Oehmichen M, Gehl H-B, Meissner C, Petersen D, Höche W, Gerling I, König H G
Institute of Legal Medicine, University Hospital Schleswig-Holstein, Campus Lübeck, Kahlhorststrasse 31-35, 23562, Lübeck, Germany.
Acta Neuropathol. 2003 Jun;105(6):570-80. doi: 10.1007/s00401-003-0683-4. Epub 2003 Mar 8.
To determine the value of imaging procedures such as computer tomography (CT) and magnetic resonance imaging (MRI) of the head in providing additional information of forensic relevance, we examined 17 cadavers of human victims of gunshot wounds to the head. Three of the victims briefly survived the gunshot wound. The weapons involved were all guns with low muzzle energy (<550 J), i.e., handguns and low-velocity rifles. In the majority of cases ( n=15) a penetrating wound to the head was found, only two cases showed the bullet lodged in the brain. In some cases, imaging of the skull and brain was performed prior to autopsy; in others imaging took place after autopsy on the isolated, formalin-fixed brain. The imaging findings were correlated with the criminological data and the results of macroscopic and microscopic examination of the brain. The findings on the bony structures of the head provided imaging criteria for differentiation between entrance and exit of the gunshot wounds, which corresponded to the forensic pathological findings at autopsy. CT scans and MRI of the cerebral parenchyma revealed lanes of opaque bone and missile fragments along the course of the missile, which allowed recognition of the missile track in 3D reconstruction. Biometric reconstruction allowed easy determination of the angle of the missile track in all three planes. Examination of the parenchymal structures and imaging of the isolated, formalin-fixed brain enabled tracking of the missile path directly along the zone of destruction as well as demonstration of secondary changes such as air bubbles along the bullet course, hemorrhage and edema. The significance of a translucent zone surrounding the missile track in several cases remains unclear; it probably represents tissue destruction secondary to temporary cavitation. The imaging procedures described here allowed excellent documentation of in situ conditions, while the storing of data enabled biometric reconstruction for determination of the angle of trajectory, of entrance and exit wounds, and the extent of tissue damage along the missile track and, possibly, in the zone of temporary cavitation.
为了确定头部计算机断层扫描(CT)和磁共振成像(MRI)等成像检查在提供法医相关额外信息方面的价值,我们检查了17例头部枪伤人类受害者的尸体。其中3名受害者在枪伤后短暂存活。涉案武器均为枪口能量较低(<550焦耳)的枪支,即手枪和低速步枪。在大多数案例(n = 15)中发现头部有贯通伤,只有2例显示子弹嵌于脑内。在一些案例中,颅骨和脑部成像在尸检前进行;在其他案例中,成像在尸检后对分离的福尔马林固定脑进行。成像结果与犯罪学数据以及脑部大体和显微镜检查结果相关。头部骨质结构的检查结果为区分枪伤入口和出口提供了影像学标准,这与尸检时的法医病理学发现相符。脑实质的CT扫描和MRI显示沿弹道有不透明骨条带和导弹碎片,这使得在三维重建中能够识别导弹轨迹。生物测量重建能够轻松确定导弹轨迹在所有三个平面的角度。对实质结构的检查以及对分离的福尔马林固定脑的成像能够直接沿着破坏区域追踪导弹路径,并显示诸如沿子弹路径的气泡、出血和水肿等继发性改变。在几个案例中围绕导弹轨迹的半透明区域的意义仍不清楚;它可能代表继发于暂时空化的组织破坏。本文所述的成像检查能够很好地记录原位情况,而数据存储则能够进行生物测量重建,以确定轨迹角度、入口和出口伤口以及沿导弹轨迹以及可能在暂时空化区域内组织损伤的程度。