Stein Kirsten Marion, Ruf Katharina, Ganten Maria Katharina, Mattern Rainer
Institut für Rechts- und Verkehrsmedizin der Universitätsklinik Heidelberg, Abteilung Postmortale Computertomographie, Vossstrasse 2, 69115 Heidelberg, Germany.
Forensic Sci Int. 2006 Nov 10;163(1-2):93-101. doi: 10.1016/j.forsciint.2005.11.015. Epub 2005 Dec 20.
The postmortem diagnosis of shaken baby syndrome, a severe form of child abuse, may be difficult, especially when no other visible signs of significant trauma are obvious. An important finding in shaken baby syndrome is subdural haemorrhage, typically originating from ruptured cerebral bridging veins. Since these are difficult to detect at autopsy, we have developed a special postmortem computed tomographic (PMCT) method to demonstrate the intracranial vein system in infants. This method is minimally invasive and can be carried out conveniently and quickly on clinical computed tomography (CT) systems. Firstly, a precontrast CT is made of the infant's head, to document the original state. Secondly, contrast fluid is injected manually via fontanel puncture into the superior sagittal sinus, followed by a repeat CT scan. This allows the depiction of even very small vessels of the deep and superficial cerebral veins, especially the bridging veins, without damaging them. Ruptures appear as extravasation of contrast medium, which helps to locate them at autopsy and examine them histologically, whenever necessary.
摇晃婴儿综合征是一种严重的虐待儿童形式，其尸检诊断可能具有挑战性，尤其是在没有其他明显重大创伤迹象的情况下。摇晃婴儿综合征的一个重要发现是硬膜下出血，通常源于脑桥静脉破裂。由于这些在尸检时很难检测到，我们开发了一种特殊的尸检计算机断层扫描（PMCT）方法来显示婴儿的颅内静脉系统。该方法微创，可在临床计算机断层扫描（CT）系统上方便快捷地进行。首先，对婴儿头部进行平扫CT，记录原始状态。其次，通过囟门穿刺将造影剂手动注入上矢状窦，然后重复CT扫描。这可以描绘出深、浅脑静脉中非常小的血管，尤其是桥静脉，而不会对其造成损伤。破裂表现为造影剂外渗，这有助于在尸检时定位它们，并在必要时进行组织学检查。
