Bauer Melanie, Gerlach Kathrin, Scheurer Eva, Lenz Claudia
Institute of Forensic Medicine, Department of Biomedical Engineering, University of Basel, Basel, Switzerland; Institute of Forensic Medicine, Health Department Basel-Stadt, Basel, Switzerland.
Institute of Forensic Medicine, Department of Biomedical Engineering, University of Basel, Basel, Switzerland; Institute of Forensic Medicine, Health Department Basel-Stadt, Basel, Switzerland.
Forensic Sci Int. 2020 Mar;308:110164. doi: 10.1016/j.forsciint.2020.110164. Epub 2020 Jan 23.
While cerebral edema is a live-threatening condition in living persons, also an edema-like fluid redistribution can occur post mortem. In deceased, usually macroscopic signs are evaluated during autopsy in order to determine the presence or absence of cerebral edema. As a quantitative and objective classification is beneficial, an already existing method (Radojevic et al., 2017), which is based on a mathematical formula using the intracranial dimensions and the cerebral weight, was compared to the evaluation of macroscopic signs in 31 cases. The results showed an excellent agreement for the comparison between the raters as well as the measurement methods (at opened skull or in CT images). However, both measurement methods only poorly agree with the macroscopic edema evaluation. In order to find a more concordant method, the normalized cerebral weight, which puts the cerebral weight in relation to the intracranial volume, was calculated for 115 cases. This method resulted in an excellent agreement with the macroscopic rating and showed a clear numerical difference between the edematous and nonedematous group. While the influence of the post mortem time and the cooling time was found to be negligible, the age at death might confound the edema classification due to pre-existing cerebral atrophy leading to lower cerebral weights. In summary, the present study compared different assessment methods to classify cerebral edema and developed a rater independent, objective and quantitative classification method, which was as reliable as the rating of the forensic pathologists.
虽然脑水肿在活人身上是一种危及生命的状况，但死后也可能发生类似水肿的液体重新分布。在死者中，通常在尸检期间评估宏观体征以确定是否存在脑水肿。由于进行定量和客观分类是有益的，因此将一种基于使用颅内尺寸和脑重量的数学公式的现有方法（Radojevic等人，2017年）与31例病例的宏观体征评估进行了比较。结果表明，评分者之间以及测量方法（在打开颅骨时或CT图像中）之间的比较具有极好的一致性。然而，两种测量方法与宏观水肿评估的一致性都很差。为了找到一种更一致的方法，计算了115例病例的归一化脑重量，即将脑重量与颅内体积相关联。该方法与宏观评级具有极好的一致性，并且在水肿组和非水肿组之间显示出明显的数值差异。虽然发现死后时间和冷却时间的影响可以忽略不计，但由于预先存在的脑萎缩导致脑重量降低，死亡年龄可能会混淆水肿分类。总之，本研究比较了不同的评估方法来对脑水肿进行分类，并开发了一种独立于评分者、客观且定量的分类方法，该方法与法医病理学家的评级一样可靠。
