Postmortem multislice computed tomography and magnetic resonance imaging of odontoid fractures, atlantoaxial distractions and ascending medullary edema.
Non-invasive imaging methods are increasingly entering the field of forensic medicine. Facing the intricacies of classical neck dissection techniques, postmortem imaging might provide new diagnostic possibilities which could also improve forensic reconstruction. The aim of this study was to determine the value of postmortem neck imaging in comparison to forensic autopsy regarding the evaluation of the cause of death and the analysis of biomechanical aspects of neck trauma. For this purpose, 5 deceased persons (1 female and 4 male, mean age 49.8 years, range 20-80 years) who had suffered odontoid fractures or atlantoaxial distractions with or without medullary injuries, were studied using multislice computed tomography (MSCT), magnetic resonance imaging (MRI) and subsequent forensic autopsy. Evaluation of the findings was performed by radiologists, forensic pathologists and neuropathologists. The cause of death could be established radiologically in three of the five cases. MRI data were insufficient due to metal artefacts in one case, and in another, ascending medullary edema as the cause of delayed death was only detected by histological analysis. Regarding forensic reconstruction, the imaging methods were superior to autopsy neck exploration in all cases due to the post-processing possibilities of viewing the imaging data. In living patients who suffer medullary injury, follow-up MRI should be considered to exclude ascending medullary edema.
Yen
Kathrin
K
Institute of Forensic Medicine, University of Bern, Buehlstrasse 20, 3012 Bern, Switzerland. yen@irm.unibe.ch
Sonnenschein
Martin
M
Thali
Michael J
MJ
Ozdoba
Christof
C
Weis
Joachim
J
Zwygart
Karin
K
Aghayev
Emin
E
Jackowski
Christian
C
Dirnhofer
Richard
R
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001268:Atlanto-Axial Joint / Q000293:injuries / Q000473:pathology*; D001929:Brain Edema / Q000473:pathology*; D001930:Brain Injuries / Q000473:pathology; D005260:Female; D049429:Forensic Pathology; D006801:Humans; D004204:Joint Dislocations / Q000473:pathology*; D008279:Magnetic Resonance Imaging; D008297:Male; D008526:Medulla Oblongata / Q000473:pathology*; D008875:Middle Aged; D009809:Odontoid Process / Q000293:injuries / Q000473:pathology*; D012887:Skull Fractures / Q000473:pathology*; D014057:Tomography, X-Ray Computed / Q000379:methods