DOI: 10.1148/rg.265065001
VIRTOPSY: Minimally Invasive, Imaging-guided Virtual Autopsy
Richard Dirnhofer, MD,
Christian Jackowski, MD,
Peter Vock, MD,
Kimberlee Potter, PhD and
Michael J. Thali, MD
1 From the Institute of Forensic Medicine, University of Bern, Buehlstrasse 20, CH-3012 Bern, Switzerland (R.D., C.J., M.J.T.); the Institute of Diagnostic Radiology, Inselspital, University of Bern, Bern, Switzerland (P.V.); and the Armed Forces Institute of Pathology, MRM Facility, Washington, DC (K.P.). Presented as an education exhibit at the 2003 RSNA Annual Meeting. Received January 3, 2006; revision requested January 30 and received March 23; accepted March 24. All authors have no financial relationships to disclose.
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Figure 1. Chart illustrates the Virtopsy project, in which forensic information is acquired with various radiologic methods.
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Figure 2a. Corpse identification with CT in four different cases. (a) Oblique VR bone image obtained in a completely burned corpse shows a helical wire in the left humerus representing a rare technique of humeral osteosynthesis. (b) Anteroposterior view of the pelvis shows two screws in the left femur. (c) Anteroposterior view of the knees shows replacement of the right anterior cruciate ligament with screws in the femur and tibia. (d) Anteroposterior view of the lumbar spine shows percutaneous vertebroplasty with cement in the vertebral bodies, a finding that can be used for identification. Routine forensic autopsy would be incapable of demonstrating the findings in a–d.
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Figure 2b. Corpse identification with CT in four different cases. (a) Oblique VR bone image obtained in a completely burned corpse shows a helical wire in the left humerus representing a rare technique of humeral osteosynthesis. (b) Anteroposterior view of the pelvis shows two screws in the left femur. (c) Anteroposterior view of the knees shows replacement of the right anterior cruciate ligament with screws in the femur and tibia. (d) Anteroposterior view of the lumbar spine shows percutaneous vertebroplasty with cement in the vertebral bodies, a finding that can be used for identification. Routine forensic autopsy would be incapable of demonstrating the findings in a–d.
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Figure 2c. Corpse identification with CT in four different cases. (a) Oblique VR bone image obtained in a completely burned corpse shows a helical wire in the left humerus representing a rare technique of humeral osteosynthesis. (b) Anteroposterior view of the pelvis shows two screws in the left femur. (c) Anteroposterior view of the knees shows replacement of the right anterior cruciate ligament with screws in the femur and tibia. (d) Anteroposterior view of the lumbar spine shows percutaneous vertebroplasty with cement in the vertebral bodies, a finding that can be used for identification. Routine forensic autopsy would be incapable of demonstrating the findings in a–d.
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Figure 2d. Corpse identification with CT in four different cases. (a) Oblique VR bone image obtained in a completely burned corpse shows a helical wire in the left humerus representing a rare technique of humeral osteosynthesis. (b) Anteroposterior view of the pelvis shows two screws in the left femur. (c) Anteroposterior view of the knees shows replacement of the right anterior cruciate ligament with screws in the femur and tibia. (d) Anteroposterior view of the lumbar spine shows percutaneous vertebroplasty with cement in the vertebral bodies, a finding that can be used for identification. Routine forensic autopsy would be incapable of demonstrating the findings in a–d.
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Figure 3a. Increased intracranial pressure as the cause of death. (a) Coronal T2-weighted MR image shows herniation of basilar parts of the cerebellum into the foramen magnum. (b) Autopsy photograph shows the cerebellum, with swelling of the tonsils (solid arrows) and a pressure mark caused by the foramen magnum (dashed arrows).
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Figure 3b. Increased intracranial pressure as the cause of death. (a) Coronal T2-weighted MR image shows herniation of basilar parts of the cerebellum into the foramen magnum. (b) Autopsy photograph shows the cerebellum, with swelling of the tonsils (solid arrows) and a pressure mark caused by the foramen magnum (dashed arrows).
