In forensic autopsies, the terminal circulatory status in the form of acute congestion or findings consistent with severe blood loss can be significant, as it may indicate different causes of death. However, the autopsy-related description of acute congestion or severe blood loss is predominantly subjective. Post-mortem computed tomography (PMCT) offers the possibility of recording metric parameters such as the cross-sectional area of blood vessels, which could be used for the objective description of acute congestion or severe blood loss. The aim of the present study was therefore to record and compare the cross-sectional areas of smaller and larger blood vessels for different causes of death in forensic PMCT. In n = 500 forensic autopsy cases (n = 250 men and n = 250 women), the cross-sectional area of various blood vessels near the heart (internal jugular veins, subclavian veins, pulmonary trunk, ascending aorta, descending thoracic aorta, superior vena cava, and inferior vena cava) was measured using PMCT. The cross-sectional area measurements were compared for different causes of death (acute cardiac arrest due to underlying myocardial disease, pulmonary embolism, pneumonia, hypothermia, central dysregulation due to head trauma, suffocation, strangulation, drowning, fatal hemorrhage, and intoxication) in each vessel examined. For all causes of death combined, significant differences (p < 0.05) between men and women were found for each individual vessel. In each vessel examined, the lowest mean cross-sectional area measurements were observed in fatal hemorrhage (HE), and the highest mean cross-sectional area measurements were observed in pulmonary embolism (PE) and acute cardiac arrest (CA) in both sexes. The PE and CA groups, as well the HE groups, differed significantly from all other causes of death in both men and women. PMCT cross-sectional area measurements of larger and smaller blood vessels near the heart can be used to objectively describe the terminal circulatory status in cases of pronounced acute blood congestion or fatal hemorrhage.

Background:Intervertebral disc (IVD) degeneration is a major contributor to low back pain, yet its initiating factors remain unclear. While the individual effects of pro-inflammatory cytokines and mechanical loading on IVDs have been studied, their combined impact is poorly understood. This study investigated how dynamic compression and torsion interact with interleukin-1 beta (IL-1β) and its inhibitor, interleukin-1 receptor antagonist (IL-1Ra), using bovine IVDs in an ex vivo organ culture system. Methods:Whole bovine caudal IVDs were cultured for one week in a custom bioreactor applying diurnal dynamic compression (0.1-0.5 MPa) and torsion (±6°) under three media conditions: physiological, catabolic (10 ng/mL IL-1β), and inhibitory (10 ng/mL IL-1Ra). Static compression (0.1 MPa) served as control. 3 T magnetic resonance imaging (MRI) was used pre- and post-culture for imaging and segmentation using 3DSlicer. Subject-personalized finite element (FE) models were generated via morphing algorithms and coupled with a parallel network (PN) model to analyze metabolite transport and its impact on gene expression. Outcomes included disc height, glycosaminoglycan (GAG) content, qPCR, and cell metabolic activity. Results & Conclusions:Degenerative changes were detected in all treatment groups. Results of decreased disc height, hydration, and ACAN expression, alongside increased MMP-13, indicated that the applied loading was supraphysiological and induced catabolic responses. IL-1Ra, at the given dose, did not counteract degeneration. MRI-based FE modeling effectively captured patterns of tissue consolidation and degeneration, providing valuable insights into IVD responses under combined mechanical and inflammatory stress. This integrative platform highlights the importance of modeling complex IVD environments and may inform the design of improved anti-catabolic therapies.

