Imaging of alert patients after non-self-inflicted strangulation: MRI is superior to CT

To assess the accuracy of CT and MRI reports of alert patients presenting after non-self-inflicted strangulation (NSIS) and evaluate the appropriateness of these imaging modalities in NSIS.

The study was a retrospective analysis of patient characteristics and strangulation details, with a comparison of original radiology reports (ORR) to expert read-outs (EXR) of CT and MRI studies of all NSIS cases seen from 2008 to 2020 at a single centre.

The study included 116 patients (71% women, p < .001, χ²), with an average age of 33.8 years, mostly presenting after manual strangulation (97%). Most had experienced intimate partner violence (74% of women, p < .001, χ²) or assault by unknown offender (88% of men, p < 0.002 χ²). Overall, 132 imaging studies (67 CT, 51% and 65 MRI, 49%) were reviewed. Potentially dangerous injuries were present in 7%, minor injuries in 22%, and no injuries in 71% of patients. Sensitivity and specificity of ORR were 78% and 97% for MRI and 30% and 98% for CT. Discrepancies between ORR and EXR occurred in 18% of all patients, or 62% of injured patients, with a substantial number of unreported injuries on CT.

The results indicate that MRI is more appropriate than CT for alert patients presenting after non-self-inflicted strangulation and underline the need for radiologists with specialist knowledge to report these cases in order to add value to both patient care and potential future medico-legal investigations.

MRI should be preferred over CT for the investigation of strangulation related injuries in alert patients because MRI has a higher accuracy than CT and does not expose this usually young patient population to ionizing radiation.

• Patients presenting after strangulation are often young women with a history of intimate partner violence while men typically present after assault by an unknown offender. • Expert read-outs of CT and MRI revealed potentially dangerous injuries in one of 14 patients. • MRI has a significantly higher sensitivity than CT and appears to be more appropriate for the diagnostic workup of alert patients after strangulation.