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Figure 4a. Traumatic intraaxial bleeding. (a) Axial gradient-recalled acquisition in the steady state image shows local hypointense areas (arrow) in the left temporal lobe that reach the subarachnoidal space. These areas represent degenerative products of hemoglobin and indicate trauma. (b) Autopsy photograph of a slice through the temporal lobe of the formalin-fixed brain shows trauma-related bleeding, predominantly in the cortex and subcortex (arrow).
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Figure 4b. Traumatic intraaxial bleeding. (a) Axial gradient-recalled acquisition in the steady state image shows local hypointense areas (arrow) in the left temporal lobe that reach the subarachnoidal space. These areas represent degenerative products of hemoglobin and indicate trauma. (b) Autopsy photograph of a slice through the temporal lobe of the formalin-fixed brain shows trauma-related bleeding, predominantly in the cortex and subcortex (arrow).
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Figure 5a. Natural cardiac death. (a) Short-axis T2-weighted MR image shows local hypointense areas (arrow) in the left lateral wall, with areas of hyperintensity in the surrounding myocardial tissue. (b) Photograph of the corresponding autopsy specimen shows hemorrhagic myocardial infarction (arrow) in the lateral wall of the left ventricle. (c) Short-axis T2-weighted MR image obtained in a patient with chronic uremic cardiomyopathy shows massive eccentrically hypertrophic ventricles in a so-called cor bovinum. (d) Photograph of the corresponding autopsy specimen helps confirm biventricular eccentric hypertrophy (heart weight, 1070 g). On all scales shown in the figures, the smallest units are millimeters.
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Figure 5b. Natural cardiac death. (a) Short-axis T2-weighted MR image shows local hypointense areas (arrow) in the left lateral wall, with areas of hyperintensity in the surrounding myocardial tissue. (b) Photograph of the corresponding autopsy specimen shows hemorrhagic myocardial infarction (arrow) in the lateral wall of the left ventricle. (c) Short-axis T2-weighted MR image obtained in a patient with chronic uremic cardiomyopathy shows massive eccentrically hypertrophic ventricles in a so-called cor bovinum. (d) Photograph of the corresponding autopsy specimen helps confirm biventricular eccentric hypertrophy (heart weight, 1070 g). On all scales shown in the figures, the smallest units are millimeters.
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Figure 5c. Natural cardiac death. (a) Short-axis T2-weighted MR image shows local hypointense areas (arrow) in the left lateral wall, with areas of hyperintensity in the surrounding myocardial tissue. (b) Photograph of the corresponding autopsy specimen shows hemorrhagic myocardial infarction (arrow) in the lateral wall of the left ventricle. (c) Short-axis T2-weighted MR image obtained in a patient with chronic uremic cardiomyopathy shows massive eccentrically hypertrophic ventricles in a so-called cor bovinum. (d) Photograph of the corresponding autopsy specimen helps confirm biventricular eccentric hypertrophy (heart weight, 1070 g). On all scales shown in the figures, the smallest units are millimeters.
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Figure 5d. Natural cardiac death. (a) Short-axis T2-weighted MR image shows local hypointense areas (arrow) in the left lateral wall, with areas of hyperintensity in the surrounding myocardial tissue. (b) Photograph of the corresponding autopsy specimen shows hemorrhagic myocardial infarction (arrow) in the lateral wall of the left ventricle. (c) Short-axis T2-weighted MR image obtained in a patient with chronic uremic cardiomyopathy shows massive eccentrically hypertrophic ventricles in a so-called cor bovinum. (d) Photograph of the corresponding autopsy specimen helps confirm biventricular eccentric hypertrophy (heart weight, 1070 g). On all scales shown in the figures, the smallest units are millimeters.
