Imaging Techniques for Postmortem Forensic Radiology

  • Gaia CartocciEmail author
  • Alessandro Santurro
  • Paola Frati
  • Giuseppe Guglielmi
  • Raffaele La Russa
  • Vittorio Fineschi


Postmortem forensic radiology aims to acquisition, interpretation, and reporting of radiologic images for the purpose of forensic investigations, in the living as well as the deceased. Conventional radiology still remains the most common modality used in the forensic setting and the gold standard method for many forensic challenges. X-rays are commonly used for visualization and localization of foreign bodies, and for body identification and identities confirmation. Computed tomography (PMCT) is the most frequent imaging tool in forensic pathology besides X-ray. Indications of PMCT are especially focused on cases of unnatural deaths: traumatic events such as bone fractures and nonaccidental injury in children; gunshot injuries; hanging, strangulation, and drowning cases; putrefied, carbonized, and badly damaged bodies. In order to visualize the soft tissue, especially organs, MRI can be used. Although this technique has the potential to overcome the limitations of PCMT, it is only rarely used in forensic imaging as it is a complex technology requiring specific training, expensive, and with some complication in execution due to body size, artifact, and protocols. MRI is of special significance for the diagnosis of natural death, especially related to diseases of the cardiovascular or central nervous system, and for investigations concerning neonatal and perinatal deaths. Comparing the results of postmortem imaging with subsequent autopsies, rates of major discrepancies between cause of death identified by radiology and autopsy of 32% for PMCT, 43% for PMMR, and 30% for PMCT + PMMRI have been reported. Vice versa, different studies have demonstrated that PMCT or PMMRI in conjunction with conventional postmortem examinations can augment the value of postmortem examinations, providing more information than either examination alone.


