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Application of postmortem MRI for identification of medulla oblongata contusion as a cause of death: a case report

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Abstract

Whiplash injury is common in traffic accidents, and severe whiplash is characterized by cervical spinal cord injuries with cervical dislocation or fracture, that can be diagnosed by postmortem computed tomography (PMCT), postmortem magnetic resonance (PMMR), or conventional autopsy. However, for cervical spinal cord injury without fracture and dislocation, PMMR can be more informative because it provides higher resolution of soft tissues. We report the case of a 29-year-old male who died immediately following a traffic accident, in which the vehicle hit an obstacle at a high speed, causing deformation of the bumper and severe damage of the vehicle body. PMCT indicated no significant injuries or diseases related to death, but PMMR showed patchy abnormal signals in the medulla oblongata, and the lower edge of the cerebellar tonsil was herniated out of the foramen magnum. The subsequent pathological and histological results confirmed that death was caused by medulla oblongata contusion combined with cerebellar tonsillar herniation. Our description of this case of a rare but fatal whiplash injury in which there was no fracture or dislocation provides a better understanding of the potentially fatal consequences of cervical spinal cord whiplash injury without fracture or dislocation and of the underlying lethal mechanisms. Compared with PMCT, PMMR provides important diagnostic information in forensic practice for the identification of soft tissue injuries, and is therefore an important imaging modality for diagnosis of whiplash injury when there is no fracture or dislocation.

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References

  1. Rutty GN, Morgan B, Robinson C et al (2017) Diagnostic accuracy of post-mortem CT with targeted coronary angiography versus autopsy for coroner-requested post-mortem investigations: a prospective, masked, comparison study. Lancet 390:145–154. https://doi.org/10.1016/S0140-6736(17)30333-1

    Article  Google Scholar 

  2. Roberts ISD, Benamore RE, Benbow EW et al (2012) Post-mortem imaging as an alternative to autopsy in the diagnosis of adult deaths: a validation study. Lancet 379:136–142. https://doi.org/10.1016/S0140-6736(11)61483-9

    Article  Google Scholar 

  3. Ampanozi G, Halbheer D, Ebert LC, Thali MJ, Held U (2020) Postmortem imaging findings and cause of death determination compared with autopsy: a systematic review of diagnostic test accuracy and meta-analysis. Int J Legal Med 134:321–337. https://doi.org/10.1007/s00414-019-02140-y

    Article  Google Scholar 

  4. Mondello C, Baldino G, Bottari A et al (2022) The role of PMCT for the assessment of the cause of death in natural disaster (landslide and flood): a Sicilian experience. Int J Legal Med 136:237–244. https://doi.org/10.1007/s00414-021-02683-z

    Article  Google Scholar 

  5. Busardo FP, Frati P, Guglielmi G et al (2015) Postmortem-computed tomography and postmortem-computed tomography-angiography: a focused update. Radiol Med 120:810–823. https://doi.org/10.1007/s11547-015-0559-4

    Article  Google Scholar 

  6. Grabherr S, Egger C, Vilarino R, Campana L, Jotterand M, Dedouit F (2017) Modern post-mortem imaging: an update on recent developments. Foren Sci Res 2:52–64. https://doi.org/10.1080/20961790.2017.1330738

    Article  Google Scholar 

  7. Gershon A, Little D, Ball CG, Williams AS (2020) Fatal secondary aortoduodenal fistula diagnosed with postmortem computed tomography angiography. Forensic Sci Med Pat 16:515–518. https://doi.org/10.1007/s12024-020-00256-x

    Article  Google Scholar 

  8. Hovet S, Ren HL, Xu S, Wood B, Tokuda J, Tse ZTH (2018) MRI-powered biomedical devices Minim Invasiv Ther 27:191–202. https://doi.org/10.1080/13645706.2017.1402188

    Article  Google Scholar 

  9. Martin-Noguerol T, Mohan S, Santos-Armentia E, Cabrera-Zubizarreta A, Luna A (2021) Advanced MRI assessment of non-enhancing peritumoral signal abnormality in brain lesions. Eur J Radiol 143. https://doi.org/10.1016/j.ejrad.2021.109900

  10. Busse A, Rajagopal R, Yucel S et al (2020) Cardiac MRI—update 2020. Radiologe. https://doi.org/10.1007/s00117-020-00687-1

    Article  Google Scholar 

  11. Russo V, Lovato L, Ligabue G (2020) Cardiac MRI: technical basis. Radiol Med 125:1040–1055. https://doi.org/10.1007/s11547-020-01282-z

    Article  Google Scholar 

  12. Ros PR, Li KC, Vo P, Baer H, Staab EV (1990) Preautopsy magnetic-resonance-imaging — initial experience. Magn Reson Imaging 8:303–308. https://doi.org/10.1016/0730-725x(90)90103-9

    Article  Google Scholar 

  13. Ruder TD, Bauer-Kreutz R, Ampanozi G et al (2012) Assessment of coronary artery disease by post-mortem cardiac MR. Eur J Radiol 81:2208–2214. https://doi.org/10.1016/j.ejrad.2011.06.042

