Department of Legal Medicine, Graduate School of Medicine, Chiba University, Japan.
Forensic Sci Int. 2013 Sep 10;231(1-3):e33-6. doi: 10.1016/j.forsciint.2013.05.012. Epub 2013 Jun 12.
Diagnosis of cerebral hemorrhage as a cause of death is often difficult when bodies are in a highly decomposed state. Postmortem imaging can be useful for estimating cause of death in cerebral hemorrhage cases, but the effects of decomposition on imaging findings have not been well studied. We report here two cases in which pre-autopsy computed tomography (CT) accurately detected cerebral hemorrhage in highly decomposed bodies and consequently allowed for careful autopsy dissection. We found that the CT attenuation value of hematoma remained high in intracranial hemorrhagic lesions, probably due to a postmortem increase in the density of hematomas. The high contrast against the background parenchyma enabled the hematomas to be discriminated from the surrounding cerebral parenchyma even in considerably decomposed bodies. However, dispersion and breakdown of the hematomas over time with decomposition appeared to result in contrast reduction. In such cases, hematomas may be missed or their size underestimated on CT. Thus, a comprehensive approach involving autopsy is necessary to determine cause of death for highly decomposed bodies.
当尸体处于高度腐烂状态时，通常很难诊断脑出血是死亡的原因。死后影像学检查对于估计脑出血病例的死因可能很有用，但尸体腐烂对影像学发现的影响尚未得到很好的研究。我们在此报告两例在高度腐烂的尸体中，术前计算机断层扫描（CT）准确检测到脑出血的病例，从而能够进行仔细的尸检解剖。我们发现，颅内出血病变的血肿 CT 衰减值仍然很高，这可能是由于死后血肿密度增加所致。血肿与背景实质之间的高对比度使得即使在高度腐烂的尸体中也能够将血肿与周围脑实质区分开来。然而，随着时间的推移，血肿的分散和破裂似乎导致对比度降低。在这种情况下，CT 可能会漏诊血肿或低估其大小。因此，对于高度腐烂的尸体，需要综合运用尸检来确定死因。
