骨折法医鉴定中多层螺旋CT（MSCT）重建技术的应用分析

目的探讨MSCT及后处理功能在法医鉴定中的应用方法。方法对366例法医鉴定者行MSCT薄层扫描并表面遮盖成像(SSD),透明化X线模拟投影(see-through)和多平面重建(MPR)处理。分析技术参数和应用方法。结果采集层厚1~3mm,重建间隔0.5~1mm。SSD重建366例,其中细小骨折显示欠佳,4例眼眶重建出现“假孔”。21例关节分解后关节面显示清晰。透明化X线模拟投影重建18例,准确鉴别新鲜与陈旧骨折。MPR重建366例,显示骨折326例。结论选择适宜的后处理技术并联合应用可更好的显示骨折,为法医鉴定提供高质量图像。     

多层螺旋CT、普通CT和X线在骨折法医学鉴定中的应用

目的比较多层螺旋CT（MSCT）、普通CT与X线3种检查法,评价它们在骨折法医鉴定中的应用价值。方法对366例受检者（已接受其他影像学检查）行MSCT薄层扫描并行SSD,透明化X线模拟投影和MPR处理。统计分析MSCT、CT常规与X线检查在各部位骨折中的诊断正确率和漏、误诊率并行χ2检验。结果鼻骨、肋骨、四肢及关节、眶骨、颅骨骨折MSCT诊断正确率明显高于普通CT或X线（P〈0.01）。MSCT与普通CT对脊柱骨折的诊断正确率无统计学差异（P〉0.05）。MSCT、普通CT与X线的总体诊断正确率分别为99.45%、70.27%和59.17%。常规CT、X线与MSCT诊断结果间存在显著统计学差异（P〈0.001）。结论MSCT对骨折的显示更准确,可作为法医鉴定的重要辅助检查手段。     

MSCT及图像后处理在鼻骨骨折法医鉴定中的应用

目的探讨多层螺旋CT(MSCT)及图像后处理在鼻骨骨折法医学鉴定中的应用价值。方法采用MSCT对134例被鉴定人进行薄层扫描并行多平面重建(MPR)和表面遮盖成像(SSD)。比较MSCT与常规X线诊断结果。结果线型骨折55(41.04%)例,粉碎型骨折46例(34.33%),凹陷型骨折27例(20.15%),未见骨折6例(4.48%)。X线平片及CR片漏、误诊48例(35.82%)。MSCT正确诊断133例(99.25%)。两者诊断结果存在显著差异(χ2=45.0816,P<0.001)。结论MSCT及后处理图像应作为鼻骨骨折法医鉴定的主要依据。     

多层螺旋CT及后处理技术在眼眶骨折法医鉴定中的应用

目的探讨MSCT及后处理技术在眼眶骨折法医鉴定中的应用价值。方法采用MSCT对98例法医鉴定者进行薄层扫描并行多平面重建(MPR)和表面遮盖成像(SSD)处理。比较MSCT与常规CT诊断结果。结果爆裂骨折51例(52.04%),直接骨折32例(32.65%),复合骨折11例(11.22%),未见骨折4(4.09%)例。常规CT漏、误诊32例(32.65%)。98例患者经MSCT检查明确诊断。二者诊断结果存在显著统计学差异(χ2=66.00,P<0.001)。结论MSCT及后处理技术在眼眶骨折法医鉴定中具有较高的实用价值。     

多层螺旋CT及后处理技术在眼眶骨折法医鉴定中的应用

目的 探讨MSCT及后处理技术在眼眶骨折法医鉴定中的应用价值。方法 采用MSCT对98例法医鉴定者进行薄层扫描并行多平面重建(MPR)和表面遮盖成像(SSD)处理。比较MSCT与常规CT诊断结果。结果 爆裂骨折51例(52．04％)，直接骨折32例(32．65％)，复合骨折11例(11．22％)，未见骨折4(4．09％)例。常规CT、误诊32例(32.65％)。98例患者经MSCT检查明确诊断。二者诊断结果存在显著统计学差异(x^2=66．00，P&lt;0．001)。结论 MSCT及后处理技术在眼眶骨折法医鉴定中具有较高的实用价值。     