    Article  Google Scholar 

  14. Jackowski C, Schwendener N, Grabherr S, Persson A (2013) Post-mortem cardiac 3-T magnetic resonance imaging visualization of sudden cardiac death? J Am Coll Cardiol 62:617–629. https://doi.org/10.1016/j.jacc.2013.01.089

    Article  Google Scholar 

  15. Okuda T, Shiotani S, Hayakawa H, Kikuchi K, Kobayashi T, Ohno Y (2013) A case of fatal cervical discoligamentous hyperextension injury without fracture: correlation of postmortem imaging and autopsy findings. Forensic Sci Int 225:71–74. https://doi.org/10.1016/j.forsciint.2012.04.035

    Article  Google Scholar 

  16. Michaud K, Grabherr S, Jackowski C, Bollmann MD, Doenz F, Mangin P (2014) Postmortem imaging of sudden cardiac death. Int J Legal Med 128:127–137. https://doi.org/10.1007/s00414-013-0819-6

    Article  Google Scholar 

  17. Franckenberg S, Schulze C, Bolliger SA, Gascho D, Thali MJ, Flach PM (2015) Postmortem angiography in computed tomography and magnetic resonance imaging in a case of fatal hemorrhage due to an arterio-venous malformation in the brain. Legal Med-Tokyo 17:180–183. https://doi.org/10.1016/j.legalmed.2014.11.006

    Article  Google Scholar 

  18. Zech WD, Schwendener N, Persson A, Warntjes MJ, Jackowski C (2015) Postmortem MR quantification of the heart for characterization and differentiation of ischaemic myocardial lesions. Eur Radiol 25:2067–2073. https://doi.org/10.1007/s00330-014-3582-2

    Article  Google Scholar 

  19. Makino Y, Arai N, Hoshioka Y et al (2019) Traumatic axonal injury revealed by postmortem magnetic resonance imaging: a case report. Legal Med-Tokyo 36:9–16. https://doi.org/10.1016/j.legalmed.2018.09.019

    Article  Google Scholar 

  20. Makino Y, Kojima M, Yoshida M et al (2020) Postmortem CT and MRI findings of massive fat embolism. Int J Legal Med 134:669–678. https://doi.org/10.1007/s00414-019-02128-8

    Article  Google Scholar 

  21. Chen YJ (2014) Research development and application of virtopsy. Fa Yi Xue Za Zhi 30:360–366. https://doi.org/10.3969/j.issn.1004-5619.2014.05.012

    Article  Google Scholar 

  22. Saunders SL, Morgan B, Raj V, Robinson CE, Rutty GN (2011) Targeted post-mortem computed tomography cardiac angiography: proof of concept. Int J Legal Med 125:609–616. https://doi.org/10.1007/s00414-011-0559-4

    Article  Google Scholar 

  23. Roberts ISD, Benamore RE, Peebles C, Roobottom C, Traill ZC (2011) Diagnosis of coronary artery disease using minimally invasive autopsy: evaluation of a novel method of post-mortem coronary CT angiography. Clin Radiol 66:645–650. https://doi.org/10.1016/j.crad.2011.01.007

    Article  Google Scholar 

  24. Skopp G (2004) Preanalytic aspects in postmortem toxicology. Forensic Sci Int 142:75–100. https://doi.org/10.1016/j.forsciint.2004.02.012

    Article  Google Scholar 

  25. de Lima IV, Midio AF (1999) Origin of blood ethanol in decomposed bodies. Forensic Sci Int 106:157–162. https://doi.org/10.1016/S0379-0738(99)00150-4

    Article  Google Scholar 

  26. Childs SG (2004) Cervical whiplash syndrome. Hyperextension-hyperflexion injury. Orthop Nurs 23: 106–10; quiz 11–2. https://doi.org/10.1097/00006416-200403000-00005

  27. Hayashi K, Yone K, Ito H, Yanase M, Sakou T (1995) MRI findings in patients with a cervical spinal cord injury who do not show radiographic evidence of a fracture or dislocation. Paraplegia 33:212–215. https://doi.org/10.1038/sc.1995.47

    Article  Google Scholar 

  28. Shimada K, Tokioka T (1995) Sequential MRI studies in patients with cervical cord injury but without bony injury. Paraplegia 33:573–578. https://doi.org/10.1038/sc.1995.123

    Article  Google Scholar 

  29. Pang D, Wilberger JE (1982) Spinal-cord injury without radiographic abnormalities in children. J Neurosurg 57:114–129. https://doi.org/10.3171/jns.1982.57.1.0114

    Article  Google Scholar 

  30. Rozzelle CJ, Aarabi B, Dhall SS et al (2013) Spinal Cord Injury Without Radiographic Abnormality (SCIWORA). Neurosurgery 72:227–233. https://doi.org/10.1227/NEU.0b013e3182770ebc

    Article  Google Scholar 

  31. Carreon L, Glassman S, Campbell M (2004) Pediatric spine fractures: a review of 137 hospital admissions. J Spinal Disord Tech 17:477–482. https://doi.org/10.1097/01.bsd.0000132290.50455.99

