title: Postmortem imaging of blunt chest trauma using CT and MRI: comparison with autopsy.
abstract: OBJECTIVE
  Postmortem examination of chest trauma is an important domain in forensic medicine, which is today performed using autopsy. Since the implementation of cross-sectional imaging methods in forensic medicine such as computed tomography (CT) and magnetic resonance imaging (MRI), a number of advantages in comparison with autopsy have been described. Within the scope of validation of cross-sectional radiology in forensic medicine, the comparison of findings of postmortem imaging and autopsy in chest trauma was performed.
  
  
  METHODS
  This retrospective study includes 24 cases with chest trauma that underwent postmortem CT, MRI, and autopsy. Two board-certified radiologists, blind to the autopsy findings, evaluated the radiologic data independently. Each radiologist interpreted postmortem CT and MRI data together for every case. The comparison of the results of the radiologic assessment with the autopsy and a calculation of interobserver discrepancy was performed.
  
  
  RESULTS
  Using combined CT and MRI, between 75% and 100% of the investigated findings, except for hemomediastinum (70%), diaphragmatic ruptures (50%; n=2) and heart injury (38%), were discovered. Although the sensitivity and specificity regarding pneumomediastinum, pneumopericardium, and pericardial effusion were not calculated, as these findings were not mentioned at the autopsy, these findings were clearly seen radiologically. The averaged interobserver concordance was 90%.
  
  
  CONCLUSIONS
  The sensitivity and specificity of our results demonstrate that postmortem CT and MRI are useful diagnostic methods for assessing chest trauma in forensic medicine as a supplement to autopsy. Further radiologic-pathologic case studies are necessary to define the role of postmortem CT and MRI as a single examination modality.
authors.affiliation: Institute of Forensic Medicine, University of Bern, Bern, Switzerland. emin.aghayev@memcenter.unibe.ch
authors.forename: Emin
authors.initials: E
authors.lastname: Aghayev
authors.forename: Andreas
authors.initials: A
authors.lastname: Christe
authors.forename: Martin
authors.initials: M
authors.lastname: Sonnenschein
authors.forename: Kathrin
authors.initials: K
authors.lastname: Yen
authors.forename: Christian
authors.initials: C
authors.lastname: Jackowski
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Thali
authors.forename: Richard
authors.initials: R
authors.lastname: Dirnhofer
authors.forename: Peter
authors.initials: P
authors.lastname: Vock
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001344:Autopsy; D002675:Child, Preschool; D005260:Female; D005554:Forensic Medicine / Q000379:methods; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D013902:Radiography, Thoracic / Q000379:methods*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013898:Thoracic Injuries / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology; D014057:Tomography, X-Ray Computed / Q000379:methods*; D014949:Wounds, Nonpenetrating / Q000175:diagnosis*