Imaging in forensic radiology: an illustrated guide for postmortem computed tomography technique and protocols

Flach, Patricia M.; Gascho, Dominic; Schweitzer, Wolf; Ruder, Thomas D.; Berger, Nicole; Ross, Steffen; Thali, Michael J.; Ampanozi, Garyfalia

doi:10.1007/s12024-014-9555-6

Cited by 157 publications

(92 citation statements)

References 81 publications

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“…Scans were obtained at 120 kV, reference mAs 400 and 128 9 0.6 mm collimation with automated dose modulation (CARE dose4D, Siemens, Erlangen, Germany) [33]. Slice thickness was 2 mm with an increment of 1 mm.…”

Section: Software and Hardwarementioning

confidence: 99%

Postmortem pulmonary CT in hypothermia

Schweitzer

Thali

Giugni

et al. 2014

Forensic Sci Med Pathol

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Fatal hypothermia has been associated with pulmonary edema. With postmortem full body computed tomography scanning (PMCT), the lungs can also be examined for CT attenuation. In fatal hypothermia cases low CT attenuation appeared to prevail in the lungs. We compared 14 cases of fatal hypothermia with an age-sex matched control group. Additionally, 4 cases of carbon monoxide (CO) poisoning were examined. Furthermore, 10 test cases were examined to test predictability based on PMCT. Two readers measured CT attenuation on four different axial slices across the lungs (blinded to case group and other reader's results). Hypothermia was associated with statistically significantly lower lung PMCT attenuation and lower lung weights than controls, and there was a dose-effect relationship at an environmental temperature cutoff of 2 °C. CO poisoning yielded low pulmonary attenuation but higher lung weights. General model based prediction yielded a 94% probability for fatal hypothermia deaths and a 21% probability for non-hypothermia deaths in the test group. Increased breathing rate is known to accompany both CO poisoning and hypothermia, so this could partly explain the low PMCT lung attenuation due to an oxygen dissociation curve left shift. A more marked distension in fatal hypothermia, compared to CO poisoning, indicates that further, possibly different mechanisms, are involved in these cases. Increased dead space and increased stiffness to deflation (but not inflation) appear to be effects of inhaling cold air (but not CO) that may explain the difference in low PMCT attenuation seen in hypothermia cases.

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Section: Software and Hardwarementioning

confidence: 99%

Postmortem pulmonary CT in hypothermia

Schweitzer

Thali

Giugni

et al. 2014

Forensic Sci Med Pathol

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“…The identification and categorization of these artifacts according to their type, anatomical location, and timing of appearance during the angiography are of utmost importance, because the MPMCTA technique was developed with the aim of applying it in routine forensic investigations. The results obtained by this preliminary study [88] show essentially three groups of artifacts/pitfalls which may be misinterpreted for pathological findings; they are reassumed in Table 5. The identification of these artifacts and "an understanding of their meaning" are fundamental in order to guarantee a proper interpretation of PMCTA images.…”

Section: Discussionmentioning

confidence: 68%

“…Moreover, it provides the chance to revise stored data at any time, even after cremation or burial of the corpse. Currently, the management of a MDCT unit is easier, and its maintenance costs are more affordable, making it a valid tool available in numerous Forensic Science Centers [85][86][87][88].…”

Section: Discussionmentioning

confidence: 99%

Postmortem-computed tomography and postmortem-computed tomography–angiography: a focused update

et al. 2015

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The use of multidetector CT (MDCT) represents a reality routinely used in several forensic institutes, for the numerous advantages that this diagnostic tool can provide; costs are becoming increasingly lower; data acquisition is always faster and once acquired may be revalued at any time. However, there are also some diagnostic limitations, for example, the visualization of the vascular system or a limited soft tissue contrast. In order to overcome these limitations, in recent years, contrast medium has been introduced in postmortem cases, with the development of several techniques of PMCT angiography (PMCTA) and standardized protocols to make them easily reproducible. The aim of this review is to highlight the advantages and pitfalls of PMCT and PMCTA in forensic investigation, taking into consideration the broad spectrum of applications both for natural and unnatural deaths and the numerous methods currently used. Secondly, in the light of the considerable progress in this field and the attempt to develop standardized protocols of PMCTA, the authors aim to evaluate the diagnostic value of PMCTA in comparison both to PMCT and conventional autopsy.

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“…Unenhanced PMCT and PMCTA were performed using a 128-slice CT scanner (SOMATOM Flash Definition; Siemens Medical Solutions, Forchheim, Germany). The general scan parameters were applied as recommended by the literature 17 : 120 kVp (PMCT) and 100 kVp (PMCTA) tube voltage, 350 effective mA tube current-time product, 1.0 mm slice thickness, 0.5 mm increment, and reconstructions in soft and hard kernels, with a medium-hard kernel for PMCTA with the according windows. The head and neck scan was calculated from the scan with lowered arms in an adjusted field of view (maximum, 300 mm) with a medium soft kernel in an angio window with a slice thickness of 1 mm and an increment of 0.5 mm.…”

Section: Pmct and Pmcta Imagingmentioning

confidence: 99%

A Fatal Case of a Ruptured Cerebral Aneurysm Detected by Postmortem Computed Tomography Angiography Using a New Contrast-Medium Solution

Stamou

Gascho

Eggert

et al. 2016

Am J Forensic Med Pathol

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Forensic autopsy is still the criterion standard in legal investigations. Currently, notable transformation is occurring because postmortem imaging is being increasingly endorsed. This article highlights the effectiveness of postmortem computed tomography angiography by using a new contrast medium mixture as a solitary tool to define the cause and manner of death in a ruptured cerebral aneurysm case. Based on the imaging results, autopsy was not mandated and the case was closed. Abstract: Forensic autopsy is still the criterion standard in legal investigations. Currently, notable transformation is occurring because postmortem imaging is being increasingly endorsed. This article highlights the effectiveness of postmortem computed tomography angiography by using a new contrast medium mixture as a solitary tool to define the cause and manner of death in a ruptured cerebral aneurysm case. Based on the imaging results, autopsy was not mandated and the case was closed.

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Imaging in forensic radiology: an illustrated guide for postmortem computed tomography technique and protocols

Cited by 157 publications

References 81 publications

Postmortem pulmonary CT in hypothermia

Postmortem pulmonary CT in hypothermia

Postmortem-computed tomography and postmortem-computed tomography–angiography: a focused update

A Fatal Case of a Ruptured Cerebral Aneurysm Detected by Postmortem Computed Tomography Angiography Using a New Contrast-Medium Solution

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