Neck-MRI experience for investigation of survived strangulation victims

Abstract

For the medicolegal evaluation of victims of survived strangulation, a neck-magnetic resonance imaging (MRI) can be performed for assessing lesions in the inner soft tissues (fat, muscles or lymph nodes, for example). In our institute, such MRI examinations have been performed for a test period of 4 years with the aim of evaluating the use of this tool by forensic pathologists and identifying medicolegal indicators for the performance of neck-MRI in surviving victims of strangulation. We retrospectively reviewed medicolegal reports from all victims examined during the test period. We extracted objective lesions (e.g. petechiae, bruising and abrasions) and reported clinical symptoms (e.g. vision disorder, dysphasia) from the reports. These findings were compared to those reported from the neck-MRI. In total, 112 victims were clinically examined after suspected strangulation. Eleven of these victims underwent an MRI examination of the neck. Eighty-four of the victims presented objective lesions during the clinical examination, with eight showing signs of both petechiae and bruising. Neck-MRI was performed in four of these eight victims and three of them showed lesions visible in MRI. Of 76 victims with bruising as the only objective finding, 66 victims described clinical symptoms. Of those 66 victims, seven were examined by MRI and two demonstrated lesions in MRI. When MRI was performed, relevant findings were detected in 45% of the cases. This leads to the suspicion that many more findings could have been detected in the other victims, if an MRI had been performed in those cases. Our results lead us to the conclusion that an MRI examination of victims of suspected strangulation is useful, and strict indications for its application should be established.

Medical evidence assisting non-fatal strangulation prosecution: a scoping review

“…Four of the articles identified that survivors of NFS were referred for medical imaging as part of police investigation or by other protective organisations such as child/adult protective services 17 21–23. The remaining three articles did not specify a referral pathway 24–26…”

“…Radiological imaging, including MRI and CT, was used in six studies. Of these, four studies used MRI,17 21 22 25 and one study used CT or MRI 26. Separately, one article did not use radiological imaging to investigate strangulation injuries, instead using alternative light sources (ALS) 23.…”

“…Unlike prospective studies, these studies were uncontrolled and were, therefore, less likely to have any consistent protocols for assessing and documenting injuries from strangulation and for whether a person was eligible for imaging, excluding that of Bruguier et al . 25 This may have resulted in more cases where injuries were already visible receiving imaging and inflating the number of NFS injuries identified through MRI or CT scans. 22 26 Further, exercise of discretion for referral was identified as a problem even when decision guidelines were in place regarding imaging.…”

“…First, the evidence for medical imaging largely involved studies with retrospective review of NFS cases presenting in medical settings. Unlike prospective studies, these studies were uncontrolled and were, therefore, less likely to have any consistent protocols for assessing and documenting injuries from strangulation and for whether a person was eligible for imaging, excluding that of Bruguier et al 25. This may have resulted in more cases where injuries were already visible receiving imaging and inflating the number of NFS injuries identified through MRI or CT scans 22 26.…”

Thyroid cartilage asymmetry as a potential diagnostic finding for occult cartilaginous fractures for the evaluation of nonfatal manual strangulation

“…To exclude life-threatening complications such as carotid dissections [5], computed tomography (CT) with angiography is often applied in severe cases of NFS. The application of magnetic resonance imaging has been investigated with mixed results [6][7][8][9]. Overall, the need for sharply defined findings for the evaluation of NFS remains.…”