Comment on "Abbreviated injury scale-guided assessment of traumatic deaths: postmortem CT versus autopsy".

Identification of a jawless skull by superimposing AM and PM CT images

Identification of a jawless skull by superimposing post-mortem and ante-mortem CT

BackgroundWhile several research groups champion the potential for postmortem CT (PMCT) to replace the invasive postmortem (PM), many questions still remain.AimsPerhaps the two most important questions are whether PMCT can...

Virtual autopsies (VAs) are non-invasive, bypassing many of the challenges posed by traditional autopsies (TAs). This is a literature review about the sensitivity of the main VA techniques: post mortem (PM) computed tomography (PMCT) and PM magnetic resonance (PMMR). This could help to identify the most appropriate uses for VA, and where future research should focus. A review was performed, searching for literature from the last 10 years regarding how sensitive VA is at detecting common lesions that could cause or contribute to death. 33 studies were included. There was strong agreement that PMCT had strengths in detecting: free gas; fractures; large fluid accumulations; and calcifications. PMCT’s weaknesses included missing: pulmonary emboli; myocardial infarctions; and visceral/soft tissue lesions. The strengths of PMMR were less widely agreed, but included detecting: large fluid collections; myocardial infarctions; and visceral/soft tissue lesions. There were no wide agreements on PMMR’s weaknesses due to a lack of literature. Therefore, VA is a useful adjunct to TA; however, its drawbacks in reliably detecting common causes of death restrict its ability to fully replace TA. Novel imaging techniques are being developed in order to bridge the current gaps of VA, and make autopsies even less invasive.

Intracranial hemorrhage is a major cause of sudden unexpected death and its identification is important for death investigations. Cisternal puncture of the cerebellomedullary cistern (CMC) can be used to identify intracranial hemorrhage during postmortem examination. Intracranial hemorrhage comprises various types of hemorrhage, and the possibility of hemorrhage identification by cisternal puncture can differ according to the type of intracranial hemorrhage. Postmortem computed tomography (PMCT) is non-invasive and can be performed before autopsy. In this study, we aimed to identify the hemorrhage in the CMC using PMCT in cases of various intracranial hemorrhage. PMCT was performed before the autopsy. Autopsy reports and PMCT were retrospectively reviewed for 108 cases of intracranial hemorrhage confirmed by conventional autopsy. Hemorrhagic regions showed ≥60 Hounsfield units on PMCT. Hemorrhage in the CMC was identified in 42.6% (46/108) by PMCT and was frequently identified in the cases of basal subarachnoid hemorrhage (SAH) (19/21). Hemorrhage in the CMC was identified in approximately 50% of patients with non-basal SAH and intracerebral hemorrhage. Detection of hemorrhage in the CMC by PMCT is hindered by several factors, such as dental artifacts. This study does not guarantee the usefulness of postmortem cisternal puncture. However, this study verified hemorrhage in the CMC according to the various types of intracranial hemorrhages using PMCT and showed its possibilities and limitations.

Identification of deceased based on sternal bone computed tomography features

Background: Postmortem examination is indispensable to ascertain the cause of an unnatural death and as such is mandatory by the law. From ages, traditional autopsy (TA) has proved its worth in establishing the cause of death in the deceased despite some inherent difficulties and challenges and has enjoyed an insurmountable status. The increasing use of application of the modern-day radiology for postmortem examination has however opened a new arena overcoming some of the difficulties of the TA. There are conflicting reports in the published literature regarding superiority of one modality of the postmortem over the other. Objective: The objective of this study was to compare the findings of postmortem computed tomography (CT) scan and TA in the victims of traumatic deaths and to analyze whether postmortem CT can be used to replace TA. Materials and Methods: All patients with a history of trauma that were declared brought dead on arrival in the emergency department were subjected to full-body CT scan. An experienced radiologist reported the findings of CT scan. Subsequently, a forensic expert subjected the patients to TA. The physician who performed autopsy was blinded to the findings of CT scan and vice versa. An individual who was not part of the radiology or forensic team then entered the findings of CT scan and autopsy in a predesigned Pro forma. An unbiased assessor finally compared the findings of the two modalities and analyzed the results. McNemar's test was used to ascertain the level of significance between the findings reported by these two modalities considering P = 0.05 as statistically significant. The agreement or disagreement on cause of death reported by these two modalities was also assessed. Results: About 95% of the deceased were males. The mean age of the corpses was 35 years (range 16–67 years). CT was found superior in picking up most of the bony injuries, air-containing lesions, hemothorax, and hemoperitoneum. However, autopsy was found more sensitive for soft-tissue and solid visceral injuries. Both modalities were equally helpful in identifying extremity fractures. Statistically significant agreement (>95%) on cause of death by both modalities was not achieved in any patient of trauma. Conclusion: Postmortem CT scan is promising in reporting injuries in traumatic deaths and can significantly complement the conventional autopsy. However, at present, it cannot be considered as a replacement for TA.

