Virtual anthropology and forensic identification: report of one case

A charred body was found after a fire in a house in a mountainous region of France. The body was severely burned and was not formally identified as the owner of the house. Autopsy was carried out to seek vital reactions and/or traumatic lesions and to identify the corpse. Before bone preparation and after autopsy, multislice computed tomography (MSCT) was performed in order to assess the potential of the technique for radiological anthropological bone identification. The challenge was to determine as accurately as possible the sex, age, ante-mortem stature and ethnic of the victim using both MSCT and conventional bone study. The results of the two techniques were compared. MSCT provided an answer to all the questions, whereas bone study did not. To the best of our knowledge, this case is the first to use MSCT for forensic anthropological study and illustrates the potential contribution of this technique in this field.     

Virtopsy,a new imaging horizon in forensic pathology: virtual autopsy by postmortem multislice computed tomography (MSCT) and magnetic resonance imaging (MRI)--a feasibility study

Using postmortem multislice computed tomography (MSCT) and magnetic resonance imaging (MRI), 40 forensic cases were examined and findings were verified by subsequent autopsy. Results were classified as follows: (I) cause of death, (II) relevant traumatological and pathological findings, (III) vital reactions, (IV) reconstruction of injuries, (V) visualization. In these 40 forensic cases, 47 partly combined causes of death were diagnosed at autopsy, 26 (55%) causes of death were found independently using only radiological image data. Radiology was superior to autopsy in revealing certain cases of cranial, skeletal, or tissue trauma. Some forensic vital reactions were diagnosed equally well or better using MSCT/MRI. Radiological imaging techniques are particularly beneficial for reconstruction and visualization of forensic cases, including the opportunity to use the data for expert witness reports, teaching, quality control, and telemedical consultation. These preliminary results, based on the concept of "virtopsy," are promising enough to introduce and evaluate these radiological techniques in forensic medicine.     

Image-guided virtual autopsy findings of gunshot victims performed with multi-slice computed tomography and magnetic resonance imaging and subsequent correlation between radiology and autopsy findings

Because the use of radiology in modern forensic medicine has been, until today, mostly restricted to conventional X-rays, which reduces a 3D body to a 2D projection, a detailed 3D documentation of a gunshot's wound ballistic effects was not possible. The aim of our study was to evaluate whether the progress in imaging techniques over the last years has made it possible to establish an observer-independent and reproducible forensic assessment using multi-slice computed tomography (MSCT) and magnetic resonance imaging (MRI) technologies for the documentation and analysis of gunshot wounds. The bodies of eight gunshot victims were scanned by MSCT and by MRI; the data of these imaging techniques were post-processed on a workstation, interpreted and subsequently correlated with the findings of classical autopsy. With the spiral CT and MRI examinations and the subsequent 2D multi-planar reformation (MPR) and 3D shaded surface display (SSD) reconstruction, the entire gunshot-created complex skull fractures and brain injuries (such as wound channels and deeply-driven bone splinters) could be documented in complete and graphic detail. CT and MRI also documented vital reaction to the gunshot by demonstrating air emboli in the heart and blood vessels and the classic pattern of blood aspiration to the lung. Gunshot residues deposited within and under the skin were visible. In conclusion, we think that the radiological methods of MSCT and MRI have the potential to become a routine "virtual autopsy" tool in the future. Bullets and relevant histological samples from specific sites then might be won in image-guided minimally invasive fashion via percutaneous biopsy. The rapid application of developing radiological methods may lead to new horizons in forensic documentation and intravital as well as postmortem examination.     

Virtopsy hemorrhage of the posterior cricoarytenoid muscle by blunt force to the neck in postmortem multislice computed tomography and magnetic resonance imaging

In forensic autopsies, one of the most important and common signs of violence to the neck is hemorrhages of the soft tissues. The Institute of Forensic Medicine in Bern evaluates the usefulness of postmortem multislice computed tomography (MSCT) and magnetic resonance imaging (MRI) of forensic cases prior to autopsy. The aim of this study was to prove the sensitivity of postmortem MSCT and MRI in the detection of hemorrhages of the neck muscles. A full body scan prior to and a detailed scan of the explanted larynx after autopsy were performed. MSCT detected multiple fractures of the larynx. Detailed MRI was able to demonstrate the hemorrhage of the left posterior cricoarytenoid muscle. The minor hemorrhage of the right posterior cricoarytenoid muscle could not be detected with certainty. Although more experience is required, we conclude that combined MRI and MSCT examination is a useful tool for documentation and examination of neck muscle hemorrhages in forensic cases.     