骨折法医鉴定中常规X线与CT漏诊、误诊的技术因素分析

目的探讨X线平片和常规CT检查技术对骨折漏、误诊的影响。方法对366例已接受普通X线或常规CT检查的骨折法医鉴定者行MSCT扫描并行对照性研究。结果骨折法医鉴定中普通X线、常规CT漏、误诊率分别为40.83%和29.73%,存在显著统计学差异(x2=4.69,P<0.05)。二者漏、误诊病例中与技术因素相关者分别占66.29%和88.63%,亦存在显著统计学差异(x2=7.58,P<0.01)。结论普通X线与常规CT的设备和技术缺陷与失误是造成漏、误诊的重要因素。     

眼眶爆裂骨折的CT表现及法医学鉴定分析

目的研究眼眶爆裂骨折的CT表现特点及其法医学鉴定问题。方法对76例眼眶爆裂骨折的临床法医学鉴定案例进行回顾性分析、总结。结果单纯头部CT以及X线检查诊断眼眶爆裂骨折漏诊率较高,其中CT诊断阳性率高于X线;眼部CT检查是诊断眼眶爆裂骨折的首选方法。76例骨折中以眶内侧壁骨折多见,其次为眶下壁骨折。CT直接征象主要表现为眶壁骨质连续性中断和眶壁移位,间接征象主要为骨折处积血和软组织增厚;临床表现以眼周瘀斑、肿胀、视力下降及复视为主。眼眶爆裂骨折对伤眼视力影响不明显,患者伤后视力多在0.8以上,但是容易出现复视;损伤程度以轻伤为主。结论单纯头部CT及X线检查诊断眶壁爆裂骨折有局限性,对眼部损伤患者,建议法医鉴定时将眶部CT检查作为常规;眶壁骨折对伤眼视力影响不明显,但是容易出现复视,法医鉴定时应引起注意。     

骨折法医鉴定中常规X线与CT漏诊、误诊的技术因素分析

目的 探讨X线平片和常规CT检查技术对骨折漏、误诊的影响。方法 对366例已接受普通X线或常规CT检查的骨折法医鉴定者行MSCT扫描并行对照性研究。结果 骨折法医鉴定中普通X线、常规CT漏、误诊率分别为40.83%和29.73%，存在显著统计学差异（x^2=4.69，P＜0.05）。二者漏、误诊病例中与技术因素相关者分别占66.29%和88.63%，亦存在显著统计学差异（x^2=7.58，P＜0.01）。结论 普通X线与常规CT的设备和技术缺陷与失误是造成漏、误诊的重要因素。     

鼻骨骨折螺旋CT3D成像与X线片对比研究

目的 评价螺旋CT扫描三维重建成像与X线摄片对比对鼻骨骨折法医学鉴定的价值。方法 使用SOMATOM BALANCE 1s螺旋CT机，对32例复杂鼻部外伤者2mm／2mm扫描，常规进行最大密度投影法(MIP)、多平面重建(MPR)、表面覆盖法(SSD)、容积成像(VR)方式。全貌显示受伤鼻骨骨折影像，并与常规鼻骨摄片比较。结果 螺旋CT三维成像纠正3例X线照片的假阳性和6例诊断骨折类型不准确。结论 螺旋CT三维重建对诊断复杂鼻骨骨折块数目、移位，以及骨折类型优于X线摄片。     

多排螺旋CT在脊柱损伤法医学鉴定中的应用价值

脊柱及其所合并的脊髓损伤是导致严重伤残甚至死亡的最常见因素。X线检查由于在显示椎体骨折,尤其在了解脊髓情况方面存在一定局限性,不能完全满足临床诊断以及法医学鉴定的要求。而多排螺旋CT(multidetector spiral CT,MSCT)因其具有扫描速度快、空间分辨力高以及后处理功能强     

