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。     

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。     

MSCT鉴定交通事故致死2例分析

目的使用多层螺旋CT(multi-slice spiral computed tomography,MSCT)对交通事故的致伤特征进行观察和分析,探讨MSCT在分析交通事故中的应用价值。方法以2例交通事故为对象,运用MSCT平扫、三维重建技术以及心脏穿刺造影技术对尸体进行全面检查,结合尸表检查分析交通伤形成机制等特点。结果案例1 MSCT结合心脏穿刺造影,发现死者右心破裂,死亡原因为交通事故挤压胸部致右心破裂、心脏压塞。案例2 MSCT发现左侧躯干部损伤引起脾破裂、腹腔出血,死亡原因为失血合并创伤性休克。结论 MSCT对于骨骼损伤、软组织损伤、血液改变均具有良好的观察效果,MSCT平扫结合心脏造影有助于诊断心血管系统的损伤。     

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。     

52例交通事故颅骨骨折尸检与MSCT比对分析

目的探讨头颅多层螺旋扫描CT(Multi-slice Spiral Computed Tomography,MSCT)在道路交通事故颅脑损伤案件中颅骨骨折检验分析的应用价值。方法收集中国刑事警察学院司法鉴定中心2015年至2017年交通事故致颅脑损伤伴颅骨骨折死亡案件52例(包括案情、受伤过程、尸体检验、头颅MSCT及临床资料)。影像学诊断同头颅解剖阳性所见比对验证。结果头颅暴力作用部位以颅前部、颅侧部和面颅部受力容易出现颅底骨折,颅前窝、颅中窝部位骨折MSCT检验准确率低于颅后窝骨折线的检验。结论头颅MSCT对于颅骨骨折类型判断存在一定的局限性,尸检与影像学结合及三维影像重建的使用是有必要的。     

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。     

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。     

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。     

脊柱损伤三项检查的作用探讨(附12例分析)

CT、MRI和诱发电位三项检查对脊柱损伤具有一定的针对性。笔者通过对去年的十二例脊柱损伤案例进行回顾分析，可以说明三项检查在脊柱损伤的法医学鉴定中有着不可替代的作用。一股资料十二例脊柱损伤中，男性7例，女性5例，年龄范围为23～51岁，坠落伤4例，砸伤4例，撞伤1例，其他损伤3例，12例损伤首选做X线检查。其中颈椎损伤2例，X线检查示颈椎变直，CT检查颈椎间盘突出和颈椎骨折，谁管变窄，MRI检查发现局部脊髓损伤的表现即脊髓明显萎缩及增粗改变，诱发电位检查结果和截瘫反映的症状相符。其余8例胸、腰椎损伤中，X线检查多数…     

利用体视数码显微镜观察分离型舌骨1例

1案例资料 1.1案例来源 韩某,男,59岁,尸体被发现浮于重庆某区水塘内,高度腐败,解剖中发现左侧舌骨大角与舌骨体连接处不连续、可活动,疑似骨折。因高度腐败颈部皮肤及肌肉等软组织难以认定是否有损伤、出血。经硅藻等检验分析死因为溺死。     

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.     

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。     

溺死诊断中浮游生物检验方法的研究现状及进展

法医学实践中,判断是否为生前溺死是法医学尸检及鉴定工作中的一个重点和难点,目前尚无能明确诊断溺死的生物学和法庭化学指标。在溺死案件的诊断中,浮游生物检验是常见的方法。尽管目前还存在一些争议,但国内法医工作者认为,器官组织中浮游生物的存在仍然是判断生前溺死的重要证据之一。本文就国内外有关浮游生物的检验方法、检验标准及检验结果的判定等研究现状作一综述,旨在使人们更加清晰地认识浮游生物检验在溺死诊断中的作用。     

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.     

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.     

溺死诊断中浮游生物检验方法的研究现状及进展

法医学实践中,判断是否为“生前溺死”是法医学尸检及鉴定工作中的一个重点和难点,目前尚无能明确诊断溺死的生物学和法庭化学指标。在溺死案件的诊断中,浮游生物检验是常见的方法。尽管目前还存在一些争议,但国内法医工作者认为,器官组织中浮游生物的存在仍然是判断生前溺死的重要证据之一。本文就国内外有关浮游生物的检验方法、检验标准及...     

Charred body: virtual autopsy with multi-slice computed tomography and magnetic resonance imaging

The correct examination of a charred body is a forensic challenge. Examination, interpretation, and conclusion in respect to identification, vital reactions, toxicological analysis, and determining cause and manner of death are all more difficult than without burns. To evaluate what can be seen in the case of a charred body, we made an examination with the new radiological modalities of cross-section techniques, via multi-slice Computed Tomography (MSCT) and Magnetic Resonance Imaging (MRI), prior to performing the classical forensic autopsy. In a charred body case of a single motor vehicle/fixed object collision with a post crash fire, the radiological methods of MSCT and MRI made it possible to document the injuries caused by burn as well as the forensic relevant vital reactions (air embolism and blood aspiration). In conclusion, we think postmortem imaging is a good forensic visualization tool with a great potential for the forensic documentation and examination of charred bodies.     

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。     

Virtual autopsy and forensic anthropology of a mummified fetus: a report of one case

A jar containing the mummified body of a fetus was found in a bush near a building. Full-body multislice computed tomography (MSCT) was performed prior to autopsy to study the bones and internal organs. Age was estimated by measuring femoral and tibial lengths and examining the temporal and occipital bones. The results were then compared with the autopsy and histopathological findings. MSCT was superior to autopsy for examination of the bones and internal organs. Autopsy was difficult because of the fragility of the dried corpse. MSCT determined the gestational age of the fetus and excluded skeletal abnormalities. Estimated age was similar with the two methods used. However, the major advantage of MSCT was rapid measurement of bones or anatomical regions which are difficult to examine during autopsy and which required specific preparation for further anthropological study. This case report illustrates the possibilities offered by MSCT for studying mummified bodies, even fetuses.