Yen Kathrin, Lövblad Karl-Olof, Scheurer Eva, Ozdoba Christoph, Thali Michael J, Aghayev Emin, Jackowski Christian, Anon Javier, Frickey Nathalie, Zwygart Karin, Weis Joachim, Dirnhofer Richard
Institute of Forensic Medicine, University of Bern, 3012 Bern, Switzerland.
Forensic Sci Int. 2007 Nov 15;173(1):21-35. doi: 10.1016/j.forsciint.2007.01.027. Epub 2007 Feb 28.
Multislice-computed tomography (MSCT) and magnetic resonance imaging (MRI) are increasingly used for forensic purposes. Based on broad experience in clinical neuroimaging, post-mortem MSCT and MRI were performed in 57 forensic cases with the goal to evaluate the radiological methods concerning their usability for forensic head and brain examination. An experienced clinical radiologist evaluated the imaging data. The results were compared to the autopsy findings that served as the gold standard with regard to common forensic neurotrauma findings such as skull fractures, soft tissue lesions of the scalp, various forms of intracranial hemorrhage or signs of increased brain pressure. The sensitivity of the imaging methods ranged from 100% (e.g., heat-induced alterations, intracranial gas) to zero (e.g., mediobasal impression marks as a sign of increased brain pressure, plaques jaunes). The agreement between MRI and CT was 69%. The radiological methods prevalently failed in the detection of lesions smaller than 3mm of size, whereas they were generally satisfactory concerning the evaluation of intracranial hemorrhage. Due to its advanced 2D and 3D post-processing possibilities, CT in particular possessed certain advantages in comparison with autopsy with regard to forensic reconstruction. MRI showed forensically relevant findings not seen during autopsy in several cases. The partly limited sensitivity of imaging that was observed in this retrospective study was based on several factors: besides general technical limitations it became apparent that clinical radiologists require a sound basic forensic background in order to detect specific signs. Focused teaching sessions will be essential to improve the outcome in future examinations. On the other hand, the autopsy protocols should be further standardized to allow an exact comparison of imaging and autopsy data. In consideration of these facts, MRI and CT have the power to play an important role in future forensic neuropathological examination.
多层螺旋计算机断层扫描（MSCT）和磁共振成像（MRI）越来越多地用于法医目的。基于临床神经影像学的广泛经验，对57例法医案例进行了死后MSCT和MRI检查，目的是评估放射学方法在法医头部和脑部检查中的可用性。一位经验丰富的临床放射科医生对影像数据进行了评估。将结果与尸检结果进行比较，尸检结果是常见法医神经创伤发现（如颅骨骨折、头皮软组织损伤、各种形式的颅内出血或脑压升高迹象）的金标准。成像方法的敏感性范围从100%（如热诱导改变、颅内气体）到零（如作为脑压升高迹象的中基底压痕、黄色斑块）。MRI和CT之间的一致性为69%。放射学方法在检测小于3毫米大小的病变时普遍失败，而在评估颅内出血方面总体上令人满意。由于其先进的二维和三维后处理可能性，特别是CT在法医重建方面与尸检相比具有某些优势。在几例病例中，MRI显示出尸检期间未发现的法医相关发现。在这项回顾性研究中观察到的成像敏感性部分受限基于几个因素：除了一般技术限制外，很明显临床放射科医生需要扎实过硬的法医背景知识才能检测到特定体征。有针对性的教学课程对于改善未来检查的结果至关重要。另一方面，尸检方案应进一步标准化，以便能够对影像和尸检数据进行精确比较。考虑到这些事实，MRI和CT在未来法医神经病理学检查中能够发挥重要作用。
