法医尸检中的“盲点”：通过死后计算机断层扫描（PMCT）改善球后出血和眼眶病变的检测
"Blind spots" in forensic autopsy: improved detection of retrobulbar hemorrhage and orbital lesions by postmortem computed tomography (PMCT).
作者信息
Flach P M, Egli T C, Bolliger S A, Berger N, Ampanozi G, Thali M J, Schweitzer W
机构信息
Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, 8057 Zurich, Switzerland; Department of Diagnostic and Interventional Radiology, University Hospital of Zurich, Raemistrasse 100, 8091 Zurich, Switzerland; Institute of Forensic Medicine, University of Bern, Buehlstrasse 20, 3012 Bern, Switzerland.
Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, 8057 Zurich, Switzerland; Institute of Forensic Medicine, University of Bern, Buehlstrasse 20, 3012 Bern, Switzerland.
出版信息
Leg Med (Tokyo). 2014 Sep;16(5):274-82. doi: 10.1016/j.legalmed.2014.06.003. Epub 2014 Jun 26.
OBJECTIVES
The purpose of this study was to correlate the occurrence of retrobulbar hemorrhage (RBH) with mechanism of injury, external signs and autopsy findings to postmortem computed tomography (PMCT).
METHODS
Six-teen subjects presented with RBH and underwent PMCT, external inspection and conventional autopsy. External inspection was evaluated for findings of the bulbs, black eye, raccoon eyes and Battle's sign. Fractures of the viscerocranium, orbital lesions and RBH were evaluated by PMCT. Autopsy and PMCT was evaluated for orbital roof and basilar skull fracture.
RESULTS
The leading manner of death was accident with central regulatory failure in cases of RBH (31.25%). Imaging showed a high sensitivity in detection of orbital roof and basilar skull fractures (100%), but was less specific compared to autopsy. Volume of RBH (0.1-2.4ml) correlated positively to the presence of Battle's sign (p<0.06) and the postmortem interval. Ecchymosis on external inspection correlated with RBH. There was a statistical significant correlation between bulbar lesion and RBH. Orbital roof fracture count weakly correlated with the total PMCT derived RBH volume. Maxillary hemosinus correlated to maxillary fractures, but not to RBH.
CONCLUSIONS
RBH are a specific finding in forensically relevant head trauma. PMCT is an excellent tool in detecting and quantifying morphological trauma findings particularly in the viscerocranium, one of the most relevant "blind spots" of classic autopsy. PMCT was superior in detecting osseous lesions, scrutinizing autopsy as the gold standard.
目的
本研究旨在将球后出血（RBH）的发生与损伤机制、外部体征以及尸检结果与死后计算机断层扫描（PMCT）进行关联。
方法
16例出现RBH的受试者接受了PMCT、外部检查和传统尸检。对外部检查评估眼球、黑眼圈、熊猫眼和Battle征的表现。通过PMCT评估面颅骨骨折、眼眶病变和RBH。对尸检和PMCT评估眶顶和颅底骨折情况。
结果
RBH病例中主要死亡方式为伴有中枢调节衰竭的意外事故（31.25%）。影像学在检测眶顶和颅底骨折方面显示出高敏感性（100%），但与尸检相比特异性较低。RBH的体积（0.1 - 2.4ml）与Battle征的存在（p<0.06）和死后间隔呈正相关。外部检查中的瘀斑与RBH相关。眼球病变与RBH之间存在统计学显著相关性。眶顶骨折数量与PMCT得出的RBH总体积呈弱相关。上颌窦积血与上颌骨骨折相关，但与RBH无关。
结论
RBH是法医相关头部创伤中的一个特定发现。PMCT是检测和量化形态学创伤结果的优秀工具，尤其是在面颅骨方面，这是经典尸检最相关的“盲点”之一。在检测骨性病变方面，PMCT优于作为金标准的尸检。
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