Post-mortem forensic neuroimaging: correlation of MSCT and MRI findings with autopsy results

Multislice-computed tomography (MSCT) and magnetic resonance imaging (MRI) are increasingly used for forensic purposes. Based on broad experience in clinical neuroimaging, post-mortem MSCT and MRI were performed in 57 forensic cases with the goal to evaluate the radiological methods concerning their usability for forensic head and brain examination. An experienced clinical radiologist evaluated the imaging data. The results were compared to the autopsy findings that served as the gold standard with regard to common forensic neurotrauma findings such as skull fractures, soft tissue lesions of the scalp, various forms of intracranial hemorrhage or signs of increased brain pressure. The sensitivity of the imaging methods ranged from 100% (e.g., heat-induced alterations, intracranial gas) to zero (e.g., mediobasal impression marks as a sign of increased brain pressure, plaques jaunes). The agreement between MRI and CT was 69%. The radiological methods prevalently failed in the detection of lesions smaller than 3mm of size, whereas they were generally satisfactory concerning the evaluation of intracranial hemorrhage. Due to its advanced 2D and 3D post-processing possibilities, CT in particular possessed certain advantages in comparison with autopsy with regard to forensic reconstruction. MRI showed forensically relevant findings not seen during autopsy in several cases. The partly limited sensitivity of imaging that was observed in this retrospective study was based on several factors: besides general technical limitations it became apparent that clinical radiologists require a sound basic forensic background in order to detect specific signs. Focused teaching sessions will be essential to improve the outcome in future examinations. On the other hand, the autopsy protocols should be further standardized to allow an exact comparison of imaging and autopsy data. In consideration of these facts, MRI and CT have the power to play an important role in future forensic neuropathological examination.     

Into the decomposed body-forensic digital autopsy using multislice-computed tomography

It is impossible to obtain a representative anatomical documentation of an entire body using classical X-ray methods, they subsume three-dimensional bodies into a two-dimensional level. We used the novel multislice-computed tomography (MSCT) technique in order to evaluate a case of homicide with putrefaction of the corpse before performing a classical forensic autopsy. This non-invasive method showed gaseous distension of the decomposing organs and tissues in detail as well as a complex fracture of the calvarium. MSCT also proved useful in screening for foreign matter in decomposing bodies, and full-body scanning took only a few minutes. In conclusion, we believe postmortem MSCT imaging is an excellent vizualisation tool with great potential for forensic documentation and evaluation of decomposed bodies.     

Virtopsy-postmortem multislice computed tomography (MSCT) and magnetic resonance imaging (MRI) in a fatal scuba diving incident

The body of a 44-year-old scuba diver was examined using postmortem multislice computed tomography (MSCT) and magnetic resonance imaging (MRI), and findings were verified by subsequent autopsy. The goal was to find out whether the important pathomorphological findings for the reconstruction of events and the identification of cause and manner of death could be identified using modem digital cross-sectioning techniques. The findings of a massive vital decompression with pulmonary barotrauma and lethal gas embolism were identified in the radiological images. MSCT and MRI were superior to autopsy in the demonstration of the extent and distribution of gas accumulation in intraparenchymal blood vessels of internal organs as well as in areas of the body inaccessible by standard autopsy.     

MRI detects hemorrhages in the muscles of the back in hypothermia

Morphological findings in death due to hypothermia are variable and predominantly unspecific. Goal of this study was to check the usefulness of post-mortem cross-sectional imaging methods in the diagnosis of externally invisible findings in death due to hypothermia. Three consecutive forensic cases that died due to hypothermia were examined using post-mortem multi-slice computed tomography (MSCT) and magnetic resonance imaging (MRI) prior to autopsy. MSCT excluded traumatic skeletal and fatty tissue injury. Using MRI, it was possible to detect hemorrhages within the muscles of the back in all three cases, a so far unknown finding in death due to hypothermia. MRI also allowed the detection of hemorrhages in the iliopsoas muscles. Wishnewsky spots remained radiologically undetected using the present examination techniques. In conclusion, hemorrhages of the muscles of the back might serve as a new sign of death due to hypothermia; however, additional studies on their specificity are necessary. Post-mortem MRI is considered as a good diagnosing tool for muscular hemorrhages, with a great potential for examination and documentation.     