Comparative Analysis of Artery Anatomy Evaluated by Postmortem Tomography, CT Angiography, and Postmortem and Predeath CT Scans

Dental Post-mortem Computed Tomography for Disaster Victim Identification: A literature review

Computed tomography (CT) and magnetic resonance (MR) have been increasingly used in routine forensic practice and research, and, recently, also in cases of natural deaths. Post mortem CT and MR of single organs is currently applied only for investigation of cardiovascular pathologies. The aim of the present study was to show our experience of radiological analysis of single organs, as an integrative tool for research and forensic applications. The anatomo-radiologic study for forensic purpose was performed on single organs sampled at autopsy and on historical specimens. The specimen underwent CT and MR examinations. Basing on our experience, post-mortem CT and MR on single organ are very useful tool in detection of anatomical variations; diagnosis of cardiovascular pathologies in combination with macroscopic examination and histological evaluation; evaluation of findings shown at post-mortem CT examination of the body and not confirmed by macroscopic examination; analysis of historical anatomical specimens.

Background: The Postmortem in Computed tomography (PMCT) had been started from since 1990. PMCT advantages are more relevant in full-body examination (FBE) through scan is quite helpful to assess the whole body scan with clear evidence and computed recorded data. Material and methods: Here trying to justify the PMCT application, analysis and its interpretation in cadaveric, CT examination test before autopsy test to know the causes of death (COD), cause of injury (COI) and other additional information related to image study. Inclusion Criteria: The original contribution selected form (1990 to 2019) is included in study. Exclusion Criteria: An irrelevant study or any case study subject excluded from this study. Statistical analysis: Here simple statistics used from the available database for interpretation. Results: PMCT in analysis given more than (70-90%) better picture than the autopsy test. It clearly analyzed the cause of death (COD), manners of injury (MOI), and personal of identification (POI) through the postmortem examination (PME) and its development in the field of forensic medicine and toxicological research (FMTR). Conclusion: PMCT technology newly added and highly recommendable for correct information through their slice images. So many types of variables (TOVs) may easily compare and predict through the different informative slice images (DISIs) to use the accurate application on forensic medicine and toxicological angle.

Illustrated cross-sectional computed tomography of the cetacean abdomino-pelvic organs

ObjectivesFire deaths are challenging fatalities for forensic pathologists, as the main question of whether death was due to the fire or not needs to be answered. In this retrospective study, we assessed whether post-mortem computed tomography (PMCT) has an added value prior to a forensic autopsy of burned victims.MethodsFrom 2008 to 2016, a PMCT was performed in 50 burned corpses prior to a complete forensic autopsy. In retrospect, all 50 PMCT scans were systematically assessed by a forensically experienced radiologist, masked from the autopsy reports. Subsequently, the PMCT findings were compared with the autopsy reports.ResultsHeat fractures, contractions and destruction of extremities, subcutaneous emphysema and post-mortem gas collections were easier to detect by PMCT compared to autopsy. Alterations by penetrating and blunt trauma and the presence of foreign bodies were easy to detect by PMCT as well by autopsy. PMCT was, however, not successful in detecting signs of vitality during the fire, detection of superficial thermal injuries and to answer the main question of the forensic autopsy, which is to investigate the cause of death.ConclusionsPMCT prior to autopsy is a valuable add-on in the post-mortem forensic investigation of burned victims for detection of hidden signs of trauma, gas collections and foreign bodies. However, since PMCT cannot answer the two main questions in forensic examination—determining the cause of death and detecting signs of vitality during the fire—it cannot replace an autopsy.Key Points• Post-mortem CT (PMCT) in burned victims shows hidden signs of trauma.• Foreign bodies and gas collections can easily be detected.• Cause of death and vitality signs cannot be assessed by PMCT.

Validation of post mortem dental CT for disaster victim identification

When hemopericardium (HP) is found at autopsy, it represents a challenge for the forensic pathologist when having to assess its role in causing death. In fact, a proper diagnosis of pericardial tamponade (PT) must be based on clinical and instrumental data, which are not often available at post-mortem investigation. The aim of this study was to individuate post-mortem (PMCT) findings indicative for the diagnosis of PT. We revised PMCT images and autopsy reports of 14 cases with fatal HP and intact pericardium. From autopsy reports, we obtained volume and cause of HP. PMCT images were reviewed to describe appearance of HP and the presence of indirect signs of increased intrapericardial pressure. A control group of 11 cases submitted to PMCT prior to autopsy was selected with the following criteria: absence of relevant pericardial effusion, venous system congestion and bleeding. Of the 14 PT subjects, 13 had a double-concentric stratification of HP and compression of the coronary sinus and/or of the pulmonary trunk, all showing a flattening of the anterior surface of the heart; other findings indicative of venous system congestion were variably observed. In the control group, none of these findings was identified, with the exception of a distended or non-completely collapsed superior vena cava (11/11 cases). PMCT is able to provide some findings indicative of PT. Based on this evidence, in other instances HP could be judged circumstantial rather than fatal. This study suggests the possibility to use PMCT findings to retrospectively demonstrate a clinical condition, such as PT.