissue at high resolution. This article illustrates the use of CT and MRI for the examination of a gravid Boa constrictor before necropsy and demonstrates the detection of "normal" postmortem findings leading to the confirmation of fetal death in situ.
Collapse
Key Words
- BIBD, boid inclusion body disease
- Boa constrictor
- CT, computed tomography
- Computed tomography
- IHC, immunohistochemical
- MRI, Magnetic resonance imaging
- Magnetic resonance imaging
- Postmortem imaging
- RAVs, reptarenaviruses
- TE, echo time
- TR, repitition time
- Virtopsy
- Virtual necropsy
- kVp, kilovoltage peak
- mAs, milliampere seconds
- ms, milliseconds
Collapse
Affiliation(s)
- Dominic Gascho
- Institute of Forensic Medicine and Imaging, University of Zurich, Switzerland
- Corresponding author: Dominic Gascho, Department of Forensic Medicine and Imaging, Zurich Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, CH-8057 Zurich, Switzerland, Telephone number: +41 44 635 5611, Fax number: +41 44 635 6851
| | - Udo Hetzel
- Institute of Veterinary Pathology, Vetsuisse Faculty, University of Zurich, Switzerland
| | - Nicole Schmid
- Clinic for Zoo Animals, Exotic Pets and Wildlife, Vetsuisse Faculty, University of Zurich, Switzerland
| | - Rosa M Martinez
- Institute of Forensic Medicine and Imaging, University of Zurich, Switzerland
| | - Michael J Thali
- Institute of Forensic Medicine and Imaging, University of Zurich, Switzerland
| | - Henning Richter
- Diagnostic Imaging Research Unit (DIRU), Clinic for Diagnostic Imaging, Vetsuisse Faculty, University of Zurich, Switzerland
| |
Collapse
|
21
|
Hueck U, Muggenthaler H, Hubig M, Heinrich A, Güttler F, Wagner R, Mall G, Teichgräber U. Forensic postmortem computed tomography in suspected unnatural adult deaths. Eur J Radiol 2020; 132:109297. [PMID: 33035918 DOI: 10.1016/j.ejrad.2020.109297] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 09/04/2020] [Accepted: 09/18/2020] [Indexed: 01/16/2023]
Abstract
PURPOSE Our study sought to evaluate validity of forensic postmortem CT in establishing cause of death (COD) in suspected unnatural adult death based on the reference standard of autopsy. METHODS In our prospective, single-center study, 64 of 94 consecutive corpses (70.7 % male, mean age: 47.4 years) who underwent CT and autopsy between November 2013 and April 2019 were included in the analysis. Primary objective was agreement between CT and autopsy on primary COD using kappa statistics. Secondary objectives were competing COD and specific pathological findings. RESULTS Agreement on primary COD between forensic CT and autopsy without or in consideration of toxicological and histological findings was strong (85.9 % [55 of 64 corpses]; κ = 0.83 [95 %CI: 0.74 to 0.93] and 95.3 % [61 of 64 corpses]; κ = 0.94 [95 %CI: 0.84-1.04], respectively, McNemar p = 0.03). Sensitivity and specificity of CT in identification of acute heart failure, intracranial bleeding, burns and heat shocks, gunshot wounds, polytrauma, cranio-cerebral trauma, and strangulation or hanging was 100 %, each. Acute respiratory failure was detected with a sensitivity and specificity of 100 % and 96.8 %, cuts and stab wounds with 95.2 % and 100 %, and intoxication, pneumonia, or gastrointestinal bleeding with 60.0 % and 100 %, respectively. Agreement on competing COD was moderate (51.6 %, [33 of 64 corpses]; κ = 0.47 [95 %CI: 0.40 to 0.53], p < 0.001). CONCLUSIONS Forensic postmortem CT, complemented by external, toxicological, and histological examination was sufficiently valid to assess primary COD in the majority of suspected unnatural deaths with few restrictions.
Collapse
Affiliation(s)
- U Hueck
- Department of Radiology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - H Muggenthaler
- Department of Forensic Medicine, Jena University Hospital, Jena, Am Klinikum 1, 07747, Jena, Germany
| | - M Hubig
- Department of Forensic Medicine, Jena University Hospital, Jena, Am Klinikum 1, 07747, Jena, Germany
| | - A Heinrich
- Department of Radiology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - F Güttler
- Department of Radiology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - R Wagner
- Department of Forensic Medicine, Jena University Hospital, Jena, Am Klinikum 1, 07747, Jena, Germany
| | - G Mall
- Department of Forensic Medicine, Jena University Hospital, Jena, Am Klinikum 1, 07747, Jena, Germany
| | - U Teichgräber
- Department of Radiology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany.
