Panzer Stephanie, Covaliov Lidia, Augat Peter, Peschel Oliver
Department of Radiology, Trauma Center Murnau, Prof.-Küntscher-Straße 8, D-82418 Murnau, Germany; Institute of Biomechanics, Trauma Center Murnau and Paracelsus Medical University Salzburg, Prof.-Küntscher-Straße 8, D-82418 Murnau, Germany.
Institute of Legal Medicine, Ludwig-Maximilians University, Munich, Nussbaumstraße 26, D-80336 Munich, Germany.
J Forensic Leg Med. 2017 Nov;52:62-69. doi: 10.1016/j.jflm.2017.08.007. Epub 2017 Aug 26.
The aim of this study was to compare pathological findings after traumatic brain injury between autopsy and ante-mortem computed tomography (CT). A second aim was to identify changes in these findings between the primary posttraumatic CT and the last follow-up CT before death.
Through the collaboration between clinical radiology and forensic medicine, 45 patients with traumatic brain injury were investigated. These patients had undergone ante-mortem CT as well as autopsy. During autopsy, the brain was cut in fronto-parallel slices directly after removal without additional fixation or subsequent histology. Typical findings of traumatic brain injury were compared between autopsy and radiology. Additionally, these findings were compared between the primary CT and the last follow-up CT before death.
The comparison between autopsy and radiology revealed a high specificity (≥80%) in most of the findings. Sensitivity and positive predictive value were high (≥80%) in almost half of the findings. Sixteen patients had undergone craniotomy with subsequent follow-up CT. Thirteen conservatively treated patients had undergone a follow-up CT. Comparison between the primary CT and the last ante-mortem CT revealed marked changes in the presence and absence of findings, especially in patients with severe traumatic brain injury requiring decompression craniotomy.
The main pathological findings of traumatic brain injury were comparable between clinical ante-mortem CT examinations and autopsy. Comparison between the primary CT after trauma and the last ante-mortem CT revealed marked changes in the findings, especially in patients with severe traumatic brain injury. Hence, clinically routine ante-mortem CT should be included in the process of autopsy interpretation.
本研究旨在比较创伤性脑损伤后尸检与生前计算机断层扫描（CT）的病理结果。第二个目的是确定这些结果在创伤后初次CT与死亡前最后一次随访CT之间的变化。
通过临床放射学与法医学的合作，对45例创伤性脑损伤患者进行了研究。这些患者均接受了生前CT检查以及尸检。尸检时，大脑在取出后直接切成额平行切片，无需额外固定或后续组织学检查。比较了尸检与放射学检查中创伤性脑损伤的典型结果。此外，还比较了初次CT与死亡前最后一次随访CT的这些结果。
尸检与放射学检查结果的比较显示，大多数结果具有较高的特异性（≥80%）。几乎一半的结果中敏感性和阳性预测值较高（≥80%）。16例患者接受了开颅手术及后续随访CT检查。13例保守治疗的患者接受了随访CT检查。初次CT与最后一次生前CT的比较显示，结果的有无有明显变化，尤其是在需要减压开颅手术的重度创伤性脑损伤患者中。
创伤性脑损伤的主要病理结果在临床生前CT检查和尸检之间具有可比性。创伤后初次CT与最后一次生前CT的比较显示结果有明显变化，尤其是在重度创伤性脑损伤患者中。因此，临床常规生前CT应纳入尸检解读过程。
