虚拟解剖技术在医疗纠纷尸体检验中的应用

目的探讨CT扫描技术在医疗纠纷死亡原因鉴定中的应用价值。方法在2017年7月至2018年12月间,对12例医疗纠纷案例行全身CT检验,比较CT影像诊断与解剖所见及生前与死后CT诊断的差异性,分析尸体的CT常规检验在病变与损伤的诊断方面的优势与劣势。结果 CT影像诊断与解剖所见比较显示,在密度改变差异大的病变和损伤的诊断方面CT检验存在优势,如肺不张、肺炎、钙化、骨折、出血等;生前与死后CT诊断的比较显示医疗纠纷案件的尸体保存都较为良好,死后CT扫描检验对生前疾病诊断具有意义。结论虚拟解剖技术在医疗纠纷尸体检验中有较高的应用价值,可在尸体解剖前为鉴定人提供有效信息,也可在无法进行解剖的情况下为死亡原因分析提供参考依据。     

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。     

基于PMCT的尸表检验骨折的灵敏度研究

目的 探究尸表检验用于骨折检查的灵敏度。方法 对满足研究条件的25例机械性损伤死亡案例进行回顾性研究。以全身尸体计算机断层扫描（post-mortem computed tomography,PMCT）检验的骨折检查结果为金标准，统计分析尸表检查对于不同解剖部位和不同骨折类型的灵敏度大小。结果 尸表检验仅发现不足1/2的骨折，且极易造成3个解剖部位（肩胛骨、椎骨和骨盆）和3种骨折类型（线状非完全性骨折、线状完全性骨折无错位和局部凹陷性骨折）的漏诊。结论 尸表检验用于骨折检查的灵敏度较低，引入现代尸体影像学检查可有效改善这一现状，以提升法医学尸体检案质量。     

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。     

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。     

虚拟解剖技术的应用研究进展

尸体解剖是法医学传统的、经典的技术手段,但由于需破坏尸体,尸体解剖有时会遭到抵制和排斥。虚拟解剖技术为法医学检验提供了一种非侵入性的检验途径,可客观准确地反映骨折、软组织损伤、创道、器官损伤等,为法医学鉴定实践提供直观有力的证据。本文综合国内外最新文献资料,从虚拟解剖在法医损伤鉴定、机械性窒息、溺死、高低温死亡、疾病诊断及其在法医有限元损伤研究中的应用等方面进行综述,阐述了这一新的法医学研究方向。     

CT技术在尸体检验中的应用

自1990年CT首次应用于死后尸体检验以来,不断有学者对其在全身尸体检验中的价值和优势进行探讨。CT用于解剖前的系统检验,对解剖有指导作用,可以与解剖所见互相印证,有时还能弥补解剖检验的不足。本文综述了CT技术在尸体检验中对死因分析、致伤方式推断和个体识别等方面的主要应用价值及其发展趋势,提示CT技术与其他学科联合应用将在法医病理学领域发挥更大的作用。     

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。     

152例火场尸体的法医学检验分析

目的 探讨火场尸体的法医学检验特点及其鉴定。方法 对86起火场中152例尸体的相关检验资料进行回顾性研究。结果 152例火场尸体,生前烧死109例,纵火焚尸38例,无明显高温作用的尸体5例。主要死因有“烧死综合征”100例,火场有毒气体中毒8例,机械性损伤32例(含高坠死4例),机械性窒息5例,电击、服毒各1例;不能确定死因5例。自杀5例,他杀40例,意外107例。在生前烧死尸体,87例呼吸道内有炭末沉着,71例皮肤局部烧伤边缘组织有红肿,46例检见水泡,17例有“闭眼反应”征象,大部分尸体血中HbCO浓度超过20％;纵火焚尸少见或不见上述改变。结论 检验火场尸体,根据烧死尸体征象和血中HbCO浓度检测,并结合火场勘验资料综合分析,其死因鉴定和死亡方式推断结论方能准确。     

Application of superimposition-based personal identification using skull computed tomography images

Superimposition has been applied to skulls of unidentified skeletonized corpses as a personal identification method. The current method involves layering of a skull and a facial image of a suspected person and thus requires a real skeletonized skull. In this study, we scanned skulls of skeletonized corpses by computed tomography (CT), reconstructed three-dimensional (3D) images of skulls from the CT images, and superimposed the 3D images with facial images of the corresponding persons taken in their lives. Superimposition using 3D-reconstructed skull images demonstrated, as did superimposition using real skulls, an adequate degree of morphological consistency between the 3D-reconstructed skulls and persons in the facial images. Three-dimensional skull images reconstructed from CT images can be saved as data files and the use of these images in superimposition is effective for personal identification of unidentified bodies.     

对冻死尸体血糖变化的研究

用分光光度计对10具冻死尸体、50具非冻死尸体、50名健康体检人的血糖及5只家兔冻死前后的血糖分别进行测定,测得的数据用统计学“方差分析”方法处理,结果为健康人男、女的血糖浓度、健康人与非冻死尸体血糖的浓度差异无显著性;冻死与非冻死血糖的浓度、冻死与健康人血糖的浓度差异有高度显著性;家兔在冻前与冻死后血糖浓度的差异有高度的显著性。结论为冻死尸体血糖明显升高,可以做为法医确定冻死的佐证之一。     

Morphology of acute lung injuries in mechanic trauma

The lungs from 60 subjects who had died of polytrauma were studied morphologically. The heads of the corpses were not injuried. The aim of the study was investigation of characteristics and time of development of structural changes associated with lung injury. Early structural changes in trauma were disorders of circulation including microcirculation, acute emphysema, distelectases and atelectases, injury of bronchial and bronchiolar mucosa. Pulmonary edema and systemic inflammatory reaction emerge in the first hours after trauma.     

