多层螺旋CT检查在尸体颈椎损伤中的应用

对需要在尸体检验时进行颈椎多层螺旋CT(MSCT)检查的情形进行讨论,研究利用MSCT对疑有颈椎损伤的尸体进行颈椎检查的方法,并对一例疑似颈椎损伤尸体的颈椎提取后进行MSCT检查。发现对疑似有颈椎骨折尸体提取颈椎进行MSCT检查,可以快速精确地显示颈椎的细微骨折及骨折的空间分布,从而推断致伤方式。解决了传统尸检中费时费力,容易漏诊和误诊的问题。     

MSCT鉴定高坠死亡1例分析

目的使用多层螺旋CT(multi-slice spiral computed tomography,MSCT)技术对高坠伤的损伤特征进行观察分析,并通过对高坠伤的分析和观察重建高坠过程,从而探讨MSCT在分析高坠伤案例中的应用价值。方法以真实的高坠伤案例为对象,分别运用MSCT平扫、三维重建技术对尸体进行全面检查,联合运用系统尸体解剖分析高坠伤死亡方式等特点,比较尸体解剖和MSCT在获取损伤信息方面的差异。结果MSCT扫描结合三维重建,发现全身多部位骨折以及肝破裂,尸体解剖与影像学检查结果相对应,推断死亡原因为高坠致全身多发伤。结论 MSCT在高坠伤案件致伤方式分析中可作为传统尸体解剖的补充手段。     

三维螺旋CT在机械性损伤尸体检验中的价值

目的应用三维螺旋CT对尸体进行检验,探索其对机械性损伤尸体的诊断能力及其优势,同时积累尸体CT检验的经验。方法对机械性损伤致死的10例尸体在解剖前行全身CT检验,随后在CT诊断的指导下进行尸体解剖,比较两者在损伤的诊断、显示效果方面的差异。结果尸体CT检验可以清晰显示身体各部位骨折及体腔内出血的三维形态特征,而且可以敏感的检查到全身各部位的积气,对于非常规解剖暴露的部位,在解剖前行CT检验可减少骨折的漏诊;对软组织内出血、器官破裂等未能形成明显X线密度差异的损伤,CT检验效果欠佳。结论对机械性损伤尸体的检验,CT有其特殊的价值,可作为尸体解剖前有效的补充,避免损伤的漏诊;对于某些无法进行尸体解剖的案件,CT检验所见可作为死亡原因判断以及致伤方式推断的参考依据。     

放射影像学在法医学尸体检验中的应用

随着放射影像学诊断技术的发展和成熟,X线检查、计机断层成像(CT)、磁共振成像(MRI)等临床诊断技术也临床法医学活体损伤鉴定中广泛应用,为科学、准确的定提供了精确可靠的检查手段。尽管放射学几乎自其发初始就成为法医学的检查手段的一部分,然而这些技术法医病理尸体检验中却一直处于被忽略的地位[1],把放影像学诊断技术用于尸体检验中仍然处于探索阶段,在国鲜有这方面的相关报道。可喜的是,在法医学实践中,放射影像学诊断技术作为法医病理学的检验手段正日受到重视,在尸体个人识别、组织器官的损伤、死亡原因鉴定中发挥重要作用[1],其…     

影像学技术与尸体解剖在致伤方式鉴定中的应用比较

目的探讨影像学技术在法医学死因鉴定、致伤方式分析研究中的应用范围。方法以真实高坠死亡案例为研究对象,分别运用多层螺旋CT平扫、三维重建和磁共振成像技术对尸体进行全面检查,随后即行系统尸体解剖,分别比较影像学技术与尸体解剖在关键信息和细节信息获取方面的优点和不足。结果对于损伤死亡案例,影像学技术可以收集损伤、骨折、出血等关键信息,且具有预先探知、显示非常规解剖部位微小损伤等优点,对于细节问题显示尚存在不足,某些技术的法医学应用尚需进一步磨合。结论影像学技术应用可在致伤方式鉴定中作为法医尸体解剖的指导和补充,在特定情况下可起到一定的替代作用。     

