A Method for Estimating Sex Using Metric Analysis of the Scapula*

Abstract: The most accurate and precise methods for the assessment of age and stature often require knowledge of sex. Thus, being able to correctly identify sex from skeletal remains is critical in the forensic context. The presence of the os coxae or skull can never be guaranteed, making the development of reliable methods of sex estimation using other skeletal elements necessary. Using a 724 individual calibration sample from the Hamann‐Todd collection, this study identifies sexual dimorphism in the human scapula, and presents a new five‐variable discriminant function for sex estimation. The overall accuracy of this method proved to be 95.7% on the cross‐validated calibration sample, 92.5% on an 80 individual test sample from the Hamann‐Todd collection, and 84.4% on a 32 individual test sample from the skeletal collection of the Wichita State University Biological Anthropology Laboratory. Additionally, a slightly less accurate two‐variable model was developed and has cross‐validated accuracy of 91.3%.     

Abdominal Stab Wounds with Tension Pneumopericardium Confirmed by Autopsy and Postmortem Computed Tomography

We present the first report of pneumopericardium observed by autopsy and on postmortem computed tomography (PMCT) images. The subject was a woman who died of self‐inflicted stab wounds to the abdomen. The PMCT scan revealed air in the pericardial sac, a “flattened heart” sign, and retroperitoneal hemorrhage. Medicolegal autopsy revealed two abdominal stab wounds near the xiphoid process that had cut the apical pericardium and adjacent diaphragm and liver. Examination of the open thorax confirmed that the pericardial sac was distended with air. The wound extended to the abdominal aorta, causing retroperitoneal hemorrhage. PMCT images showed that the pneumopericardial volume was 133 mL. We believe that cardiac tamponade occurred resulting from the tension pneumopericardium; however, the effects were mitigated by hypovolemia secondary to the retroperitoneal hemorrhage as well as obstructive shock. Therefore, the cause of death appears to have been low‐pressure cardiac tamponade.     

Postmortem Computed Tomography Findings of Upper Airway Obstruction by Food

Abstract: This study is a retrospective analysis of 14 cases with food bolus upper airway obstruction as the defined cause of death where both postmortem computed tomography and autopsy were performed. Three groups were defined by the images i.e., Type 1: foreign body situated between the oral cavity and oropharynx, while the epiglottis sits in normal position, Type 2: foreign body situated in the oropharynx just above the epiglottis pushing it posteriorly and obstructing the airway, and Type 3: foreign body obstructing the laryngeal inlet while pushing the epiglottis anteriorly. At the time of autopsy, foreign bodies were detected by pathologists, occasionally in a different position, presumably being dislodged in the act of organ removal especially for the “Type 1” pattern. CT imaging provides accurate interrogation of upper airway bolus obstruction prior to autopsy.     

Postmortem Computed Tomography in Firearm Homicides: A Retrospective Case Series,

Postmortem computed tomography (PMCT) is integrated into the evaluation of decedents in several American medical examiner offices and medicolegal death investigative centers in many other countries. We retrospectively investigated the value of PMCT in a series of firearm homicide cases from a statewide centralized medical examiner’s office that occurred during 2016. Autopsies were performed or supervised by board-certified forensic pathologists who reviewed the PMCT scans prior to autopsy. PMCT scans were re-evaluated by a forensic radiologist blinded to the autopsy findings and scored by body region (head–neck, thoracoabdominal, and extremities). Injury discrepancies were scored using a modified Goldman classification and analyzed with McNemar’s test. We included 60 males and 20 females (median age 31 years, range 3–73). Based on PMCT, 56 (79.1%) cases had injuries relevant to the cause of death in a single body region (24 head–neck region, 32 thoracoabdominal region). Out of these 56 cases, 9 had a missed major diagnosis by PMCT outside that region, including 6 extremity injuries visible during standard external examination. Yet all had evident lethal firearm injury. We showed that PMCT identifies major firearm injuries in homicide victims and excludes injuries related to the cause of death in other regions when a single body region is injured. Although PMCT has a known limited sensitivity for soft tissue and vascular pathology, it can be combined with external examination to potentially reduce or focus dissections in some of these cases depending on the circumstances and medicolegal needs.     

