Usui Akihito, Kawasumi Yusuke, Usui Kiyotaka, Ishizuka Yuya, Takahashi Kaito, Funayama Masato, Saito Haruo
Department of Diagnostic Image Analysis, Tohoku University Graduate School of Medicine.
Department of Clinical Imaging, Tohoku University Graduate School of Medicine.
Tohoku J Exp Med. 2017 Jul;242(3):183-192. doi: 10.1620/tjem.242.183.
Traditional autopsy has changed little in the past century. In Japan, the rate of forensic autopsy in cases of unusual death is very low. Therefore, multi-slice computed tomography (CT) has been used to obtain imaging data instead of or in addition to autopsy in suspicious forensic cases. In our institute, postmortem multi-slice CT has been performed since 2009, and by 2014 there were over 1,000 cases. Our extensive experience with postmortem CT shows that in many cases of death by drug overdose, stomach contents exhibit high X-ray absorption. This article reviews the relationship between CT findings of stomach contents and toxicological analysis results in 23 cases of death by drug overdose. All cases (12 females and 11 males, aged 44 ± 11 years) known to have orally ingested drugs were included in this study. We assessed the slices of all stomach areas on consecutive axial CT images. Twenty cases (87%) showed high X-ray absorption in the stomach, while the other three did not demonstrate radio-dense stomach contents even though drug analysis detected lethal concentrations of drugs in the blood. In conclusion, drugs were frequently, but not always, visualized as contents with high X-ray absorption in the stomach. Postmortem gastric CT images can provide useful information in cases of oral drug intoxication if there are empty drug packages or a suicide note at the death scene. However, precise determination of the cause of death requires full autopsy in cases where there is no indication of suicide at the death scene.
在过去的一个世纪里，传统尸检变化不大。在日本，异常死亡案件中的法医尸检率非常低。因此，在可疑的法医案件中，多层计算机断层扫描（CT）已被用于获取成像数据，以替代尸检或作为尸检的补充。在我们研究所，自2009年以来一直进行死后多层CT检查，到2014年已有超过1000例病例。我们在死后CT方面的丰富经验表明，在许多药物过量致死的案例中，胃内容物显示出高X射线吸收率。本文回顾了23例药物过量致死案例中胃内容物的CT表现与毒理学分析结果之间的关系。本研究纳入了所有已知口服药物的病例（12名女性和11名男性，年龄44±11岁）。我们在连续的轴向CT图像上评估了所有胃部区域的切片。20例（87%）在胃中显示出高X射线吸收率，而其他3例尽管药物分析在血液中检测到致死浓度的药物，但胃内容物并未显示出高密度。总之，药物在胃中常表现为具有高X射线吸收率的内容物，但并非总是如此。如果死亡现场有空药包或遗书，死后胃部CT图像可为口服药物中毒案件提供有用信息。然而，在死亡现场没有自杀迹象的情况下，精确确定死因需要进行全面尸检。
