Journal of Forensic Radiology and Imaging最新文献

Objective

Confirmation whether an optimized clinical cardiac CT scan protocol is also optimal for post mortem cardiac CT scans without iodine contrast or the reconstruction parameters should be changed.

Materials and methods

27 CT volumes (three cases for three recon- struction kernel with three different iterative reconstruction settings) were graded by six readers in order to find the optimal reconstruction parame- ters. The scans were performed on a Siemens Definition Flash CT scanner using 120 kV tube potentials.

Results

The study has shown that from the investigated options the softest cardiac kernel with the strongest iterative reconstruction were pre- ferred by the readers (I26 Safire 3).

Conclusion

The results indicate that the scan protocol which was adopted from clinical practice is applicable in forensic radiology too even though iodine contrast agent was not administered.

The formation of a biological profile (including the estimation of sex and age) is usually the first task undertaken when skeletal remains are analysed by a forensic anthropologist. Recent literature attests to a growing awareness of the value of research focusing on age and sex related morphoscopic features visualized in high resolution multiple detector computerized tomography (MDCT) scans. The present study provides insight into the analysis of MDCT scans, with a specific focus on quantifying the accuracy of the Phenice sex estimation method in a Western Australian population.

The sample comprises 448 clinical pelvic MDCT scans representing 226 male and 222 female individuals between 18 and 64 years of age. The scans (all ≤ 1.5 mm slice thickness) are reconstructed using three-dimensional volume rendered models in OsiriX software. A precision test was performed prior to data collection to quantify observer accordance; thereafter the accuracy of the identification of the Phenice pelvic traits (ischiopubic ramus; ventral arc; subpubic concavity) are statistically quantified.

Intra-observer accordance is above 0.81 (Kappa value) for each morphological attribute assessed. Congruent with previous research the single most accurate trait overall is the ventral arc (86.61%), albeit an age-related sex-bias in classification accuracy was demonstrated. Based on the combined assessment of the three features, it is demonstrated that the Phenice method facilitates a high degree of expected accuracy in the classification of sex (92.24%), thus indicating that the method can be successfully applied in MDCT scans and is suitable for forensic application in a Western Australian population.

The authors present a single case report illustrating on the body of a newborn found on the seashore of the island of Mayotte in the Indian Ocean, the diagnostic difficulties inherent in the detection during the post-mortem scan of a voluminous highly radiopaque foreign body in the upper aerodigestive tract. The internal examination has highlighted black sand in abundance in the upper aerodigestive tract. The CT scanning of a sand sample from the lagoon shore confirmed its high-density radiopaque nature. In a specialized laboratory, the magnetic part of this sample was investigated by means of energy dispersive X-ray spectroscopy (EDS), powder X-ray diffraction (XRD), and Mössbauer spectroscopy. The mineral composition is dominantly magnetite (Fe₃O₄) but contrary to pure magnetite, a relevant fraction of titanium was detected.

This case demonstrates how post-mortem CT may lead to inappropriate diagnosis and highlights the interest of the physicochemical study in the forensic context.

Introduction

Post-mortem computed tomography (PMCT) has become a routine part of post-mortem forensic evaluation in many institutes worldwide. Its added benefit to the traditional autopsy is indisputable, but its ability to detect different findings compared to those found in an autopsy has only been evaluated in a limited number of large scale studies.

Methods

In this retrospective study, we assessed the agreement between autopsy and PMCT, and their ability to detect pathological findings (by "Kappa" and "McNemar" scores, respectively), using all finding of both methods as reference standard. We included findings in the torso and the limbs extracted from autopsy and PMCT reports of 105 consecutive cases.

Results

The level of agreement between autopsy and PMCT depends on the tissues, locations, and type of pathologies examined. Autopsy much better demonstrates bullet tracks (68/76 vs. 18/76, p < 0.01) and stab wounds (22/25 vs. 11/25, p=0.013), while PMCT is more sensitive to shrapnel (86/121 vs. 37/121, p < 0.001). PMCT better demonstrates fractures (259/344 vs. 222/344, p = 0.012), especially in bones that are hard to access in autopsy, but is less sensitive to rib fractures (137/177 vs. 115/177, p = 0.037). Parenchymal organ pathologies are not well demonstrated by PMCT (194/257 vs. 117/257, p =< 0.001).

Conclusions

Shrapnel, foreign bodies, gas-related pathologies, pelvic fluid and fractures, excluding rib fractures, are detected more often by post-mortem CT. It is important to consider PMCT as a tool in the evaluation of specific tissues and organs, possibly providing solid answers, or at least directing the team in the performance of the autopsy.

Objectives

The presence of an intervertebral separation indicates vertebral ligamentous injuries, and it is occasionally associated with fatal spinal cord injuries. However, it is often difficult to identify the separation using post-mortem computed tomography (CT). This study retrospectively evaluated the correlation between the post-mortem CT findings and autopsy results of cervical intervertebral separation.

