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The added value of postmortem magnetic resonance imaging in cases of hanging compared to postmortem computed tomography and autopsy

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Abstract

The purpose of this study was to evaluate the added value of postmortem magnetic resonance imaging (MRI) compared to postmortem computed tomography (CT) and autopsy in cases of fatal hanging. In addition, the study analyzed the strengths of each examination method regarding typical injuries in these cases. We investigated a cohort of 25 decedents who underwent CT, MRI and autopsy. Two radiologists assessed all MR images of the head and neck as well as the corresponding CT images. The results were compared to autopsy findings by retrospectively analyzing the autopsy reports. Postmortem MRI revealed intramuscular hemorrhages in a large number of cases, however, autopsy did not confirm all of the detected hemorrhages. CT and autopsy detected fractures in several cases, whereas MRI showed a fracture in just one single case. Other previously described vital signs and relevant findings, such as fracture-related gas bubbles, soft tissue emphysema or pneumomediastinum, were observed in only a few individual cases. MRI provided added diagnostic value in the detection of soft tissue injuries and lymph node swelling in fatal hangings. As an adjunct to autopsy, postmortem MRI may reveal additional hemorrhages, which might be missed at autopsy. Since standard MRI demonstrated low sensitivity for the detection of fractures, an additional imaging modality or autopsy is required to overcome this limitation.

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References

  1. Gunnell D, Bennewith O, Hawton K, Simkin S, Kapur N. The epidemiology and prevention of suicide by hanging: a systematic review. Int J EpidemiolInt J Epidemiol. 2005;34:433–42.

    Article  Google Scholar 

  2. Kanchan T, Menon A, Menezes RG. Methods of choice in completed suicides: gender differences and review of literature. J Forensic SciJ Forensic Sci. 2009;54:938–42.

    Article  Google Scholar 

  3. Suárez-Peñaranda JM, Cordeiro C, Rodríguez-Calvo M, Vieira DN, Muñoz-Barús JI. Cardiac inhibitory reflex as a cause/mechanism of death. J Forensic SciJ Forensic Sci. 2013;58:1644–7.

    Article  Google Scholar 

  4. Ikeda N, Harada A, Suzuki T. The course of respiration and circulation in death due to typical hanging. Int J Legal MedInt J Legal Med. 1992;104:313–5.

    Article  CAS  Google Scholar 

  5. Sharma BR, Harish D, Sharma A, Sharma S, Singh H. Injuries to neck structures in deaths due to constriction of neck, with a special reference to hanging. J Forensic Legal MedJ Forensic Legal Med. 2008;15:298–305.

    Article  CAS  Google Scholar 

  6. Hellier C, Connolly R. Cause of death in judicial hanging: a review and case study. Med Sci Law. 2009;49:18–26.

    Article  Google Scholar 

  7. Nikolić S, Živković V. Cervical spine injuries in suicidal hanging without a long-drop—patterns and possible underlying mechanisms of injury: an autopsy study. Forensic Sci Med Pathol. 2014;10:193–7.

    Article  Google Scholar 

  8. Nikolic S, Micic J, Atanasijevic T, Djokic V, Djonic D. Analysis of neck injuries in hanging. Am J Forensic Med PatholAm J Forensic Med Pathol. 2003;24:179–82.

    Google Scholar 

  9. O’Donnell C, Woodford N. Post-mortem radiology—a new sub-speciality? Clin RadiolClin Radiol. 2008;63:1189–94.

    Article  Google Scholar 

  10. Ruder TD, Germerott T, Thali MJ, Hatch GM. Differentiation of ante-mortem and post-mortem fractures with MRI: a case report. BJR. 2011;84:e75–8.

    Article  CAS  Google Scholar 

  11. de Bakker HM, de Bakker BS. Conventional X-ray as an additional tool in the analysis of fatal neck trauma. Forensic Sci Med Pathol. 2019;15:677.

    Article  Google Scholar 

  12. Filograna L, Ross S, Bolliger S, Germerott T, Preiss U, Flach PM, et al. Blood aspiration as a vital sign detected by postmortem computed tomography imaging. J Forensic SciJ Forensic Sci. 2011;56:630–7.

    Article  Google Scholar 

  13. Schulz F, Schäfer H, Püschel K, Tsokos M, Brinkmann B, Buschmann CT. Bowel wall hemorrhage after death by hanging. Int J Legal MedInt J Legal Med. 2011;125:403–10.

    Article  Google Scholar 

  14. Aghayev E, Yen K, Sonnenschein M, Jackowski C, Thali M, Vock P, et al. Pneumomediastinum and soft tissue emphysema of the neck in postmortem CT and MRI; a new vital sign in hanging? Forensic Sci IntForensic Sci Int. 2005;153:181–8.

    Article  Google Scholar 

  15. Tumram NK, Ambade VN, Bardale RV, Dixit PG. Injuries over neck in hanging deaths and its relation with ligature material: is it vital? J Forensic Legal MedJ Forensic Legal Med. 2014;22:80–3.

    Article  Google Scholar 

  16. Castiglioni C, Baumann P, Fracasso T. Acute pulmonary emphysema in death by hanging: a morphometric digital study. Int J Legal MedInt J Legal Med. 2016;130:1281–5.

