Institute of Forensic Medicine and Imaging, University of Zürich, Zürich, Switzerland.
Institute of Diagnostic and Interventional Radiology, University Hospital of Zürich, Zürich, Switzerland.
Acta Radiol. 2022 Apr;63(4):513-519. doi: 10.1177/0284185121999999. Epub 2021 Mar 28.
Postmortem imaging has become a powerful diagnostic tool in forensics. Postmortem computed tomography (PMCT) is often used currently to complement and sometimes even replace an autopsy.
To compare PMCT, postmortem magnetic resonance imaging (PMMRI), and autopsy findings for gunshot wounds to the head.
Cross-sectional study. We performed a retrospective analysis of 24 cases with gunshot wounds to the head that underwent both PMCT and PMMRI between 2011 and 2018 at the Institute of Forensic Medicine, University of Zurich (Switzerland).
Our study confirms that PMCT and, to a slightly lesser degree, PMMRI provide additional information that is valuable when combined with autopsy findings. Air embolism was solely detected in PMCT (67% vs. 0% at autopsy). A retained bullet or projectile and bone fragments were diagnosed more frequently with PMCT (42%, 67%, and 92%) than at autopsy (33%, 42%, and 46%). Soft tissue lesions were more often detected with PMMRI than with PMCT. With regard to autopsy, subdural hemorrhage and ventricular hemorrhage were slightly more frequently diagnosed with PMMRI (63% and 75% vs. 38% and 58% at autopsy). Intracerebral hemorrhage was by far most often diagnosed with PMMRI (92%) compared with both PMCT (38%) and autopsy (14%).
All three modalities should ideally be considered in cases of craniocerebral gunshot wounds. However, it might be conceivable that depending on the forensic query, PMCT and PMMRI may be an adequate replacement for an autopsy.
死后影像学已成为法医学中强有力的诊断工具。目前，死后计算机断层扫描（PMCT）常用于补充，甚至有时替代尸检。
比较 PMCT、死后磁共振成像（PMMRI）和尸检对头枪伤的发现。
横断面研究。我们对 2011 年至 2018 年在苏黎世大学法医学研究所（瑞士）接受 PMCT 和 PMMRI 的 24 例头枪伤患者进行了回顾性分析。
我们的研究证实，PMCT 和（程度略低的）PMMRI 提供了有价值的附加信息，与尸检结果结合使用。空气栓塞仅在 PMCT 中检测到（67% vs. 0%在尸检中）。与尸检相比（33%、42%和 46%），更多地通过 PMCT 诊断出残留的子弹或弹片和骨碎片（42%、67%和 92%）。PMRI 比 PMCT 更常检测到软组织损伤。关于尸检，硬脑膜下血肿和脑室出血在 PMMRI 中被诊断出的频率略高于尸检（63%和 75% vs. 38%和 58%）。颅内出血是迄今为止最常通过 PMMRI 诊断出的（92%），与 PMCT（38%）和尸检（14%）相比。
在颅脑枪伤的情况下，理想情况下应考虑使用所有三种方式。但是，根据法医查询，PMCT 和 PMMRI 可能足以替代尸检。
