FRACTURE MRI: Optimized 3D multi-echo in-phase sequence for bone damage assessment in craniocerebral gunshot injuries

Gascho, Dominic; Zoelch, Niklaus; Tappero, Carlo; Kottner, Sören; Bruellmann, Erika; Thali, Michael J.; Deininger‐Czermak, Eva

doi:10.1016/j.diii.2020.02.010

Cited by 16 publications

(10 citation statements)

References 9 publications

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“…In human forensic medicine, PMMRI is a modality that is mostly complementary to PMCT in detecting soft tissue lesions and parenchymal pathologies, with the fact that PMMRI alone is more prone to artefacts from gas and foreign bodies. Recent modification of a three-dimensional fast-fieldecho sequence with multiple echoes for specific bone imaging on PMMRI might also allow visualisation of beveled fractures as well as radiating bone fracture lines, which is equivalent to PMCT regarding the visualisation of bone damage in craniocerebral gunshot injuries (Gascho et al, 2020). In addition, it was suggested that adequate professional radiological training is essential for performing and reporting PMMRI (Cartocci et al, 2020).…”

Section: Discussionmentioning

confidence: 99%

Postmortem Neuroimaging of Cetacean Brains Using Computed Tomography and Magnetic Resonance Imaging

et al. 2020

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Postmortem computed tomography (PMCT) and postmortem magnetic resonance (PMMR) imaging (PMMRI) have been applied to provide vital or additional information for conventional necropsy, along the pioneering virtopsy-driven cetacean stranding response program in Hong Kong waters. It is common for stranded carcasses to become badly degraded and susceptible to rapid cerebral autolysis and putrefaction. Necropsy on decomposed brains with limited sample analysis often defy a specific diagnosis. Studies on PMMR neuroimaging have focused on neuroanatomy and brain morphology in freshly deceased or preserved specimens. Moreover, the literature is devoid of any reference on the potential value of PMMRI examination of decomposed cetacean brains. To that end, this project evaluated the benefits of PMMR neuroimaging in situ in decomposed carcasses in comparison to PMCT. A total of 18 cetacean carcasses were studied by PMCT and PMMRI examinations. Anatomical brain structures and visible brain pathologies were evaluated and scored using Likert-scale rating. Intracranial gas accumulation was clearly depicted in all cases by all radiological techniques. Other features were more clearly depictable in PMMRI than in PMCT images. Results of this study indicated that superiority of PMMRI compared to PMCT increased with advanced putrefaction of the brain. The preservation of structural integrity was presented by PMMRI due to its superior capability to evaluate soft tissue. Brain PMMRI should be incorporated in postmortem investigation of decomposed stranded cetaceans.

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Section: Discussionmentioning

confidence: 99%

Postmortem Neuroimaging of Cetacean Brains Using Computed Tomography and Magnetic Resonance Imaging

et al. 2020

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“…CT is generally the preferred modality to visualize osseous structures due to high image contrast and spatial resolution; however, ionizing radiation is of particular concern in the CCJ and neck 7–9 . Recent advances in MRI technology have allowed visualization of bone with high detail and contrast and MRI has thus become increasingly popular in clinical research 10–12 . MRI not only precludes the use of ionizing radiation, but has also shown increased diagnostic capabilities beyond soft tissue and neuronal structures 13,14 …”

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confidence: 99%

“…After acquiring multiple echoes in‐phase, all signals are summed in order to increase the signal intensities. Through subtracting the sum of those signals from the last received signal, an eventual CT‐like image can be calculated 10 . As both methods are valid options for increasing bone conspicuity on MRI, they could provide comparable information to CT on bony structures of the CCJ, possibly obviating the need for dedicated CT imaging.…”

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confidence: 99%

Comparison of MR Ultrashort Echo Time and Optimized 3D‐Multiecho In‐Phase Sequence to Computed Tomography for Assessment of the Osseous Craniocervical Junction

