Virtopsy—noninvasive detection of occult bone lesions in postmortem MRI: additional information for traffic accident reconstruction

Abstract

In traffic accidents with pedestrians, cyclists or motorcyclists, patterned impact injuries as well as marks on clothes can be matched to the injury-causing vehicle structure in order to reconstruct the accident and identify the vehicle which has hit the person. Therefore, the differentiation of the primary impact injuries from other injuries is of great importance. Impact injuries can be identified on the external injuries of the skin, the injured subcutaneous and fat tissue, as well as the fractured bones. Another sign of impact is a bone bruise. The bone bruise, or occult bone lesion, means a bleeding in the subcortical bone marrow, which is presumed to be the result of micro-fractures of the medullar trabeculae. The aim of this study was to prove that bleeding in the subcortical bone marrow of the deceased can be detected using the postmortem noninvasive magnetic resonance imaging. This is demonstrated in five accident cases, four involving pedestrians and one a cyclist, where bone bruises were detected in different bones as a sign of impact occurring in the same location as the external and soft tissue impact injuries.

Essentials of forensic post-mortem MR imaging in adults

“…6,9,10,88 However, the ability of PMMR to highlight bone marrow oedema on STIR sequences offers a more profound insight into the sequence of peri-mortem events than PMCT alone. 43,94,95 Buck et al 94 were the first to note the potential and occasional superiority of PMMR over PMCT in forensic case reconstruction of skeletal injury. 93 Their publication reports on a series of five traffic fatalities, where PMMR enabled the detection of bone contusions unseen on PMCT.…”

“…Furthermore, there is evidence that PMMR allows a distinction between antemortem and post-mortem fractures based on the presence or the absence of bone marrow oedema. 94 In addition to these reports, Ross et al 40 provided concrete evidence that PMMR is a valuable tool in forensic death investigations of trauma. In their analysis of 40 whole-body PMMR data sets, the overall sensitivity of PMMR to detect skeletal injuries was nearly 70% and reached a mean specificity of .90%.…”

Difficulties in distinguishing between an atlas fracture and a congenital posterior atlas arch defect in postmortem analysis

“…A c c e p t e d M a n u s c r i p t It was not possible to evaluate associated soft-tissue swelling (using CT or MRI) or the presence of bone marrow edema (performed by MRI) that allow a non-invasive differentiation between acute and chronic fracture and between ante-mortem and post-mortem bone injury [28,29], respectively, because our study was based on dry samples.…”

Whole‐body MRI of bone marrow: A review

“…Postmortem WBMRI allows distinction between postmortem and antemortem fractures (depending on the presence of edema) and has been used in the reconstruction of events surrounding traffic fatalities, where among other advantages WBMRI identified bone injuries that were not detected at postmortem CT (Fig. ) …”