To assess the effect of scan length, partial humeral head inclusion, and body mass index (BMI) on radiation dose of CTs of the medial clavicular epiphysis (MCE) performed with elevated arms (arms-up). Ninety consecutive MCE CTs acquired in an arms-up position for forensic age estimation were retrospectively analysed. Scans were grouped by scan length (short: ≤4 cm; long: >4 cm, rounded to the nearest cm) and by arm position (arms-out: humeral heads excluded; arms-in: humeral heads partially included). Dose-relevant parameters (effective tube current, volume CT dose index, CT dose length product, and effective dose) were compared. Adjusted geometric mean ratios (aGMRs) were calculated to quantify the association between radiation doses and scan length, arm inclusion, and BMI. Population: 88 males, 2 females; median (IQR) weight 62.0 kg (57.5–67.9), height 172 cm (168–178), BMI 21.1 kg/m² (19.5–22.4). Effective dose was lowest in short scans with arms-out (0.38 mSv, 0.32–0.43), highest in long scans with arms-in (0.49 mSv, 0.39–0.62), and equal in short scans with arms-in and long scans with arms-out (0.41 mSv, 0.36–0.46 and 0.34–0.46, respectively). Each additional centimetre of scan length increased dose by 8.3

This study evaluates the image quality of postmortem photon-counting computed tomography (PMPCCT) compared to conventional postmortem energy-integrating computed tomography (PMCT) for a protocol adapted to post-mortem imaging. The focus lies on objective image quality parameters such as noise, signal-to-noise ratio, and contrast-to-noise ratio, supplemented by subjective image quality evaluations. A Chest Phantom N1 and one decedent were scanned using PMCT (Siemens SOMATOM® X-Cite; slice thicknesses of 1 mm and 0.5 mm; Br40, Br60) and PMPCCT (Siemens NAEOTOM Alpha.peak®; slice thicknesses of 1 mm, 0.4 mm, and 0.2 mm; Br40, Br60). Image quality parameters were computed for regions of interest. In addition, two radiologists conducted subjective image quality evaluations (noise, overall image quality, sharpness, bone details, contour visibility, and artifact formation) using a modified Likert scale. The overall findings were mixed, with PMPCCT potentially demonstrating an advantage over PMCT in terms of SNR and CNR, particularly at moderate slice thicknesses of 1 mm and 0.4 mm. The results obtained from the phantom exhibit in some cases considerable differences compared to those from the decedent, so that model studies can hardly be transferred to reality without scrutiny. PMPCCT outperformed PMCT in subjective assessments of overall image quality, sharpness, and bone detail, particularly with Br40 reconstruction kernels. PMPCCT may demonstrate advantages in objective and subjective image quality, with improvements in soft tissue imaging, sharpness, and bone detail at moderate slice thicknesses. These results may suggest PMPCCTs promising potential in forensic imaging. Further studies are needed to investigate and optimize its utility in postmortem settings.

Recently, post-mortem photon-counting CT (PMPCCT) has been introduced to forensic imaging. Compared to conventional energy integrating post-mortem CT (PMCT), PMPCCT enables ultra-high resolution (UHR) imaging, which is particularly suitable for visualizing fine fractures and fissures. These are often found in rib trauma, which is usually relevant in forensic medicine. The aim of this study was to evaluate the diagnostic accuracy of rib fracture detection using PMPCCT compared to PMCT and forensic autopsy. A total of n = 20 bodies that had suffered blunt chest trauma before death and n = 5 non-trauma control cases were investigated. PMCT and PMPCCT were conducted prior to forensic autopsy. Two observers (radiologist and forensic pathologist) analyzed PMCT images (reconstructed with a slice thickness of 0.5 mm in a 512 matrix) and PMPCCT images (reconstructed with slice thicknesses of 0.5 mm and 0.2 mm (UHR) in a 1024 matrix). Imaging diagnosis of rib fractures was compared to autopsy diagnosis as gold standard. The diagnosis of different types of rib fractures assessed at imaging was compared between PMCT and PMPCCT. Inter-rater agreement between the two observers was good (κ = 0.79). Both PMCT and PMPCCT diagnosed less rib fractures than the autopsy (n = 356 fractures). Compared to PMCT, UHR-PMPCCT demonstrated slightly higher sensitivity (e.g., 92

In recent years, Photon-counting detector CT (PCD CT) has emerged as a new and groundbreaking technology in clinical radiology. While clinical research and practical applications of PCD-CT are constantly evolving, it has not yet been integrated into post-mortem CT (PMCT) imaging. Documented research into the potential applications of PCD CT in the field of post-mortem human forensic pathology and anatomical pathology is scarce in literature. This is despite the fact that PCD CT shows promise in expanding PMCT imaging diagnostic due to features such as ultra-high resolution and intrinsic spectral multienergy imaging. The authors have recently started scanning forensic corpses with a PCD CT to explore its possibilities and limits in the post-mortem field. In this technical note, the PCD CT acquisition and reconstruction parameters that resulted in excellent image quality in terms of noise and contrast for a slice thickness up to 0.2mm in unenhanced whole-body examinations are presented.

