Clinical forensic radiology in strangulation victims: forensic expertise based on magnetic resonance imaging (MRI) findings

Abstract

Based on only one objective and several subjective signs, the forensic classification of strangulation incidents concerning their life-threatening quality can be problematic. Reflecting that it is almost impossible to detect internal injuries of the neck with the standard forensic external examination, we examined 14 persons who have survived manual and ligature strangulation or forearm choke holds using MRI technique (1.5-T scanner). Two clinical radiologists evaluated the neck findings independently. The danger to life was evaluated based on the "classical" external findings alone and in addition to the radiological data. We observed hemorrhaging in the subcutaneous fatty tissue of the neck in ten cases. Other frequent findings were hemorrhages of the neck and larynx muscles, the lymph nodes, the pharynx, and larynx soft tissues. Based on the classical forensic strangulation findings with MRI, eight of the cases were declared as life-endangering incidents, four of them without the presence of petechial hemorrhage but with further signs of impaired brain function due to hypoxia. The accuracy of future forensic classification of the danger to life will probably be increased when it is based not only on one objective and several subjective signs but also on the evidence of inner neck injuries. However, further prospective studies including larger cohorts are necessary to clarify the value of the inner neck injuries in the forensic classification of surviving strangulation victims.

Virtopsy—noninvasive detection of occult bone lesions in postmortem MRI: additional information for traffic accident reconstruction

“…Furthermore, by knowing these postmortem findings, it is even possible to use whole-body MRI in clinical forensic medicine where noninvasive and non-radiation examination of a living accident victim and other living persons [17] is highly beneficial and especially when reconstructive questions are open.…”

Life-threatening versus non-life-threatening manual strangulation: are there appropriate criteria for MR imaging of the neck?

“…Intra-, subcutaneous, intramuscular, perilaryngeal and parapharyngeal oedema or haemorrhage were defined as diffuse areas of TIRM or T2 hyperintensity and T1 hypo-or hyperintensity. Special attention was paid to the platysma, since involvement of the platysma was suspected to be a specific sign of strangulation by Yen et al [5,11], but the sternocleidomastoid, strap and dorsal neck muscles were assessed together. The platysma muscle was considered affected when it was thickened or hyperintense on the TIRM or T2-weighted sequence.…”

“…MRI allows for better assessment of the inner structures of the neck, like soft tissue, vessels and larynx that cannot be clinically examined or documented. Yen et al [11] investigated 14 survivors of manual strangulation with MRI and found typical strangulation signs such as subcutaneous and intramuscular haemorrhage (platysma), haemorrhage of lymph nodes and salivary glands, but few injuries in the larynx and hyoid, which is more typical on post-mortem MRI, CT or autopsy. To our knowledge, no radiological sign was ever classified as lifethreatening in survivors of strangulation.…”

The future of pediatric and perinatal postmortem imaging

“…PMMR finds its place in research of neurological lesions (12,13), as well as the spinal cord, especially in the cervical region (14). Contrast resolution of MRI is valuable in characterizing fluid effusions, especially blood-containing ones (15) and solid organ injuries.…”