Age Estimation Based on Pulp Cavity to Tooth Volume Ratio Using Postmortem Computed Tomography Images

Pulp cavity size is known to decrease with age and can therefore serve as an indicator for age estimation. Here, we evaluated whether reconstructed images of multidetector‐row computed tomography (MDCT) acquired before forensic autopsy are useful for estimating age at death. Images of 136 mandibular first premolars obtained from bodies of known age at death were analyzed, and the volume of the regions corresponding to pulp cavity and that of the whole tooth were determined using a voxel counting function. The pulp cavity was clearly distinguishable from dental hard tissue on the reconstructed images when using a cutoff value of 1400 Hounsfield units. Regression analysis adjusted for sex showed that estimated age correlated significantly with the pulp cavity to tooth volume ratio (r = 0.76). MDCT is gaining more widespread use in forensic medicine, and analyzing dental images to obtain parameters for age prediction is a practical approach for postmortem identification.     

Postmortem Computed Tomography and Magnetic Resonance Imaging of Gunshot Wounds to the Neck

Postmortem magnetic resonance imaging (MRI) is rarely used for the radiologic assessment of gunshot injuries, although it has clear advantages over postmortem computed tomography (CT) with regard to the imaging of soft tissue injuries. Another benefit in using MRI is that lodged projectiles composed of nonferromagnetic material such as lead present only marginal metal artifacts compared with severe artifacts on CT. This case report presents CT and MRI findings in a case with two gunshot wounds to the neck: a perforating wound and a nonperforating wound with a lead bullet lodged in the cervical spine. The decedent underwent CT and MRI before the scheduled autopsy. A ring of radiopaque material under the dermis in the fatty tissue was identified at both entrance wounds on CT, which was indicative of contact shots. The perforating gunshot was clearly indicated on CT by bullet fragments along the wound channel through the perforated 6th cervical vertebra and the fractured cricoid cartilage at the exit wound. The second trajectory, however, was only assumed based on the presence of gunshot residues at the entrance wound and the position of the lodged bullet. The radiologic assessment was severely impeded by the metal artifacts on CT. Barely noticeable metal artifacts on MRI allowed for clear visualization of the soft tissue injuries and the ruptured medulla oblongata. Only MRI clarified the soft tissue injuries of the brainstem noninvasively, which could provide specific and graphic information on the rapidity of death and the incapacitation of the victim.     

The Lateral Angle Revisited: A Validation Study of the Reliability of the Lateral Angle Method for Sex Determination Using Computed Tomography (CT),

This article presents the results of a validation study of a previously published method of sex determination from the temporal bone. The purpose of this study was to evaluate the lateral angle method for the internal acoustic canal for accurately determining the sex of human skeletal remains using measurements taken from computed tomography (CT) scans. Previous reports have observed that the lateral angle size in females is significantly larger than in males. The method was applied to an independent series of 77 postmortem CT scans (42 males, 35 females) to validate its accuracy and reliability. The mean lateral angle of the internal acoustic canal was found to be larger in females (46.5°) than in males (43.4°). However, the difference was not statistically significant and the sex differences reported in previous studies were not substantiated. In light of the observed results, the lateral angle method appears to be of minimal practical use in forensic anthropology and archeology.     

Metric Assessment of the Pubic Bone Using Known and Novel Data Points for Sex Estimation,

Biological sex estimation of skeletal remains is essential in forensic and archaeological analyses. Anthropologists most often use the pelvis, which is the most sexually dimorphic element both morphologically and metrically. While nonmetric pubic bone features have been studied extensively, few metric studies have examined this individual bone for dimorphism. For this study, three observers examined three previously identified and ten novel measurements of the pubic body on a modern sample of isolated pubic bones from the Maricopa County Forensic Science Center (FSC), in Phoenix, Arizona (n = 400). A relationship between pubic body measurements and biological sex was demonstrated, with significant correlations. Discriminant function analyses found that five measurements, four of which were novel, discriminated between males (89%) and females (86%). Observer experience level did not significantly impact the results. These five measurements were reliable and show promise for inclusion in metric methods for assessment of sex.     