Deininger‐Czermak

Villefort

Doeberitz

et al. 2020

Magnetic Resonance Imaging

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Background To assess changes of the craniocervical junction (CCJ), computed tomography (CT) is considered the reference standard. Recent advances in bone depiction on magnetic resonance imaging (MRI) enable high‐quality visualization of osseous structures. Consequently, MRI may serve as an alternative to CT, without the use of ionizing radiation. Purpose To compare two MRI sequences optimized for bone visualization to the CT reference standard in the assessment of the osseous CCJ. Study Type Prospective. Population/Subjects Twenty‐seven decedents and five healthy volunteers. Field Strength/Sequence 3T/ultrashort‐echo time gradient echo (UTE) and optimized 3D‐multiecho in‐phase gradient echo sequences (FRACTURE). Assessment All decedents were scanned with both MRI sequences and CT. Three observers rated degeneration to obtain a score for the upper (atlanto‐dental and left/right atlanto‐occipital joint) and for the lower part of the CCJ (left and right atlanto‐axial joint). Two reader rated the following quantitative parameters: basion‐axial‐interval, atlanto‐dental‐interval, atlanto‐occipital‐interval, Powers‐ratio, and signal/contrast‐to‐noise‐ratio. As a proof of concept, five healthy volunteers were scanned with both MRI sequences. Statistical Tests Degeneration was assessed on a Likert scale by three independent observers. Interrater and intermodality reliability were calculated using an intraclass correlation coefficient. To compare distance measurements between examination methods, a Friedman test, between‐degenerative ratings, and a Kruskal–Wallis test were performed. Results Degenerative ratings of the CCJ between MRI sequences and CT showed a good interrater and intermodality agreement. MRI sequences tended to underestimate the degree of degeneration compared to CT, and this became more marked with increasing degeneration severity. There were no significant relationships between distance measurements and the degree of degeneration (PCT = 0.62, PUTE = 0.64, PFRACTURE = 0.67). The in vivo examination proved the feasibility of both MRI methods in a clinical setting. Data Conclusion Quantitative and qualitative ratings on MR images were comparable to CT images; thus, MRI may be a valid alternative to CT assessing the CCJ. Level of Evidence 1. Technical Efficacy Stage 3.

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“…Although several postmortem studies have demonstrated the diagnostic potential of MRI in forensic neuroimaging [27][28][29][30][31], medico-legal societies still do not consider MRI a substitute for forensic autopsies and instead view MRI as a supplementary examination. Autopsy and CT are considered the gold standard in forensic investigations of craniocerebral gunshot wounds since these examination modalities usually provide information related to the most relevant forensic questions, while the diagnostic opportunities for MRI are frequently unknown.…”

Section: Discussionmentioning

confidence: 99%

“…MRI is known to be superior to CT for the detection of soft tissue injuries, while CT is appreciated for the detection of osseous injuries. However, using dedicated MRI sequences can yield equally good visualization of bone damage as CT and allow differentiation of the entrance and exit wounds and the detection of characteristic osseous injuries in craniocerebral gunshot wounds [31]. On CT, the wound tract is usually identified by bone splintering and bullet fragments along the bullet's path and blood in the wound tract.…”

Section: Discussionmentioning

confidence: 99%

Noninvasive 7 tesla MRI of fatal craniocerebral gunshots – a glance into the future of radiologic wound ballistics

Gascho

Deininger‐Czermak

Zoelch

et al. 2020

Forensic Sci Med Pathol

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Compared to computed tomography (CT), magnetic resonance imaging (MRI) provides superior visualization of the soft tissue. Recently, the first 7 Tesla (7 T) MRI scanner was approved for clinical use, which will facilitate access to these ultra-high-field MRI scanners for noninvasive examinations and scientific studies on decedents. 7 T MRI has the potential to provide a higher signal-to-noise ratio (SNR), a characteristic that can be directly exploited to improve image quality and invest in attempts to increase resolution. Therefore, evaluating the diagnostic potential of 7 T MRI for forensic purposes, such as assessments of fatal gunshot wounds, was deemed essential. In this article, we present radiologic findings obtained for craniocerebral gunshot wounds in three decedents. The decedents were submitted to MRI examinations using a 7 T MRI scanner that has been approved for clinical use and a clinical 3 T MRI scanner for comparison. We focused on detecting tiny injuries beyond the wound tract caused by temporary cavitation, such as microbleeds. Additionally, 7 T T2-weighted MRI highlighted a dark (hypo intense) zone beyond the permanent wound tract, which was attributed to increased amounts of paramagnetic blood components in damaged tissue. Microbleeds were also detected adjacent to the wound tract in the white matter on 7 T MRI. Based on the findings of radiologic assessments, the advantages and disadvantages of postmortem 7 T MRI compared to 3 T MRI are discussed with regard to investigations of craniocerebral gunshot wounds as well as the potential role of 7 T MRI in the future of forensic science.

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FRACTURE MRI: Optimized 3D multi-echo in-phase sequence for bone damage assessment in craniocerebral gunshot injuries

Cited by 16 publications

References 9 publications

Postmortem Neuroimaging of Cetacean Brains Using Computed Tomography and Magnetic Resonance Imaging

Postmortem Neuroimaging of Cetacean Brains Using Computed Tomography and Magnetic Resonance Imaging

Comparison of MR Ultrashort Echo Time and Optimized 3D‐Multiecho In‐Phase Sequence to Computed Tomography for Assessment of the Osseous Craniocervical Junction

Noninvasive 7 tesla MRI of fatal craniocerebral gunshots – a glance into the future of radiologic wound ballistics

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