Institute of Forensic Medicine, Department of Forensic Medicine and Imaging, University of Zurich, Winterthurerstrasse 190/52, CH-8057, Zurich, Switzerland.
Institute of Diagnostic, Interventional, and Paediatric Radiology, University Hospital Bern, CH-3010, Bern, Switzerland.
Eur Radiol. 2019 Jul;29(7):3458-3466. doi: 10.1007/s00330-019-06033-x. Epub 2019 Feb 22.
The aims of this study were (1) to provide an overview of craniocervical magnetic resonance imaging (MR) findings following nonfatal strangulation (NFS), (2) to detect the time dependency of the presence of these findings, and (3) to explore the additional value of MR with regard to the forensic interpretation of NFS.
All 633 victims of manual strangulation between October 2011 and March 2018 were examined, including the case history and external findings. Following written consent, 114 cases were included in the study. The duration between the event, clinical forensic examination, and MR was noted. Radiologic images were reviewed by a clinical and a forensic radiologist.
The case group consisted of 90 women and 24 men with a mean age of 32.5 years. Delimitable external findings were present in 93% (N = 106) of cases. MR yielded a positive finding in 43% of cases (N = 49). There was no significant difference in the mean time interval between examinations between MR-positive and MR-negative cases. Perilaryngeal fluid accumulation was associated with difficulty swallowing and victims put in a chokehold. All cerebral MR were unremarkable, except for one patient with edema of the corpus callosum.
The role of craniocervical MR following NFS is currently limited, particularly with regard to the forensic interpretation of NFS. MR may reveal internal injury in victims who report subjective symptoms of airway compression and in those who were placed in a chokehold. The presence of MR findings is not dependent on immediate examinations following the assault.
• Magnetic resonance imaging does not currently provide additional value for the estimation of the severity of nonfatal manual strangulation. • Magnetic resonance imaging of the neck may reveal internal injury in cases without external findings, particularly in victims placed in a chokehold and with symptoms of airway compression. • The incidence of carotid artery dissections and laryngeal fractures is low in victims of nonfatal manual strangulation.
本研究旨在（1）概述非致命性绞杀（NFS）后颅颈磁共振成像（MR）的发现，（2）检测这些发现的存在时间依赖性，以及（3）探讨 MR 在法医解读 NFS 方面的额外价值。
对 2011 年 10 月至 2018 年 3 月间所有 633 例手动绞杀受害者进行了检查，包括病史和外部发现。在书面同意后，共有 114 例纳入研究。记录事件、临床法医检查和 MR 之间的时间间隔。由一名临床和法医放射科医生对放射学图像进行了回顾。
病例组包括 90 名女性和 24 名男性，平均年龄为 32.5 岁。93%（N=106）的病例存在可界定的外部发现。43%的病例（N=49）MR 检查呈阳性。MR 阳性和 MR 阴性病例之间的平均检查时间间隔无显著差异。咽旁积液与吞咽困难和受害者被勒颈有关。所有大脑 MR 均未见异常，除了一名胼胝体水肿的患者。
目前，NFS 后颅颈 MR 的作用有限，特别是在 NFS 的法医解读方面。MR 可能会在报告气道压迫主观症状和被勒颈的受害者中发现内部损伤。MR 发现的存在与袭击后立即检查无关。
• 磁共振成像目前对于非致命性手动绞杀严重程度的评估没有提供额外的价值。
• 无外部发现的情况下，颈部磁共振成像可能会发现内部损伤，尤其是在无外部发现且有气道压迫症状的受害者，以及被勒颈的受害者。
• 非致命性手动绞杀受害者颈动脉夹层和喉骨折的发生率较低。
