Albano Giuseppe Davide, Re Giuseppe Lo, Salerno Sergio, Triskari Marika Barberi, Fornasari Mariagrazia, Micci Giuseppe, Albano Domenico, Midiri Mauro, Spina Corinne La, Malta Ginevra, Zerbo Stefania, Argo Antonina
Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Institute of Legal Medicine, University of Palermo, Palermo, Italy.
Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Institute of Legal Medicine, University of Palermo, Via del Vespro 129, Palermo, 90100, Italy.
Int J Legal Med. 2025 Sep 18. doi: 10.1007/s00414-025-03601-3.
Nowadays, according to the Istanbul Protocol, diagnostic tests are not an essential part of the clinical assessment of a person alleging torture or ill-treatment. In many cases, a medical history and physical examination are sufficient. However, literature evidence suggests a helpful role of diagnostic imaging in the allegation of evidence of torture, especially in the case of musculoskeletal injuries. The purpose of this narrative review is to highlight the role of imaging tests in suspected torture victims, emphasizing the role of these methods in establishing legal evidence of mistreatment. No specific imaging features are described in the literature, however, musculoskeletal imaging allows the detection of previous fractures, bone deformities, and tendon and ligament injuries. These are mainly due to blunt force injuries. MRI is the most helpful imaging tests to allegate evidence of Falaka. Imaging tests, particularly conventional X-rays and CT, are helpful in forensic investigations of when there is suspicion of retained foreign bodies, such as bullets or shrapnel, especially in cases where clinical examination is inconclusive. CT and MRI can show late sequelae of head trauma such as subdural hematomas, hygromas, old intracerebral bleeding, and hydrocephalus. The current literature highlights the importance of subjecting patients to imaging and specialists examinations to document evidence of torture and support the assessment of the degree of consistency with the reported history. These are second-level investigations that must be targeted to specific diagnostic questions and preceded by a thorough examination conducted by experts in the field using standardized methodologies, in line with the recommendations of the Istanbul Protocol. Imaging studies can bridge the gap between clinical examination and the patient's history.
如今，根据《伊斯坦布尔议定书》，诊断测试并非对声称遭受酷刑或虐待者进行临床评估的必要组成部分。在许多情况下，病史和体格检查就足够了。然而，文献证据表明，诊断成像在酷刑证据的指控中可发挥有益作用，尤其是在肌肉骨骼损伤的情况下。本叙述性综述的目的是强调成像测试在疑似酷刑受害者中的作用，着重指出这些方法在确立虐待法律证据方面的作用。文献中未描述具体的成像特征，然而，肌肉骨骼成像能够检测既往骨折、骨骼畸形以及肌腱和韧带损伤。这些主要是由钝器伤所致。磁共振成像（MRI）是指认法拉克（Falaka，一种刑罚）证据最有用的成像测试。成像测试，尤其是传统X线和计算机断层扫描（CT），在怀疑有子弹或弹片等异物留存的法医调查中很有帮助，特别是在临床检查结果不明确的情况下。CT和MRI能够显示头部创伤的晚期后遗症，如硬膜下血肿、积液、陈旧性脑内出血和脑积水。当前文献强调了让患者接受成像和专科检查以记录酷刑证据并支持评估与所报告病史的相符程度的重要性。这些是二级调查，必须针对特定的诊断问题，并在该领域专家按照《伊斯坦布尔议定书》的建议采用标准化方法进行全面检查之后进行。成像研究可以弥合临床检查与患者病史之间的差距。