    Article  Google Scholar 

  32. Bracken M, Shepard M, Holford T et al (1997) Administration of methylprednisolone for 24 or 48 hours or tirilazad mesylate for 48 hours in the treatment of acute spinal cord injury. Results of the Third National Acute Spinal Cord Injury Randomized Controlled Trial. National Acute Spinal Cord Injury Study. JAMA 277:1597–1604. https://doi.org/10.1001/jama.277.20.1597

    Article  Google Scholar 

  33. Hendey G, Wolfson A, Mower W, Hoffman J (2002) Spinal cord injury without radiographic abnormality: results of the National Emergency X-Radiography Utilization Study in blunt cervical trauma. J Trauma 53:1–4. https://doi.org/10.1097/00005373-200207000-00001

    Article  Google Scholar 

  34. Miyanji F, Furlan JC, Aarabi B, Arnold PM, Fehlings MG (2007) Acute cervical traumatic spinal cord injury: MR imaging findings correlated with neurologic outcome — prospective study with 100 consecutive patients. Radiology 243:820–827. https://doi.org/10.1148/radiol.2433060583

    Article  Google Scholar 

  35. Ruder TD, Hatch GM, Siegenthaler L et al (2012) The influence of body temperature on image contrast in post mortem MRI. Eur J Radiol 81:1366–1370. https://doi.org/10.1016/j.ejrad.2011.02.062

    Article  Google Scholar 

  36. Tashiro K, Shiotani S, Kobayashi T et al (2015) Cerebral relaxation times from postmortem MR imaging of adults. Magn Reson Med Sci 14:51–56. https://doi.org/10.2463/mrms.2013-0126

    Article  Google Scholar 

  37. Arnold I, Schwendener N, Lombardo P, Jackowski C, Zech WD (2021) 3Tesla post-mortem MRI quantification of anatomical brain structures. Forensic Sci Int 327. https://doi.org/10.1016/j.forsciint.2021.110984

  38. Xia ZY, Bruguier C, Dedouit F, Grabherr S, Augsburger M, Liu BB (2020) Oleic Acid (OA), A potential dual contrast agent for postmortem MR angiography (PMMRA): a pilot study. Curr Med Sci 40:786–794. https://doi.org/10.1007/s11596-020-2244-7

    Article  Google Scholar 

  39. Ruder TD, Thali MJ, Hatch GM (2014) Essentials of forensic post-mortem MR imaging in adults. Brit J Radiol 87. https://doi.org/10.1259/bjr.20130567

  40. Jia YQ, Jin GD, Tian MH et al (2019) Effect of corpse cryopreservation on forensic pathological identification. Fa Yi Xue Za Zhi 35:74–7. https://doi.org/10.12116/j.issn.1004-5619.2019.01.014

    Article  Google Scholar 

  41. Bolliger S, Tomasin D, Heimer J, Richter H, Thali M, Gascho D (2018) Rapid and reliable detection of previous freezing of cerebral tissue by computed tomography and magnetic resonance imaging. Forensic Sci Med Pathol 14:85–94. https://doi.org/10.1007/s12024-018-9955-0

    Article  Google Scholar 

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Funding

This project was supported by Foundation of Jilin Educational Committee (Grant Number: JJKH20221052KJ).

Author information

Authors and Affiliations

  1. Department of Forensic Medicine, Basic Medical College, Jilin University, Changchun, Jilin, 130021, China

    Liyao Yang, Haiyan Liu, Xin Zhao, Hongyang Li, Bo Wang, Lu Zhao, Haichao Zhu, Yong Zhang & Zhiming Chen

  2. Department of Radiology, The First Hospital, Jilin University, Changchun, Jilin, 130021, China

    Dandan Zhou & Huimao Zhang

  3. Changchun City Public Security Bureau, Jilin, 130051, China

    Lijun Wang & Yanbin Gao

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  1. Liyao Yang
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Contributions

Liyao Yang and Zhiming Chen had complete access to all data and were responsible for the integrity and correctness of the data and analyses; Liyao Yang and Dandan Zhou performed the data collection and analysis; Haiyan Liu, Xin Zhao, and Hongyang Li performed the conventional autopsy and histopathological examination; Bo Wang, Lu Zhao, and Lijun Wang performed the PMMR; Yanbin Gao, Haichao Zhu, and Yong Zhang performed the PMCT; and Huimao Zhang and Zhiming Chen were responsible for the critical revisions of the manuscript, provided important intellectual content, and supervised this study. The first draft of the manuscript was written by Liyao Yang, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Huimao Zhang or Zhiming Chen.

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Ethical approval for the publication of case-related data was obtained by the Ethics Committee of the First Hospital of Jilin University.

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The ethics committee of the First Hospital of Jilin University approved this study. The article includes participants from whom informed consent was required.

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Yang, L., Liu, H., Zhao, X. et al. Application of postmortem MRI for identification of medulla oblongata contusion as a cause of death: a case report. Int J Legal Med 137, 115–121 (2023). https://doi.org/10.1007/s00414-022-02909-8

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