Abstract
ObjectivesTo assess the diagnostic accuracy (ACC) of post-mortem computed tomography (PMCT) for fractures of the isolated larynx-hyoid complex (LHC) in comparison to post-mortem fine preparation (PMFP).MethodsThis monocentric prospective study enclosed 54 LHCs that were extracted during autopsy, fixed in formalin, and underwent a PMCT scan (64-row multidetector CT, helical pitch). Two radiologists independently analyzed the LHC scans for image quality (IQ) and fractures (4-point Likert scales). A specialized forensic preparator dissected the specimens under the stereomicroscope. The PMFP results were standardized documented, and used as the standard of reference for the comparison to PMCT.ResultsThe PMCT-IQ of 95% of the LHC images was rated as good or excellent. IQ was decreased by decay, incisions during autopsy, and separation of the hyoid from the cartilaginous components in 7, 3, and 12 specimens, respectively. PMFP detected 119 fractures in 34 LHCs (63.0%). PMCT identified 91 fractures in 32 specimens (59.3%). PMFP and PMCT significantly agreed concerning the location (Cohen’s κ = 0.762; p < 0.001) and the degree of dislocation (κ = 0.689; p < 0.001) of the fractures. Comparing PMCT to PMFP resulted in a sensitivity of 88.2%, a specificity of 90.0%, and an ACC of 88.9% for the LHC. The ACCs for the hyoid, thyroid, and cricoid were 94.4%, 87.0%, and 81.5%, respectively. PMCT procedure was significantly faster than PMFP (28.9 ± 4.1 min vs. 208.2 ± 32.5 min; p < 0,001).ConclusionsPMCT can detect distinct injuries of the isolated LHC and may promptly confirm violence against the neck as cause of death. PMFP outmatches PMCT in the detection of decent injuries like tears of the cricoid cartilage.Key Points• Post-mortem computed tomography is able to assess fractures of the larynx-hyoid complex.• Prospective monocentric in vitro study showed that post-mortem computed tomography of the larynx-hyoid complex is faster than post-mortem fine preparation.• Post-mortem computed tomography can confirm violence against the neck as cause of death.
Highlights
post-mortem computed tomography (PMCT)The first application of CT in a forensic context was for the examination of cranial gunshot wounds in 1977 [1]
PMCT seems to be a promising tool in forensic cases of violent neck injuries, as these are frequently associated with fractures of the larynx-hyoid complex (LHC) [8]
Specimens were consecutively recruited from autopsies between July 2013 and May 2014 according to the following criteria: (1) forensic cases with an inconclusive result of the autopsy regarding the determination of the cause of death, (2) forensic cases with suspicion of violent neck injuries, and (3) forensic cases older than 15 years at the time of death
Summary
The first application of CT in a forensic context was for the examination of cranial gunshot wounds in 1977 [1]. Post-mortem computed tomography (PMCT) is discussed as an alternative to autopsy [2,3,4] or has become a routine procedure before autopsy [5]. PMCT is highly efficient in the evaluation of traumatic fractures and gunshot wounds as well as intracranial injuries [5,6,7]. Decay and post-mortem changes of the cardiovascular system impair the image analysis [4]. PMCT seems to be a promising tool in forensic cases of violent neck injuries, as these are frequently associated with fractures of the larynx-hyoid complex (LHC) [8]. Manual, and ligature strangulation are the most frequent causes of violent neck injuries. Objective verification of LHC fractures via PMCT is essential in decomposed bodies and is advantageous in forensic cases, when petechial hemorrhage or facial congestion is missing
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