    Article  Google Scholar 

  17. Gascho D, Heimer J, Tappero C, Schaerli S. Relevant findings on postmortem CT and postmortem MRI in hanging, ligature strangulation and manual strangulation and their additional value compared to autopsy – a systematic review. Forensic Sci Med Pathol. 2019;15:84–92.

    Article  Google Scholar 

  18. Yen K, Lövblad KO, Scheurer E, Ozdoba C, Thali MJ, Aghayev E, et al. Post-mortem forensic neuroimaging: correlation of MSCT and MRI findings with autopsy results. Forensic Sci IntForensic Sci Int. 2007;173:21–35.

    Article  CAS  Google Scholar 

  19. Heimer J, Tappero C, Gascho D, Flach P, Ruder TD, Thali MJ, et al. Value of 3T craniocervical magnetic resonance imaging following nonfatal strangulation. Eur RadiolEur Radiol. 2019; http://link.springer.com/10.1007/s00330-019-06033-x.

  20. Martin MJ, Weng J, Demetriades D, Salim A. Patterns of injury and functional outcome after hanging: analysis of the National Trauma Data Bank. 2005;190:838–43.

  21. Thali MJ, Yen K, Schweitzer W, Vock P, Boesch C, Ozdoba C, et al. Virtopsy, a new imaging horizon in forensic pathology: virtual autopsy by postmortem multislice computed tomography (MSCT) and magnetic resonance imaging (MRI)-a feasibility study. J Forensic SciJ Forensic Sci. 2003;48:386–403.

    Google Scholar 

  22. Yen K, Thali MJ, Aghayev E, Jackowski C, Schweitzer W, Boesch C, et al. Strangulation signs: initial correlation of MRI, MSCT, and forensic neck findings. J Magn Reson ImagingJ Magn Reson Imaging. 2005;22:501–10.

    Article  Google Scholar 

  23. Duband S, Timoshenko A, Mohammedi R, Prades JM, Barral FG, Debout M, et al. Study of endolaryngeal structures by videolaryngoscopy after hanging: a new approach to understanding the physiopathogenesis. Forensic Sci IntForensic Sci Int. 2009;192:48–52.

    Article  CAS  Google Scholar 

  24. Betz P. Histological and enzyme histochemical parameters for the age estimation of human skin wounds. Int J Legal MedInt J Legal Med. 1994;107:60–8.

    Article  CAS  Google Scholar 

  25. You JH, Kim IH, Hwang J, Lee HS, Park EH. Fracture of ankle: MRI using opposed-phase imaging obtained from turbo spin echo modified Dixon image shows improved sensitivity. BJR. 2018;91:20170779.

    Article  Google Scholar 

  26. Eley KA, Watt-Smith SR, Golding SJ. Black bone. MRI: a potential alternative to CT when imaging the head and neck: report of eight clinical cases and review of the Oxford experience BJR. 2012;85:1457–64.

    CAS  Google Scholar 

  27. Schulze K, Ebert LC, Ruder TD, Fliss B, Poschmann SA, Gascho D, et al. The gas bubble sign-a reliable indicator of laryngeal fractures in hanging on post-mortem CT. Br J RadiolBr J Radiol. 2018;91:20170479.

    Article  Google Scholar 

  28. Takahashi N, Satou C, Higuchi T, Shiotani M, Maeda H, Hirose Y. Quantitative analysis of brain edema and swelling on early postmortem computed tomography: comparison with antemortem computed tomography. Jpn J RadiolJpn J Radiol. 2010;28:349–54.

    Article  Google Scholar 

Download references

Acknowledgements

The authors express their gratitude to Emma Louise Kessler for her donation to the Zurich Institute of Forensic Medicine, University of Zurich, Switzerland.

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Authors and Affiliations

  1. Department of Forensic Medicine and Imaging, Zurich Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse, 190/52, CH-8057, Zurich, Switzerland

    Eva Deininger-Czermak, Jakob Heimer, Carlo Tappero, Michael J. Thali & Dominic Gascho

  2. Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland

    Eva Deininger-Czermak

  3. Department of Radiology, Hôpital Fribourgeois, Fribourg, Switzerland

    Carlo Tappero

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  1. Eva Deininger-Czermak
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  2. Jakob Heimer
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  3. Carlo Tappero
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  4. Michael J. Thali
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  5. Dominic Gascho
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Correspondence to Eva Deininger-Czermak.

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The authors have no conflict of interest to report.

Ethical approval

This study was performed with human cadavers. This article does not contain any studies with (living) human participants or animals performed by any of the authors. The scan data was acquired as part of a forensic judicial investigation. That data usage is conformant with Swiss laws and ethical standards as approved by the Ethics Committee of the Canton of Zurich (written approval, KEK ZH-Nr. 2015–0686).

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Deininger-Czermak, E., Heimer, J., Tappero, C. et al. The added value of postmortem magnetic resonance imaging in cases of hanging compared to postmortem computed tomography and autopsy. Forensic Sci Med Pathol 16, 234–242 (2020). https://doi.org/10.1007/s12024-020-00233-4

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  • DOI: https://doi.org/10.1007/s12024-020-00233-4

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