Abstract
• MRI is recommended in cases of strangulation with few or no superficial skin lesions and only a few petechiae but subjective symptoms. • The quantity and quality (extent/size) of MRI findings must be considered for the assessment of life-threatening strangulation. • Distinct intramuscular hemorrhage may be an indicator of a severe assault. • The validity of hemorrhagic lymph nodes as an indicator of life-threatening strangulation is controversial. • Perilaryngeal fluid accumulation appear to be a potentially relevant finding in chokeholds. The assessment of danger to life (DTL) is the central question for medicolegal reports in cases of nonfatal strangulation. Petechiae (petechial hemorrhages on conjunctivae, mucosal surfaces and facial skin), and subjective symptoms, such as loss of consciousness, serve as indicators for the forensic assessment of DTL. However, only distinct petechiae are considered an objective finding for life-threatening strangulation. Since the presence of only a few petechiae does not necessarily indicate an asphyxial process and since petechiae may vanish within 1-3 days after the incident, further objective indicators are desired. Radiologic imaging has been considered a potential supplement for the forensic assessment of DTL. Computed tomography (CT) is the most commonly used radiologic modality for detecting the extent of injuries from blunt trauma to the neck and CT angiography allows the diagnosis of vascular injuries, such as carotid dissection. However, the focus of clinical radiology is the diagnosis of injuries that require medical treatment; thus, the applied examination methods and imaging protocols are not necessarily appropriate for forensic assessment in cases of strangulation. Furthermore, exposing a victim to radiation using CT may not be justifiable if the victim does not present severe symptoms. Consequently, noninvasive magnetic resonance imaging (MRI) has been considered for medicolegal examinations in cases of nonfatal strangulation. The aim of this article is to discuss the role and potential value of MRI for the assessment of DTL in cases of nonfatal strangulation. For this purpose, the results, conclusions and recommendations of individual studies were compared and assessed.
Highlights
Only distinct petechiae are considered an objective finding for life-threatening strangulation
Computed tomography (CT) is the most commonly used radiologic modality for detecting the extent of injuries from blunt trauma to the neck and CT angiography allows the diagnosis of vascular injuries, such as carotid dissection
Cases with perilaryngeal fluid accumulation were significantly associated with difficulty swallowing; magnetic resonance imaging (MRI) can provide an objective confirmation for this subjective symptom
Summary
The essential questions in cases of nonfatal strangulation are the severity of the assault and the potential danger to life (DTL) [7] This assessment is often challenging when solely based on the presence or absence of external findings and subjective symptoms reported by the victim. (water only) was replaced by the T2 DIXON w.o. after the first MRI examinations ***true fast imaging with steady-state precession is a coherent technique that uses a fully balanced gradient waveform studies [13,14,15,16] investigating the use of MRI in cases of nonfatal strangulation In each of these studies, the scan protocol included a T1-weighted sequence, a T2-weighted sequence, and a fat-saturated T2-weighted sequence.
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