Forensic radiology Postmortem CT Foreign bodies Bone fractures PMMRA 

Further Reading

  1. Appleby J, Rutty GN, Hainsworth SV, Woosnam-Savage RC, Morgan B, Brough A, Earp RW, Robinson C, King TE, Morris M, Buckley R (2015) Perimortem trauma in King Richard III: a skeletal analysis. Lancet 385(9964):253–259PubMedCrossRefGoogle Scholar
  2. Arthurs OJ, Hutchinson JC, Sebire NJ (2017) Current issues in postmortem imaging of perinatal and forensic childhood deaths. Forensic Sci Med Pathol 13(1):58–66PubMedPubMedCentralCrossRefGoogle Scholar
  3. Bolliger SA, Thali MJ (2015) Imaging and virtual autopsy: looking back and forward. Philos Trans R Soc Lond Ser B Biol Sci 370(1674):20140253CrossRefGoogle Scholar
  4. Bonney HE (2015) Richard III: skeletal evidence of perimortem. Lancet 385(9964):210PubMedCrossRefGoogle Scholar
  5. Brogdon BG (2000) Scope of forensic radiology. Crit Rev Diagn Imaging 41(1):43–67PubMedCrossRefGoogle Scholar
  6. Busardò FP, Frati P, Guglielmi G, Grilli G, Pinto A, Rotondo A, Panebianco V, Fineschi V (2015) Postmortem-computed tomography and postmortem-computed tomography-angiography: a focused update. Radiol Med 120(9):810–823PubMedCrossRefGoogle Scholar
  7. Chevallier C, Doenz F, Vaucher P, Palmiere C, Dominguez A, Binaghi S, Mangin P, Grabherr S (2013) Postmortem computed tomography angiography vs. conventional autopsy: advantages and inconveniences of each method. Int J Legal Med 127(5):981–989PubMedCrossRefGoogle Scholar
  8. De Marco E, Vacchiano G, Frati P, La Russa R, Santurro A, Scopetti M, Guglielmi G, Fineschi V (2018) Evolution of post-mortem coronary imaging: from selective coronary arteriography to post-mortem CT-angiography and beyond. Radiol Med 123(5):351–358PubMedCrossRefGoogle Scholar
  9. Dirnhofer R, Jackowski C, Vock P, Potter K, Thali MJ (2006) VIRTOPSY: minimally invasive, imaging-guided virtual autopsy. Radiographics 26(5):1305–1333PubMedCrossRefGoogle Scholar
  10. Elifritz JM, Nolte KB, Hatch GM, Adolphi NL, Gerrard C (2014) Radiology, forensic imaging and the ‘virtual autopsy’. In: Pathobiology of human disease: a dynamic encyclopedia of disease mechanisms. Elsevier, Amsterdam, pp 3448–3458CrossRefGoogle Scholar
  11. Fais P, Giraudo C, Viero A, Miotto D, Bortolotti F, Tagliaro F, Montisci M, Cecchetto G (2016) Micro computed tomography features of laryngeal fractures in a case of fatal manual strangulation. Leg Med (Tokyo) 18:85–89CrossRefGoogle Scholar
  12. Flach PM, Gascho D, Schweitzer W, Ruder TD, Berger N, Ross SG, Thali MJ, Ampanozi G (2014a) Imaging in forensic radiology: an illustrated guide for postmortem computed tomography technique and protocols. Forensic Sci Med Pathol 10(4):583–606CrossRefGoogle Scholar
  13. Flach PM, Thali MJ, Germerott T (2014b) Times have changed! Forensic radiology—a new challenge for radiology and forensic pathology. AJR Am J Roentgenol 202(4):W325–W334PubMedCrossRefGoogle Scholar
  14. Fukutake K, Ishiwatari T, Takahashi H, Tsuchiya K, Okubo Y, Shinozaki M, Tochigi N, Wakayama M, Nemoto T, Shibuya K, Wada A (2015) Investigation of ossification in the posterior longitudinal ligament using micro-focus X-ray CT scanning and histological examination. Diagn Pathol 10:205PubMedPubMedCentralCrossRefGoogle Scholar
  15. Grabherr S, Baumann P, Minoiu C, Fahrni S, Mangin P (2016) Post-mortem imaging in forensic investigations: current utility, limitations, and ongoing developments. Res Rep Forensic Med Sci 6:25–37Google Scholar
  16. Grabherr S, Doenz F, Steger B, Dirnhofer R, Dominguez A, Sollberger B, Gygax E, Rizzo E, Chevallier C, Meuli R, Mangin P (2011) Multi-phase post-mortem CT angiography: development of a standardized protocol. Int J Legal Med 125(6):791–802PubMedCrossRefGoogle Scholar
  17. Grabherr S, Grimm J, Baumann P, Mangin P (2015) Application of contrast media in post-mortem imaging (CT and MRI). Radiol Med 120(9):824–834PubMedCrossRefGoogle Scholar
  18. Grabherr S, Grimm J, Dominguez A, Vanhaebost J, Mangin P (2014) Advances in post-mortem CT-angiography. Br J Radiol 87(1036):20130488PubMedPubMedCentralCrossRefGoogle Scholar
  19. Grabherr S, Gygax E, Sollberger B, Ross S, Oesterhelweg L, Bolliger S, Christe A, Djonov V, Thali MJ, Dirnhofer R (2008) Two-step postmortem angiography with a modified heart-lung machine: preliminary results. AJR Am J Roentgenol 190(2):345–351PubMedCrossRefGoogle Scholar
  20. Guidi B, Aquaro GD, Gesi M, Emdin M, Di Paolo M (2018) Postmortem cardiac magnetic resonance in sudden cardiac death. Heart Fail Rev 23(5):651–665PubMedCrossRefGoogle Scholar
  21. Hughes N, Baker M (1997) The use of radiography in forensic medicine. Radiography 3(4):311–320CrossRefGoogle Scholar
  22. Hutchinson JC, Arthurs OJ, Ashworth MT, Ramsey AT, Mifsud W, Lombardi CM, Sebire NJ (2016) Clinical utility of postmortem microcomputed tomography of the fetal heart: diagnostic imaging vs macroscopic dissection. Ultrasound Obstet Gynecol 47(1):58–64PubMedCrossRefGoogle Scholar
  23. Kahana T, Hiss J (2005) Forensic radiology. In: Forensic pathology reviews, vol 3. Humana Press, Totowa, NJ, pp 443–460CrossRefGoogle Scholar
  24. Kettner M, Potente S, Schulz B, Knauff P, Schmidt PH, Ramsthaler F (2014) Analysis of laryngeal fractures in decomposed bodies using microfocus computed tomography (mfCT). Forensic Sci Med Pathol 10(4):607–612PubMedCrossRefGoogle Scholar
