Postmortem Computed Tomography Data Research Articles

Mandibular torus thickness associated with age: Postmortem computed tomographic analysis

Age estimation is an essential step in identifying human corpses. Several mandibular landmarks have been highlighted as skeletal sites for age estimation since aging causes morphological changes. Reports suggest that mandibular torus size may be associated with aging; however, thorough investigation has not been performed owing to the difficulty in measuring it. Therefore, this study aimed to determine the association between age and mandibular torus thickness using postmortem computed tomography data from Japanese corpses. This study included 2,792 corpses with mean (standard deviation) age of 58.0 (22.4) years (range, 0–101 years) and 67.6 % males. Further, 2,662 (95.3 %), 14 (0.5 %), 59 (2.1 %), and 57 (2.0 %) corpses were in the permanent, mixed, primary, and predental dentition periods, respectively. Multivariable analysis was performed to quantify the impact of age on mandibular torus thickness, adjusting for sex, height, weight, and occlusal contact status. The model also included an interaction term between age and occlusal status because of the potential effect modification by occlusion. Results of the multivariable regression analysis showed that mandibular torus thickness increased with age (the regression coefficients (95 % confidence interval) were 0.6 (0.2–1.0), 0.7 (0.3–1.0), 1.0 (0.6–1.4), 1.3 (0.9–1.7), 1.3 (0.8–1.8), and 1.1 (0.4–1.7) for age groups 30–39, 40–49, 50–59, 60–69, 70–79, and 80–89 years, respectively), especially in males with occlusal contact. A significant association between mandibular torus thickness and age, modified by occlusal status and sex, was identified. Therefore, data regarding the thickness of the mandibular torus and occlusal status may be useful for age estimation in human corpses.

Normal Distal Tibiofibular Syndesmosis Assessment Using Postmortem Computed Tomography (PMCT).

Distal tibiofibular syndesmotic injuries, often misdiagnosed, can lead to substantial morbidity. This study utilized postmortem computed tomography (PMCT) to define normal syndesmotic relationships in 131 subjects. Three parameters were measured: fibular rotation (FR), sagittal translation (ST), and incisura depth (ID). Interobserver reliability was excellent for FR and ID but moderate for ST. Anatomical variability was wide, with FR ranging from -0.4° to 16.6°, ST from 0.33 mm to 3.49 mm, and ID from 1.89 mm to 6.05 mm. Side-to-side variability within subjects was minimal. Gender-specific differences were observed in ST, possibly due to size variations, highlighting the need for gender-specific diagnostic criteria. Although establishing universal reference values is challenging, using contralateral ankles for comparison can enhance diagnostic accuracy in syndesmotic injuries. This study, the first of its kind, offers valuable insights into normal distal tibiofibular syndesmotic relationships based on PMCT data. Future validation studies in patients with syndesmotic injuries can further improve diagnostic accuracy.

Estimation of missing mandible from the skull using postmortem CT images

Skeletal remains often have missing mandibles owing to the environment in which the corpse was placed or damage caused by an animal. Loss of the mandible reduces the accuracy of skull identification. Although several studies have validated methods for estimating mandibular morphology from conventional anthropological measurements using skull specimens, there are no reports using three-dimensional computed tomography (3DCT) images. Here, we examined methods for establishing the mandibular morphology from the remaining skulls using postmortem computed tomography (PMCT) images. We used PMCT images from 200 Japanese subjects as samples. After verifying the morphological correlation between the cranium and mandible, we created and validated estimation models using multiple regression analysis (stepwise method) for seven sites that were necessary for understanding the morphology of the mandible. Among the regression models, the estimated model for bicondylar breadth had the highest coefficient of determination (adjR2 = 0.53). We verified the accuracy of the model on a sample independent from the specimen used to create the estimation model and found that the formulated model of bicondylar breadth had good estimation accuracy, with a high correlation coefficient between the measured and predicted values of 0.82 and a mean absolute error of 3.582 mm, indicating that the model had good estimation accuracy. Here, we established a novel method for estimating the missing mandibular morphology based on PMCT data from the Japanese population. Our estimation model can help determine the missing mandibular morphology in a cranium remnant.

