Abstract
BackgroundComputed Tomography (CT) has become a widely used supplement to medico legal autopsies at several forensic institutes. Amongst other things, it has proven to be very valuable in visualising fractures of the cranium. Also CT scan data are being used to create head models for biomechanical trauma analysis by Finite Element Analysis. If CT scan data are to be used for creating individual head models for retrograde trauma analysis in the future we need to ascertain how well cranial fractures are captured by CT scan. The purpose of this study was to compare the diagnostic agreement between CT and autopsy regarding cranial fractures and especially the precision with which cranial fractures are recorded.MethodsThe autopsy fracture diagnosis was compared to the diagnosis of two CT readings (reconstructed with Multiplanar and Maximum Intensity Projection reconstructions) by registering the fractures on schematic drawings. The extent of the fractures was quantified by merging 3-dimensional datasets from both the autopsy as input by 3D digitizer tracing and CT scan.ResultsThe results showed a good diagnostic agreement regarding fractures localised in the posterior fossa, while the fracture diagnosis in the medial and anterior fossa was difficult at the first CT scan reading. The fracture diagnosis improved during the second CT scan reading. Thus using two different CT reconstructions improved diagnosis in the medial fossa and at the impact points in the cranial vault. However, fracture diagnosis in the anterior and medial fossa and of hairline fractures in general still remained difficult.ConclusionThe study showed that the forensically important fracture systems to a large extent were diagnosed on CT images using Multiplanar and Maximum Intensity Projection reconstructions. Difficulties remained in the minute diagnosis of hairline fractures. These inconsistencies need to be resolved in order to use CT scan data of victims for individual head modelling and trauma analysis.
Highlights
Computed Tomography (CT) has become a widely used supplement to medico legal autopsies at several forensic institutes
The anatomic localisation of the cranial fractures as diagnosed at the autopsy It was seen at the autopsy that the basal fossae and the vault were affected in 34 instances
Our study showed that the forensically important fracture systems to a large extent were diagnosed on CT images using Multiplanar reconstruction (MPR) and Maximum Intensity Projection (MIP) reconstructions
Summary
Computed Tomography (CT) has become a widely used supplement to medico legal autopsies at several forensic institutes. Computed tomography (CT) scanning of bodies prior to medico legal autopsy has become a powerful tool in several forensic institutes throughout the world [1,2,3]. BMC Medical Imaging 2009, 9:18 http://www.biomedcentral.com/1471-2342/9/18 pathology as well as in clinical settings the investigation of head trauma is based on a combined analysis of the present external lesions, cranial fractures and intracranial lesions. Especially minor lesions of the soft tissue, bone or intracranial content can be difficult to diagnose on CT scan which has to be kept in mind when investigating head trauma and the corresponding injury mechanisms
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