Ampanozi Garyfalia, Halbheer Delaja, Ebert Lars C, Thali Michael J, Held Ulrike
Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, 8057, Zurich, Switzerland.
Horten Centre, University of Zurich, Pestalozzistrasse 24, 8091, Zurich, Switzerland.
Int J Legal Med. 2020 Jan;134(1):321-337. doi: 10.1007/s00414-019-02140-y. Epub 2019 Aug 27.
The aim of this study was to evaluate the sensitivity of postmortem computed tomography (PMCT), postmortem magnetic resonance imaging (PMMR) and PMCT angiography (PMCTA) compared with autopsy in cases of adult death investigations.
For this systematic review and meta-analysis, Embase, PubMed, Scopus, Web of Science and Medline were searched for eligible studies in October 2016; a follow-up literature search was conducted in March 2018. Studies referring to PMCT, PMCTA and/or PMMR of more than 3 cases with subsequent autopsy were included. Data were extracted from published texts in duplicate. The extracted outcomes were categorized as follows: soft tissue and organ findings, skeletal injuries, haemorrhages, abnormal gas accumulations and causes of death. The summary measure was sensitivity, if 3 or more studies were available. To combine studies, a random effects model was used. Variability and heterogeneity within the meta-analysis was assessed.
Of 1053 studies, 66 were eligible, encompassing a total of 4213 individuals. For soft tissue and organ findings, there was a high pooled sensitivity with PMCTA (0.91, 95% CI 0.81-0.96), without evidence for between-study variability (Cochrane's Q test p = 0.331, I = 24.5%). The pooled sensitivity of PMCT+PMMR was very high in skeletal injuries (0.97, CI 0.87-0.99), without evidence for variability (p = 0.857, I = 0.0%). In detecting haemorrhages, the pooled sensitivity for PMCT+PMMR was the highest (0.88, 95% CI 0.35-0.99), with strong evidence of heterogeneity (p < 0.05, I > 50%). Pooled sensitivity for the correct cause of death was the highest for PMCTA with 0.79 (95% CI 0.52-0.93), again with evidence of heterogeneity (p = 0.062, I > 50%).
Distinct postmortem imaging modalities can achieve high sensitivities for detecting various findings and causes of death. This knowledge should lead to a reasoned use of each modality. Both forensic evidence and in-hospital medical quality would be enhanced.
本研究旨在评估在成人死亡调查案例中，与尸检相比，死后计算机断层扫描（PMCT）、死后磁共振成像（PMMR）和PMCT血管造影（PMCTA）的敏感性。
对于本系统评价和荟萃分析，2016年10月检索了Embase、PubMed、Scopus、Web of Science和Medline以查找符合条件的研究；2018年3月进行了后续文献检索。纳入了涉及3例以上病例的PMCT、PMCTA和/或PMMR并随后进行尸检的研究。数据从已发表的文本中重复提取。提取的结果分类如下：软组织和器官发现、骨骼损伤、出血、异常气体积聚和死亡原因。如果有3项或更多研究，则汇总测量指标为敏感性。为合并研究，使用随机效应模型。评估荟萃分析中的变异性和异质性。
在1053项研究中，66项符合条件，共涉及4213名个体。对于软组织和器官发现，PMCTA的汇总敏感性较高（0.91，95%可信区间0.81-0.96），没有研究间变异性的证据（Cochrane Q检验p = 0.331，I² = 24.5%）。在骨骼损伤方面，PMCT+PMMR的汇总敏感性非常高（0.97，可信区间0.87-0.99），没有变异性的证据（p = 0.857，I² = 0.0%）。在检测出血方面，PMCT+PMMR的汇总敏感性最高（0.88，95%可信区间0.35-0.99），有很强的异质性证据（p < 0.05，I² > 50%）。PMCTA对正确死亡原因的汇总敏感性最高，为0.79（95%可信区间0.52-0.93），同样有异质性证据（p = 0.062，I² > 50%）。
不同的死后成像方式在检测各种发现和死亡原因方面可达到较高的敏感性。这一认识应促使合理使用每种方式。法医证据和医院内医疗质量都将得到提高。