Usefulness of virtual reassembly of the skull and spine in cases of fragmentation due to high-energy trauma: A feasibility study

With the widespread use of postmortem computed tomography (PMCT) beside forensic autopsies for investigation of causes of death, three-dimensional (3D) reconstruction and fusion imaging using PMCT data are now becoming common. In the present study, the applicability of virtual reassembly from PMCT data was investigated in three cases involving fragmentation of the skull or spine due to high-energy trauma, as in such cases it is sometimes difficult to obtain detailed information on fractures using macroscopic observation alone. In the first case, virtual reassembly of the skull provided more information about the fractures than conventional reconstruction with adhesive. In the second case, although the skull was severely fractured and could not be examined macroscopically, virtual reassembly allowed detailed visualization of the fractures. In the last case, virtual reassembly of the spine helped to clarify that the 6th–8th thoracic vertebrae had been run over by a vehicle at the scene. Thus, virtual reassembly was shown to be useful for assessment of injury patterns, and event reconstruction.

Technical note: Semiautomated targeted postmortem computed tomography angiography of the pulmonary arteries using a robotic system

IntroductionTo better depict vascular lesions on postmortem computed tomography (PMCT), whole-body postmortem computed tomography angiography (PMCTA) can be used in forensic diagnostics. Targeted angiography, in which only a specific vessel is filled with contrast agent, might help in cases of traumatic changes that render whole-body PMCTA impossible. Moreover, in targeted PMCTA, the contrast agent does not affect the haptics of any other organs. In this article, we describe automated, CT-guided targeted angiography of the pulmonary artery (PA) using the Virtobot system. Material and methodsOur study group consisted of 8 deceased persons (3 males, 5 females). We first performed an unenhanced CT scan and used the data obtained to plan the needle trajectories with the Virtobot planning software. Then, the needle was fully automatically placed by the Virtobot system. Subsequently, 50 ml of contrast agent was injected manually, and the CT scan was repeated (targeted PMCTA). Results and discussionWe tested a new method for performing semiautomated targeted postmortem angiography of the PAs using a robotic needle placement system (Virtobot). In 6 out of our 8 cases, the injection of contrast agent in the PA was successful. In five of the six successful cases, there was reflux of contrast agent to some extent, but the reflux did not affect the readout. In general, the procedure was easy to plan based on a PMCT data set, and the pulmonary trunk was easy to reach with a robotic needle placement system.

Post mortem computed tomography is highly sensitive for pyelonephritis. A radiologic-pathologic correlation series.

Pyelonephritis is a potentially lethal disease occasionally encountered in the forensic setting. Post mortem computed tomography (PMCT) is an important investigative tool for the forensic pathologist. In particular, it may be used to document and screen disease prior to traditional autopsy methods. While the sensitivity and specificity of computed tomography for pyelonephritis is well studied in the antemortem clinical setting, the test characteristics of PMCT are not yet described in the forensic pathology literature. A series of all cases of fatal pyelonephritis identified at the Ontario Forensic Pathology Service, over the course of 1year was studied. Radiologic, clinical and pathologic findings were reviewed. A fulsome autopsy, including histopathologic examination, was considered the gold standard for sensitivity and specificity calculations. A control group consisting of 16 cases without pyelonephritis (ex: opiate toxicity) in which both PMCT and histologic data were available by way of comparison. Sixteen cases of pyelonephritis were identified. Post mortem computed tomographical signs of pyelonephritis included asymmetric renal enlargement, perinephric fat stranding, and ectopic renal air. The most (57%) individually sensitive of these findings was perinephric fat stranding but sensitivity increased to 100% if any of the three signs were present. The control group analysis revealed the specificity of air asymmetry (81%), asymmetric renal enlargement (81%), and fat stranding (69%). PMCT findings may rule in a diagnosis of pyelonephritis, and should prompt the pathologist to grossly and microscopically examine the kidneys.

