Kirchhoff S, Fischer F, Lindemaier G, Herzog P, Kirchhoff C, Becker C, Bark J, Reiser M F, Eisenmenger W
Institute of Clinical Radiology, University Hospital Munich Grosshadern/Innenstadt, Ziemssenstrasse 1, 80336, Munich, Germany.
Int J Legal Med. 2008 Nov;122(6):471-9. doi: 10.1007/s00414-008-0274-y. Epub 2008 Aug 5.
The gold standard for identification of the dead is the visual dental record. In this context, several authors emphasize computed tomography (CT) as valuable supportive tool for forensic medicine. However, studies focusing on diagnostic accuracy of post-mortem computed tomography (PMCT) are still missing. Therefore, the aim of this study was to compare diagnostic accuracy of the visual dental record and post-mortem computed tomography (PMCT) of the dentition for identification of the dead. Ten whole skulls were included into the study. The entire dentition of each skull was first examined with the visual dental record as a gold standard and second using dental PMCT scans, performed on a 64-multi-detector CT (MDCT). 3D reformations, multi-planar reformations (MPR), and CT-orthopantomography (OPG) were performed in the post-processing. All examinations were analyzed by three independent investigators regarding the criteria for identification of the dead, e.g., in case of disaster. PMCT for the dental identification of the dead was difficult to perform and time consuming. Due to dental overlays and corresponding artifacts, the definite periphery of the dental fillings/inlays was not accurately defined resulting in 2.9% incorrect and 64.1% false negative findings, especially synthetic inlays were hardly or not recognizable at all. For the identification of the dead especially in case of disasters with large numbers of victims, the visual dental record is still to be considered the gold standard. In the identification process itself, there is no room for error at all, although some non-concordant information may occur. Thus, PMCT should only be performed for identification in individual cases due to the relatively high error rate.
识别死者的金标准是视觉牙科记录。在这种情况下，几位作者强调计算机断层扫描（CT）作为法医学的重要辅助工具。然而，目前仍缺乏关于死后计算机断层扫描（PMCT）诊断准确性的研究。因此，本研究的目的是比较视觉牙科记录和死后牙列计算机断层扫描（PMCT）在识别死者方面的诊断准确性。本研究纳入了10个完整的颅骨。每个颅骨的整个牙列首先以视觉牙科记录作为金标准进行检查，其次使用在64排多层探测器CT（MDCT）上进行的牙科PMCT扫描。在后处理中进行了三维重建、多平面重建（MPR）和CT曲面断层摄影（OPG）。三位独立的研究人员根据识别死者的标准，例如在灾难情况下，对所有检查进行了分析。用于死者牙科识别的PMCT操作困难且耗时。由于牙齿重叠和相应的伪影，牙科填充物/嵌体的明确边缘无法准确界定，导致2.9%的错误结果和64.1%的假阴性结果，尤其是合成嵌体几乎无法识别或根本无法识别。对于死者的识别，尤其是在有大量受害者的灾难情况下，视觉牙科记录仍应被视为金标准。在识别过程本身中，尽管可能会出现一些不一致的信息，但根本没有出错的余地。因此，由于错误率相对较高，PMCT仅应在个别情况下用于识别。