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Figure 6a. Cardiac trauma (stab wound to the heart). (a) Short-axis T2-weighted MR image through the cardiac apex shows a myocardial injury (solid white arrow). Subsequent pericardial tamponade manifests as sedimented cellular components (dashed white arrows) with medium signal intensity and an upper layer of serum (black arrows) with increased signal intensity. (b) Photograph of the corresponding autopsy specimen demonstrates transmural laceration of the left ventricle in the apical region (arrow).
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Figure 6b. Cardiac trauma (stab wound to the heart). (a) Short-axis T2-weighted MR image through the cardiac apex shows a myocardial injury (solid white arrow). Subsequent pericardial tamponade manifests as sedimented cellular components (dashed white arrows) with medium signal intensity and an upper layer of serum (black arrows) with increased signal intensity. (b) Photograph of the corresponding autopsy specimen demonstrates transmural laceration of the left ventricle in the apical region (arrow).
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Figure 7a. Lethal air embolism of the pulmonary artery in the victim of a gunshot wound to the head. (a) Anteroposterior 3D VR image shows the air-filled right ventricle and pulmonary artery. CT-based volumetry showed 59 mL of gas within these two structures. 1 = cranial veins, 2 = trachea, 3 = main pulmonary artery, 4 = right ventricular outflow tract, 5 = intrahepatic veins. (b) Autopsy photograph demonstrates the procedure used to confirm the presence of an air embolism. After the pericardium has been opened, the pericardial space is filled with clear water to totally cover the heart. The right ventricle is then punctured with a scalpel, and turning the scalpel produces ascending air bubbles (arrow).
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Figure 7b. Lethal air embolism of the pulmonary artery in the victim of a gunshot wound to the head. (a) Anteroposterior 3D VR image shows the air-filled right ventricle and pulmonary artery. CT-based volumetry showed 59 mL of gas within these two structures. 1 = cranial veins, 2 = trachea, 3 = main pulmonary artery, 4 = right ventricular outflow tract, 5 = intrahepatic veins. (b) Autopsy photograph demonstrates the procedure used to confirm the presence of an air embolism. After the pericardium has been opened, the pericardial space is filled with clear water to totally cover the heart. The right ventricle is then punctured with a scalpel, and turning the scalpel produces ascending air bubbles (arrow).
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Figure 8a. Pulmonary edema. (a) Coronal T2-weighted MR image of the thorax shows a global increase in signal intensity throughout the lungs caused by an increased fraction of intrapulmonary water. (b) Photograph of the corresponding autopsy specimen shows the loss of tissue water after sectioning. Note the accumulation of the drained edema (arrows) surrounding the thumbs of the forensic pathologist.
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Figure 8b. Pulmonary edema. (a) Coronal T2-weighted MR image of the thorax shows a global increase in signal intensity throughout the lungs caused by an increased fraction of intrapulmonary water. (b) Photograph of the corresponding autopsy specimen shows the loss of tissue water after sectioning. Note the accumulation of the drained edema (arrows) surrounding the thumbs of the forensic pathologist.
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Figure 9a. Severe postmortem broncho-pneumonia. (a) CT scan shows complete air displacement in the right lung. Only parts of the left lung are ventilated. (b) Coronal T2-weighted MR image demonstrates increased signal intensity throughout the right lung and in parts of the left lung. Note also the ascites below the diaphragm. (c) Photomicrograph (original magnification, x100; H-E stain) shows purulent bronchitis with massive intraalveolar edema.
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Figure 9b. Severe postmortem broncho-pneumonia. (a) CT scan shows complete air displacement in the right lung. Only parts of the left lung are ventilated. (b) Coronal T2-weighted MR image demonstrates increased signal intensity throughout the right lung and in parts of the left lung. Note also the ascites below the diaphragm. (c) Photomicrograph (original magnification, x100; H-E stain) shows purulent bronchitis with massive intraalveolar edema.
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Figure 9c. Severe postmortem broncho-pneumonia. (a) CT scan shows complete air displacement in the right lung. Only parts of the left lung are ventilated. (b) Coronal T2-weighted MR image demonstrates increased signal intensity throughout the right lung and in parts of the left lung. Note also the ascites below the diaphragm. (c) Photomicrograph (original magnification, x100; H-E stain) shows purulent bronchitis with massive intraalveolar edema.