Planned complex suicide combining pistol head shot and train suicide and Virtopsy examination

• What resolution is necessary for forensic triage post-mortem CT • How to search for and identify gunshot injury to the head in apparent case of train suicide • Comparison of CT and macroscopy of bone fragments This case report focuses on the findings in what appeared to be a planned complex pistol head shot and train suicide. The post mortem computed tomography (PMCT) scan in this instance yielded two interesting skull fragments among the many fragments of a highly fragmented body and head. These two fragments, based on initial resolution, appeared to show findings consistent with a firearm shot to the head. Upon reconstruction of higher resolution data, the necessary discrimination of non-gunshot related semi-circular fragment rims and firearm-related beveling matched the macroscopic aspect of the skull fragments. As a first lesson to be learned, a thorough examination of PMCT data in relatively high degrees of fragmentation may have to inspect all bone edges also for relatively subtle changes, possibly indicative of sharp force trauma or gunshot trauma. To that end, individual bone fragments should be placed on the scanner table carefully and with proper spacing, to expose their edges. Only this allows to capture data that avoids edge overlaps or edge collisions and that allows for optimal checking of the edges of all bone fragments for possible semicircular defects in the PMCT data. A second technical lesson to be learned is that particularly in instances of high fragmentation of at least parts of a body, resolution may have to be at least as good as maximally achievable. To that end, availability of the raw data to reconstruct images with maximal image quality rather than using a trade-off between lesser cost and lesser yield may be a key issue. A third lesson to be learned is that findings in relatively highly fragmented bodies as consequence of an apparent form of injury - fire/thermal, fall from great height, collision with a train - for other forms of trauma - sharp force trauma, firearm injury - may have to interpreted with caution, particularly with regard to what can be ruled out.

Quantitative analysis of pulmonary structures in PMCT; Stereological comparison of drowning compared to opioid-overdose cases.

• Stereology can be applied on post mortem CT scans of the lungs. • The method provides information of volume and attenuation of lung structures • No difference in volume and attenuation in lungs of drowning victims and controls The aim of this study, was to introduce stereology as a versatile and robust tool for quantitative image analysis of volume and attenuation characteristics (Hounsfield Units (HU's)), in a blinded control case study investigating lungs of drowning victims compared to a control group on post mortem computed tomography (PMCT) data. PMCT scans of the lungs from 14 drowned cases and 14 matched opioid-overdose-controls was included. Quantitative CT-analysis was performed using a stereological approach adapted to PMCT data that allowed for precise extraction of volume and HU-values using stereological point-probes assigned manually to individual lung-structures. Qualitative radiological image interpretation performed by a trained radiologist was compared to the quantitative analyses. No significant difference was found for total lung volume, volumes of consolidations, ground glass opacities, bronchi, and air-filled lung tissue. When comparing drowning cases with opioid overdose cases as controls, the extracted HU-values did not show statistically significant changes in mean attenuation characteristics. No major discrepancies were found between the quantitative analysis and qualitative analysis. Conventional radiological evaluation of PMCT images rely on the radiologists’ ability to distinguish normal from pathological. Quantitative image analysis offers, to name a few, precise estimations of structure volume and HU-statistics. Although the used 14 matched cases data failed to significantly aid the diagnosis of drowning statistically, we envisage that quantitative PMCT analysis using stereology could become a valuable tool to improve objective forensic radiological interpretation.

Image segmentation of post-mortem computed tomography data in forensic imaging: Methods and applications

• The basic concepts of medical image segmentation are explained. • The applications for segmentation in forensics medicine and anthropology are discussed. • Background on required image qualities, available software and workflow considerations for medical image segmentation are given. Many forensic institutes worldwide use postmortem computed tomography (PMCT) as a standard imaging modality. A variety of techniques, such as visualization, polygonization, volumetry, autopsy planning and 3D printing, require knowledge about case-specific anatomy and pathologies. The means by which voxels are assigned additional information regarding the anatomical structure or tissue is called image segmentation (sometimes labeling). In this article, we introduce the most relevant segmentation techniques used on forensic medical data. We provide information about different software packages that allow for the segmentation of PMCT data and discuss data requirements. Finally, we introduce a variety of different applications in forensic imaging, in which segmentation techniques have proven to be useful, including applications in forensic anthropology.