| |
Collapse
|
22
|
Abstract
This paper aims to demonstrate that post-mortem CT (PMCT) can locate intracranial hemorrhages, even in decomposed cases. This is of relevance in that post-mortem decomposition is particularly damaging to the brain tissue’s consistency, resulting in great difficulties to reliably diagnose and locate intracranial hemorrhages. We searched our case database of the last 11 years to find cases with decomposition of the body, where PMCT and an autopsy had been performed. We identified eleven cases according to these criteria. Postmortem interval ranged from 2 days to 2 weeks, and post-mortem radiological alteration index (RAI) was at or above 49. Eight out of eleven cases showed an intraparenchymal hemorrhage whereas the hemorrhage was extra-axial in the remaining three cases. Autopsy validated the presence of intracranial hemorrhage in all eleven cases, but location could not be confirmed due to liquid state of the brain. PMCT identified and localized intracranial hemorrhages in decomposed bodies, and in all of these cases, autopsy validated their presence. The actual cause of the hemorrhage (e.g. tumor, metastasis, vascular malformation, hypertensive hemorrhage) remained obscure. From this case series, it can be concluded that PMCT may add relevant information pertaining to localization of intracranial hemorrhages in decomposed bodies.
Collapse
|
23
|
Gonoi W, Watanabe Y, Shirota G, Abe H, Okuma H, Shintani-Domoto Y, Tajima T, Fukayama M, Abe O, Ishida M. Pulmonary postmortem computed tomography of bacterial pneumonia and pulmonary edema in patients following non-traumatic in-hospital death. Leg Med (Tokyo) 2020; 45:101716. [PMID: 32442911 DOI: 10.1016/j.legalmed.2020.101716] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 04/05/2020] [Accepted: 05/06/2020] [Indexed: 10/24/2022]
Abstract
In this study, we compared the postmortem computed tomography (PMCT) findings among nonpathological lungs, lungs with bacterial pneumonia, and lungs with pulmonary edema in patients following non-traumatic in-hospital death. We studied 104 consecutive adult patients (208 lungs) who died in our tertiary care hospital and underwent PMCT and pathological autopsy (both within 2.5 days after death), and were pathologically diagnosed with nonpathological lungs, bacterial pneumonia, and pulmonary edema. Thirteen pulmonary features were assessed on the CT scans. We also examined the association between the time elapsed since death and the pulmonary findings. We observed increased lung opacities with horizontal plane formation, diffuse opacities, diffuse bronchovascular bundle thickening, symmetric opacities to the contralateral lung, and decreased segmental opacities with time elapsed since death (Cochran-Armitage test for trend). Multiple logistic regression revealed that the presence of opacities without horizontal plane formation or centrilobular opacities, and the absence of diffuse bronchovascular bundle thickening were associated with histopathological pneumonia, whereas the presence of opacities with horizontal plane formation, diffuse opacities, and interlobular septal thickening were associated with histopathological pulmonary edema. In conclusion, specific pulmonary PMCT findings increased with time elapsed since death, and some lung findings may facilitate the diagnosis of bacterial pneumonia and pulmonary edema.
Collapse
Affiliation(s)
- Wataru Gonoi
- Radiology, Graduate School of Medicine, The University of Tokyo, Japan.
| | - Yusuke Watanabe
- Radiology, Graduate School of Medicine, The University of Tokyo, Japan
| | - Go Shirota
- Radiology, Graduate School of Medicine, The University of Tokyo, Japan
| | - Hiroyuki Abe
- Radiology, Graduate School of Medicine, The University of Tokyo, Japan
| | - Hidemi Okuma
- Radiology, Graduate School of Medicine, The University of Tokyo, Japan
| | | | - Taku Tajima
- Radiology, Graduate School of Medicine, The University of Tokyo, Japan
| | - Masashi Fukayama
- Radiology, Graduate School of Medicine, The University of Tokyo, Japan
| | - Osamu Abe
- Radiology, Graduate School of Medicine, The University of Tokyo, Japan
| | - Masanori Ishida
- Radiology, Graduate School of Medicine, The University of Tokyo, Japan
| |
Collapse
|
24
|
Asao R, Nishida K, Goto H, Goto Y, Ichiba N, Ohsawa I. Postmortem computed tomography of gas gangrene with aortic gas in a dialysis patient. CEN Case Rep 2020; 9:308-12. [PMID: 32323214 DOI: 10.1007/s13730-020-00456-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Accepted: 02/11/2020] [Indexed: 12/05/2022] Open
Abstract
Recently, postmortem imaging is sometimes used as an alternative to conventional autopsy. However, there are few case reports of postmortem imaging of dialysis patients. Here, we report a fatal case of gas gangrene involving a 76-year-old man who underwent dialysis. He died suddenly before a diagnosis could be established. Immediately after his death, postmortem computed tomography (PMCT) revealed gas accumulation in his right upper extremity and ascending aorta. Gas gangrene progresses rapidly and may sometimes result in sudden death before it is diagnosed. In this case, PMCT findings were useful to diagnose gas gangrene. Intravascular gas is a common finding on PMCT and is generally caused by cardiopulmonary resuscitation and decomposition. However, the detection of gas in the ascending aorta by PMCT was not described previously. Moreover, Gram stain and culture of the exudate showed anaerobic Gram-positive bacilli which suggested that the gas generation in the blood was caused by Clostridia species. To the best our knowledge, this is the first report of a dialysis patient whose cause of death was determined as gas gangrene using PMCT.
