Postmortem Magnetic Resonance Imaging and Postmortem Computed Tomography in Ligature and Manual Strangulation

Deininger‐Czermak, Eva; Heimer, Jakob; Tappero, Carlo; Thali, Michael J.; Gascho, Dominic

doi:10.1097/paf.0000000000000542

Cited by 12 publications

(5 citation statements)

References 29 publications

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“…This would be similar to the results of Hueck et al, who reported a Cohen’s Kappa coefficient of 0.54 for injuries of the laryngeal cartilages [ 9 ], albeit the group subsequently used different thresholds for the stated level of agreement. We also experienced the same difficulties in diagnosing laryngeal fractures as outlined by other groups, including decreased ossification [ 4 , 19 , 21 ], the size of the lesions [ 21 ] and non-displaced fractures [ 21 ]. However, there is considerable variation in the rate of detection of laryngeal fractures using PMCT within the medical literature.…”

Section: Discussionmentioning

confidence: 95%

“…It is well recognised that PMCT is superior to TIA in the identification of gas deposition within the body [ 9 ]. In hanging cases, fracture-associated gas bubbles and subcutaneous emphysema have been described, but again there is some variation in results/opinions across manuscripts [ 3 , 5 , 7 – 9 , 12 , 17 , 19 , 23 ]. Schulze et al reported that a ‘gas bubble sign’ was highly suggestive of laryngeal fractures in hanging cases with a positive-predictive-value of 95% and overall accuracy of 83%, but the study excluded decomposed decedents [ 5 ].…”

Section: Discussionmentioning

confidence: 99%

“…Schulze et al reported that a ‘gas bubble sign’ was highly suggestive of laryngeal fractures in hanging cases with a positive-predictive-value of 95% and overall accuracy of 83%, but the study excluded decomposed decedents [ 5 ]. In contrast, the two papers by Deininger-Czermak et al identified fracture-related gas bubbles in only 20% [ 8 ] and 16.67% of cases [ 19 ], and additional gas bubbles in proximity of the laryngeal structures without any fractures in 16% of cases [ 8 ]. Our study recorded gas bubbles in proximity of fractures in only 8% of cases, and only one of these fractures was identified during both TIA and PMCT.…”

Section: Discussionmentioning

confidence: 99%

“…However, these findings were not present in all cases. In addition, there was general agreement that PMCT was less able to detect soft tissue haemorrhage in comparison to TIA [ 3 , 9 , 19 , 23 ], the detection of which is important as it not only indicates antemortem injury, but if excessive may also suggest additional neck trauma prior to a ligature being applied, e.g. in a masked homicide.…”

Section: Introductionmentioning

confidence: 99%

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Comparison of findings identified at traditional invasive autopsy and postmortem computed tomography in suicidal hangings

Lyness¹,

Collins

Rutty

et al. 2022

Int J Legal Med

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Cases of suicidal hanging are a common death referred for medico-legal autopsy throughout the world. Although some advocate using postmortem computed tomography (PMCT) without traditional invasive autopsy (TIA) to investigate such deaths, others reject this approach. There is currently limited evidence to guide practice. In this context, the TIA reports and PMCT images of 50 cases of suspected suicidal hanging during an 11-month period were reviewed. The reviewers were blinded to the findings of the other modality. A Cohen’s Kappa coefficient (K) was calculated to assess agreement between TIA and PMCT across a range of pertinent findings. This analysis demonstrated perfect agreement for identification of a ligature (K = 1.00) and a strong level of agreement for identification of a ligature suspension point (K = 0.832) but only a minimal level of agreement for overall ligature mark (K = 0.223). PMCT demonstrated a weak level of agreement for fractures of hyoid bone (K = 0.555) and thyroid cartilage (K = 0.538). Three probable fractures not identified at TIA were identified on PMCT. TIA was shown to be superior in the identification of intramuscular and laryngeal fracture–related haemorrhage/bruising whereas PMCT was superior to TIA in identifying body gas deposition. There was overall good correlation between the natural disease and trauma identified elsewhere in the body during the TIA and PMCT. The study demonstrates that PMCT can assist the investigation of suspected suicidal hangings. However, the accuracy of many findings is limited, and if it is used as an alternative to the TIA, potentially pertinent findings, such as fractures of the laryngeal cartilages, could be missed.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Comparison of findings identified at traditional invasive autopsy and postmortem computed tomography in suicidal hangings

Lyness¹,

Collins

Rutty

et al. 2022

Int J Legal Med

View full text Add to dashboard Cite

show abstract

“…Various internal injury findings can be identified in the context of a fatal strangulation as demonstrated by forensic autopsies and indicated by postmortem imaging procedures. These findings may include for example hemorrhages or edema in various soft tissue structures of the neck, lesions of the intimal layer of carotid arteries or fractures of the laryngeal skeleton or hyoid bone [1][2][3][4][5][6][7]. However, the vast majority of internal findings have in common that they are not visible in clinical forensic examinations of surviving victims of violence against the neck [3,[8][9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

Longitudinal visibility of MRI findings in living victims of strangulation

Bauer,

Hollenstein,

Lieb

et al. 2024

Int J Legal Med

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Initial experiences with magnetic resonance imaging (MRI) of living strangulation victims demonstrated additional findings of internal injuries compared to the standard clinical forensic examination. However, existing studies on the use of MRI for this purpose mostly focused on the first 48 h after the incident. The aims of this study were (a) to evaluate the longitudinal visibility of MRI findings after violence against the neck by performing two MRI examinations within 12 days and a minimum of four days between both MRI scans and (b) to assess which MRI sequences were most helpful for the detection of injuries. Twenty strangulation victims participated in this study and underwent one (n = 8) or two (n = 12) MRI scans. The first MRI examination was conducted during the first five days, the second five to 12 days after the incident. Two blinded radiologists assessed the MRI data and looked for lesions in the structures of the neck. In total, 140 findings were reported in the 32 MRI examinations. Most of the findings were detected in the thyroid and the muscles of the neck. T2-weighted SPACE with fat suppression, T1-weighted TSE and T1-weighted MPRAGE were rated as the most helpful MRI sequences. Subjects who showed findings in the initial scan also demonstrated comparable results in the second scan, which was performed on average 8.4 days after the incident. Our results show that even up to 12 days after the incident, the criminal proceeding of strangulation cases may greatly profit from the information provided by an MRI examination of the neck in addition to the standard clinical forensic examination.

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