Model for the prediction of mechanical asphyxia as the cause of death based on four biological indexes in human cardiac tissue

Determination of mechanical asphyxia as the cause of death has always been difficult for forensic pathologists, particularly when signs of asphyxia are not obvious on the body. Currently, depending on only physical examination of corpses, pathologists must be cautious when making cause-of-death appraisals. In a previous study, four biomarkers—dual-specificity phosphatase 1 (DUSP1), potassium voltage-gated channel subfamily J member 2 (KCNJ2), miR-122, and miR-3185—were screened in human cardiac tissue from cadavers that died from mechanical asphyxia compared with those that died from craniocerebral injury, hemorrhagic shock, or other causes. Expression of the markers correlated with death from mechanical asphyxia regardless of age, environmental temperature, and postmortem interval. However, a single biological index is not an accurate basis for the identification of the cause of death. In this study, receiver operating characteristic curves of the ΔCq values of the four indexes were generated. The diagnostic accuracy of the indexes was judged according to their area under the curve (DUSP1: 0.773, KCNJ2: 0.775, miR-122: 0.667, and miR-3185: 0.801). Finally, a nomogram was generated, and single blind experiment was conducted to verify the cause of death of mechanical asphyxia.     

Histopathologic criteria of primary and secondary brain stem lesions

The brain stems from 52 corpses were microscopically examined. These cases died as a result of closed head injuries, which were clinically diagnosed and/or diagnosed postmortem as primary brain stem lesions. The morphological changes in these cases were compared with morphological changes in the brain stems of corpses who died from cerebral hemorrhage with additional secondary brain stem lesions. The examinations revealed acidophilic necrosis of the vessel walls in brain stem hemorrhages with fibrin impregnation of the vessel walls. Fibrin penetration to the perivascular space was the basic morphological marker that helped to differentiate between these two groups of cases.     

Forensic medical estimation of acute blood loss based on morphologic and functional changes in the internal organs

The objective of the present work was to obtain histological and morphometric characteristics of internal organs available for forensic medical examination from 236 corpses of subjects aged between 23 to 48 years whose death was caused by acute blood loss following a mechanical injury and concomitant alcohol or drug intoxication. Diagnostic signs of acute blood loss have been identified that can be used by forensic medical experts to estimate the length of the terminal period and reveal characteristic features of blood loss associated with alcohol and drug intoxication.     

Traumatology of the traffic accident--dead people for the safety in traffic

Since 1970, traumatomechanics has been a focal point in research at the Institute for Legal Medicine and Traffic Medicine in Heidelberg. Here, the main topics are the understanding of the interrelation between mechanical strain and the resulting degree of injury; at the forefront of all interest is the determination of the mechanical resilience in humans, their organs and tissues. Important are not only the means, but likewise the individual strain tolerance and the causes for its variability. Their understanding leads to scientifically justifiable expert's reports. In safety research, these data are of major importance for the validation of crash-dummies and for the improvement of safety protection systems. Before this background, national and international institutions have supported numerous projects. With the help of 2 examples, the Thorax-Trauma-Index (TTI) and the synergy between safety belt and airbag, the relevance of these data for international regulatory provisions and the progress in safety practice are illustrated. Some traumatomechanical insights can only be gathered from human corpses. Legal prerequisites and ethical problems of experiments with corpses are discussed.     

Virtopsy: postmortem imaging of the human heart in situ using MSCT and MRI

The rapid further development of computed tomography (CT) and magnetic resonance imaging (MRI) induced the idea to use these techniques for postmortem documentation of forensic findings. Until now, only a few institutes of forensic medicine have acquired experience in postmortem cross-sectional imaging. Protocols, image interpretation and visualization have to be adapted to the postmortem conditions. Especially, postmortem alterations, such as putrefaction and livores, different temperature of the corpse and the loss of the circulation are a challenge for the imaging process and interpretation. Advantages of postmortem imaging are the higher exposure and resolution available in CT when there is no concern for biologic effects of ionizing radiation, and the lack of cardiac motion artifacts during scanning. CT and MRI may become useful tools for postmortem documentation in forensic medicine. In Bern, 80 human corpses underwent postmortem imaging by CT and MRI prior to traditional autopsy until the month of August 2003. Here, we describe the imaging appearance of postmortem alterations--internal livores, putrefaction, postmortem clotting--and distinguish them from the forensic findings of the heart, such as calcification, endocarditis, myocardial infarction, myocardial scarring, injury and other morphological alterations.     

Virtopsy: postmortem minimally invasive angiography using cross section techniques--implementation and preliminary results

Postmortem investigation is increasingly supported by Computed Tomography (CT) and Magnetic Resonance Imaging (MRI). This led to the idea to implement a noninvasive or minimally invasive autopsy technique. Therefore, a minimally invasive angiography technique becomes necessary, in order to support the vascular cross section diagnostic. Preliminary experiments investigating different contrast agents for CT and MRI and their postmortem applicability have been performed using an ex-vivo porcine coronary model. MSCT and MRI angiography was performed in the porcine model. Three human corpses were investigated using minimally invasive MSCT angiography. Via the right femoral artery a plastic tube was advanced into the aortic arch. Using a flow adjustable pump the radiopaque contrast agent meglumine-ioxithalamate was injected. Subsequent MSCT scanning provided an excellent anatomic visualization of the human arterial system including intracranial and coronary arteries. Vascular pathologies such as calcification, stenosis and injury were detected. Limitations of the introduced approach are cases of major vessel injury and cases that show an advanced stage of decay.