Lombardo Paolo, Hartmann Conny, Fridle Chantal, von Tengg-Kobligk Hendrik, Ruder Thomas D, Zech Wolf-Dieter
Institute of Forensic Medicine, University of Bern, Bern, Switzerland.
Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Int J Legal Med. 2025 Sep 16. doi: 10.1007/s00414-025-03597-w.
Recently, post-mortem photon-counting CT (PMPCCT) has been introduced to forensic imaging. Compared to conventional energy integrating post-mortem CT (PMCT), PMPCCT enables ultra-high resolution (UHR) imaging, which is particularly suitable for visualizing fine fractures and fissures. These are often found in rib trauma, which is usually relevant in forensic medicine. The aim of this study was to evaluate the diagnostic accuracy of rib fracture detection using PMPCCT compared to PMCT and forensic autopsy.
A total of n = 20 bodies that had suffered blunt chest trauma before death and n = 5 non-trauma control cases were investigated. PMCT and PMPCCT were conducted prior to forensic autopsy. Two observers (radiologist and forensic pathologist) analyzed PMCT images (reconstructed with a slice thickness of 0.5 mm in a 512 matrix) and PMPCCT images (reconstructed with slice thicknesses of 0.5 mm and 0.2 mm (UHR) in a 1024 matrix). Imaging diagnosis of rib fractures was compared to autopsy diagnosis as gold standard. The diagnosis of different types of rib fractures assessed at imaging was compared between PMCT and PMPCCT.
Inter-rater agreement between the two observers was good (κ = 0.79). Both PMCT and PMPCCT diagnosed less rib fractures than the autopsy (n = 356 fractures). Compared to PMCT, UHR-PMPCCT demonstrated slightly higher sensitivity (e.g., 92% vs. 82% in observer 1), slightly higher specificity (e.g., 97% vs. 95%), and lower positive predictive value (e.g., 75% vs. 82%) for the diagnosis of all rib fractures. Chi-squared tests showed significant differences (p-value < 0.05 in both observers) between UHR-PMPCCT and PMCT for the diagnosis of incomplete rib fractures with visible dehiscence of one cortical line.
Based on the results, it is questionable whether PMPCCT offers additional forensic value over PMCT for the specific forensic issue of diagnosing rib fractures.
最近，尸检光子计数CT（PMPCCT）已被引入法医成像领域。与传统的能量积分尸检CT（PMCT）相比，PMPCCT能够实现超高分辨率（UHR）成像，特别适合于显示细微骨折和裂缝。这些情况在肋骨创伤中经常出现，而肋骨创伤在法医学中通常具有相关性。本研究的目的是评估与PMCT和法医尸检相比，使用PMPCCT检测肋骨骨折的诊断准确性。
共调查了n = 20例生前遭受钝性胸部创伤的尸体和n = 5例非创伤对照病例。在法医尸检前进行PMCT和PMPCCT检查。两名观察者（放射科医生和法医病理学家）分析了PMCT图像（在512矩阵中重建，切片厚度为0.5毫米）和PMPCCT图像（在1024矩阵中重建，切片厚度为0.5毫米和0.2毫米（UHR））。将肋骨骨折的影像学诊断与作为金标准的尸检诊断进行比较。比较了PMCT和PMPCCT在影像学上评估的不同类型肋骨骨折的诊断情况。
两名观察者之间的评分者间一致性良好（κ = 0.79）。PMCT和PMPCCT诊断出的肋骨骨折均少于尸检（n = 356处骨折）。与PMCT相比，UHR - PMPCCT在诊断所有肋骨骨折时显示出略高的敏感性（例如，观察者1中分别为92%和82%）、略高的特异性（例如，分别为97%和95%）以及较低的阳性预测值（例如，分别为75%和82%）。卡方检验显示，对于诊断有一条皮质线可见裂开的不完全肋骨骨折，UHR - PMPCCT和PMCT之间存在显著差异（两名观察者的p值均<0.05）。
基于这些结果，对于诊断肋骨骨折这一特定法医问题，PMPCCT是否比PMCT具有额外的法医价值值得怀疑。
