title: Traumatic extra-axial hemorrhage: correlation of postmortem MSCT, MRI, and forensic-pathological findings.
abstract: OBJECTIVE
  To evaluate the diagnostic accuracy of in situ postmortem multislice computed tomography (MSCT) and magnetic resonance imaging (MRI) in the detection of primary traumatic extra-axial hemorrhage.
  
  
  METHODS
  Thirty forensic neurotrauma cases and 10 nontraumatic controls who underwent both in situ postmortem cranial MSCT and MR imaging before autopsy were retrospectively reviewed. Both imaging modalities were analyzed in view of their accuracy, sensitivity, and specificity concerning the detection of extra-axial hemorrhage. Statistical significance was calculated using the McNemar test. kappa values for interobserver agreement were calculated for extra-axial hemorrhage types and to quantify the agreement between both modalities as well as MRI, CT, and forensics, respectively.
  
  
  RESULTS
  Analysis of the detection of hemorrhagic localizations showed an accuracy, sensitivity, and specificity of 89%, 82%, and 92% using CT, and 90%, 83%, and 94% using MRI, respectively. MRI was more sensitive than CT in the detection of subarachnoid hemorrhagic localizations (P = 0.001), whereas no significant difference resulted from the detection of epidural and subdural hemorrhagic findings (P = 0.248 and P = 0.104, respectively). Interobserver agreement for all extra-axial hemorrhage types was substantial (CT kappa = 0.76; MRI kappa = 0.77). The agreement of both modalitites was almost perfect (readers 1 and 2 kappa = 0.88).
  
  
  CONCLUSIONS
  CT and MRI are of comparable potential as forensic diagnostic tools for traumatic extra-axial hemorrhage. Not only of forensic, but also of clinical interest is the observation that most thin blood layers escape the radiological evaluation.
authors.affiliation: Department of Neuroradiology, University of Bern, Inselspital, Bern, Switzerland.
authors.forename: Javier
authors.initials: J
authors.lastname: Añon
authors.forename: Luca
authors.initials: L
authors.lastname: Remonda
authors.forename: Adrian
authors.initials: A
authors.lastname: Spreng
authors.forename: Eva
authors.initials: E
authors.lastname: Scheurer
authors.forename: Gerhard
authors.initials: G
authors.lastname: Schroth
authors.forename: Chris
authors.initials: C
authors.lastname: Boesch
authors.forename: Michael
authors.initials: M
authors.lastname: Thali
authors.forename: Richard
authors.initials: R
authors.lastname: Dirnhofer
authors.forename: Kathrin
authors.initials: K
authors.lastname: Yen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001344:Autopsy; D002648:Child; D002675:Child, Preschool; D006259:Craniocerebral Trauma / Q000473:pathology*; D005260:Female; D006470:Hemorrhage / Q000473:pathology*; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*