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Figure 10a. Emphysema aquosum. (a) Thoracic CT scan (lung windowing) demonstrates emphysema aquosum caused by drowning, with anterior contact between the lungs. Note the postmortem sedimentation phenomenon with an increase in attenuation from ventral to dorsal, a finding that is especially visible in the right upper lobe. (b) Anteroposterior 3D VR lung image allows correlation with the traditional autopsy findings (cf c). (c) On an autopsy photograph, the ventral parts of the lungs overlap retrosternally. (d) Anteroposterior maximum-intensity-projection (MIP) image from coronal T2-weighted MR imaging data shows hyperintense contents in the stomach (solid arrow) and duodenum (dashed arrow), findings that indicate active swallowing of drowning fluid. (e) Autopsy photograph shows a distinctively fluid-filled stomach (solid arrow) and duodenum (dashed arrow). The organs were opened to sample the fluid.
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Figure 10b. Emphysema aquosum. (a) Thoracic CT scan (lung windowing) demonstrates emphysema aquosum caused by drowning, with anterior contact between the lungs. Note the postmortem sedimentation phenomenon with an increase in attenuation from ventral to dorsal, a finding that is especially visible in the right upper lobe. (b) Anteroposterior 3D VR lung image allows correlation with the traditional autopsy findings (cf c). (c) On an autopsy photograph, the ventral parts of the lungs overlap retrosternally. (d) Anteroposterior maximum-intensity-projection (MIP) image from coronal T2-weighted MR imaging data shows hyperintense contents in the stomach (solid arrow) and duodenum (dashed arrow), findings that indicate active swallowing of drowning fluid. (e) Autopsy photograph shows a distinctively fluid-filled stomach (solid arrow) and duodenum (dashed arrow). The organs were opened to sample the fluid.
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Figure 10c. Emphysema aquosum. (a) Thoracic CT scan (lung windowing) demonstrates emphysema aquosum caused by drowning, with anterior contact between the lungs. Note the postmortem sedimentation phenomenon with an increase in attenuation from ventral to dorsal, a finding that is especially visible in the right upper lobe. (b) Anteroposterior 3D VR lung image allows correlation with the traditional autopsy findings (cf c). (c) On an autopsy photograph, the ventral parts of the lungs overlap retrosternally. (d) Anteroposterior maximum-intensity-projection (MIP) image from coronal T2-weighted MR imaging data shows hyperintense contents in the stomach (solid arrow) and duodenum (dashed arrow), findings that indicate active swallowing of drowning fluid. (e) Autopsy photograph shows a distinctively fluid-filled stomach (solid arrow) and duodenum (dashed arrow). The organs were opened to sample the fluid.
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Figure 10d. Emphysema aquosum. (a) Thoracic CT scan (lung windowing) demonstrates emphysema aquosum caused by drowning, with anterior contact between the lungs. Note the postmortem sedimentation phenomenon with an increase in attenuation from ventral to dorsal, a finding that is especially visible in the right upper lobe. (b) Anteroposterior 3D VR lung image allows correlation with the traditional autopsy findings (cf c). (c) On an autopsy photograph, the ventral parts of the lungs overlap retrosternally. (d) Anteroposterior maximum-intensity-projection (MIP) image from coronal T2-weighted MR imaging data shows hyperintense contents in the stomach (solid arrow) and duodenum (dashed arrow), findings that indicate active swallowing of drowning fluid. (e) Autopsy photograph shows a distinctively fluid-filled stomach (solid arrow) and duodenum (dashed arrow). The organs were opened to sample the fluid.
