title: Evaluation of unenhanced post-mortem computed tomography to detect chest injuries in violent death.
abstract: OBJECTIVE
  The aim of this study was to assess the performances of unenhanced post-mortem computed tomography (CT) to detect thoracic injuries in violent death.
  
  
  METHODS
  Retrospectively, we conducted a review of unenhanced CT scans of 67 victims of violent deaths with thoracic injuries and compared CT findings with the results of clinical autopsy. Our gold standard was a comparison of CT scans with autopsy discussed in a monthly forensic radiology multidisciplinary team meeting (MDTM). The data were collected by organ system: heart, pericardium, aorta, lungs, pleura, bone, and diaphragm and performance indices (sensitivity, specificity, accuracy) were calculated.
  
  
  RESULTS
  Pleural (59/67) and bone (55/67) injuries detected on CT were also found at autopsy and confirmed by the MDTM (sensitivity and specificity 100%). Seventeen out of 67 diaphragmatic lesions were visible on CT. Eighteen out of 67 were confirmed during MDTM after autopsy, yielding overall sensitivity of 94% and specificity of 98%. Forty out of 67 lung contusions were found on CT with two false positives and one false negative yielding 95% sensitivity for CT with a specificity of 96%, and accuracy of 95%. Fourteen out of 67 aortic injuries were found on CT compared to 19 confirmed during MDTM (sensitivity 74%, specificity 85%, accuracy 82%). In terms of pericardial lesions, 19/67 were found on CT and 20 on autopsy and confirmed during MDTM (sensitivity 80%, specificity 94%, accuracy 85%). Ten out of 10/67 cardiac lesions were visible on CT imaging and 15 found on autopsy and confirmed during MDTM (sensitivity 57%, specificity 94%, accuracy 81%).
  
  
  CONCLUSIONS
  Unenhanced post-mortem CT performs well to detect pleural, pulmonary, bone and diaphragmatic injuries but less well to identify cardiac and aortic injuries, for which the use of indirect signs is essential.
authors.affiliation: Department of Radiology, Angers University Hospital Centre, 4, rue Larrey, 49000 Angers, France. Electronic address: isnemes@hotmail.com.
authors.forename: I
authors.initials: I
authors.lastname: Sifaoui
authors.affiliation: Department of Radiology, Angers University Hospital Centre, 4, rue Larrey, 49000 Angers, France.
authors.forename: C
authors.initials: C
authors.lastname: Nedelcu
authors.affiliation: Department of Radiology, Angers University Hospital Centre, 4, rue Larrey, 49000 Angers, France.
authors.forename: G
authors.initials: G
authors.lastname: Beltran
authors.affiliation: Department of legal medicine, Angers University Hospital Centre, 4, rue Larrey, 49000 Angers, France.
authors.forename: V
authors.initials: V
authors.lastname: Dupont
authors.affiliation: Department of Radiology, Angers University Hospital Centre, 4, rue Larrey, 49000 Angers, France.
authors.forename: J
authors.initials: J
authors.lastname: Lebigot
authors.affiliation: Department of legal medicine, Angers University Hospital Centre, 4, rue Larrey, 49000 Angers, France.
authors.forename: A
authors.initials: A
authors.lastname: Gaudin
authors.affiliation: Department of Radiology, Angers University Hospital Centre, 4, rue Larrey, 49000 Angers, France.
authors.forename: C
authors.initials: C
authors.lastname: Ridereau Zins
authors.affiliation: Department of legal medicine, Angers University Hospital Centre, 4, rue Larrey, 49000 Angers, France.
authors.forename: C
authors.initials: C
authors.lastname: Rouge Maillard
authors.affiliation: Department of Radiology, Angers University Hospital Centre, 4, rue Larrey, 49000 Angers, France.
authors.forename: C
authors.initials: C
authors.lastname: Aubé
mesh_terms: D001344:Autopsy / Q000379:methods*; D002423:Cause of Death; D005260:Female; D005554:Forensic Medicine; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013898:Thoracic Injuries / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed; D014754:Violence
keywords: Autopsy; Post-mortem CT scan; Thorax; Violent death