Fractures of the neuro-cranium: sensitivity and specificity of post-mortem computed tomography compared with autopsy.

Post-mortem computed tomography (PMCT) is a routine tool in many forensic pathology departments as it is fast and non-destructive and allows less gruesome visualization than photographs, and the images are indefinitely storable. Several studies investigated congruence between PMCT and autopsy for skull fracture but registered only the presence or absence of fracture systems. The objective of this study was to determine location-specific sensitivity and specificity of PMCT for individual fracture lines in blunt force head trauma. Accurate 3D models based on PMCT data with all fracture lines visible are important for future studies on fractures, applying finite element analysis (FEA). We retrospectively sampled adult cases from 2013 to 2019 with skull fracture mentioned in the autopsy report. PMCT was on a Siemens 64-slice scanner and autopsy according to international guidelines. The location and direction of all fracture lines at autopsy and at de novo interpretation of scans were registered and compared. Ninety-nine cases with 4809 individual findings were included. Age ranged from 18 to 100years. The overall sensitivity was 0.58, and specificity was 0.91. For individual locations, sensitivity ranged from 0.24 to 0.85, and specificity ranged from 0.73 to 1.00. Intra-observer agreement was 0.74, and inter-observer agreement ranged from 0.43 to 0.58. In conclusion, PMCT is suited for detection of fracture systems, but not for detection of all individual fracture lines. Our results differed from the existing literature due to the methodological choices of registering individual fracture lines. Future studies utilising FEA must supplement PMCT with autopsy data.

Juvenile Body Mass Estimation from the Femur Using Postmortem Computed Tomography Data

Skeletal estimation methods to reconstruct the juvenile biological profile are largely limited to those estimating age and, to a lesser extent, sex. While body mass is not generally estimated as part of the biological profile in forensic investigations, this is a logical candidate for inclusion in the forensic biological profile, as it has long been of interest in paleoanthropology and several methods to estimate juvenile body mass currently exist. To explore the performance of body mass estimation for juveniles, the authors tested the accuracy and precision of previously published panel regression formulae using two femoral measurements: the breadth of the distal metaphysis and the cross-sectional polar moment of inertia (J). The test sample consisted of measurements of 94 individuals from birth to 12.5 years of age, taken from postmortem computed tomography scans housed at the Office of the Medical Investigator, New Mexico, USA. Results indicate that body mass estimates are more accurate when estimated from cross-sectional than from metaphyseal measures. Both formulae, however, consistently underestimated weight, and the magnitude of the underestimation increased exponentially with age. This suggests that, contrary to what others have argued, body mass estimation is complicated by population variation in body composition. This study reinforces the importance of documenting and investigating the ontogeny of human variation. The global increase in medical imaging in clinical settings can be leveraged to obtain skeletal data for juveniles from a wide range of ontogenic environments, marking an exciting time for the study of human variation.

Rupture of segmental dilatation of the sigmoid colon resulting from blunt force to the abdomen in a child

• PMCT revealed segmental sigmoid colon dilatation. • Segmental dilatation of the sigmoid colon might be a risk factor for rupture due to blunt force • 3D volume-rendered imaging suggested a mechanical cause for the colon rupture resulting from blunt force. A four-year-old child died nine hours after he was found lying crying in the yard of a nursery school during morning playtime. Although no-one had witnessed any related event, time-lapse images recorded by a security camera suggested that he had fallen forward onto the ground while running with a hula hoop he had been using to simulate a car steering wheel. Since the cause of death was not determined by the doctor at the general hospital to which the boy had been transferred, and police investigation suspected that the hula hoop had struck the boy in the abdomen, a medicolegal autopsy was performed to clarify the cause of death. Prior to autopsy, postmortem computed tomography (PMCT) revealed free intraperitoneal fluid, free intraperitoneal gas, and segmental sigmoid colon dilatation, suggesting perforation or rupture of the bowel and subsequent peritonitis. At autopsy, external examination demonstrated no bruising on the abdomen, but internal examination revealed bleeding in the subcutaneous fatty tissue of the abdominal wall, rupture in the region of the sigmoid colon showing segmental dilatation, and disseminated peritonitis. 3D volume-rendered images constructed from the PMCT data suggested that a direct blow to the abdomen might have caused injury to the sigmoid colon by compressing it against the spine, and that the rupture could have been facilitated by the segmental dilatation. In the present case, reciprocity between autopsy and PMCT was useful for verifying rupture in an area of segmental dilatation of the sigmoid colon caused by blunt force to the abdomen.