Collapse
|
25
|
Abstract
The question whether an injury was sustained during life or not is one of the most important subjects in forensic medicine. Therefore, vital reactions have been a main research topic in forensic medicine for a long period and many renowned forensic pathologists have devoted important papers to this field. The research area ranges from macroscopically visible organ reactions, over tissue alterations (enzyme histochemistry, later on immunohistochemistry with a wide range of enzymes and other analytes, molecular pathology) to biochemical responses to injury. Especially in the field of immunohistochemistry and molecular pathology much progress has been achieved in the last years (e.g. heat-shock-proteins or positive aquaporine3-staining in mechanical skin trauma). Furthermore, 20 years after its implementation postmortem imaging also contributes to the detection and visualization of vital signs. The aim of the present review is to provide an update on forensically relevant vital signs/vital reactions. Systemic vital reactions especially of the circulatory and respiratory system as well as local vital reactions will be addressed. Vital reactions of different organ systems will be discussed in detail regarding pathogenesis and possible postmortem evolution. Current research on immunohistochemically detectable vital reactions (heat-shock-protein expression, aquaporine3-staining in mechanical trauma of the skin) will be addressed as well as biochemical vital reactions (agonochemical stress reaction, myoglobine in electrocution death, hypoxanthine as marker of hypoxia).
Collapse
Affiliation(s)
- Burkhard Madea
- Institute of Forensic Medicine, University of Bonn, Stiftsplatz 12, D-53111 Bonn, Germany.
| | - Elke Doberentz
- Institute of Forensic Medicine, University of Bonn, Stiftsplatz 12, D-53111 Bonn, Germany
| | - Christian Jackowski
- Institute of Forensic Medicine, University of Bern, Bühlstrasse 20, CH-3012 Bern, Switzerland
| |
Collapse
|
26
|
Lombardi S, Scola E, Ippolito D, Zambelli V, Botta G, Cuttin S, Triulzi F, Lombardi CM. Micro-computed tomography: a new diagnostic tool in postmortem assessment of brain anatomy in small fetuses. Neuroradiology 2019; 61:737-746. [PMID: 30693410 DOI: 10.1007/s00234-019-02168-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 01/11/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE The aim of our study was to evaluate the postmortem micro-CT anatomy of early fetal human fetal brains, either in situ or isolated. METHODS We studied 12 ex vivo specimens, 9 whole human fetuses (9-18 GW), and 3 isolated samples (16-26 GW). Specimens were fixed in formalin, then immersed in Lugol solution. Images were evaluated by two neuroradiologists. The depiction of CNS structures was defined based on the comparison between micro-CT images and a reference histologic anatomical Atlas of human brain development. RESULTS Micro-CT provided informative high-resolution brain images in all cases, with the exception of one case (9 weeks) due to advanced maceration. All major CNS structures (i.e., brain hemispheres, layering, ventricles, germinal neuroepithelium, basal ganglia, corpus callosum, major cranial nerves, and structures of the head and neck) were recognizable. CONCLUSIONS Micro-CT imaging of the early fetal brain is feasible and provides high-quality images that correlate with the histological Atlas of the human brain, offering multiplanar and volumetric images that can be stored and shared for clinical, teaching, and research purposes.
Collapse
Affiliation(s)
- Sophie Lombardi
- Department of Neuroradiology, Grande Ospedale Metropolitano Niguarda, Milan, Italy.
| | - Elisa Scola
- Neuroradiology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Vanessa Zambelli
- Department of Health Sciences, Università di Milano-Bicocca, Milan, Italy
| | - Giovanni Botta
- Azienda Ospedaliera Città della Salute e delle Scienze di Torino, Presidio Ospedaliero OIRM-Sant'Anna, Turin, Italy
| | - Serena Cuttin
- Department of Pathology, San Gerardo Hospital, Monza, Italy
| | - Fabio Triulzi
- Neuroradiology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | | |
Collapse
|
27
|
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.