To compare the effect of arm positioning on radiation dose, scan length, and image noise in computed tomography (CT) scans of the medial clavicular epiphysis for forensic age estimation performed with the arms alongside the body (arms-down) versus elevated above the head (arms-up). Twenty consecutive CT scans were analysed, ten performed with arms-down and ten with arms-up. The scans were conducted at 120 kVp and 37 mAs reference tube current. Scan length extended from 10 mm above to 10 mm below the medial clavicular epiphysis. Dose-relevant parameters (effective CT tube current, volume CT dose index (CTDIvol), CT dose length product (DLP), and effective dose) as well as scan length and image noise were compared between arms-up and arms-down CT scans. Population characteristics: 19 males, 1 female; mean weight 65.8 ± 9.2 kg; height 174.6 ± 7.8 cm; and body mass index (BMI) 21.6 ± 2.5 kg/m². Dose-relevant parameters were significantly lower with arms-up compared to arms-down (effective tube current: 80.9 ± 21.7 mAs vs. 146.0 ± 47.5 mAs, p = 0.001; CTDIvol: 5.5 ± 1.5 mGy vs. 9.9 ± 3.2 mGy, p = 0.001; DLP: 40.2 ± 13.7 mGy*cm vs. 63.8 ± 21.9 mGy*cm, p = 0.010; effective dose: 0.6 ± 0.2 mSv vs. 0.9 ± 0.3 mSv, p = 0.010). No significant differences were found in scan length, image noise, or population characteristics. Removing the arms from the CT beam path reduced radiation dose by 33

The last decades have seen a constant decline in non-forensic clinical autopsy rates worldwide. In this context, post-mortem computed tomography (PMCT) and post-mortem magnetic resonance imaging (PMMR) might offer an alternative to the clinical autopsy. So far, post-mortem imaging is used routinely only in forensic medicine, but it has not yet been implemented into routine clinical pathology casework. This study aimed to assess the diagnostic accuracy of unenhanced PMCT and PMMR for basic pathology groups and specific diagnoses compared to the clinical autopsy. Post-mortem imaging (PMCT and PMMR) was conducted before autopsy on n = 120 non-forensic patients deceased in hospitals in a prospective study. Imaging findings were compared to autopsy findings, and sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for causes of death and specific pathologic findings. Some of the diagnoses recorded showed high specificity and NPV of over 85% for both PMCT and PMMR. However, even the combined use of PMCT and PMMR could not visualize various relevant autopsy findings such as those related to sepsis, hematologic malignancies, chronic liver congestion, endomyocardial, myocardial, and liver fibrosis, acute tubular necrosis, aortic valve stenosis, duodenal ulceration, and small macroscopic findings in general. For specific findings, post-mortem imaging showed no significant differences to autopsy and high diagnostic accuracy with over 85% sensitivity. Examples for such findings included the diagnosis of acute myocardial infarction and pulmonary embolism in PMMR, pneumonia in PMCT, as well as pancreatitis, abscesses, metastases, and aortic dissection in both PMCT and PMMR.