多层螺旋CT在交通事故损伤生物力学分析中的应用

目的探讨多层螺旋CT(multi-slice computed tomography,MSCT)及三维重建技术在交通事故损伤生物力学分析方面的应用价值。方法以真实案例为基础,通过MSCT扫描获得尸体断层影像,进行三维图像重建,结合尸体解剖、车辆勘验等结果综合分析交通事故撞击、碾压和挤压等行为方式中的生物力学过程,并与尸体解剖结果进行对比。结果 MSCT和三维重建获得了不同受力部位骨折的位置、骨折线走向以及骨内碎裂状况等原位特征,其对于骨折的精细还原优于尸体解剖。结论 MSCT和三维重建技术在原位特征的再现、图像的易操作性以及证据的保全等方面凸显优势,可对道路交通事故损伤生物力学分析起补充和引导作用。     

法医学鉴定中的颅脑损伤MRI诊断

正法医学鉴定中,对颅脑损伤进行明确的诊断。磁共振成像(MRI)具有独特的优势。MRI可以清晰显示脑的三种基本组织,即灰质、白质与脑脊液,能分辨出脑干内的灰质核团,不受骨质伪影和部分容积效应的干扰,清楚显示幕下和脑干的损伤。随着MRI技术的进步,已证实MRI对于脑细胞微结构的损伤,特别是弥漫性轴突损伤、胼胝体损伤、皮质及皮质下灰     

法医学鉴定中的颅脑损伤MRI诊断

法医学鉴定中,对颅脑损伤进行明确的诊断。磁共振成像(MRI)具有独特的优势。MRI可以清晰显示脑的三种基本组织,即灰质、白质与脑脊液,能分辨出脑干内的灰质核团,不受骨质伪影和部分容积效应的干扰,清楚显示幕下和脑干的损伤。随着MRI技术的进步,已证实MRI对于脑细胞微结构的损伤,特别是弥漫性轴突损伤、胼胝体损伤、皮质及皮质下灰     

道路交通事故死者MSCT扫描与尸体解剖结果的比较

目的使用多层螺旋CT(MSCT)对道路交通事故中死者的损伤进行观察分析,探索MSCT在道路交通事故鉴定中的应用价值。方法对10例道路交通事故死亡者进行全身MSCT扫描,随后进行系统尸体解剖,并将两者的结果进行对比,分析两者在获取交通事故损伤信息方面的优点和不足。结果 MSCT可以清晰显示身体各部位骨折三维形态特征,并可检查到全身各部位的积气,相对于尸体解剖优势明显;但对于器官和软组织损伤的检测,MSCT的分辨率有限。结论对于道路交通事故死者,确定死亡方式和死亡原因的最好方法是联合进行MSCT检查和尸体解剖。     

尸体靶向心脏冠状动脉造影在诊断冠心病猝死中的应用

目的 应用靶向心脏冠状动脉死后计算机体层成像血管造影（postmortem computed tomography angiography,PMCTA）方法 对冠状动脉狭窄进行诊断,探索其对冠心病猝死的诊断价值。方法 选用鉴定实践中的6例死亡案例,用5F猪尾型导管经股动脉入路高压注射对比剂碘海醇,获取冠状动脉影像学数据并处理分析,将冠状动脉靶向显影及冠状动脉钙化积分与常规尸体解剖、组织病理学检验结果 进行比较。结果 尸体解剖和组织病理学检验存在冠状动脉狭窄的病例在靶向心脏冠状动脉造影中均得到相似的结果 ,诊断吻合率达83.3%。靶向心脏冠状动脉造影方法 可以有效显示心脏冠状动脉病变,冠状动脉钙化积分与常规尸体解剖、组织病理学检验结果 具有一致性。结论 靶向心脏冠状动脉造影技术在冠心病猝死案件中可以作为常规尸体检验的有效辅助手段。     

Contributions from Forensic Imaging to the Investigation of Upper Cervical Fractures