Materials and methods

Forty-two subjects (8 females and 34 males) with cervical intervertebral separation were evaluated. The average age was 67 (range, 29–88) years. A radiologist retrospectively reviewed the cervical spines on axial, sagittal, and coronal CT images and determined whether intervertebral separations could be detected. The radiologist also classified the CT findings in cases with detectable separations.

Results

Of the 57 cervical intervertebral separations, 39 were detectable on the CT images. The CT findings were grouped into the following six categories: intervertebral gas (n = 19; 40.4%); forward intervertebral widening (n = 10; 21.3%); backward intervertebral widening (n = 1; 2.1%); anteroposterior misalignment (n = 6; 12.8%); spur fracture (n = 7; 14.9%); and hematoma in front of a vertebral body (n = 4; 8.5%). The sensitivity and specificity of intervertebral gas in the diagnosis of cervical intervertebral separation were 33.9% and 99.7%, respectively.

Conclusion

Approximately 70% of the cases with cervical intervertebral separations had various abnormal findings on CT imaging. The most common finding was intervertebral gas, but the sensitivity of intervertebral gas was not adequate.

Aim

The present study aimed to assess the volume of the frontal sinuses before and after rapid maxillary expansion (RME).

Material and methods

The sample consisted of 12 subjects (8 females and 4 males) with maxillary deficiency aged between 10 and 15 years old. In order to treat the skeletal deficiency, RME was performed using Hyrax system. Cone Beam Computed Tomography (CBCT) scans were obtained from each subject before (T1) and 120 days after (T2) the RME. A table digitizer G-Pen F350 (Genius, Taipei, Taiwan) was used to select the area of the frontal sinuses in CBCT slices. The volume of the sinuses was quantified in T1 and T2. T-test for paired samples was used to compare the differences between the volume of the frontal sinuses before and after RME

Results

The mean volume of the frontal sinuses before and after the RME was 3.03 mm³ (ranging from 2.20 mm³ to 4.40 mm³) and 3.21 mm³ (ranging from 2.55 mm³ to 4.52 mm³), respectively. Differences in volume between T1 and T2 were not statistically significant (p > .05). The present study indicates that the frontal sinuses do not modify considerably in volume after RME.

Conclusion

From the forensic scope, this outcome supports the usefulness of the frontal sinuses for ante-mortem and post-mortem comparisons in human identification cases.

This case report details a sternal finding that first was reported as penetrating knife stab wound. It was one in a series of 24 otherwise relatively superficial skin stab wounds allegedly performed by a single assailant within the scope of a single attack. The effort required to penetrate the sternum with a knife appears to be considerably higher than to inflict relatively superficial skin and soft tissue penetration. This initially raised suspicion of another person contributing to the attack, or, a different weapon being used. After reviewing the clinical CT scans, we identified the combination of a preexisting sternal foramen with a marginal fracture and concluded that the sternal “penetration” was in keeping with the depth of the other 23 stab wounds. None of the injuries were lethal, the victim survived the attack. Assuming that a knife penetration fracture of a sternum and a foramen sternale are mutually exclusive constitutes an exclusive-OR fallacy (XOR fallacy).

The allegation of child abuse, or non-accidental trauma, is very serious and can have a devastating impact on children and their families. However, the lack of recognition of injuries resulting from abusive incidents can be equally detrimental. When a child presents to the emergency facility with a suspicious injury it is of the utmost importance that a well-documented medical history be obtained.

We present a case of a 3-day old infant sent to the pediatric ER after the pediatrician noted bruising over the right shoulder and clavicle. A subsequent skeletal survey performed demonstrated a mildly depressed skull fracture and an overriding displaced right clavicular fracture raising a concern of non-accidental trauma (NAT). Upon further review of the patient's history, it was noted that the mother was involved in a high- speed motor vehicle collision on the day of delivery. Review of the mother's body trauma computed tomography (CT) scan revealed that the injuries were, in fact, sustained in utero and obviating the need for further NAT work up and investigation. This case demonstrates forensic use of radiologic images to establish a diagnosis of an accidental trauma.

Background

A fair playground is absolutely necessary in any age limited sports. Age determination in countries where birth registration is not compulsory can often be difficult making it a challenge to determine ages of people born in such countries.

Objective

To determine correlation between chronological ages of under 17 Ghanaian footballers and the FIFA MRI grading.

Method

The degree of radial epiphyseal fusion was evaluated in 286 male Ghanaian footballers aged 13–16 years over a 4 year period (June 2012–November 2016) using 1.5 T Magnetic Resonance Imaging. The ages of the participants used in the study were those provided by the football players and confirmed with their national passports.

Results

Over 48% of these Ghanaian players below the age of 17 years had completely fused radial epiphysis. No significant correlation between the given chronological ages and the degree of fusion was found. The Spearmans correlation was given as (r = 0.069; p = 0.540).

Conclusion

There was no correlation between chronological age and degree of radial fusion among Ghanaian players. Normative study among Ghanaian/black African players is long overdue to ensure the U-17 players from these countries are not unfairly disadvantaged.