BACKGROUND:In forensic post-mortem medicine, intracranial hemorrhage is a relatively common and usually relevant finding. In recent years, the feasibility of post-mortem MRI (PMMR) for visualization of relevant intracranial findings, such as hemorrhage, has been demonstrated. The aim of this study was to investigate the PMMR T1 and T2 signal behavior of intracranial hemorrhages of different ages and the influence of post-mortem interval and degree of putrefaction on PMMR signal. METHODS:N = 200 forensic cases with natural and traumatic intracranial hemorrhages were examined in T1 and T2 weighted PMMR of the head. Hemorrhage age was determined based on police and/or medical case information and categorized into different age stages (hyperacute: < 12 hours; acute: 12-48 hours; early subacute: 2-7 days; late subacute: 7 days-1 month; chronic: > 1 month). T1w and T2w signal behavior was recorded and correlated according to the assessed individual age stages. Multinomial logistic regression was used to analyze whether signal behavior was influenced by the postmortem interval or the degree of putrefaction as assed by the radiological alteration index (RAI). RESULTS:In all age groups, predominant signal intensities were observed on both the T1 and T2 weighted images across all different hemorrhage types. The predominant PMMR signals corresponded to the known signal patterns of living patients in clinical MRI. However, deviations from the predominant signal intensity were observed in all age groups. The T1 and T2 signal characteristics of intracranial hemorrhage were not significantly influenced in cases with high RAI respectively advanced putrefaction.

The authors present the case of a 58-year-old man found hanging from a radiator by his shoelaces. The time of death was approximately 6 h before the body was discovered. An autopsy was performed approximately 24 h after the body was found, which revealed hemorrhages in the thoracic aorta at the junctions of the posterior intercostal arteries. Before autopsy, a routine whole-body CT scan was performed. Histologic examination of the aorta and the posterior intercostal arteries revealed a fresh hemorrhage into the tunica adventitia of the aorta. To our knowledge, there is no case description of such findings in hanged persons in the literature. Conclusion: Hemorrhages into the tunica adventitia of the junction of the posterior costal arteries may occur in association with suicidal hanging. The significance of these hemorrhages as a sign of vitality may be debated.

This case report describes the death of a 73-year-old man who suffered a fatal myocardial infarction following pulmonary vein isolation (PVI) for the treatment of atrial fibrillation. Post-mortem examination and imaging revealed the presence of an atrioesophageal fistula (AEF) leading to gas embolism at various sites of the heart including the right coronary artery. Atrioesophageal fistulas are rare complications of pulmonary vein isolation with high mortality rates.

Darstellung der wesentlichen forensisch-radiologischen Untersuchungsmodalitäten und Befunde bei stumpfer Gewalt bei lebenden und verstorbenen Erwachsenen. Herausarbeitung der wesentlichen Punkte anhand eigener praktischer Erfahrung der Autoren sowie einschlägiger Fachliteratur. Verletzungsbedingte Folgen stumpfer Gewalt sind in der forensisch-radiologischen Diagnostik häufig zu beobachten, vor allem im Rahmen von Unfällen und Suiziden, seltener bei Tötungsdelikten. Die Methode der Wahl zur radiologischen Darstellung von stumpfer Gewalt bei Verstorbenen ist die native postmortale Computertomographie (PMCT). Grundsätzlich unterscheiden sich Folgen stumpfer Gewalt radiologisch in der PMCT nicht wesentlich vom Lebenden. Die postmortale Magnetresonanztomographie (PMMR) ist im kürzeren postmortalen Intervall sehr gut zur Darstellung von stumpfen Weichteilverletzungen geeignet. Bei Lebenden mit Folgen stumpfer Gewalt erfolgt die Indikation zur Bildgebung primär aus klinisch-diagnostischen Gründen. Häufige Indikationen sind häusliche Gewalt, Gewalt an älteren Personen sowie Auseinandersetzungen im öffentlichen Raum. Die Wahl der radiologischen Untersuchungsmethode ist abhängig von klinischer Anamnese und Symptomatik, wobei die radiologischen Untersuchungen einer forensischen Begutachtung unterzogen werden können.