Bioelectrical Impedance as a Technique for Estimating Postmortem Interval,,

Estimation of postmortem interval (PMI) is a critical component of death investigation. A cadaver can be hypothesized to be a resistor–capacitor (RC) circuit the impedance (Z) of which changes in a quantifiable manner as the cadaver decomposes. This hypothesis was tested using bioelectrical impedance analysis (BIA) equipment to apply a current with a fixed amplitude at a single frequency to four cadavers over time and measuring two components of Z, resistance (R) and reactance (X_c). Quadratic regression analysis between Z and accumulated degree days (ADD) showed a statistically significant parabolic relationship. The parabolic relationship poses an initial challenge to the use of the method, and additional research is needed to address this issue. However, the results of the reported research support the hypothesis that Z measured using BIA has a relationship to PMI.     

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.     

Identification Using Frontal Sinus by Three‐Dimensional Reconstruction from Computed Tomography*

Abstract: Radiographs and computed tomography (CT) images have been increasingly applied and accepted in forensic sciences. Along with radiographs and CT images, the frontal sinus is often used for the individual identification because of its unique and unchangeable characteristics. The purpose of this study is to define the usefulness of three‐dimensional (3‐D) images of the frontal sinus for identification. CT images from 119 Korean cadavers were built up for 3‐D reconstruction and surveyed with 15 measurements. The total volume of the sinus, some nonmetric characteristics, and the bilateral asymmetry index in men differed significantly from those in women (p < 0.05). The digit codes, six sections and 10‐digit number, were almost able to accurately identify individuals (98%). This study showed a statistical difference between the sexes and classified the fused and prominent middle sinuses for the first time. This proposed method for identification is more accurate than those used in other studies.     

A Method for Estimating Sex Using the Clavicle,Humerus, Radius,and Ulna

Sex estimation from skeletal remains can be an important part of preliminary identification. The best source of information for estimating sex is the pelvis but it is not always available for analysis. For these cases, a probabilistic sex estimation method is presented using combinations of standard and alternative measurements of the clavicle, humerus, radius, and ulna. Various equations are developed that are not population specific and that are applicable in various recovery scenarios. The equations were tested using four independent samples (n > 370), including a forensic sample. Allocation accuracies vary by test sample and equation and are consistently good (87.4–97.5%) except for a sample of very small males that show the extreme effects of poverty and mortality bias. For many of the cases where allocation was incorrect, the probabilistic approach indicated that no confidence should be placed in the incorrect allocation and the unknown should be classified as sex indeterminate.     

256例命案尸体死亡时间推断的回顾性分析

目的探讨降低死亡时间推断误差的方法。方法收集常州市和南京市2003年1月一2013年1月256例已破命案．采用传统方法进行死亡时间推断,与破案后获得的实际死亡时间进行比较,并根据死亡时间进行分组,计算死亡时间推断准确率,分析判断错误原因。结果早期尸体死亡时间（≤12h和13～24h）推断准确率分别为90％、89％,晚期尸体死亡时间（1—7d、1～2周、3～4周、1～6个月、7～12个月和1～5年）的推断准确率随时间的延长下降,分别为79％、76％、83％、79％、60％和50％。推断方法不当、水中尸体、极端温度、客观依据不足、抛尸以及变动或破坏现场是影响死亡时间推断准确率的常见因素。结论综合参考多项指标可降低死亡时间推断的误差。     

Age at Death Estimation Using Multislice Computed Tomography Reconstructions of the Posterior Pelvis*

Abstract: Thanks to recent advances, computed tomography is now seen as a tool of great value in the field of physical anthropology. In this study, we focused on the posterior pelvis and the auricular surface and evaluated the accuracy of 3D reconstructions of the auricular surface, using a methodology derived from a previous study by Lovejoy et al. We also looked for trabecular bone criteria expressing age‐related changes. Forty‐six coxal bones were scanned, and scoring of macroscopic criteria showed a good agreement between 3D reconstructions and photographs, especially for transverse organization (k = 0.90). The changes occurring in the posterior part of the sacropubic trabecular bundle were evaluated on CT reconstructions via three new criteria, which exhibited a good intra‐ and inter‐observer agreement (k = 0.77–0.89), and were particularly useful in identifying older subjects. We concluded that these CT‐evaluated trabecular bone criteria are promising and yield useful information about age at death.     