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Figure 10e. Emphysema aquosum. (a) Thoracic CT scan (lung windowing) demonstrates emphysema aquosum caused by drowning, with anterior contact between the lungs. Note the postmortem sedimentation phenomenon with an increase in attenuation from ventral to dorsal, a finding that is especially visible in the right upper lobe. (b) Anteroposterior 3D VR lung image allows correlation with the traditional autopsy findings (cf c). (c) On an autopsy photograph, the ventral parts of the lungs overlap retrosternally. (d) Anteroposterior maximum-intensity-projection (MIP) image from coronal T2-weighted MR imaging data shows hyperintense contents in the stomach (solid arrow) and duodenum (dashed arrow), findings that indicate active swallowing of drowning fluid. (e) Autopsy photograph shows a distinctively fluid-filled stomach (solid arrow) and duodenum (dashed arrow). The organs were opened to sample the fluid.
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Figure 11a. Hypothermia. (a) Coronal reformatted short inversion time inversion-recovery image of the lower abdomen shows areas of bleeding (arrow) within the body core (left psoas muscle) with no causative trauma. (b) Autopsy photograph shows the left psoas muscle with a local intramuscular hematoma (arrow) and no injury to the surrounding tissue.
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Figure 11b. Hypothermia. (a) Coronal reformatted short inversion time inversion-recovery image of the lower abdomen shows areas of bleeding (arrow) within the body core (left psoas muscle) with no causative trauma. (b) Autopsy photograph shows the left psoas muscle with a local intramuscular hematoma (arrow) and no injury to the surrounding tissue.
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Figure 12a. Fatal hemorrhage. 1 = superior vena cava, 2 = ascending aorta, 3 = main pulmonary artery. (a) Postmortem CT scan obtained at the level of the right pulmonary artery in a case in which elevated intracranial pressure was the cause of death shows normal vessel dimensions. (b) Postmortem CT scan obtained at the level of the right pulmonary artery in a different case demonstrates fatal hemorrhage with collapsed thoracic vessels.
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Figure 12b. Fatal hemorrhage. 1 = superior vena cava, 2 = ascending aorta, 3 = main pulmonary artery. (a) Postmortem CT scan obtained at the level of the right pulmonary artery in a case in which elevated intracranial pressure was the cause of death shows normal vessel dimensions. (b) Postmortem CT scan obtained at the level of the right pulmonary artery in a different case demonstrates fatal hemorrhage with collapsed thoracic vessels.
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Figure 13a. Aspiration as a postmortem sign of vitality of sustained injuries in a man who was killed in an airplane crash. (a) Thoracic CT scan shows a local hyperattenuating area (arrow) in the right lower lobe. (b) Autopsy photograph of a lung specimen reveals aspirated blood (arrows), a finding that indicates that the victim was still alive when he sustained the injuries.
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Figure 13b. Aspiration as a postmortem sign of vitality of sustained injuries in a man who was killed in an airplane crash. (a) Thoracic CT scan shows a local hyperattenuating area (arrow) in the right lower lobe. (b) Autopsy photograph of a lung specimen reveals aspirated blood (arrows), a finding that indicates that the victim was still alive when he sustained the injuries.
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Figure 14. Soft-tissue emphysema as a vital sign of trauma in a pedestrian who had been rolled over by a car. Abdominal CT scan demonstrates massive soft-tissue emphysema (arrowheads). Distinctive air collections between the subcutis and the muscle as well as within the soft tissues indicate that ventilation continued for some time after the accident.
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Figure 15a. Swallowed foreign bodies as a vital sign in a person who died in an automobile accident. (a) Thoracic CT scan shows a foreign body (arrow) in the esophagus. The image fails to demonstrate any traumatic injury to the esophagus that might represent an entry wound, a finding that indicates active swallowing of the foreign body. (b) Autopsy photograph of the opened esophagus shows multiple small pieces of windshield (arrows) that have partly lacerated the mucosa.