An algorithm for automatically generating gas, bone and foreign body visualizations from postmortem computed tomography data

Post mortem computed tomography (PMCT) can aid in localizing foreign bodies, bone fractures, and gas accumulations. The visualization of these findings play an important role in the communication of radiological findings. In this article, we present an algorithm for automated visualization of gas distributions on PMCT image data of the thorax and abdomen. The algorithm uses a combination of region growing segmentation and layering of different visualization methods to automatically generate overview images that depict radiopaque foreign bodies, bones and gas distributions in one image. The presented method was tested on 955 PMCT scans of the thorax and abdomen. The algorithm managed to generate useful images for all cases, visualizing foreign bodies as well as gas distribution. The most interesting cases are presented in this article. While this type of visualization cannot replace a real radiological analysis of the image data, it can provide a quick overview for briefings and image reports.

Juvenile Body Mass Estimation from the Femur Using Postmortem Computed Tomography Data.

Skeletal estimation methods to reconstruct the juvenile biological profile are largely limited to those estimating age and, to a lesser extent, sex. While body mass is not generally estimated as part of the biological profile in forensic investigations, this is a logical candidate for inclusion in the forensic biological profile, as it has long been of interest in paleoanthropology and several methods to estimate juvenile body mass currently exist. To explore the performance of body mass estimation for juveniles, the authors tested the accuracy and precision of previously published panel regression formulae using two femoral measurements: the breadth of the distal metaphysis and the cross-sectional polar moment of inertia (J). The test sample consisted of measurements of 94 individuals from birth to 12.5 years of age, taken from postmortem computed tomography scans housed at the Office of the Medical Investigator, New Mexico, USA. Results indicate that body mass estimates are more accurate when estimated from cross-sectional than from metaphyseal measures. Both formulae, however, consistently underestimated weight, and the magnitude of the underestimation increased exponentially with age. This suggests that, contrary to what others have argued, body mass estimation is complicated by population variation in body composition. This study reinforces the importance of documenting and investigating the ontogeny of human variation. The global increase in medical imaging in clinical settings can be leveraged to obtain skeletal data for juveniles from a wide range of ontogenic environments, marking an exciting time for the study of human variation.

Pair-Matching Digital 3D Models of Temporomandibular Fragments Using Mesh-To-Mesh Value Comparison and Implications for Commingled Human Remain Assemblages.

The mesh-to-mesh value comparison (MVC) method developed by Karell et al. (Int J Legal Med 130(5):1315-1322, 2016) facilitates the digital comparison of three-dimensional mesh geometries obtained from laser-scanned or computed tomography data of osteological materials. This method has been employed with great success to pair-matching geometries of intact skeletal antimeres, that is, left and right sides. However, as is frequently the case for archaeological materials, there are few circumstances which proffer complete skeletal remains and fewer still when considering contexts of commingling. Prior to the present research, there existed a paucity of sorting techniques for the diverse taphonomic conditions of skeletal materials found within commingled assemblages, especially regarding fragmentary remains. The present chapter details a study in which the MVC method was adapted to encompass comparisons of isolated components of bone in lieu of entire bone geometries in order to address this dearth. Using post-mortem computed tomography data from 35 individuals, three-dimensional models of 70 mandibular fossae and 69 mandibular condyles were created and then compared using Viewbox 4, to produce numerical mesh-to-mesh values which indicate the geometrical and spatial relationship between any two given models. An all-to-all comparison was used to determine if the MVC method, using an automated Trimmed Iterative Closest Point (TrICP) algorithm, could be utilized to (1) match corresponding bilateral pairs of condyles and fossae and (2) match same-sided articular correlates. The pair-matching of both the condyles and the fossae generally produced high sensitivity and specificity rates. However, the articulation results were much poorer and are not currently recommended.

