International Journal of Legal Medicine

, Volume 128, Issue 5, pp 795–802 | Cite as

Characterization and differentiation of body fluids, putrefaction fluid, and blood using Hounsfield unit in postmortem CT

  • Wolf-Dieter ZechEmail author
  • Christian Jackowski
  • Yanik Buetikofer
  • Levent Kara
Original Article


The purpose of the present study was to evaluate the ranges of Hounsfield unit (HU) found in body fluids, putrefaction fluids, and blood on postmortem CT and how these ranges are affected by postmortem interval, temperatures, and CT beam energy. Body fluids, putrefaction fluids, and blood from a total of 53 corpses were analyzed to determine the ranges of HU values from postmortem CT images that were taken prior to autopsy. The fluids measured in CT images were obtained at autopsy and examined in terms of macroscopic and microscopic appearances. Body fluids and blood were also collected in plastic bottles, which were subjected to CT scans at different beam energies (80–130 kV) and at various fluid temperatures (4 to 40 °C). At a postmortem interval of 1 to 4 days, the ranges of HU values of the serous fluids (13–38 HU) and the nonsedimented blood (40–88 HU) did not overlap. In the sedimented blood, the upper serum layer exhibited HU value ranges that overlapped with those of the serous fluids. The putrefaction fluids exhibited a range of HU values between 80 and −130 HU. Elevated HU values were observed in fluids with accretive cell impurities. HU values decreased slightly with increasing temperature and CT beam energy. We concluded that serous fluids and blood in fresh corpses can be characterized and differentiated from each other based on HU value ranges. In contrast, body fluids in decomposed corpses cannot be differentiated by their HU value ranges. Different beam energies and corpse temperatures had only minor influences on HU value ranges and therefore should not be obstacles to the differentiation and characterization of body fluids and blood.


Computed tomographie Post mortem imaging HU measurements Blood Body fluids 



The authors would like to thank the team of forensic pathologists and forensic autopsy technicians at the Institute of Forensic Medicine Bern for their support in handling the cases.


