122例鼻部骨折X线和CT诊断的法医学分析

目的　探讨CT在鼻部骨折诊断中的优点。方法　观察 12 2例鼻损伤伤者的鼻部CT和普通X线片 ,对鼻部诸骨骨折进行对比分析。结果　 12 2例鼻部骨折 (鼻骨骨折 3 2例 ,上颌骨额突骨折 3 3例 ,鼻中隔骨折 9例 ,多发性骨折 48例 )均经CT认定。其中 40例因X线片漏诊直接通过高分辨率鼻骨CT薄层扫描认定 ;82例通过鼻骨侧位X线片显示有鼻部骨折 ,因存在骨折类型认定不准确和 /或有漏诊鼻部其它部位骨折可能 ,通过鼻骨CT认定。结论　鼻骨侧位X线片易漏诊、误诊鼻部骨折 ;鼻骨CT能避免鼻部诸骨骨折的漏诊及误诊 ,且骨折认定准确。     

An Assessment of the Skeletal Fracture Patterns Resulting from Fatal High (˃3 m) Free Falls

The injury patterns resulting from fatal high (?3 m) free falls have previously been documented in clinical and medico‐legal contexts; however, details relating specifically to the skeletal blunt force trauma (BFT) have been limited. This study aimed to augment what is known of the skeletal fracture patterns resulting from fatal high free falls. Skeletal trauma was analyzed from full‐body postmortem computed tomography scans of 95 individuals who died following a high free fall. Fracture patterns were documented using the five general anatomical regions, axial and appendicular regions, and postcranial unilateral and bilateral regions. Patterns were analyzed in the context of the extrinsic and intrinsic variables that may influence fractures using multiple logistic regression. Fracture patterns involved all aspects of the skeleton, with 98.9% exhibiting polytrauma, and were influenced primarily by the height fallen, manner of death, and landing surface. This improved understanding of fracture patterns will augment anthropological interpretations of the mechanism of BFT in cases of suspected high falls.     

Utilization of X‐ray Computed Tomography for the Exclusion of a Specific Caliber and Bullet Type in a Living Shooting Victim

A bystander claimed to have been shot by a police officer, and CT scans were used to match qualitative and quantitative aspects of the unremoved bullet with police issued 9 mm Luger ammunition. CT scan methodology proved a valid approach for the measurement of bullets based on calculated measurement capability and correlation with “gold standard” physical measurement by vernier caliper. Measurements regarding length and base diameter, as well as length/diameter ratio, were insufficient to unambiguously identify a specific caliber, or a bullet of specific mass within a caliber class. It was, however, possible to exclude a bullet of specific design and mass with well‐characterized precision and accuracy values under selected CT scan conditions. A 9 mm Luger bullet (115 gr FMJ RN) was excluded from involvement in a shooting based on qualitative bullet shape combined with length, base, and ratio measurements of the bullet in‐situ for the victim.     

Pericardial Cyst: Cause of Sudden Cardiac Death?

Cardiovascular disease is the leading cause of sudden death in the world. The etiology of sudden cardiac death involves a wide range of diseases, but seldom pericardial cysts. A pericardial cyst is an uncommon cyst usually located in the middle mediastinum and rarely in the posterior part. They are usually harmless and asymptomatic. Here, we present a case of a 63‐year‐old woman who presented with dyspnea and hoarseness, but died suddenly after a CT scan was attempted. The detailed forensic pathologic and histologic examination revealed a pericardial cyst located in the posterior mediastinum. Toxicology and biochemistry tests, including tryptase, found no competing cause of death.     

Sexual Dimorphism of Maxillary Sinus Dimensions Using Cone‐Beam Computed Tomography

Sex determination of unknown persons plays an important role in forensic medicine. Cone‐beam computed tomography (CBCT) is an excellent imaging modality for accurate measurement of maxillary sinus dimensions. This study aimed to evaluate whether maxillary sinus measurements on CBCT scans can be applied for sex determination. The width, length, and height of maxillary sinuses in CBCT images of 100 patients (50 males and 50 females) were measured. Student's t‐test and discriminant function analysis were used to compare differences in the measured parameters between males and females. The correct predictive accuracy rate of sex determination was 78% in females and 74% in males with overall accuracy of 76%. Based on discriminant analysis, the most pronounced variable in differentiation of sex groups was maxillary sinus height. This study suggests that maxillary sinus measurements can be valuable for sex determination in forensic investigation, especially for cases in which other traditional methods are not applicable.     

Fimag: The United Kingdom Disaster Victim/Forensic Identification Imaging System

Abstract:  Imaging is an integral diagnostic tool in mass fatality investigations undertaken traditionally by plain X-rays, fluoroscopy, and dental radiography. However, little attention has been given to appropriate image reporting, secure data transfer and storage particularly in relation to the need to meet stringent judicial requirements. Notwithstanding these limitations, it is the risk associated with the safe handling and investigation of contaminated fatalities which is providing new challenges for mass fatality radiological imaging. Mobile multi-slice computed tomography is an alternative to these traditional modalities as it provides a greater diagnostic yield and an opportunity to address the requirements of the criminal justice system. We present a new national disaster victim/forensic identification imaging system—Fimag—which is applicable for both contaminated and non-contaminated mass fatality imaging and addresses the issues of judicial reporting. We suggest this system opens a new era in radiological diagnostics for mass fatalities.     

Thyroid Cartilage Ossification and Multislice Computed Tomography Examination: A Useful Tool for Age Assessment?

Abstract: Many authors have studied the thyroid cartilage ossification process using radiographic features for age estimation of individuals. Their results were various: Sugiyama reported excellent correlation coefficients between ossification rates and civil age, unlike most other authors. We hypothesized that recent advances in imaging techniques would enable more precise evaluation of the ossification of the thyroid cartilage. We retrospectively analyzed the CT scans of 312 French patients using postprocessing software to examine the pattern of thyroid cartilage ossification, calculating the ossified volume of the cartilage on 3D reconstructions. Pearson’s correlation coefficients for volume were 0.73 for men and 0.75 for women (standard error 18.02 and 17.06), indicating considerable inter‐individual variability. Although a correlation between civil age and morphological changes was found, these methods based on thyroid cartilage ossification were not accurate enough for the assessment of individual age.     

螺旋CT重建在寰枢椎损伤法医鉴定中的应用

目的探讨螺旋CT重建技术对寰枢椎损伤的诊断价值。方法分析25例患者的螺旋CT重建图像,并与CT平扫、X线片比较。结果7例齿状突骨折中,X线显示4例,CT显示5例,CT重建确诊7例,且清楚显示骨折移位情况;6例X线、CT显示寰枢椎左右间隙不对称,通过CT重建排除寰枢关节半脱位;寰枢外侧关节脱位1例,CT重建可清楚显示,而X线片和CT平扫均未能显示;寰枢椎畸形3例,分别为齿状突、后弓缺如1例,齿状突发育不良2例,CT重建均能清楚显示,而X线、CT均误诊为齿状突骨折、寰枢椎半脱位。结论螺旋CT重建技术能够提供准确、完整的影像学信息,在寰枢椎损伤与畸形的诊断中具有重要应用价值。