Use of post-mortem computed tomography in disaster victim identification. Updated positional statement of the members of the disaster victim identification working group of the International Society of Forensic Radiology and Imaging; July 2019

This case report focuses on the findings in what appeared to be a planned complex pistol head shot and train suicide. The post mortem computed tomography (PMCT) scan in this instance yielded two interesting skull fragments among the many fragments of a highly fragmented body and head. These two fragments, based on initial resolution, appeared to show findings consistent with a firearm shot to the head. Upon reconstruction of higher resolution data, the necessary discrimination of non-gunshot related semi-circular fragment rims and firearm-related beveling matched the macroscopic aspect of the skull fragments. As a first lesson to be learned, a thorough examination of PMCT data in relatively high degrees of fragmentation may have to inspect all bone edges also for relatively subtle changes, possibly indicative of sharp force trauma or gunshot trauma. To that end, individual bone fragments should be placed on the scanner table carefully and with proper spacing, to expose their edges. Only this allows to capture data that avoids edge overlaps or edge collisions and that allows for optimal checking of the edges of all bone fragments for possible semicircular defects in the PMCT data. A second technical lesson to be learned is that particularly in instances of high fragmentation of at least parts of a body, resolution may have to be at least as good as maximally achievable. To that end, availability of the raw data to reconstruct images with maximal image quality rather than using a trade-off between lesser cost and lesser yield may be a key issue. A third lesson to be learned is that findings in relatively highly fragmented bodies as consequence of an apparent form of injury - fire/thermal, fall from great height, collision with a train - for other forms of trauma - sharp force trauma, firearm injury - may have to interpreted with caution, particularly with regard to what can be ruled out.

Accuracy of computed radiography in osteometry: A comparison of digital imaging techniques and the effect of magnification

Abstract Introduction Osteometric data may be obtained using digital imaging techniques, such as post-mortem computed tomography (PMCT) and digital radiography, non-invasively and without ethical objection. Osteometric data from PMCT is known to be as accurate as taking direct measurements. Digital radiography is more accessible and affordable than PMCT but is limited due to the magnification of its subjects. Objectives To investigate the viability of implementing digital radiographic techniques for measurement of long bones, and to establish whether magnification can be accurately corrected for. Materials and Methods Twenty hind pig (Sus scrofa) legs were imaged using computed radiography (CR) and PMCT, and osteometric data obtained from the digital images and 3D CT volume reconstructions. Direct measurements were taken following maceration. A calibration object was imaged using CR, to provide magnification correction factors. Results Accuracy was determined by mean absolute error (AE), giving values of 3.3 ± 2.5 mm for PMCT (MPR), 2.4 ± 1.3 mm for PMCT (3D), 11.1 ± 7.4 mm for CR (PA), and 18.3 ± 14.5 mm for CR (LAT). PMCT data was more accurate than CR data. Through applying correction for magnification, CR data became closer to the direct measurement data, and stature estimation was substantially altered. Conclusion Magnification in computed radiography affects osteometric data and resulting stature estimations. Applying correction factors may be a viable option for improving accuracy. For digital radiography to be used reliably in forensic anthropology, further empirical research is needed to validate a magnification correction method.