Collapse
|
28
|
Carballeira Álvarez A, Mancini J, Tuchtan-Torrents L, Gach P, Bartoli C, Desfeux J, Piercecchi MD, Gorincour G. Diagnostic value of unenhanced postmortem computed tomography in the detection of traumatic abdominal injuries. Diagn Interv Imaging 2018; 99:397-402. [PMID: 29475777 DOI: 10.1016/j.diii.2017.12.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 12/26/2017] [Accepted: 12/30/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To determine the diagnostic capabilities of unenhanced postmortem computed tomography (UPMCT) in detecting traumatic abdominal injuries. MATERIAL AND METHODS Cases of traumatic death with both UPMCT and classical autopsy were collected retrospectively from our institution "virtopsy" database in a period of 5 years. Cadavers with gunshot injuries were excluded. Sensitivity, specificity, accuracy, negative (NPV) and positive (PPV) predictive values of PMCT globally and for hemoperitoneum, liver, spleen, pancreas and kidney injuries individually were estimated using the autopsy report as gold standard. RESULTS Seventy-one cadavers were included. UPMCT had a sensitivity of 80% and a specificity 94%, with an accuracy of 83%, a PPV of 98% and a NPV of 59% for the diagnosis of traumatic abdominal injuries. The highest sensitivity was obtained for the detection of hepatic injuries (71%) and the lowest for pancreatic injuries (12%). UPMCT had a specificity of 100% for the detection of hemoperitoneum. A NPV of 98% was found for the detection of perihepatic hematomas. CONCLUSION The low sensitivity and low NPV do not support the use of UPMCT as an alternative to conventional autopsy to diagnose and/or rule out traumatic abdominal injuries. Nevertheless, UPMCT remains a helpful tool as it helps detect hemoperitoneum and virtually exclude presence of perihepatic hematomas.
Collapse
Affiliation(s)
- A Carballeira Álvarez
- Department of Radiology, Donostia Hospital (Osakidetza), P° Doctor Beguiristain, s/n, 20014 San Sebastián, Spain.
| | - J Mancini
- Inserm, IRD, UMR912 SESSTIM, Aix-Marseille université, 105, 27, boulevard Leï Roure, CS 30059, 13273 Marseille cedex 09, France; Public Health Department (BIOSTIC), Timone hospital (APHM), 264, rue Saint-Pierre, 13385 Marseille cedex 05, France
| | - L Tuchtan-Torrents
- Department of Forensic Medicine, Timone hospital (APHM), 264, rue Saint-Pierre, 13385 Marseille cedex 05, France
| | - P Gach
- Department of Medical Imaging, Timone hospital (APHM), 264, rue Saint-Pierre, 13385 Marseille cedex 05, France
| | - C Bartoli
- Department of Forensic Medicine, Timone hospital (APHM), 264, rue Saint-Pierre, 13385 Marseille cedex 05, France
| | - J Desfeux
- Department of Forensic Medicine, Timone hospital (APHM), 264, rue Saint-Pierre, 13385 Marseille cedex 05, France
| | - M D Piercecchi
- Department of Forensic Medicine, Timone hospital (APHM), 264, rue Saint-Pierre, 13385 Marseille cedex 05, France
| | - G Gorincour
- Department of Medical Imaging, Timone hospital (APHM), 264, rue Saint-Pierre, 13385 Marseille cedex 05, France
| |
Collapse
|
29
|
Gascho D, Philipp H, Flach PM, Thali MJ, Kottner S. Standardized medical image registration for radiological identification of decedents based on paranasal sinuses. J Forensic Leg Med 2018; 54:96-101. [PMID: 29348074 DOI: 10.1016/j.jflm.2017.12.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 08/25/2017] [Accepted: 12/18/2017] [Indexed: 10/18/2022]
Abstract
Image registration software is frequently used in clinical radiology, e.g., for follow-up diagnosis. To a certain extent, the radiological identification of decedents (RadID) is comparable to a clinical follow-up diagnosis, in that two datasets from different dates are compared in terms of their anatomical characteristics (e.g., paranasal sinuses) or surgical implants. Due to the increasing use of computed tomography (CT) for head examinations in clinical radiology and the increased use of postmortem CT (PMCT) in forensic imaging, the comparison of three-dimensional (3D) clinical CT (termed as antemortem CT (AMCT) in this article) and PMCT datasets for RadID is becoming increasingly practical. In particular, the comparison of paranasal sinuses in AMCT and PMCT imaging is considered a suitable and reliable modality for RadID. However, previous publications regarding RadID based on comparisons of 3D datasets have not considered the implementation of image registration to provide software-side support for RadID. This article demonstrates and evaluates the use of a standard medical image registration procedure for RadID by comparing paranasal sinuses.
Collapse
Affiliation(s)
- Dominic Gascho
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, 8057 Zurich, Switzerland.