Objective: Description of the main forensic radiological examination modalities and findings in blunt force trauma in living and deceased adults. Methods: Elaboration of the essential points based on the authors' own experiences and relevant literature. Results and conclusion: Injury-related consequences of blunt force are frequently observed in forensic radiological diagnostics, especially in the context of accidents and suicides, and less frequently in homicides. The method of choice for radiological imaging of blunt force in deceased persons is native postmortem computed tomography (PMCT). In principle, the radiological effects of blunt force in PMCT do not differ significantly from those in living persons. Postmortem magnetic resonance imaging (PMMRI) is very suitable for imaging blunt soft tissue injuries in the shorter postmortem interval. In the case of living individuals with the consequences of blunt force trauma, imaging is primarily indicated for clinical diagnostic reasons. Common indications are domestic violence, violence against the elderly, and disputes in public spaces. The choice of radiological examination method depends on the clinical history and symptoms, and the radiological examinations can be subjected to a forensic assessment.

Background: A 3D sequence was introduced to unenhanced post-mortem cardiac magnetic resonance imaging (PMCMR) to enable multiplanar coronary artery image analysis and to investigate its diagnostic accuracy for the diagnosis of coronary artery stenosis and thrombosis.Materials and Methods: N = 200 forensic cases with suspected coronary artery pathology underwent 3 Tesla PMCMR (sequence used: T2 weighted transversal 3D turbo spin echo) before autopsy. Main coronary artery stenosis and thrombosis were assessed in PMCMR by multiplanar image analysis by two observers. Coronary artery histology was determined as the gold standard and compared to PMCMR. Sensitivity, specificity, negative (NPV) and positive predictive values (PPV) with 95% confidence intervals were calculated.Results: For all coronary arteries combined, sensitivity was 75% (PPV 73%) for the diagnosis of stenosis and 72% (PPV 71%) for the diagnosis of thrombosis. Specificity was 92% (NPV 90%) for correct diagnosis of non-existing stenosis and 97% (NPV 97%) for non-existing thrombosis. Sensitivity for correct diagnosis of different degrees of stenosis ranged between 67% and 80% (PPVs 67-82%); specificity ranged between 96% and 99% (NPVs 96-99%). Conclusion: Multiplanar PMCMR coronary artery stenosis and thrombosis assessment based on an unenhanced T2 weighted 3D sequence provide moderate sensitivity and high specificity for the diagnosis of coronary artery stenosis and/or thrombosis. Hence, 3D T2w PMCMR cannot reliably detect existing coronary artery stenosis and thrombosis but may be particularly useful for the exclusion of stenosis or thrombosis of the main coronary arteries.

Objective 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. Material and methods 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. Results The study included 116 patients (71% women, p < .001, χ 2 ), 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, χ 2 ) or assault by unknown offender (88% of men, p < 0.002 χ 2 ). 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. Conclusions 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. Clinical relevance statement 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. Key Points • 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.

The AGFAD (Arbeitsgemeinschaft für Forensische Alterdiagnostik, Study Group on Forensic Age Diagnostics) has published several recommendations regarding both technical aspects of computed tomography (CT) of the medial clavicular epiphysis (MCE) and the process of reading and interpreting the CT images for forensic age estimations (FAE). There are, however, no published recommendations regarding CT scan protocols and no dose reference values for CT of the MCE. The objective of this analysis was to assess adherence to AGFAD recommendations among practitioners of FAE and analyse reported dose-relevant CT scan parameters with the objective of helping to establish evidence-based dose reference values for FAE. A systematic literature search was conducted in PubMed and in Google Scholar with specific MeSH terms to identify original research articles on FAE with CT of the MCE from 1997 to 2022. A total of 48 studies were included. Adherence to AGFAD recommendations among practitioners of FAE is high regarding the use of Schmeling main stages (93%), bone window (79%), ≤ 1 mm CT slices (67%), axial/coronal CT images (65%), and Kellinghaus sub-stages (59%). The reporting of CT technique and CT dose-relevant scan parameters is heterogeneous and often incomplete in the current literature. Considering the success achieved by the AGFAD in creating standards of practice of FAE in living subjects, there is potential for the AGFAD to establish standards for radiation protection in FAE as well.