Abstract: Injuries to the upper cervical spine (UCS) are common in traumatic deaths and postmortem computed tomography (PMCT) may contribute to the forensic investigation. This study presents PMCT in comparison with autopsy in the examination of UCS injury. Thirteen consecutive cases with UCS fracture and/or cranio‐cervical dislocation were examined with PMCT and autopsy, and the findings were correlated. Neither of the techniques identified all UCS injuries. Fractures of atlas and axis were best visualized with PMCT whereas cranio‐cervical dislocation was better identified during autopsy. Serious injuries were present after both high‐ and low‐energy trauma. Medico‐legal autopsy in combination with PMCT produced a thorough evaluation of UCS injuries. By combining these procedures detailed investigations, including accident reconstruction and injury pattern analysis, can be performed. This study supports the routine application of PMCT, as a supplement to the medico‐legal autopsy of deaths with UCS injuries.     

Cervical Arterial Injury After Strangulation—Different Types of Arterial Lesions

After strangulation, cervical arterial injuries (CAI) are uncommon. We report three unusual cases where strangulation induced immediate stroke. CAI were examined using brain CT scan and Doppler ultrasonography in the three cases and then by autopsy in one of the victims. One of the two victims who survived the attempted strangulation had a unilateral carotid dissection, whereas in the other victim, no arterial dissection or thrombosis was observed. As regards the deceased victim, the autopsy confirmed the bilateral dissection showed on CT scan and Doppler ultrasonic examination and revealed that both carotid arteries were dilated up to two times the normal diameter. Microscopic examination showed a major bilateral hemorrhagic dissection of the media with obliterating fibrous endarteritis lesions associated with inflammatory damage. CT scan with arteriography does not demonstrate all the different types of arterial injury, particularly atheromatous embolism, direct compression, or prolonged spasm. Thus, traditional autopsy remains an essential forensic tool after strangulation to show the type of CAI.     

Pathologic evaluation of the cervical spine following surgical and chiropractic interventions

When patients die after chiropractic or surgical interventions of the cervical spine, pathologists tasked with the autopsy are frequently overwhelmed by the complicated anatomy, laborious dissections, complex operative procedures and surgical hardware, and the necessity to differentiate artifacts from trauma and disease. However, abundant data can be obtained from careful evaluation of the cervical spine in situ; extensive postmortem diagnostic imaging procedures; detailed dissections of the removed, formalin-fixed and decalcified spine; and histology. This study presents a regimented, stepwise approach to the evaluation of the cervical spine in these difficult cases, promotes uniform assessment, facilitates diagnoses, and supports the accumulation of otherwise hard-to-come-by reference material that can be of value in future cases. The resultant detailed autopsy findings may prove useful in the medico-legal death investigation process. Autopsy findings may also be of great value to health care providers involved in quality assurance processes.     

Observational Case Series: An Algorithm Incorporating Multidetector Computed Tomography in the Medicolegal Investigation of Human Remains after a Natural Disaster

An algorithm incorporating multidetector computed tomography (MDCT), digital radiographs, and external examination was used to triage cases for noninvasive or complete autopsy after a natural disaster. The algorithm was applied to 27 individuals who died during or soon after the earthquake that struck the Republic of Haiti on January 12, 2010. Of the 27 cases reviewed, 7 (26%) required a complete autopsy to determine cause and manner of death. In the remaining 20 (74%), cause and manner of death were determined with a reasonable degree of medical certainty after review of circumstances, an external examination, and postmortem imaging by MDCT and digital radiography (noninvasive autopsy). MDCT was particularly useful in detecting skeletal fractures caused by blunt force injury which were not evident on digital radiographs. The algorithm incorporating postmortem MDCT can be useful in the triage of human remains for autopsy after a natural disaster.     