| | - Hinderberger Philipp
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, 8057 Zurich, Switzerland
| | - Patricia M Flach
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, 8057 Zurich, Switzerland
| | - Michael J Thali
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, 8057 Zurich, Switzerland
| | - Sören Kottner
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, 8057 Zurich, Switzerland
| |
Collapse
|
30
|
Takei H, Sano R, Takahashi Y, Takahashi K, Kominato Y, Tokue H, Shimada T, Awata S, Hirasawa S, Ohta N. Usefulness of coronary postmortem computed tomography angiography to detect lesions in the coronary artery and myocardium in cases of sudden death. Leg Med (Tokyo) 2017; 30:46-51. [PMID: 29175582 DOI: 10.1016/j.legalmed.2017.11.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 11/16/2017] [Accepted: 11/16/2017] [Indexed: 12/17/2022]
Abstract
Coronary postmortem computed tomography angiography (coronary PMCTA) has been introduced as a routine examination procedure for autopsy at our department. Here, we reviewed eight autopsy cases in which apparent histopathological changes including acute myocardial infarction (AMI), anomalous aortic origin of a coronary artery (AAOCA), hypertrophic obstructive cardiomyopathy (HOCM) and acute myocarditis were involved in the cause of death. For investigation of the coronary artery and shape of the heart, coronary PMCTA was valuable in detecting narrowing or obstruction of coronary artery in AMI, indicating an anomalous aortic origin of the left coronary artery in AAOCA, and demonstrating septal hypertrophy and intracavitary obstruction in HOCM. However, it was debatable whether the hypervascularity demonstrated by coronary PMCTA in the case of acute myocarditis was more prominent than the vascular images obtained in other cases without inflammation. Thus, coronary PMCTA appeared to be useful not only for detection of coronary artery stenosis, but also for indicating other distinctive changes involved in AAOCA and HOCM.
Collapse
Affiliation(s)
- Hiroyuki Takei
- Division of Electronics and Informatics, Gunma University Graduate School of Science and Technology, Kiryu 376-8515, Japan; Department of Radiology, Gunma University Hospital, Maebashi 371-8511, Japan
| | - Rie Sano
- Department of Legal Medicine, Gunma University Graduate School of Medicine, Maebashi 371-8511, Japan
| | - Yoichiro Takahashi
- Department of Legal Medicine, Gunma University Graduate School of Medicine, Maebashi 371-8511, Japan; Lieber Institute for Brain Develoment, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Keiko Takahashi
- Department of Legal Medicine, Gunma University Graduate School of Medicine, Maebashi 371-8511, Japan
| | - Yoshihiko Kominato
- Department of Legal Medicine, Gunma University Graduate School of Medicine, Maebashi 371-8511, Japan.
| | - Hiroyuki Tokue
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University, Graduate School of Medicine, Maebashi 371-8511, Japan
| | - Takehiro Shimada
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University, Graduate School of Medicine, Maebashi 371-8511, Japan
| | - Sachiko Awata
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University, Graduate School of Medicine, Maebashi 371-8511, Japan
| | - Satoshi Hirasawa
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University, Graduate School of Medicine, Maebashi 371-8511, Japan
| | - Naoya Ohta
- Division of Electronics and Informatics, Gunma University Graduate School of Science and Technology, Kiryu 376-8515, Japan
| |
Collapse
|
31
|
Davis J, Novotny N, Macknis J, Alpay-Savasan Z, Goncalves LF. Diagnosis of neonatal neuroblastoma with postmortem magnetic resonance imaging. Radiol Case Rep 2017; 12:191-195. [PMID: 28228908 PMCID: PMC5310243 DOI: 10.1016/j.radcr.2016.08.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 08/24/2016] [Accepted: 08/29/2016] [Indexed: 11/28/2022] Open
Abstract
Postmortem magnetic resonance imaging (MRI) is emerging as a valuable tool to accompany traditional autopsy and has potential for use in cases when traditional autopsy is not possible. This case report will review the use of postmortem MRI with limited tissue sampling to differentiate between metastatic neuroblastoma and hepatoblastoma which could not be clearly differentiated with prenatal ultrasound, prenatal MRI, or emergent postnatal ultrasound. The mother presented to our institution at 27 weeks gestation after an obstetric ultrasound at her obstetrician's office identified a large abdominal mass. Fetal ultrasonography and MRI confirmed the mass but were unable to differentiate between neuroblastoma and multifocal hepatoblastoma. The baby was delivered by cesarean section after nonreassuring heart tones led to an emergent cesarean section. The baby underwent decompressive laparotomy to relieve an abdominal compartment syndrome; however, the family eventually decided to withdraw life support. At this time, we performed a whole body postmortem MRI which further characterized the mass as an adrenal neuroblastoma which was confirmed with limited tissue sampling. Postmortem MRI was especially helpful in this case, as the patient’s family declined traditional autopsy.
