Value of 3T craniocervical magnetic resonance imaging following nonfatal strangulation

Abstract

Objective The aims of this study were (1) to provide an overview of craniocervical magnetic resonance imaging (MR) findings following nonfatal strangulation (NFS), (2) to detect the time dependency of the presence of these findings, and (3) to explore the additional value of MR with regard to the forensic interpretation of NFS. Methodology All 633 victims of manual strangulation between October 2011 and March 2018 were examined, including the case history and external findings. Following written consent, 114 cases were included in the study. The duration between the event, clinical forensic examination, and MR was noted. Radiologic images were reviewed by a clinical and a forensic radiologist. ResultsThe case group consisted of 90 women and 24 men with a mean age of 32.5 years. Delimitable external findings were present in 93% (N = 106) of cases. MR yielded a positive finding in 43% of cases (N = 49). There was no significant difference in the mean time interval between examinations between MR-positive and MR-negative cases. Perilaryngeal fluid accumulation was associated with difficulty swallowing and victims put in a chokehold. All cerebral MR were unremarkable, except for one patient with edema of the corpus callosum. Conclusions The role of craniocervical MR following NFS is currently limited, particularly with regard to the forensic interpretation of NFS. MR may reveal internal injury in victims who report subjective symptoms of airway compression and in those who were placed in a chokehold. The presence of MR findings is not dependent on immediate examinations following the assault. Key Points• Magnetic resonance imaging does not currently provide additional value for the estimation of the severity of nonfatal manual strangulation.• Magnetic resonance imaging of the neck may reveal internal injury in cases without external findings, particularly in victims placed in a chokehold and with symptoms of airway compression. • The incidence of carotid artery dissections and laryngeal fractures is low in victims of nonfatal manual strangulation.

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

“…Only two studies reported the absence of subjective complaints showing that 17% of those 463 survivors reported no subjective symptoms following NFS. 22 26 Thus, the majority (83%) of strangulation survivors had some reported symptoms including neck pain, loss of consciousness and difficulty swallowing. On the other hand, absence of external injuries ranged from 17% to 93%, with the average being 44% of NFS survivors with no externally visible evidence of external injury.…”

“… 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. For example, Bruguier et al showed that despite MRI eligibility criteria for NFS symptoms and injuries, only 11 of the 112 survivors over a 4-year period received an MRI following clinical assessment.…”

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.…”

Postmortem Magnetic Resonance Imaging and Postmortem Computed Tomography in Ligature and Manual Strangulation

“…1,13,14 During the process of strangulation, neck injuries occur frequently, which can be visualized by computed tomography (CT), magnetic resonance imaging (MRI), or autopsy. 3,[15][16][17][18][19] According to these studies, intramuscular hemorrhages and subcutaneous bleeding are considered important indicators of severity. In those studies, MRI showed a significant value in detecting these injuries.…”

“…In those studies, MRI showed a significant value in detecting these injuries. 4,15,19 However, postmortem imaging of ligature and manual strangulation has been described mainly in CT and x-ray, focusing on laryngeal lesions and subcutaneous hemorrhages. 20,21 Only a small case study analyzing MRI in fatal manual strangulation was presented by Yen et al 22 almost 15 years ago.…”