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Postmortem Multislice Computed Tomography and Magnetic Resonance Imaging of odontoid fractures, atlantoaxial distractions and ascending medullary edema

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Abstract

Non-invasive imaging methods are increasingly entering the field of forensic medicine. Facing the intricacies of classical neck dissection techniques, postmortem imaging might provide new diagnostic possibilities which could also improve forensic reconstruction. The aim of this study was to determine the value of postmortem neck imaging in comparison to forensic autopsy regarding the evaluation of the cause of death and the analysis of biomechanical aspects of neck trauma. For this purpose, 5 deceased persons (1 female and 4 male, mean age 49.8 years, range 20–80 years) who had suffered odontoid fractures or atlantoaxial distractions with or without medullary injuries, were studied using multislice computed tomography (MSCT), magnetic resonance imaging (MRI) and subsequent forensic autopsy. Evaluation of the findings was performed by radiologists, forensic pathologists and neuropathologists. The cause of death could be established radiologically in three of the five cases. MRI data were insufficient due to metal artefacts in one case, and in another, ascending medullary edema as the cause of delayed death was only detected by histological analysis. Regarding forensic reconstruction, the imaging methods were superior to autopsy neck exploration in all cases due to the post-processing possibilities of viewing the imaging data. In living patients who suffer medullary injury, follow-up MRI should be considered to exclude ascending medullary edema.

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Acknowledgments

The authors would like to thank Roland Dorn, Urs Koenigsdorfer and Therese Perinat for their excellent technical assistance and Verena Beutler, Elke Spielvogel, Carolina Dobrowolska and Christoph Laeser for their help with data acquisition. The research was supported by grants from the Gebert-Ruef-Foundation, Basel, Switzerland, and from the Government of Vorarlberg, Bregenz, Austria.

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Authors and Affiliations

  1. Institute of Forensic Medicine, University of Bern, Buehlstrasse 20, 3012 , Bern, Switzerland

    Kathrin Yen, Michael J. Thali, Emin Aghayev, Christian Jackowski & Richard Dirnhofer

  2. Institute of Diagnostic Radiology, Inselspital Bern, Freiburgstrasse 20, 3012, Bern, Switzerland

    Martin Sonnenschein

  3. Department of Neuroradiology, Inselspital Bern, Freiburgstrasse, 3010, Bern, Switzerland

    Christof Ozdoba

  4. Division of Neuropathology, Institute of Pathology, University of Bern, Murtenstrasse 31, 3010, Bern, Switzerland

    Joachim Weis

  5. Institute of Neuropathology, University Hospital RWTH, Aachen, Germany

    Joachim Weis

  6. Department of Clinical Research, Magnetic Resonance Spectroscopy and Methodology, University of Bern, Switzerland

    Karin Zwygart

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  1. Kathrin Yen
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  2. Martin Sonnenschein
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  3. Michael J. Thali
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  7. Emin Aghayev
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  8. Christian Jackowski
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  9. Richard Dirnhofer
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Correspondence to Kathrin Yen.

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Yen, K., Sonnenschein, M., Thali, M.J. et al. Postmortem Multislice Computed Tomography and Magnetic Resonance Imaging of odontoid fractures, atlantoaxial distractions and ascending medullary edema. Int J Legal Med 119, 129–136 (2005). https://doi.org/10.1007/s00414-004-0507-7

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  • DOI: https://doi.org/10.1007/s00414-004-0507-7

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