Collapse
Affiliation(s)
- James Davis
- Department of Diagnostic Radiology, Beaumont Hospital, Royal Oak, MI
| | - Nathan Novotny
- Department of Pediatric Surgery, Beaumont Hospital, Royal Oak, MI
| | | | | | - Luis F Goncalves
- Department of Diagnostic Radiology, Beaumont Hospital, Royal Oak, MI
| |
Collapse
|
32
|
Noriki S, Kinoshita K, Inai K, Sakai T, Kimura H, Yamauchi T, Iwano M, Naiki H. Newly recognized cerebral infarctions on postmortem imaging: a report of three cases with systemic infectious disease. BMC Med Imaging 2017; 17:4. [PMID: 28068928 PMCID: PMC5223344 DOI: 10.1186/s12880-016-0174-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 12/22/2016] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Postmortem imaging (PMI) refers to the imaging of cadavers by computed tomography (CT) and/or magnetic resonance imaging (MRI). Three cases of cerebral infarctions that were not found during life but were newly recognized on PMI and were associated with severe systemic infections are presented. CASE PRESENTATIONS An 81-year-old woman with a pacemaker and slightly impaired liver function presented with fever. Imaging suggested interstitial pneumonia and an iliopsoas abscess, and blood tests showed liver dysfunction and disseminated intravascular coagulation (DIC). Despite three-agent combined therapy for tuberculosis, she died 32 days after hospitalization. PMI showed multiple fresh cerebral and cerebellar infarctions and diffuse ground-glass shadows in bilateral lungs. On autopsy, the diagnosis of miliary tuberculosis was made, and non-bacterial thrombotic endocarditis that involved the aortic valve may have caused the cerebral infarctions. A 74-year-old man on steroid therapy for systemic lupus erythematosus presented with severe anemia, melena with no obvious source, and DIC. Imaging suggested intestinal perforation. The patient was treated with antibiotics and drainage of ascites. However, he developed adult respiratory distress syndrome, worsening DIC, and renal dysfunction and died 2 months after admission. PMI showed infiltrative lung shadow, ascites, an abdominal aortic aneurysm, a wide infarction in the right parietal lobe, and multiple new cerebral infarctions. Autopsy examination showed purulent ascites, diffuse peritonitis, invasive bronchopulmonary aspergillosis, and non-bacterial thrombotic endocarditis that likely caused the cerebral infarctions. A 65-year-old man with an old pontine infarction presented with a fever and neutropenia. Despite appropriate treatment, his fever persisted. CT showed bilateral upper lobe pneumonia, pain appeared in both femoral regions, and intramuscular abscesses of both shoulders developed. His pneumonia worsened, his level of consciousness decreased, right hemiplegia developed, and he died. PMI showed a newly diagnosed cerebral infarction in the left parietal lobe. The autopsy revealed bilateral bronchopneumonia, right-sided pleuritis with effusion, an intramuscular abscess in the right thigh, and fresh multiple organ infarctions. Systemic fibrin thrombosis and DIC were also found. Postmortem cultures showed E. coli and Burkholderia cepacia. CONCLUSION Cerebral infarction that is newly recognized on PMI might suggest the presence of severe systemic infection.
Collapse
Affiliation(s)
- Sakon Noriki
- Division of Tumor Pathology, Department of Pathological Sciences, School of Medical Sciences, University of Fukui, 23-3 Shimoaizuki, Matsuoka Eiheiji-cho, Yoshida-gun, 910-1193, Fukui, Japan. .,Autopsy Imaging Center, School of Medical Sciences, University of Fukui, Fukui, Japan.
| | - Kazuyuki Kinoshita
- Division of Radiology, Department of Radiology and Laboratory Medicine, School of Medical Sciences, University of Fukui, 23-3 Shimoaizuki, Matsuoka Eiheiji-cho, Yoshida-gun, 910-1193, Fukui, Japan.,Autopsy Imaging Center, School of Medical Sciences, University of Fukui, Fukui, Japan
| | - Kunihiro Inai
- Division of Molecular Pathology, Department of Pathological Sciences, School of Medical Sciences, University of Fukui, Fukui, Japan.,Autopsy Imaging Center, School of Medical Sciences, University of Fukui, Fukui, Japan
| | - Toyohiko Sakai
- Division of Radiology, Department of Radiology and Laboratory Medicine, School of Medical Sciences, University of Fukui, 23-3 Shimoaizuki, Matsuoka Eiheiji-cho, Yoshida-gun, 910-1193, Fukui, Japan.,Autopsy Imaging Center, School of Medical Sciences, University of Fukui, Fukui, Japan
| | - Hirohiko Kimura
- Division of Radiology, Department of Radiology and Laboratory Medicine, School of Medical Sciences, University of Fukui, 23-3 Shimoaizuki, Matsuoka Eiheiji-cho, Yoshida-gun, 910-1193, Fukui, Japan.,Autopsy Imaging Center, School of Medical Sciences, University of Fukui, Fukui, Japan
| | - Takahiro Yamauchi
- Division of Hematology and Oncology, Faculty of Medical Sciences, University of Fukui, 23-3 Shimoaizuki, Matsuoka Eiheiji-cho, Yoshida-gun, 910-1193, Fukui, Japan
| | - Masayuki Iwano
- Division of Nephrology, Department of General Medicine, University of Fukui, 23-3 Shimoaizuki, Matsuoka Eiheiji-cho, Yoshida-gun, 910-1193, Fukui, Japan
| | - Hironobu Naiki
- Division of Molecular Pathology, Department of Pathological Sciences, School of Medical Sciences, University of Fukui, Fukui, Japan.,Autopsy Imaging Center, School of Medical Sciences, University of Fukui, Fukui, Japan
| |
Collapse
|
33
|
Eriksson A, Gustafsson T, Höistad M, Hultcrantz M, Jacobson S, Mejare I, Persson A. Diagnostic accuracy of postmortem imaging vs autopsy-A systematic review. Eur J Radiol 2017; 89:249-69. [PMID: 28089245 DOI: 10.1016/j.ejrad.2016.08.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Revised: 07/11/2016] [Accepted: 08/02/2016] [Indexed: 11/23/2022]
Abstract
