title: Racking the brain: detection of cerebral edema on postmortem computed tomography compared with forensic autopsy.
abstract: OBJECTIVE
  The purpose of this study was to compare postmortem computed tomography with forensic autopsy regarding their diagnostic reliability of differentiating between pre-existing cerebral edema and physiological postmortem brain swelling.
  
  
  METHODS
  The study collective included a total of 109 cases (n=109/200, 83 male, 26 female, mean age: 53.2 years) and were retrospectively evaluated for the following parameters (as related to the distinct age groups and causes of death): tonsillar herniation, the width of the outer and inner cerebrospinal fluid spaces and the radiodensity measurements (in Hounsfield Units) of the gray and white matter. The results were compared with the findings of subsequent autopsies as the gold standard for diagnosing cerebral edema. p-Values <0.05 were considered statistically significant.
  
  
  RESULTS
  Cerebellar edema (despite normal postmortem swelling) can be reliably assessed using postmortem computed tomography and is indicated by narrowed temporal horns and symmetrical herniation of the cerebellar tonsils (p<0.001). There was a significant difference (p<0.001) between intoxication (or asphyxia) and all other causes of death; the former causes demonstrated higher deviations of the attenuation between white and gray matter (>20 Hounsfield Units), and the gray to white matter ratio was >1.58 when leukoencephalopathy was excluded.
  
  
  CONCLUSIONS
  Despite normal postmortem changes, generalized brain edema can be differentiated on postmortem computed tomography, and white and gray matter Hounsfield measurements help to determine the cause of death in cases of intoxication or asphyxia. Racking the brain about feasible applications for a precise and reliable brain diagnostic forensic radiology method has just begun.
authors.affiliation: Institute of Forensic Medicine, Virtopsy, University of Zurich, Winterthurerstrasse 190/52, 8057 Zurich, Switzerland; Institute of Diagnostic and Interventional Radiology, University Hospital of Zurich, Raemistrasse 100, 8091 Zurich, Switzerland.
authors.forename: Nicole
authors.initials: N
authors.lastname: Berger
authors.affiliation: Institute of Forensic Medicine, Virtopsy, University of Zurich, Winterthurerstrasse 190/52, 8057 Zurich, Switzerland.
authors.forename: Garyfalia
authors.initials: G
authors.lastname: Ampanozi
authors.affiliation: Institute of Forensic Medicine, Virtopsy, University of Zurich, Winterthurerstrasse 190/52, 8057 Zurich, Switzerland.
authors.forename: Wolf
authors.initials: W
authors.lastname: Schweitzer
authors.affiliation: Institute of Forensic Medicine, Virtopsy, University of Zurich, Winterthurerstrasse 190/52, 8057 Zurich, Switzerland.
authors.forename: Steffen G
authors.initials: SG
authors.lastname: Ross
authors.affiliation: Institute of Forensic Medicine, Virtopsy, University of Zurich, Winterthurerstrasse 190/52, 8057 Zurich, Switzerland.
authors.forename: Dominic
authors.initials: D
authors.lastname: Gascho
authors.affiliation: Institute of Forensic Medicine, Virtopsy, University of Zurich, Winterthurerstrasse 190/52, 8057 Zurich, Switzerland; Institute of Diagnostic, Interventional and Pediatric Radiology, University Hospital of Bern, Freiburgstrasse, 3010 Bern, Switzerland.
authors.forename: Thomas D
authors.initials: TD
authors.lastname: Ruder
authors.affiliation: Institute of Forensic Medicine, Virtopsy, University of Zurich, Winterthurerstrasse 190/52, 8057 Zurich, Switzerland.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Thali
authors.affiliation: Institute of Forensic Medicine, Virtopsy, University of Zurich, Winterthurerstrasse 190/52, 8057 Zurich, Switzerland; Institute of Diagnostic and Interventional Radiology, University Hospital of Zurich, Raemistrasse 100, 8091 Zurich, Switzerland. Electronic address: patricia.flach@irm.uzh.ch.
authors.forename: Patricia M
authors.initials: PM
authors.lastname: Flach
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001344:Autopsy / Q000379:methods; D001921:Brain / Q000000981:diagnostic imaging; D001929:Brain Edema / Q000000981:diagnostic imaging*; D005260:Female; D049429:Forensic Pathology / Q000379:methods*; D066128:Gray Matter; D006801:Humans; D056784:Leukoencephalopathies; D008297:Male; D008875:Middle Aged; D011180:Postmortem Changes; D015203:Reproducibility of Results; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods*; D066127:White Matter; D055815:Young Adult
keywords: Cerebral edema; Forensic radiology; Intoxication; Postmortem computed tomography (PMCT); Virtopsy