title: Strangulation signs: initial correlation of MRI, MSCT, and forensic neck findings.
abstract: OBJECTIVE
  To evaluate multislice spiral computed tomography (MSCT) and magnetic resonance imaging (MRI) findings in hanging and manual strangulation cases and compare them with forensic autopsy results.
  
  
  METHODS
  Postmortem MSCT and MRI of nine persons who died from hanging or manual strangulation were performed. The neck findings were compared with those discovered during forensic autopsy. In addition, two living patients underwent imaging and clinical examination following severe manual strangulation and near-hanging, respectively. For evaluation, the findings were divided into "primary" (strangulation mark and subcutaneous desiccation (i.e., soft-tissue thinning as a result of tissue fluids being driven out by mechanical compression) in hanging, and subcutaneous and intramuscular hemorrhage in manual strangulation) and "collateral" signs. The Wilcoxon two-tailed test was used for statistical analysis of the lymph node and salivary gland findings.
  
  
  RESULTS
  In hanging, the primary and most frequent collateral signs were revealed by imaging. In manual strangulation, the primary findings were accurately depicted, with the exception of one slight hemorrhage. Apart from a vocal cord hemorrhage, all frequent collateral signs could be diagnosed radiologically. Traumatic lymph node hemorrhage (P = 0.031) was found in all of the manual strangulation cases.
  
  
  CONCLUSIONS
  MSCT and MRI revealed strangulation signs concordantly with forensic pathology findings. Imaging offers a great potential for the forensic examination of lesions due to strangulation in both clinical and postmortem settings.
authors.affiliation: Institute of Forensic Medicine, University of Bern, Bern, Switzerland. yen@irm.unibe.ch
authors.forename: Kathrin
authors.initials: K
authors.lastname: Yen
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Thali
authors.forename: Emin
authors.initials: E
authors.lastname: Aghayev
authors.forename: Christian
authors.initials: C
authors.lastname: Jackowski
authors.forename: Wolf
authors.initials: W
authors.lastname: Schweitzer
authors.forename: Chris
authors.initials: C
authors.lastname: Boesch
authors.forename: Peter
authors.initials: P
authors.lastname: Vock
authors.forename: Richard
authors.initials: R
authors.lastname: Dirnhofer
authors.forename: Martin
authors.initials: M
authors.lastname: Sonnenschein
mesh_terms: D000328:Adult; D003250:Constriction; D003933:Diagnosis; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009333:Neck / Q000473:pathology*; D012469:Salivary Glands / Q000473:pathology; D036542:Tomography, Spiral Computed