The Use of CT Scans in Estimating Age at Death by Examining the Extent of Ectocranial Suture Closure

We examined the utility of CT scans in the evaluation of degree of ectocranial suture closure. Five cranial points (left and right midcoronal positions, left and right midlambdoidal positions, and the lambda) were evaluated in 231 CT scans using a three‐point scoring system (open, partial closed, and closed). The slice increment and thickness varied between three groups of the scans. The results showed a good correlation between degree of suture closure and increasing age in each group. Young individuals (<40 years) and old individuals (>60 years) could be clearly distinguished from the middle‐aged individuals. ANOVA test revealed no difference between two groups of scans and between left and right sides (p > 0.05). Interobserver agreement was good, especially considering the score by sides. The results of this study create the base for developing a robust and simple method to estimate the age at death using CT scans.     

An Analysis of Hounsfield Unit Values and Volumetrics from Computerized Tomography of the Proximal Femur for Sex and Age Estimation

Sex and age are two elements in the establishment of a biological profile for forensic identification. While the pelvic bones are the most ideal structures for sex estimation, the condition of a body is not always ideal due to the nature of death, such as in mass disasters, or postmortem processes. This study utilized CT scans and resultant 3D models of 100 male and 100 female adults of known ages ranging from 18 to 98 years old to collect volumetric and Hounsfield unit measurements of the proximal femur. Equations were created to establish logistic regression models for sex estimation and linear regression models for age estimation. The resultant sex estimation method had an accuracy of 93.5% and utilized the volume of the proximal femur. This study provides three linear regression models for age with an accuracy range of 86%–92% ±12 years. As imaging technologies are increasingly adopted for forensic purposes, the power of 3D data will provide the opportunity for more quantitative and reproducible analyses. The proposed method for sex and age estimation provides a reliable tool that can be utilized in both day-to-day casework and disaster victim identification.     

Metric Sex Determination of the Human Coxal Bone on a Virtual Sample using Decision Trees

Decision trees provide an alternative to multivariate discriminant analysis, which is still the most commonly used in anthropometric studies. Our study analyzed the metric characterization of a recent virtual sample of 113 coxal bones using decision trees for sex determination. From 17 osteometric type I landmarks, a dataset was built with five classic distances traditionally reported in the literature and six new distances selected using the two-step ratio method. A ten-fold cross-validation was performed, and a decision tree was established on two subsamples (training and test sets). The decision tree established on the training set included three nodes and its application to the test set correctly classified 92% of individuals. This percentage was similar to the data of the literature. The usefulness of decision trees has been demonstrated in numerous fields. They have been already used in sex determination, body mass prediction, and ancestry estimation. This study shows another use of decision trees enabling simple and accurate sex determination.     

Ontogeny of Size and Shape Sexual Dimorphism in the Ilium: A Multislice Computed Tomography Study by Geometric Morphometry

We studied sexually dimorphic differences in the ilium using geometric morphometric analysis of 10 osteometric landmarks recorded by multislice computed tomography, based on three‐dimensional reconstructions of 188 children (95 boys, 93 girls) of mixed origins living in the area of Toulouse, southern France, and ranging in age from 1 to 18 years. We used geometric morphometrics methodology first to test sexual dimorphism in size (centroid size) and shape (Procrustes residuals) and second to examine patterns of shape change with age (development) and size change with age (growth). On the basis of statistical significance testing, the ilium shape became sexually dimorphic at 11 years of age, although visible shape differences were observed as early as 1 year of age. There was no statistically significant difference in size between sexes. Trajectories of shape (development) and size (growth) differed throughout ontogeny and between sexes.     

Ontogeny of Size and Shape Sexual Dimorphism in the Pubis: A Multislice Computed Tomography Study by Geometric Morphometry

Few studies have been conducted to determine sex differences in the immature coxal bone and the results were often contradictory. The authors studied sexual dimorphic differences of the pubis using geometric morphometric analysis of five osteometric landmarks recorded by multislice computed tomography (MSCT), based on three‐dimensional reconstructions of 188 children (95 boys, 93 girls) living in the region of Toulouse, southwestern France, ranging in age from 1 to 18 years old. They used geometric morphometric methodology first to test sexual dimorphism in size (centroid size) and shape (Procrustes residuals) and second to examine patterns of shape change with age (development) and size change with age (growth). Based on statistical significance test results, the pubic shape became sexually dimorphic at 13 years old, although visible shape differences were observed as early as 9 years old. This work showed that the trajectories of pubis shape (development) and size (growth) differed throughout ontogeny and between sexes.