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Figure 15b. Swallowed foreign bodies as a vital sign in a person who died in an automobile accident. (a) Thoracic CT scan shows a foreign body (arrow) in the esophagus. The image fails to demonstrate any traumatic injury to the esophagus that might represent an entry wound, a finding that indicates active swallowing of the foreign body. (b) Autopsy photograph of the opened esophagus shows multiple small pieces of windshield (arrows) that have partly lacerated the mucosa.
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Figure 16a. Vital signs in a case of suicide by hanging. (a) Sagittal T2-weighted MR image shows areas of hyperintensity (arrow) around the sternoclavicular insertions of the sternocleidomastoid muscle. (b) Autopsy photograph reveals areas of bleeding (arrow) around the insertions of the sternocleidomastoid muscle, findings that indicate ongoing circulation at the onset of strangulation. (c) CT scan of the neck demonstrates massive soft-tissue emphysema below the strangulation mark. The air ascends from a pneumomediastinum that was caused by a rupture of alveoles during breathing attempts against occluded airways, thereby serving as a vital sign. Demonstration at autopsy is nearly impossible because the first incision allows the air to escape; therefore, the air must be palpated at autopsy. (d) Coronal T2-weighted MR image demonstrates a hyperintense lymph node (arrow) on the left side of the neck. (e) Autopsy photograph of the formalin-fixed specimen shows the lymph node with hemorrhage.
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Figure 16b. Vital signs in a case of suicide by hanging. (a) Sagittal T2-weighted MR image shows areas of hyperintensity (arrow) around the sternoclavicular insertions of the sternocleidomastoid muscle. (b) Autopsy photograph reveals areas of bleeding (arrow) around the insertions of the sternocleidomastoid muscle, findings that indicate ongoing circulation at the onset of strangulation. (c) CT scan of the neck demonstrates massive soft-tissue emphysema below the strangulation mark. The air ascends from a pneumomediastinum that was caused by a rupture of alveoles during breathing attempts against occluded airways, thereby serving as a vital sign. Demonstration at autopsy is nearly impossible because the first incision allows the air to escape; therefore, the air must be palpated at autopsy. (d) Coronal T2-weighted MR image demonstrates a hyperintense lymph node (arrow) on the left side of the neck. (e) Autopsy photograph of the formalin-fixed specimen shows the lymph node with hemorrhage.
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Figure 16c. Vital signs in a case of suicide by hanging. (a) Sagittal T2-weighted MR image shows areas of hyperintensity (arrow) around the sternoclavicular insertions of the sternocleidomastoid muscle. (b) Autopsy photograph reveals areas of bleeding (arrow) around the insertions of the sternocleidomastoid muscle, findings that indicate ongoing circulation at the onset of strangulation. (c) CT scan of the neck demonstrates massive soft-tissue emphysema below the strangulation mark. The air ascends from a pneumomediastinum that was caused by a rupture of alveoles during breathing attempts against occluded airways, thereby serving as a vital sign. Demonstration at autopsy is nearly impossible because the first incision allows the air to escape; therefore, the air must be palpated at autopsy. (d) Coronal T2-weighted MR image demonstrates a hyperintense lymph node (arrow) on the left side of the neck. (e) Autopsy photograph of the formalin-fixed specimen shows the lymph node with hemorrhage.
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Figure 16d. Vital signs in a case of suicide by hanging. (a) Sagittal T2-weighted MR image shows areas of hyperintensity (arrow) around the sternoclavicular insertions of the sternocleidomastoid muscle. (b) Autopsy photograph reveals areas of bleeding (arrow) around the insertions of the sternocleidomastoid muscle, findings that indicate ongoing circulation at the onset of strangulation. (c) CT scan of the neck demonstrates massive soft-tissue emphysema below the strangulation mark. The air ascends from a pneumomediastinum that was caused by a rupture of alveoles during breathing attempts against occluded airways, thereby serving as a vital sign. Demonstration at autopsy is nearly impossible because the first incision allows the air to escape; therefore, the air must be palpated at autopsy. (d) Coronal T2-weighted MR image demonstrates a hyperintense lymph node (arrow) on the left side of the neck. (e) Autopsy photograph of the formalin-fixed specimen shows the lymph node with hemorrhage.