Application of 3D documentation and geometric reconstruction methods in traffic accident analysis: with high resolution surface scanning, radiological MSCT/MRI scanning and real data based animation

The examination of traffic accidents is daily routine in forensic medicine. An important question in the analysis of the victims of traffic accidents, for example in collisions between motor vehicles and pedestrians or cyclists, is the situation of the impact. Apart from forensic medical examinations (external examination and autopsy), three-dimensional technologies and methods are gaining importance in forensic investigations. Besides the post-mortem multi-slice computed tomography (MSCT) and magnetic resonance imaging (MRI) for the documentation and analysis of internal findings, highly precise 3D surface scanning is employed for the documentation of the external body findings and of injury-inflicting instruments. The correlation of injuries of the body to the injury-inflicting object and the accident mechanism are of great importance. The applied methods include documentation of the external and internal body and the involved vehicles and inflicting tools as well as the analysis of the acquired data. The body surface and the accident vehicles with their damages were digitized by 3D surface scanning. For the internal findings of the body, post-mortem MSCT and MRI were used. The analysis included the processing of the obtained data to 3D models, determination of the driving direction of the vehicle, correlation of injuries to the vehicle damages, geometric determination of the impact situation and evaluation of further findings of the accident. In the following article, the benefits of the 3D documentation and computer-assisted, drawn-to-scale 3D comparisons of the relevant injuries with the damages to the vehicle in the analysis of the course of accidents, especially with regard to the impact situation, are shown on two examined cases.     

Fatal steamer accident; blunt force injuries and drowning in post-mortem MSCT and MRI

Steamer accidents, through contact with the bucket wheel, are very seldom today. No publication of such a kind of fatal accident could be found in literature. We present the case of a fatal steamer accident, in which the findings of a blunt traumatization of a person by the ship was completely documented by post-mortem combined multi-slice computed tomography (MSCT) and magnetic resonance imaging (MRI) examinations. A rupture of the aorta was detected using both radiological methods without use of radiopaque material. Radiological examination revealed a comminuted fracture of the thorax vertebrae at the same level as the aortic rupture. Injuries of the soft tissues of the back, caused by the bucket wheel of the steamer, were also diagnosed. In addition to the signs of blunt force trauma the findings of drowning such as an over inflation of the lungs, fluid in the stomach and duodenum were revealed. Furthermore, algological analysis detected diatoms in the lung tissue and blood from the left heart. Therefore, the cause of death was considered being a combination of fatal hemorrhage, caused by the aortic rupture, and drowning. We conclude that virtual autopsy using combined post-mortem MSCT and MRI is a useful tool for documentation, visualisation and analysis of the findings of blunt force trauma and drowning with a large potential in forensic medicine.     

放射影像学在颈部损伤尸体检验中的应用

多层面计算机断层成像(MSCT)和磁共振成像(MRI)对尸体骨骼系统和软组织损伤的诊断价值等同于传统的尸体解剖,运用在颈部损伤的尸体检验中可以弥补传统尸体解剖的某些不足,在某些特定的环境、腐败、烧焦或具有传染性的尸体检验中,MSCT和MRI联合使用可以作为机械性窒息、挥鞭样损伤、颈椎损伤及颈部血管损伤的可选择的法医学检查手段之一。     

Virtopsy--fatal motor vehicle accident with head injury

A man wearing no protective helmet was struck by a motor vehicle while riding a bicycle. He was loaded on his left side, and the impact point of his head was his occiput on the car roof girder. He was immediately transported to the general hospital, where he passed away. Postmortem examination using multi-slice computed tomography (MSCT) revealed an extensively comminuted fracture of the posterior part and the base of the skull. Observed were deep direct and contrecoup brain bruises, with the independent fractures of the roof of the both orbits. Massive subdural and subarachnoidal hemorrhage with cerebral edema and shifting of the mid-line towards left side were also detected. MSCT and autopsy results were compared and the body injuries were correlated to vehicle damages. In conclusion, postmortem imaging is a good forensic visualization tool with great potential for documentation and examination of body injuries and pathology.     

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。     

Adipocere in postmortem imaging using multislice computed tomography (MSCT) and magnetic resonance imaging (MRI)

A body was found in a local river almost completely converted into adipocere. The corpse was identified as a 78-year-old male who was missed for 13 months. It was assumed that he committed suicide by drowning. The postmortem imaging findings utilizing multislice computed tomography (MSCT) and magnetic resonance imaging (MRI) in this virtopsy case are presented with special focus on the radiologic appearance of adipocere. The loss of signal in MRI and hyperdensities in MSCT up to 1000 Hounsfield units, as well as the increased assessment of the intracranial structures compared with traditional autopsy, are presented.     

