Virtual autopsy: preliminary experience in high-velocity gunshot wound victims.
OBJECTIVE
To retrospectively assess virtual autopsy performed with multidetector computed tomography (CT) for the forensic evaluation of gunshot wound victims.


METHODS
The institutional review board approved this HIPAA-compliant study and did not require informed consent of the next of kin. Thirteen consecutive male gunshot wound victims (mean age, 27 years) were scanned with 16-section multidetector CT prior to routine autopsy. Retrospectively, the total-body nonenhanced scans were interpreted at a three-dimensional workstation by radiologists blinded to autopsy findings. Images were evaluated for lethal wound, number and location of wound tracks, injured structures, and metal fragment location. After image review, autopsy reports and photographs were compared with the images and interpretations to validate the multidetector CT determinations.


RESULTS
Multidetector CT aided in correct identification of all lethal wounds, and metallic fragment location was always precise. In four cases, multidetector CT aided in accurate assessment of organ injuries and lethal wounds but led to underestimation of the number of wounds if comingling paths occurred. In two cases of a chest wound, multidetector CT aided in accurate assessment of the chest as having the lethal wound but failed to help identify specific sites of hemorrhage. In two cases of craniofacial injury, the path of the wound was not clear. Autopsy revealed a total of 78 wound tracks (mean, 6; range, 1-24). Ten (13%) wound tracks were not identified at multidetector CT (six upper extremity wounds and four thigh wounds). In two cases, findings missed at autopsy (fracture of the cervical spine, bullet fragments in the posterior area of the neck) were identified at multidetector CT.


CONCLUSIONS
Multidetector CT can aid prediction of lethal wounds and location of metallic fragments.
Levy
Angela D
AD
Department of Radiologic Pathology, Armed Forces Institute of Pathology, Alaska and Fern Streets NW, Washington, DC 20306-6000, USA. levya@afip.osd.mil
Abbott
Robert M
RM
Mallak
Craig T
CT
Getz
John M
JM
Harcke
H Theodore
HT
Champion
Howard R
HR
Pearse
Lisa A
LA
D000328:Adult; D001344:Autopsy / Q000379:methods*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods*; D014584:User-Computer Interface; D051598:Whole Body Imaging; D014948:Wounds, Gunshot / Q000000981:diagnostic imaging*