A 61-year-old man was found dead on the terrace in front of his house. The body showed external signs of advanced (Grade 4) putrefaction. Routine post-mortem computed tomography (PMCT) was conducted prior to the forensic autopsy showing a radiological alteration index (RAI) of 100. Due to a suspicious hyperdense brain lesion seen in PMCT, additional post-mortem magnetic resonance imaging (PMMR) of the head was performed for research purpose. Compared to PMCT, the lesion appeared considerably more detailed in PMMR with a slightly hyperintense and focal hypointense signal in T2w images and an isointense and focal hyperintense signal in T1w images. Autoptic assessment of the brain lesion was considerably complicated due to softening and partial liquefaction of the brain. Considering post-mortem imaging and autopsy results, the lesion was determined as an acute brain hemorrhage. Case findings indicate that PMMR may be superior to autopsy in terms of diagnosis and localization of cerebral hemorrhage in putrefied brains.

Background: Using Injury Severity Score (ISS) data, this study aimed to give an overview of trauma mechanisms, causes of death, injury patterns, and potential survivability in prehospital trauma victims. Methods: Age, gender, trauma mechanism, cause of death, and ISS data were recorded regarding forensic autopsies and whole-body postmortem CT. Characteristics were analyzed for injuries considered potentially survivable at cutoffs of (I) ISS ≤ 75 vs. ISS = 75, (II) ISS ≤ 49 vs. ISS ≥ 50, and (III) ISS < lethal dose 50% (LD50) vs. ISS > LD50 according to Bull’s probit model. Results: In n = 130 prehospital trauma victims (45.3 ± 19.5 years), median ISS was 66. Severity of injuries to the head/neck and chest was greater compared to other regions (p < 0.001). 52% died from central nervous system (CNS) injury. Increasing injury severity in head/neck region was associated with CNS-injury related death (odds ratio (OR) 2.7, confidence interval (CI) 1.8–4.4). Potentially survivable trauma was identified in (I) 56%, (II) 22%, and (III) 9%. Victims with ISS ≤ 75, ISS ≤ 49, and ISS < LD50 had lower injury severity across most ISS body regions compared to their respective counterparts (p < 0.05). Conclusion: In prehospital trauma victims, injury severity is high. Lethal injuries predominate in the head/neck and chest regions and are associated with CNS-related death. The appreciable amount (9–56%) of victims dying at presumably survivable injury severity encourages perpetual efforts for improvement in the rescue of highly traumatized patients.

Quantitative post-mortem magnetic resonance imaging (PMMR) allows for measurement of T1 and T2 relaxation times and proton density (PD) of brain tissue. Quantitative PMMR values may be used for advanced post-mortem neuro-imaging diagnostics such as computer aided diagnosis. So far, the quantitative T1, T2 and PD post-mortem values of regular anatomical brain structures were unknown for a 3 Tesla PMMR application. The goal of this basic research study was to evaluate the quantitative values of post-mortem brain structures for a 3 T post-mortem magnetic resonance application with regard to various corpse temperatures. In 50 forensic cases, a quantitative PMMR brain sequence was applied prior to autopsy. Measurements of T1 (in ms), T2 (in ms), and PD (in %) values of cerebrum (Group 1: frontal grey matter, frontal white matter, thalamus, caudate nucleus, globus pallidus, putamen, internal capsule) brainstem and cerebellum (Group 2: cerebral peduncle, substantia nigra, red nucleus, pons, middle cerebellar peduncle, cerebellar hemisphere, medulla oblongata) were conducted in synthetically calculated axial PMMR brain images. Assessed quantitative values were corrected for corpse temperature. Temperature dependence was observed mainly for T1 values. ANOVA testing resulted in significant differences of quantitative values between the investigated anatomical brain structures in both groups. It can be concluded that temperature corrected 3 Tesla PMMR T1, T2 and PD values are feasible for characterization and discrimination of regular anatomical brain structures. This may provide a base for future advanced diagnostics of forensically relevant brain lesions and pathology. (c) 2021 Published by Elsevier B.V.