  1. 1.
    Thali MJ, Yen K, Schweitzer W, Vock P, Boesch C, Ozdoba C, Schroth G, Ith M, Sonnenschein M, Doernhoefer T, Scheurer E, Plattner T, Dirnhofer R (2003) 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 Sci 48(2):386–403PubMedGoogle Scholar
  2. 2.
    Knight B (1996) Forensic pathology. Arnold, LondonGoogle Scholar
  3. 3.
    Brogdon BG (2010) Brogdon’s Forensic Radiology, 2nd edn. CRC Press, Boca RatonGoogle Scholar
  4. 4.
    Dirnhofer R, Jackowski C, Vock P, Potter K, Thali MJ (2006) Virtopsy: minimally invasive, imaging-guided virtual autopsy. Radiographics 26(5):1305–1033PubMedCrossRefGoogle Scholar
  5. 5.
    Jackowski C, Thali M, Aghayev E, Yen K, Sonnenschein M, Zwygart K, Dirnhofer R, Vock P (2006) Postmortem imaging of blood and its characteristics using MSCT and MRI. Int J Legal Med 120(4):233–40PubMedCrossRefGoogle Scholar
  6. 6.
    Aghayev E, Christe A, Sonnenschein M, Yen K, Jackowski C, Thali MJ, Dirnhofer R, Vock P (2008) Postmortem imaging of blunt chest trauma using CT and MRI: comparison with autopsy. J Thorac Imaging 23(1):20–7PubMedCrossRefGoogle Scholar
  7. 7.
    Bolliger SA, Thali MJ, Aghayev E, Jackowski C, Vock P, Dirnhofer R, Christe A (2007) Postmortem noninvasive virtual autopsy: extrapleural hemorrhage after blunt thoracic trauma. Am J Forensic Med Pathol 28(1):44–7PubMedCrossRefGoogle Scholar
  8. 8.
    Aghayev E, Sonnenschein M, Jackowski C, Thali M, Buck U, Yen K, Bolliger S, Dirnhofer R, Vock P (2006) Postmortem radiology of fatal hemorrhage: measurements of cross-sectional areas of major blood vessels and volumes of aorta and spleen on MDCT and volumes of heart chambers on MRI. AJR 187:209–215PubMedCrossRefGoogle Scholar
  9. 9.
    Burke M, Parsons S, Bassed R (2012) Management of medicolegal natural deaths from hemopericardium or hemothorax using postmortem CT scanning. Forensic Sci Med Pathol 8(4):367–72PubMedCrossRefGoogle Scholar
  10. 10.
    Makhlouf F, Scolan V, Ferretti G, Stahl C, Paysant F (2013) Gunshot fatalities: correlation between post-mortem multi-slice computed tomography and autopsy findings: a 30-months retrospective study. Leg Med (Tokyo) 15(3):145–8CrossRefGoogle Scholar
  11. 11.
    Yamazaki K, Shiotani S, Ohashi N, Doi M, Kikuchi K, Nagata C, Honda K (2006) Comparison between computed tomography (CT) and autopsy findings in cases of abdominal injury and disease. Forensic Sci Int 162(1-3):163–6PubMedCrossRefGoogle Scholar
  12. 12.
    Riezzo I, Di Battista B, De Salvia A, Cantatore S, Neri M, Pomara C, Turillazzi E, Fineschi V (2014) Delayed splenic rupture: dating the sub-capsular hemorrhage as a useful task to evaluate causal relationships with trauma. Forensic Sci Int 234:64–71PubMedCrossRefGoogle Scholar
  13. 13.
    Allen BC, Barnhart H, Bashir M, Nieman C, Breault S, Jaffe TA (2012) Diagnostic accuracy of intra-abdominal fluid collection characterization in the era of multidetector computed tomography. Am Surg 78(2):185–9PubMedGoogle Scholar
  14. 14.
    Bydder GM, Kreel L (1980) Attenuation values of fluid collections within the abdomen. J Comput Assist Tomogr 4(2):145–50PubMedCrossRefGoogle Scholar
  15. 15.
    Churchill RJ (1989) CT of intra-abdominal fluid collections. Radiol Clin North Am 27(4):653–66PubMedGoogle Scholar
  16. 16.
    Huda W, Slone R (2003) Review of Radiologic Physics, 3rd edn. Lippincott Williams & Wilkins, PhiladelphiaGoogle Scholar
  17. 17.
    Christe A, Flach P, Ross S, Spendlove D, Bolliger S, Vock P, Thali MJ (2010) Clinical radiology and postmortem imaging (Virtopsy) are not the same: specific and unspecific postmortem signs. Leg Med (Tokyo) 12(5):215–22CrossRefGoogle Scholar
  18. 18.
    Schmitt WG (1986) Energy dependence of Hounsfield numbers. Röfo 145(2):221–3PubMedGoogle Scholar
  19. 19.
    Bydder GM, Kreel L (1979) The temperature dependence of computed tomography attenuation values. J Comput Assist Tomogr 3(4):506–10PubMedCrossRefGoogle Scholar
  20. 20.
    Egger C, Vaucher P, Doenz F, Palmiere C, Mangin P, Grabherr S (2012) Development and validation of a postmortem radiological alteration index: the RA-Index. Int J Legal Med 126(4):559–66PubMedCrossRefGoogle Scholar
  21. 21.
    Grabherr S, Grimm J, Dominguez A, Vanhaebost J, Mangin P (2014) Advances in post-mortem CT-angiography. Br J Radiol 87(1036):20130488. doi: 10.1259/bjr.20130488 PubMedCrossRefGoogle Scholar
  22. 22.
    Jackowski C, Persson A, Thali MJ (2008) Whole body postmortem angiography with a high viscosity contrast agent solution using poly ethylene glycol as contrast agent dissolver. J Forensic Sci 53(2):465–8PubMedCrossRefGoogle Scholar
  23. 23.
    Montano-Loza AJ (2013) New concepts in liver cirrhosis: clinical significance of sarcopenia in cirrhotic patients. Minerva Gastroenterol Dietol 59(2):173–86PubMedGoogle Scholar
  24. 24.
    Treglia G, Sadeghi R, Annunziata S, Lococo F, Cafarotti S, Bertagna F, Prior JO, Ceriani L, Giovanella L (2014) Diagnostic accuracy of (18)F-FDG-PET and PET/CT in the differential diagnosis between malignant and benign pleural lesions: a systematic review and meta-analysis. Acad Radiol 21(1):11–20PubMedCrossRefGoogle Scholar
  25. 25.
    Solooki M, Miri M (2013) Approach to undiagnosed exudative pleural effusion: the diagnostic yield of blind pleural biopsy. Caspian J Intern Med 4(2):642–7PubMedCentralPubMedGoogle Scholar
  26. 26.
    Huang XE, Wei GL, Huo JG, Wang XN, Lu YY, Wu XY, Liu J, Xiang J, Feng JF (2013) Intrapleural or intraperitoneal lobaplatin for treatment of patients with malignant pleural effusion or ascites. Asian Pac J Cancer Prev 14(4):2611–4PubMedCrossRefGoogle Scholar
  27. 27.
    Adhikari P, Pathak UN, Uprety D, Sapkota S (2012) Profile of ascites patient admitted in Nepal Medical College Teaching Hospital. Nepal Med Coll J 14(2):111–3PubMedGoogle Scholar
  28. 28.
    Schleyer F (1958) Postmortem blood viscosity, blood cell volume, osmotic erythrocyte resistance and blood sedimentation in relation to cadaver age and cause of death. Virchows Arch 331(3):276–86PubMedCrossRefGoogle Scholar
  29. 29.
    Brinkmann B, Madea B (2004) Handbuch gerichtliche Medizin, vol 1, 1st edn. Springer, BerlinGoogle Scholar
  30. 30.
    Makrogiannis S, Caturegli G, Davatzikos C, Ferrucci L (2013) Computer-aided assessment of regional abdominal fat with food residue removal in CT. Acad Radiol 20(11):1413–21PubMedCrossRefGoogle Scholar
  31. 31.
    Weissleder R, Wittenberg J, Harisinghani MG, Chen JW (2011) Primer of diagnostic imaging, 5th edn. Mosby Elsevier, St. LouisGoogle Scholar
  32. 32.
    Strandberg S, Wretling ML, Wredmark T, Shalabi A (2010) Reliability of computed tomography measurements in assessment of thigh muscle cross-sectional area and attenuation. BMC Med Imaging 10--18. doi: 10.1186/1471-2342-10-18
  33. 33.
    Ruder TD, Thali Y, Schindera ST, Dalla Torre SA, Zech WD, Thali MJ, Ross S, Hatch GM (2012) How reliable are Hounsfield-unit measurements in forensic radiology? Forensic Sci Int 220(1–3):219–23PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Wolf-Dieter Zech
    • 1
    Email author
  • Christian Jackowski
    • 1
  • Yanik Buetikofer
    • 1
  • Levent Kara
    • 1
  1. 1.Institute of Forensic MedicineUniversity of BernBernSwitzerland

Personalised recommendations