title: Clinical forensic radiology in strangulation victims: forensic expertise based on magnetic resonance imaging (MRI) findings.
abstract: Based on only one objective and several subjective signs, the forensic classification of strangulation incidents concerning their life-threatening quality can be problematic. Reflecting that it is almost impossible to detect internal injuries of the neck with the standard forensic external examination, we examined 14 persons who have survived manual and ligature strangulation or forearm choke holds using MRI technique (1.5-T scanner). Two clinical radiologists evaluated the neck findings independently. The danger to life was evaluated based on the "classical" external findings alone and in addition to the radiological data. We observed hemorrhaging in the subcutaneous fatty tissue of the neck in ten cases. Other frequent findings were hemorrhages of the neck and larynx muscles, the lymph nodes, the pharynx, and larynx soft tissues. Based on the classical forensic strangulation findings with MRI, eight of the cases were declared as life-endangering incidents, four of them without the presence of petechial hemorrhage but with further signs of impaired brain function due to hypoxia. The accuracy of future forensic classification of the danger to life will probably be increased when it is based not only on one objective and several subjective signs but also on the evidence of inner neck injuries. However, further prospective studies including larger cohorts are necessary to clarify the value of the inner neck injuries in the forensic classification of surviving strangulation victims.
authors.affiliation: Medical University of Graz, Center of Theoretical-Clinical Medicine, Forensic, Pathologic and Anatomic Imaging, Harrachgasse 21, 8010, Graz, Austria. kathrin.yen@meduni-graz.at
authors.forename: Kathrin
authors.initials: K
authors.lastname: Yen
authors.forename: Peter
authors.initials: P
authors.lastname: Vock
authors.forename: Andreas
authors.initials: A
authors.lastname: Christe
authors.forename: Eva
authors.initials: E
authors.lastname: Scheurer
authors.forename: Thomas
authors.initials: T
authors.lastname: Plattner
authors.forename: Corinna
authors.initials: C
authors.lastname: Schön
authors.forename: Emin
authors.initials: E
authors.lastname: Aghayev
authors.forename: Christian
authors.initials: C
authors.lastname: Jackowski
authors.forename: Verena
authors.initials: V
authors.lastname: Beutler
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Thali
authors.forename: Richard
authors.initials: R
authors.lastname: Dirnhofer
mesh_terms: D000328:Adult; D000402:Airway Obstruction / Q000473:pathology*; D005260:Female; D005554:Forensic Medicine / Q000379:methods*; D006801:Humans; D008026:Ligation; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019838:Neck Injuries / Q000473:pathology*; D011693:Purpura / Q000473:pathology; D017695:Soft Tissue Injuries / Q000473:pathology*; D017741:Survivors