Fatal obstructive asphyxia: Trans-pulmonary density gradient characteristic as relevant identifier in postmortem CT

Abstract To investigate effects of obstructive asphyxia on the postmortem computed tomography (PMCT) appearance of lungs, we matched 24 cases of obstructive asphyxia with age-sex matched controls. The initial qualitative impression was that obstructive asphyxia typically appeared to correlate with absence or reduced postmortem hypostasis as well as increased pulmonary radiotranslucency. Categories initially included within obstructive asphyxia were fatal aspiration of gastric contents into lungs, fatally blocked trachea or bronchi due to foreign body, fatal ligature strangulation, fatal manual strangulation and smothering. Method: We manually placed density profile vectors, with start at positionally dependent locations of each lung to derive PMCT densities for multivariate statistics. As fatal gastric content aspiration cases did not significantly differ from the controls, they were re-grouped into the control group for further testing. Results: Quantitatively, the obstructive asphyxia case group featured reduced or absent postmortem hypostasis in the lungs and an overall lower density. Linear multivariate statistics (general linear models, linear discriminant analysis) performed relatively poorly, whereas ”shallow” neural networks yielded significantly better discrimination. With disjunct training and test sets, neural networks achieved correct recognition rates (CRR) of obstructive asphyxia cases of over 95%. Conclusions: Within a more narrowly defined collective of obstructive asphyxia, pulmonary PMCT data appears to contain sufficient information to justify its use in a screening process. This questions the value of an exclusively death scene focused decision making for further investigations and may justify a wider use of PMCT. Conversely, obstructive asphyxia remains difficult to diagnose conclusively based on PMCT alone, so a full autopsy including toxicological analysis are recommended in such cases.

Significance of intracranial gas on post-mortem computed tomography in traumatic cases in the context of medico-legal opinions

The detection of intracranial gas (ICG) in people who died due to trauma became possible once postmortem computed tomography (PMCT) became available in addition to traditional post-mortem examinations. The aim of this study was to determine the importance of ICG in the context of medico-legal opinions. We assessed 159 cases of trauma-induced death. Cadavers with pronounced signs of decomposition, open skull fractures, and after neurosurgical operations were excluded. Both PMCT findings and data from autopsy reports were analyzed. ICG was found in 38.99% (n = 62) of the cadavers, 96.77% (n = 60) of which presented with pneumocephalus (PNC) and 40.23% (n = 25) with intravascular gas (IVG). There was a strong correlation between ICG and skull fractures/brain injuries, as well as chest injuries, especially lung injuries. In 13 cases, ICG presented without skull fractures; three of these cases died as a result of stab and incised wounds to the neck and chest. The mean time between trauma and death was significantly longer in the non-ICG group than the ICG group at 2.94 days (0–48 days) and 0.01 day (0–1 day), respectively (p < 0.0001). The presence of ICG is a result of severe neck and chest injuries, including stab and incised wounds. The victims die in a very short amount of time after suffering trauma resulting in ICG. The ability to demonstrate ICG on PMCT scans can be of significance in forming medico-legal opinions.

Post-mortem computed tomography (PMCT) radiological findings and assessment in advanced decomposed bodies.

The aim of the study is to report radiological findings and features in advanced decomposed bodies obtained by post-mortem computed tomography (PMCT) with autopsy correlation. This retrospective descriptive multicentric study included 41 forensic cases examined between May 2013 and November 2016. All the bodies were PMCT-scanned prior to autopsy, and internal putrefactive state was determined using the radiological alteration index (RAI) by a radiologist with expertise in forensic radiology and a forensic pathologist trained in forensic imaging. After PMCT scans, grade of external putrefaction (GEP) was assigned during the external examination and the complete autopsy was performed by forensic pathologists. The PMCT images evaluation revealed that the RAI index was > 61 in all bodies, corresponding to a moderate-massive presence of putrefactive gas. The gas grade was > II in correspondence of the major vessels, heart cavities, liver parenchyma, vertebra L3 and subcutaneous pectoral tissues, and varied from I to III in correspondence of the kidney. Cadaveric external examination revealed the presence of advanced transformative phenomena, with a GEP3 and GEP4 in most of the cases, with body swelling, eyes and tongue protrusion, body fluids expulsion and fat liquefaction. Radiological imaging by PMCT as an adjunct to autopsy in advanced decomposed bodies represents a useful tool in detecting post-mortem gas, even in very small amounts. A correct interpretation process of the PMCT data is essential to avoid images pitfalls, due to natural decomposition that can be mistaken for pathologic processes.