Jakobsen Søren Reinhold, Schellerup Lars, Boel Lene Warner Thorup, Hansen Kasper
Department of Radiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus, 8200, Denmark.
Department of Forensic Medicine, Aarhus University, Palle Juul-Jensens Boulevard 99, Health, Aarhus, 8200, Denmark.
Forensic Sci Med Pathol. 2024 Sep 3. doi: 10.1007/s12024-024-00892-7.
Asphyxia as a cause of death poses a diagnostic challenge in forensic medicine due to both the diversity of underlying mechanisms, and lack of specific markers. Acute emphysema or acute alveolar dilation have long been debated as potential findings in these asphyxia cases. To further explore the supplementary findings in our forensic asphyxia cases, this study applied lung densitometry to pulmonary postmortem computed tomography (PMCT) data. Twenty asphyxia cases (including hanging (n = 9), manual strangulation (n = 4), ligature strangulation (n = 1), smothering (n = 3), and choking (n = 3)) and 21 matched control cases were analysed using lung densitometry parameters - specifically quantification of low attenuation areas (LAA) and the 15th percentile point of lung density (Perc15). Our data revealed statistically significantly higher lung % volume falling within LAA at -950HU (p = 0.04) and - 910HU (p = 0.043) in the asphyxia cases compared to matched controls. The Perc15 values observed were trending towards a lower attenuation corresponding to a lower density in the asphyxia group, although this result was not statistically significant (p = 0.13). A subgroup analysis highlighted potential differences within the asphyxia categories, notably, higher Perc15 values were observed in the choking cases. In conclusion the results from the study support the existing evidence of low pulmonary density as a potential finding in asphyxia cases and demonstrate the potential of applying lung densitometry on pulmonary postmortem computed tomography data.
由于潜在机制的多样性以及缺乏特异性标志物，窒息作为一种死因在法医学中构成了诊断挑战。急性肺气肿或急性肺泡扩张长期以来一直被争论是否为这些窒息病例的潜在发现。为了进一步探索我们法医学窒息病例中的补充发现，本研究将肺密度测定应用于肺部尸体计算机断层扫描（PMCT）数据。使用肺密度测定参数——特别是低衰减区域（LAA）的量化和肺密度的第15百分位数点（Perc15），对20例窒息病例（包括缢死（n = 9）、扼死（n = 4）、勒死（n = 1）、闷死（n = 3）和噎死（n = 3））和21例匹配的对照病例进行了分析。我们的数据显示，与匹配的对照组相比，窒息病例中在-950HU（p = 0.04）和-910HU（p = 0.043）时，落入LAA的肺体积百分比在统计学上显著更高。观察到的Perc15值在窒息组中倾向于对应较低密度的较低衰减，尽管这一结果在统计学上不显著（p = 0.13）。亚组分析突出了窒息类别中的潜在差异，值得注意的是，在噎死病例中观察到了更高的Perc15值。总之，该研究结果支持了低肺密度作为窒息病例潜在发现的现有证据，并证明了将肺密度测定应用于肺部尸体计算机断层扫描数据的潜力。
