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Related Experiment Video

Updated: Jul 14, 2026

Assessing Cortical Cerebral Microinfarcts on High Resolution MR Images
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Air bubble artifact: why postmortem brain MRI should always be combined with postmortem CT.

Alexia Van Goethem1, Günther De Temmerman2, Astrid Van Hoyweghen3,4

  • 1Department of Forensic Medicine and Pathology, Antwerp University Hospital, Drie Eikenstraat 655, 2650, Edegem, Belgium. alexia.vangoethem@uza.be.

Forensic Science, Medicine, and Pathology
|February 10, 2023
PubMed
Summary

Forensic pathology benefits from postmortem MRI (PMMRI) in pediatric cases. Including blood-sensitive sequences and preceding with postmortem CT (PMCT) improves accuracy for detecting brain bleeds and ruling out air artifacts.

Keywords:
Air bubble artifactCerebral microbleedsMRIPediatric postmortem imagingSWI

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Area of Science:

  • Forensic Medicine
  • Radiology
  • Pediatric Pathology

Background:

  • Postmortem magnetic resonance imaging (PMMRI) is gaining traction in forensic pathology, especially for pediatric cases.
  • Current PMMRI protocols may not fully address specific forensic questions.
  • Sudden, unexpected infant and child deaths warrant a thorough forensic investigation.

Observation:

  • PMMRI protocols should integrate blood-sensitive sequences (T2* and/or susceptibility weighted imaging) to detect or exclude intracranial hemorrhage.
  • Postmortem CT (PMCT) should precede PMMRI to identify intracranial air, which can mimic small hemorrhages on MRI.
  • A case involving a 3-week-old infant illustrates the importance of this combined imaging approach.

Findings:

  • The inclusion of specific MRI sequences enhances the detection of subtle bleeding in postmortem examinations.
  • Preceding PMMRI with PMCT is crucial for differentiating air from hemorrhage, improving diagnostic accuracy.
  • This approach is vital for accurate determination of cause of death in pediatric cases.

Implications:

  • Standardizing PMMRI protocols with forensic considerations can improve the quality of postmortem investigations.
  • Educating clinical radiologists, who may interpret these scans without specialized forensic training, is essential.
  • Accurate PMMRI interpretation aids in understanding the circumstances of sudden and unexpected deaths in children.