Life-threatening versus non-life-threatening manual strangulation: are there appropriate criteria for MR imaging of the neck?
The aim of the study was to determine objective radiological signs of danger to life in survivors of manual strangulation and to establish a radiological scoring system for the differentiation between life-threatening and non-life-threatening strangulation by dividing the cross section of the neck into three zones (superficial, middle and deep zone). Forensic pathologists classified 56 survivors of strangulation into life-threatening and non-life-threatening cases by history and clinical examination alone, and two blinded radiologists evaluated the MRIs of the neck. In 15 cases, strangulation was life-threatening (27%), compared with 41 cases in which strangulation was non-life-threatening (73%). The best radiological signs on MRI to differentiate between the two groups were intramuscular haemorrhage/oedema, swelling of platysma and intracutaneous bleeding (all p = 0.02) followed by subcutaneous bleeding (p = 0.034) and haemorrhagic lymph nodes (p = 0.04), all indicating life-threatening strangulation. The radiological scoring system showed a sensitivity and specificity of ≈70% for life-threatening strangulation, when at least two neck zones were affected. MRI is not only helpful in assessing the severity of strangulation, but is also an excellent documentation tool that is even admissible in court.
KeywordsManual strangulation MRI of the neck Radiological zone score for life-threatening strangulation
The authors are grateful to the entire Virtopsy team and their research partners (see www.virtopsy.com), who made this study possible due to their exceptional commitment. Special thanks go to the forensic pathologists of the Institute of Forensic Medicine (University of Bern, Switzerland), for their expertise and support during the study. Futhermore, we thank the team of highly motivated radiology technicians of the MRI-division of the Department of Radiology at Inselspital, (University of Bern, Switzerland).
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