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High-resolution Structural Magnetic Resonance Imaging of the Human Subcortex In Vivo and Postmortem
Published on: December 30, 2015
Relevant findings on postmortem CT and postmortem MRI in hanging, ligature strangulation and manual strangulation and
Dominic Gascho1, Jakob Heimer2, Carlo Tappero2,3
1Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, 8057, Zurich, Switzerland. dominic.gascho@irm.uzh.ch.
Abstract:
Several articles have described the use of postmortem computed tomography (CT) and postmortem magnetic resonance imaging (MRI) in forensic medicine. Although access to CT scanners and, particularly, access to MRI scanners, is still limited for several institutes, both modalities are being applied with increasing frequency in the forensic setting. Certainly, postmortem imaging can provide crucial information prior to autopsy, and this method has even been considered a replacement to autopsy in selected cases by some forensic institutes. However, the role of postmortem imaging has to be assessed individually according to various injury categories and causes of death. Therefore, this systematic review focuses on the role of postmortem CT and MRI in cases of hanging and ligature and manual strangulation. We assessed the most common and relevant findings on CT and MRI in cases of strangulation and compared the detectability of these findings among CT, MRI and autopsy. According to the available literature, mainly fractures of the hyoid bone or thyroid cartilage were investigated using postmortem CT. Compared to autopsy, CT demonstrated equivalent results concerning the detection of these fractures. A currently described "gas bubble sign" may even facilitate the detection of laryngeal fractures on CT. Regarding the detection of hemorrhages in the soft tissue of the neck, postmortem MRI is more suitable for the detection of this "vital sign" in strangulation. Compared to autopsy, postmortem MRI is almost equally accurate for the detection of hemorrhages in the neck. Another "vital sign", gas within the soft tissue in hanging, which is hardly detectable by conventional autopsy, can be clearly depicted by CT and MRI. The number of cases of manual and ligature strangulation that were investigated by means of postmortem CT and MRI is much smaller than the number of cases of hanging that were investigated by CT and MRI. Likewise, judicial hanging and the hangman's fracture on postmortem imaging were described in only a few cases. Based on the results of this systematic review, we discuss the additional value of CT and MRI in fatal strangulation compared to autopsy, and we reflect on where the literature is currently lacking.
Insights
Postmortem CT and MRI offer valuable insights into strangulation deaths, detecting fractures and soft tissue signs often missed by autopsy. These imaging techniques complement traditional methods, aiding in forensic investigations.
Area of Science:
- Forensic Medicine
- Radiology
- Pathology
Background:
- Postmortem computed tomography (CT) and magnetic resonance imaging (MRI) are increasingly used in forensic medicine.
- While access to these imaging modalities can be limited, they offer crucial information prior to autopsy.
- Their role requires individual assessment based on injury type and cause of death.
Purpose of the Study:
- To systematically review the role of postmortem CT and MRI in cases of hanging and strangulation.
- To assess common findings on CT and MRI in strangulation cases.
- To compare the detectability of these findings with autopsy.
Main Methods:
- Systematic literature review focusing on postmortem CT and MRI in strangulation.
- Assessment of imaging findings related to hyoid/thyroid fractures, soft tissue hemorrhages, and gas within tissues.
- Comparison of imaging modality detectability against autopsy findings.
Main Results:
- Postmortem CT shows equivalent results to autopsy in detecting hyoid/thyroid fractures, with a "gas bubble sign" potentially aiding laryngeal fracture detection.
- Postmortem MRI is highly accurate in detecting soft tissue hemorrhages, a "vital sign" of strangulation.
- Both CT and MRI clearly depict gas within soft tissues in hanging, a finding difficult to detect via conventional autopsy.
Conclusions:
- Postmortem CT and MRI provide significant additional value in the forensic investigation of fatal strangulation compared to autopsy alone.
- Further research is needed, particularly for manual and ligature strangulation cases, and specific injuries like the "hangman's fracture".
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