  25. Kudlas M, Odle T (2010) The state of forensic radiography. Radiol Technol 81(5):484–490PubMedGoogle Scholar
  26. La Russa R, Catalano C, Di Sanzo M, Scopetti M, Gatto V, Santurro A, Viola RV, Panebianco V, Frati P, Fineschi V (2019) Postmortem computed tomography angiography (PMCTA) and traditional autopsy in cases of sudden cardiac death due to coronary artery disease: a systematic review and meta-analysis. Radiol Med 124(2):109–117Google Scholar
  27. Lundström C, Persson A, Ross S, Ljung P, Lindholm S, Gyllensvärd F, Ynnerman A (2012) State-of-the-art of visualization in post-mortem imaging. APMIS 120(4):316–326PubMedCrossRefGoogle Scholar
  28. Mokrane FZ, Savall F, Dercle L, Crubezy E, Telmon N, Rousseau H, Dedouit F (2017) A preliminary comparative study between classical and interventional radiological approaches for multi-phase post-mortem CT angiography. Forensic Sci Int 271:23–32PubMedCrossRefGoogle Scholar
  29. O’Donnell C, Woodford N (2008) Post-mortem radiology—a new sub-speciality? Clin Radiol 63(11):1189–1194CrossRefGoogle Scholar
  30. Pomara C, Bello S, Grilli G, Guglielmi G, Turillazzi E (2015) Multi-phase postmortem CT angiography (MPMCTA): a new axillary approach suitable in fatal thromboembolism. Radiol Med 120(7):670–673PubMedCrossRefGoogle Scholar
  31. Pomara C, Fineschi V, Scalzo G, Guglielmi G (2009) Virtopsy versus digital autopsy: virtual autopsy. Radiol Med 114(8):1367–1382PubMedCrossRefGoogle Scholar
  32. Reynolds A (2010) Forensic radiography: an overview. Radiol Technol 81(4):361–379PubMedGoogle Scholar
  33. Roberts IS, Benamore RE, Benbow EW, Lee SH, Harris JN, Jackson A, Mallett S, Patankar T, Peebles C, Roobottom C, Traill ZC (2012) Post-mortem imaging as an alternative to autopsy in the diagnosis of adult deaths: a validation study. Lancet 379(9811):136–142PubMedPubMedCentralCrossRefGoogle Scholar
  34. Ross S, Ebner L, Flach P, Brodhage R, Bolliger SA, Christe A, Thali MJ (2012a) Postmortem whole-body MRI in traumatic causes of death. AJR Am J Roentgenol 199(6):1186–1192PubMedPubMedCentralCrossRefGoogle Scholar
  35. Ross SG, Bolliger SA, Ampanozi G, Oesterhelweg L, Thali MJ, Flach PM (2014) Postmortem CT angiography: capabilities and limitations in traumatic and natural causes of death. Radiographics 34(3):830–846PubMedCrossRefGoogle Scholar
  36. Ross SG, Thali MJ, Bolliger S, Germerott T, Ruder TD, Flach PM (2012b) Sudden death after chest pain: feasibility of virtual autopsy with postmortem CT angiography and biopsy. Radiology 264(1):250–259CrossRefGoogle Scholar
  37. Ruder TD, Flach PM, Thali MJ (2013) Virtual autopsy. Forensic Sci Med Pathol 9(3):435–436PubMedCrossRefGoogle Scholar
  38. Ruder TD, Hatch GM, Ebert LC, Flach PM, Ross S, Ampanozi G, Thali MJ (2012) Whole body postmortem magnetic resonance angiography. J Forensic Sci 57(3):778–782PubMedCrossRefGoogle Scholar
  39. Ruder TD, Thali MJ, Hatch GM (2014) Essentials of forensic post-mortem MR imaging in adults. Br J Radiol 87:20130567PubMedPubMedCentralCrossRefGoogle Scholar
  40. Sieswerda-Hoogendoorn T, van Rijn RR (2010) Current techniques in postmortem imaging with specific attention to paediatric applications. Pediatr Radiol 40(2):141–152PubMedCrossRefGoogle Scholar
  41. Swift B, Rutty GN (2006) Recent advances in postmortem forensic radiology. Computed tomography and magnetic resonance imaging applications. In: Forensic pathology reviews, vol 4. Humana Press, Totowa, NJ, pp 355–404CrossRefGoogle Scholar
  42. 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 post-mortem multislice computed tomography (MSCT) and magnetic resonance imaging (MRI)—a feasibility study. J Forensic Sci 48(2):386–403CrossRefGoogle Scholar
  43. Turillazzi E, Frati P, Pascale N, Pomara C, Grilli G, Viola RV, Fineschi V (2016) Multi-phase post-mortem CT-angiography: a pathologic correlation study on cardiovascular sudden death. J Geriatr Cardiol 13(10):855–865PubMedPubMedCentralGoogle Scholar
  44. Underwood J (2012) Post-mortem imaging and autopsy: rivals or allies? Lancet 379(9811):100–102PubMedCrossRefGoogle Scholar
  45. Vullo A, Panebianco V, Cannavale G, Aromatario M, Cipolloni L, Frati P, Santurro A, Vullo F, Catalano C, Fineschi V (2016) Post-mortem magnetic resonance foetal imaging: a study of morphological correlation with conventional autopsy and histopathological findings. Radiol Med 121(11):847–856PubMedCrossRefGoogle Scholar
  46. Wichmann D, Heinemann A, Weinberg C, Vogel H, Hoepker WW, Grabherr S, Pueschel K, Kluge S (2014) Virtual autopsy with multiphase postmortem computed tomographic angiography versus traditional medical autopsy to investigate unexpected deaths of hospitalized patients: a cohort study. Ann Intern Med 160(8):534–541PubMedCrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Gaia Cartocci
    • 1
    Email author
  • Alessandro Santurro
    • 1
  • Paola Frati
    • 1
  • Giuseppe Guglielmi
    • 2
  • Raffaele La Russa
    • 1
  • Vittorio Fineschi
    • 1
  1. 1.Department of Anatomical, Histological, Forensic and Orthopaedic SciencesSapienza University of RomeRomeItaly
  2. 2.Department of RadiologyUniversity of FoggiaFoggiaItaly

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