Background Postmortem imaging has been used for more than a century as a complement to medico-legal autopsies. The technique has also emerged as a possible alternative to compensate for the continuous decline in the number of clinical autopsies. To evaluate the diagnostic accuracy of postmortem imaging for various types of findings, we performed this systematic literature review. Data sources The literature search was performed in the databases PubMed, Embase and Cochrane Library through January 7, 2015. Relevant publications were assessed for risk of bias using the QUADAS tool and were classified as low, moderate or high risk of bias according to pre-defined criteria. Autopsy and/or histopathology were used as reference standard. Findings The search generated 2600 abstracts, of which 340 were assessed as possibly relevant and read in full-text. After further evaluation 71 studies were finally included, of which 49 were assessed as having high risk of bias and 22 as moderate risk of bias. Due to considerable heterogeneity - in populations, techniques, analyses and reporting - of included studies it was impossible to combine data to get a summary estimate of the diagnostic accuracy of the various findings. Individual studies indicate, however, that imaging techniques might be useful for determining organ weights, and that the techniques seem superior to autopsy for detecting gas Conclusions and Implications In general, based on the current scientific literature, it was not possible to determine the diagnostic accuracy of postmortem imaging and its usefulness in conjunction with, or as an alternative to autopsy. To correctly determine the usefulness of postmortem imaging, future studies need improved planning, improved methodological quality and larger materials, preferentially obtained from multi-center studies.
Collapse
|
34
|
Brenčičová E, Baglivo M, Schwendener N, Schyma C, Jackowski C. The truth lies within: the reconstructive value of inner livores in a homicide case. Int J Legal Med 2016; 130:1599-1601. [PMID: 27169675 DOI: 10.1007/s00414-016-1386-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 05/03/2016] [Indexed: 10/21/2022]
Abstract
Through the widespread use of postmortem computed tomography, inner livores of the lungs have become a frequently observed phenomenon in the field of forensic medicine. Yet their time-dependent development, notably in comparison with the widely studied external livores, remains poorly understood. We present a unique homicide case where the victim was discovered in supine position with correspondent external livores fixed exclusively on the rear side. Yet upon postmortem computed tomography, the victim presented pronounced inner livores within the depending dorsal areas of both lungs but also vertical sedimentation levels solely within the right lung, suggesting an initial right-hand side position and a postmortem re-positioning of the body. Interestingly, this was consistent with tangible hints of postmortem manipulation on-site. It is likely that this repositioning occurred sometime during the early postmortem interval (<6 h) as the external livores have completely rearranged to the final supine position. The presented case suggests different development patterns of inner and outer livores, highlighting the necessity for controlled studies that explore the formation and fixation processes of livor mortis in internal organs. A better understanding of these issues can prove useful in forensic examinations.
Collapse
Affiliation(s)
- Eva Brenčičová
- Institute of Forensic Medicine, University of Bern, Bühlstrasse 20, 3012, Bern, Switzerland.
| | - Manuela Baglivo
- Institute of Forensic Medicine, University of Bern, Bühlstrasse 20, 3012, Bern, Switzerland
| | - Nicole Schwendener
- Institute of Forensic Medicine, University of Bern, Bühlstrasse 20, 3012, Bern, Switzerland
| | - Christian Schyma
- Institute of Forensic Medicine, University of Bern, Bühlstrasse 20, 3012, Bern, Switzerland
| | - Christian Jackowski
- Institute of Forensic Medicine, University of Bern, Bühlstrasse 20, 3012, Bern, Switzerland
| |
Collapse
|
35
|
Luijten M, Haest II, van Kan RA, van Lohuizen W, Kroll J, Schnerr RS, Hermsen R, Hofman PA. Can postmortem MRI be used to assess trajectories in gunshot victims? Int J Legal Med 2016; 130:457-62. [PMID: 26518298 DOI: 10.1007/s00414-015-1273-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 10/13/2015] [Indexed: 11/27/2022]
Abstract
Purpose Multi-detector computed tomography (MDCT) has proven to be of value for the reconstruction of trajectories of projectiles and the assessment of the injuries in deceased gunshot victim. For the depiction of soft tissue injury, MRI is superior to MDCT and MRI may be of value to assess trajectories. In a clinical setting, there are guidelines for the application of MRI in patients with projectiles or projectile fragments and with precautions MRI is safe for these patients. However, this has not been studied for the postmortem application of MRI from a forensic point of view. Subjects and method To assess the behaviour of projectiles, two ferromagnetic and one non-ferromagnetic projectile were exposed to the magnetic field of a 1.5- and 3-T MRI. Projectiles were placed in six phantoms with the characteristics of human muscle tissue, with and without a simulated trajectory in the gel. Before and after exposure to the magnetic field, the gelatine phantoms were imaged with MDCT to assess the position of the projectiles. Results The ferromagnetic projectiles rotate to a position where their long axis is parallel to the z-axis of the magnetic field and five out of the six projectiles moved through, either through the simulated trajectory or through a new trajectory. This was observed in both the 1.5- and 3-T systems. Conclusion Ferromagnetic projectiles can rotate and migrate in a gelatine phantom. It is very likely that these projectiles will also migrate in a human body in a MRI system. Therefore, from a forensic point of view, postmortem MR will make a reconstruction of the trajectories in the body and of the reconstruction of the incident as a whole less reliable.
