title: Deep Into the Fibers! Postmortem Diffusion Tensor Imaging in Forensic Radiology.
abstract: OBJECTIVE
  In traumatic brain injury, diffusion-weighted and diffusion tensor imaging of the brain are essential techniques for determining the pathology sustained and the outcome. Postmortem cross-sectional imaging is an established adjunct to forensic autopsy in death investigation. The purpose of this prospective study was to evaluate postmortem diffusion tensor imaging in forensics for its feasibility, influencing factors and correlation to the cause of death compared with autopsy.
  
  
  METHODS
  Postmortem computed tomography, magnetic resonance imaging, and diffusion tensor imaging with fiber tracking were performed in 10 deceased subjects. The Likert scale grading of colored fractional anisotropy maps was correlated to the body temperature and intracranial pathology to assess the diagnostic feasibility of postmortem diffusion tensor imaging and fiber tracking.
  
  
  RESULTS
  Optimal fiber tracking (>15,000 fiber tracts) was achieved with a body temperature at 10°C. Likert scale grading showed no linear correlation (P > 0.7) to fiber tract counts. No statistically significant correlation between total fiber count and postmortem interval could be observed (P = 0.122). Postmortem diffusion tensor imaging and fiber tracking allowed for radiological diagnosis in cases with shearing injuries but was impaired in cases with pneumencephalon and intracerebral mass hemorrhage.
  
  
  CONCLUSIONS
  Postmortem diffusion tensor imaging with fiber tracking provides an exceptional in situ insight "deep into the fibers" of the brain with diagnostic benefit in traumatic brain injury and axonal injuries in the assessment of the underlying cause of death, considering influencing factors for optimal imaging technique.
authors.affiliation: From the *Institute of Forensic Medicine, University of Zurich; and †Department of Diagnostic and Interventional Radiology, University Hospital of Zurich, Zurich; and ‡Institute of Forensic Medicine, University of Bern; and Departments of §Interventional and Diagnostic Neuroradiology and ∥Neurology, University Hospital of Bern, Inselspital, Bern, Switzerland; and ¶Institute of Legal Medicine, Medical School Hannover, Germany.
authors.forename: Patricia Mildred
authors.initials: PM
authors.lastname: Flach
authors.forename: Sarah
authors.initials: S
authors.lastname: Schroth
authors.forename: Wolf
authors.initials: W
authors.lastname: Schweitzer
authors.forename: Garyfalia
authors.initials: G
authors.lastname: Ampanozi
authors.forename: Johannes
authors.initials: J
authors.lastname: Slotboom
authors.forename: Claus
authors.initials: C
authors.lastname: Kiefer
authors.forename: Tanja
authors.initials: T
authors.lastname: Germerott
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Thali
authors.forename: Marwan
authors.initials: M
authors.lastname: El-Koussy
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001369:Axons / Q000473:pathology; D001831:Body Temperature; D001921:Brain / Q000473:pathology; D001930:Brain Injuries / Q000473:pathology*; D056324:Diffusion Tensor Imaging; D005240:Feasibility Studies; D005260:Female; D049429:Forensic Pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009412:Nerve Fibers / Q000473:pathology*; D011180:Postmortem Changes; D011446:Prospective Studies; D066127:White Matter / Q000473:pathology; D055815:Young Adult