A post-processing technique for cranial CT image identification

Objective: A major challenge in radiographic identification is the inconsistent orientation between clinical (ante-mortem, AM) and post-mortem (PM) radiographs. The objectivity and accuracy of radiological identification would be greatly enhanced by post-processing techniques that allow quantitative comparison of PM CT data in the same orientation as the AM CT data. Methods: We applied a post-processing technique to reposition a multislice computed tomography (MSCT) scan for spatial registration with a CT radiograph from the same patient. A second set of MSCT images from different individuals served as the non-matched control group. The consistency in radiographic positioning eliminated subjectivity in the comparison and identification process because the radiograph superposition provided objective evidence that confirmed the identification with fine detail. Results: A quantitative comparison with statistical validation was achieved by measuring a set of 14 landmarks from the images. Discrimination of identity based on logistic regression analysis of the earlier CT patient scans (the AM group) versus subsequent MSCT scans (the PM group) was objective and reliable. Conclusion: This quantitative comparison depends less on subjective judgment and the experience of the examiner, and so may meet legal standards.     

Use of multislice computed tomography in disaster victim identification--advantages and limitations

After a mass fatality incident (MFI), all victims have to be rapidly and accurately identified for juridical reasons as well as for the relatives' sake. Since MFIs are often international in scope, Interpol has proposed standard disaster victim identification (DVI) procedures, which have been widely adopted by authorities and forensic experts. This study investigates how postmortem multislice computed tomography (MSCT) can contribute to the DVI process as proposed by Interpol. The Interpol postmortem (PM) form has been analyzed, and a number of items in sections D and E thereof have been postulated to be suitable for documentation by CT data. CT scans have then been performed on forensic cases. Interpretation of the reconstructed images showed that indeed much of the postmortem information required for identification can be gathered from CT data. Further advantages of the proposed approach concern the observer independent documentation, the possibility to reconstruct a variety of images a long time after the event, the possibility to distribute the work by transmitting CT data digitally, and the reduction of time and specialists needed at the disaster site. We conclude that MSCT may be used as a valuable screening tool in DVI in the future.     

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.     

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.     

无骨折脱位型颈脊髓损伤法医学鉴定25例分析

目的 探讨无骨折脱位型颈脊髓损伤案例中外伤与损害后果因果关系法医学鉴定的要点.方法 收集25例无骨折脱位型颈脊髓损伤的法医学鉴定案例资料,总结被鉴定人的年龄、致伤方式、影像学检查结果、自身颈椎退变情况、临床表现、主要诊疗情况、预后情况等,按照损伤与损害后果相关程度分为直接原因、主要原因、同等原因、次要原因、无原因进行伤...     

86例鼻部复合性骨折的法医鉴定

目的探讨鼻部复合性骨折的认定、分型和损伤程度的法医学鉴定。方法对86例鼻部复合性骨折鼻骨CT片(轴扫 冠扫)和有关病历资料进行观察分析。结果将86例伤者按骨折种类分成鼻骨并发鼻部非鼻骨骨折(81例)和鼻部非鼻骨复合性骨折(5例)两类,然后再进一步细分。结论86例伤者中轻伤80例(93%),轻微伤6例(7%)。鼻部复合性骨折的损伤程度评定关键在于应按照《人体轻微伤的鉴定》(GA/T146-1996)和《人体轻伤的鉴定(试行)》的有关规定或标准认定和分型,这样鉴定结论才会准确可靠。     

CT技术在法医人类学研究中应用的进展

近年来,将计算机断层扫描(CT)等影像学新技术应用于法医人类学个体识别的研究受到国内外法医人类学家的重视。CT具有清晰快速的成像能力以及强大的后处理功能,无需骨骼前处理就能提供高分辨率模型图像,对法医人类学具有重要的研究和应用价值。本文就CT技术在法医人类学研究中应用的进展进行综述,以期为相关研究和实践提供参考和借鉴。