Collapse
|
36
|
Ishida M, Gonoi W, Okuma H, Shirota G, Shintani Y, Abe H, Takazawa Y, Fukayama M, Ohtomo K. Common Postmortem Computed Tomography Findings Following Atraumatic Death: Differentiation between Normal Postmortem Changes and Pathologic Lesions. Korean J Radiol 2015; 16:798-809. [PMID: 26175579 PMCID: PMC4499544 DOI: 10.3348/kjr.2015.16.4.798] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 03/16/2015] [Indexed: 11/25/2022] Open
Abstract
Computed tomography (CT) is widely used in postmortem investigations as an adjunct to the traditional autopsy in forensic medicine. To date, several studies have described postmortem CT findings as being caused by normal postmortem changes. However, on interpretation, postmortem CT findings that are seemingly due to normal postmortem changes initially, may not have been mere postmortem artifacts. In this pictorial essay, we describe the common postmortem CT findings in cases of atraumatic in-hospital death and describe the diagnostic pitfalls of normal postmortem changes that can mimic real pathologic lesions.
Collapse
Affiliation(s)
- Masanori Ishida
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
- Department of Radiology, Mutual Aid Association for Tokyo Metropolitan Teachers and Officials, Sanraku Hospital, Tokyo 101-8326, Japan
| | - Wataru Gonoi
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
| | - Hidemi Okuma
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
| | - Go Shirota
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
| | - Yukako Shintani
- Department of Pathology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
| | - Hiroyuki Abe
- Department of Pathology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
| | - Yutaka Takazawa
- Department of Pathology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
| | - Masashi Fukayama
- Department of Pathology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
| | - Kuni Ohtomo
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
| |
Collapse
|
37
|
Sarda-Quarello L, Bartoli C, Laurent PE, Torrents J, Piercecchi-Marti MD, Sigaudy S, Ariey-Bonnet D, Gorincour G. Whole body perinatal postmortem CT angiography. Diagn Interv Imaging 2016; 97:121-4. [PMID: 26032303 DOI: 10.1016/j.diii.2014.11.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
38
|
Germerott T, Preiss US, Ross SG, Thali MJ, Flach PM. Postmortem ventilation in cases of penetrating gunshot and stab wounds to the chest. Leg Med (Tokyo) 2013; 15:298-302. [PMID: 24060461 DOI: 10.1016/j.legalmed.2013.08.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Revised: 07/30/2013] [Accepted: 08/15/2013] [Indexed: 11/29/2022]
Abstract
We sought to determine the effect of postmortem ventilation in combination with a suction pump in cases showing penetrating trauma to the chest with haemo- and/or pneumothorax, for better evaluation of the lungs in postmortem computed tomography (PMCT). The study included 6 subjects (1 female, 5 male; age 32-67years) with a penetrating gunshot or stab wound to the chest and consecutive pneumo- and/or haemothorax. The pneumo- and haemothorax were evacuated by a suction pump, and postmortem ventilation was applied using a home care ventilator. PMCT images with and without postmortem ventilation were compared, as well as the autopsy results. In three cases haemo- and pneumothorax was clearly reduced. Postmortem ventilation led to distinct re-expansion of the lungs in two cases, and to re-expansion of single lung lobes in two cases with shotgun injuries. No visible effect was seen in the remaining two cases, because of extensive destruction of lung tissue and blood aspiration. In two cases the injuries sustained in the individual lung lobes were successfully located during postmortem ventilation. The bullet channel was apparent in one case; in another case, injury of the pericardium became visible by generating pneumopericardium. The present method is capable of improving evaluation of the postmortem lung in the presence of single stab or gunshot wounds and if there is no severe destruction of the respiratory system and aspiration. Forensic autopsy should still be considered as the gold standard, although in some cases the present method might be helpful, especially where no autopsy is required.
Collapse
Affiliation(s)
- Tanja Germerott
- Institute of Forensic Medicine, Center of Forensic Imaging and Virtopsy, University of Bern, Buehlstrasse 20, 3012 Bern, Switzerland; Institute of Forensic Medicine, Medical School Hannover, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany.
| | | | | | | | | |
Collapse
|