The Role of Forensic Anthropology in the Examination of the Daegu Subway Disaster (2003, Korea)*

Abstract: Meticulous recovery of victims in the Daegu subway disaster was possible, because charred and fragmented victims were left in situ. Because bodies were piled one over another within the train, appropriate methodology during the recovery was critical to identifying the victims. The disaster area was thoroughly documented with notes, photographs, and schematic drawings of the various locations. The recovery team, comprising two medical examiners and one forensic anthropologist, decided when charred body parts and cremated bones were linked to the same individual based on the anatomy and forensic anthropological examination. Without these recovery procedures, it would not have been possible to efficiently harvest representative DNA sample from most of the victims’ body parts. After the entire process of identification, 136 victims were positively identified, and six victims remained unidentified. This study supports the crucial role of forensic anthropologists in the recovery of victims, especially in fire scenes.     

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。     

3D surface and body documentation in forensic medicine: 3-D/CAD Photogrammetry merged with 3D radiological scanning

A main goal of forensic medicine is to document and to translate medical findings to a language and/or visualization that is readable and understandable for judicial persons and for medical laymen. Therefore, in addition to classical methods, scientific cutting-edge technologies can and should be used. Through the use of the Forensic, 3-D/CAD-supported Photogrammetric method the documentation of so-called "morphologic fingerprints" has been realized. Forensic, 3-D/CAD-supported Photogrammetry creates morphologic data models of the injury and of the suspected injury-causing instrument allowing the evaluation of a match between the injury and the instrument. In addition to the photogrammetric body surface registration, the radiological documentation provided by a volume scan (i.e., spiral, multi-detector CT, or MRI) registers the sub-surface injury, which is not visible to Photogrammetry. The new, combined method of merging Photogrammetry and Radiology data sets creates the potential to perform many kinds of reconstructions and postprocessing of (patterned) injuries in the realm of forensic medical case work. Using this merging method of colored photogrammetric surface and gray-scale radiological internal documentation, a great step towards a new kind of reality-based, high-tech wound documentation and visualization in forensic medicine is made. The combination of the methods of 3D/CAD Photogrammetry and Radiology has the advantage of being observer-independent, non-subjective, non-invasive, digitally storable over years or decades and even transferable over the web for second opinion.     

Postmortem diagnostics using MSCT and MRI of a lethal streptococcus group A infection at infancy: a case report

Postmortem cross-sectional imaging using multislice computed tomography (MSCT) and magnetic resonance imaging (MRI) was considered as a base for a minimal invasive postmortem investigation in forensic medicine such as within the Virtopsy approach. We present the case of a 3-year-old girl with a lethal streptococcus group A infection and the findings of postmortem imaging in this kind of natural death. Postmortem MSCT and MRI revealed an edematous occlusion of the larynx at the level of the vocal cords, severe pneumonia with atelectatic parts of both upper lobes and complete atelectasis of both lower lobes, purulent fluid-filled right main bronchus, enlargement of cervical lymph nodes and pharyngeal tonsils, and additionally, a remaining glossopharyngeal cyst as well as an ureter fissus of the right kidney. All relevant autopsy findings could be obtained and visualized by postmortem imaging and confirmed by histological and microbiological investigations supporting the idea of a minimal invasive autopsy technique.     

Pneumomediastinum and soft tissue emphysema of the neck in postmortem CT and MRI; a new vital sign in hanging?

Spontaneous pneumomediastinum commonly occurs in healthy young men or parturient women in whom an increased intra-alveolar pressure (Valsalva maneuver, asthma, cough, emesis) leads to the rupture of the marginal pulmonary alveoli. The air ascends along the bronchi to the mediastinum and the subcutaneous space of the neck, causing cervico-fascial subcutaneous emphysema in 70-90% of cases. Ninety-five forensic cases, including five cases of hanging, were examined using postmortem multi-slice computed tomography (MSCT) and magnetic resonance imaging (MRI) prior to autopsy until December 2003. This paper describes the findings of pneumomediastinum and cervical emphysema in three of five cases of hanging. The mechanism of its formation is discussed based on these results and a review of the literature. In conclusion, when putrefaction gas can be excluded the findings of pneumomediastinum and cervical soft tissue emphysema serve as evidence of vitality of a hanged person. Postmortem cross-sectional imaging is considered a useful visualization tool for emphysema, with a great potential for examination and documentation.