Causes and Mechanisms of Death in Fatal Water Buffalo Attacks

Deaths due to buffalo attack have not been well described. A 72‐year‐old man was trampled by a water buffalo (Bubalus bubalis) while attempting to move the animal within an enclosed area at an abattoir. At autopsy, there were numerous injuries involving the chest, head, neck, and left upper arm. Blunt force injury had resulted in multiple rib fractures with a flail chest and fracture/dislocation of the mid‐cervical vertebrae caused either by physical crushing by the animal against the walls of the enclosure or by stomping. There was also evidence of crush asphyxia with bilateral conjunctival hemorrhages and petechial hemorrhages. In addition, there was a deep degloving injury of the upper left arm compatible with goring by one of the buffalo horns. While large animal attacks may result in death from multiple injuries, careful dissection and examination of specific injuries at autopsy may clarify the complex interaction of lethal mechanisms.     

The Role of Postmortem Computed Tomography in the Evaluation of Strangulation Deaths

We explored the value of postmortem computed tomography (PMCT) to augment autopsy in evaluating strangulation fatalities. A literature search identified 16 studies describing autopsy findings in 576 deaths and two studies describing autopsy and PMCT findings in six deaths. Similar cases were identified from our institution, yielding 130 deaths with autopsy findings and 14 deaths with both autopsy and PMCT findings. The presence of laryngohyoid fracture and soft tissue hemorrhage was compared from autopsy and autopsy+PMCT cases. The detection rates of fractures in autopsy and autopsy+PMCT cases were not significantly different. PMCT identified all fractures observed at autopsy and five fractures not identified. While PMCT may not detect soft tissue injuries in decomposed remains or subtle internal hemorrhages in neck injury, it is equally able to detect bony injuries as autopsy and might surpass autopsy in detecting subtle fractures. We conclude PMCT is useful to supplement autopsy in strangulation cases.     

多层螺旋CT与三维重建技术在法医损伤学中的应用

影像学技术发展迅速．已经成为临床诊断、治疗不可或缺的有效工具。利用MSCT与三维重建技术进行虚拟解剖,因为具有非破坏性、可显示特殊部位损伤形态、分析快速且便捷、便于证据保存和出示等特点在法医学尸体解剖中日益凸显优势．在法医损伤学研究及实践鉴定过程中具有较高的应用价值。文章综述了利用MSCT与三维重建技术在锐器伤、钝器伤、高坠伤、交通伤等实践领域的研究成果,并通过实践检案中遇到的典型案例,探讨多层螺旋CT与三维重建技术在法医学损伤鉴定中的应用价值。     

Recognition of Skeletal Fractures in Infants: An Autopsy Technique

Abstract:  Complete recognition and documentation of injury pattern is crucial in the diagnosis of child abuse. Skeletal fractures regarded as highly specific to nonaccidental injury in infants include posterior rib, scapular, metaphyseal, and spinous process fractures. These injuries are often occult, especially when acute, to standard radiologic and autopsy procedures. The presented autopsy technique requires incising and reflecting skeletal muscles to expose the bones and costal osseous joints in situ , increasing the opportunity to recognize skeletal injury. Fractured or atypical appearing bones are removed and processed for complete evaluation. The bones are processed by macerating the soft tissue in a water soap bath at an elevated temperature. To aid in reconstruction of the decedent, long bones are replaced with wooden dowels and the chest cavity is packed with the organ bag. The technique is invasive and recommended for cases in which the pathologist has reasonable suspicion of acute or remote trauma.     

Cervical soft tissue emphysema in hanging--a prospective autopsy study

The underlying mechanism of cervical soft tissue emphysema (CSTE) in hanging remains unclear. The aim of this study was to determine the frequency of CSTE in cases of hanging. The sample included 83 deceased persons, average age 55.3 ± 17.9 years. CSTE was established in 44 cases. CSTE is presented as frothy air, soap bubble-like formations in superficial and/or deep connective tissue between the neck muscles up to the ligature mark, visible during gross neck examination, using special neck autopsy technique-preparation of the neck organs in layers. The interpretation of positive CSTE must be taken with caution: it could be an antemortem phenomenon possibly because of either Macklin Effect or direct or indirect trauma to the cervical airways, as well as an ante- or postmortem artifact.