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Figure 16e. Vital signs in a case of suicide by hanging. (a) Sagittal T2-weighted MR image shows areas of hyperintensity (arrow) around the sternoclavicular insertions of the sternocleidomastoid muscle. (b) Autopsy photograph reveals areas of bleeding (arrow) around the insertions of the sternocleidomastoid muscle, findings that indicate ongoing circulation at the onset of strangulation. (c) CT scan of the neck demonstrates massive soft-tissue emphysema below the strangulation mark. The air ascends from a pneumomediastinum that was caused by a rupture of alveoles during breathing attempts against occluded airways, thereby serving as a vital sign. Demonstration at autopsy is nearly impossible because the first incision allows the air to escape; therefore, the air must be palpated at autopsy. (d) Coronal T2-weighted MR image demonstrates a hyperintense lymph node (arrow) on the left side of the neck. (e) Autopsy photograph of the formalin-fixed specimen shows the lymph node with hemorrhage.
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Figure 17. Assessment of impact direction in a pedestrian who was struck by an automobile. Anteroposterior 3D VR image shows fractures of the left tibia and fibula, with a wedge-shaped fracture piece (white arrow). The base of the wedge indicates the direction of the force that caused the fracture (red arrow).
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Figure 18a. Fat contusion with formation of a subcutaneous cavity in a person who was rolled over by a car. (a) Coronal fat-saturated MR image of the thigh displays high-signal-intensity areas (arrow) within the subcutaneous tissue, findings that represent a fat contusion at the site of impact. (b) Axial T2-weighted MR image of the left lateral gluteal area shows contusion and disconnection between the muscle fascia and the subcutaneous fat (décollement injury) (arrow). The formed wound cavity is filled with liquefied fat and blood, and the sedimentation of the cellular blood components has resulted in an upper layer of hyperintense serum. (c) Autopsy photograph shows a typical décollement injury, with subcutaneous fat disconnected from the fascia.
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Figure 18b. Fat contusion with formation of a subcutaneous cavity in a person who was rolled over by a car. (a) Coronal fat-saturated MR image of the thigh displays high-signal-intensity areas (arrow) within the subcutaneous tissue, findings that represent a fat contusion at the site of impact. (b) Axial T2-weighted MR image of the left lateral gluteal area shows contusion and disconnection between the muscle fascia and the subcutaneous fat (décollement injury) (arrow). The formed wound cavity is filled with liquefied fat and blood, and the sedimentation of the cellular blood components has resulted in an upper layer of hyperintense serum. (c) Autopsy photograph shows a typical décollement injury, with subcutaneous fat disconnected from the fascia.
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Figure 18c. Fat contusion with formation of a subcutaneous cavity in a person who was rolled over by a car. (a) Coronal fat-saturated MR image of the thigh displays high-signal-intensity areas (arrow) within the subcutaneous tissue, findings that represent a fat contusion at the site of impact. (b) Axial T2-weighted MR image of the left lateral gluteal area shows contusion and disconnection between the muscle fascia and the subcutaneous fat (décollement injury) (arrow). The formed wound cavity is filled with liquefied fat and blood, and the sedimentation of the cellular blood components has resulted in an upper layer of hyperintense serum. (c) Autopsy photograph shows a typical décollement injury, with subcutaneous fat disconnected from the fascia.
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Figure 19a. (a) Injury caused by blows to the head. Oblique left lateral 3D VR CT image shows a typical local impression and ring fracture of the occipital skull due to blows with a hammer. (b) Head injury due to a fall from a great height. Oblique left lateral 3D VR CT image shows comminuted burst fractures starting at the posterior prominent part of the skull (point of impact).
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Figure 19b. (a) Injury caused by blows to the head. Oblique left lateral 3D VR CT image shows a typical local impression and ring fracture of the occipital skull due to blows with a hammer. (b) Head injury due to a fall from a great height. Oblique left lateral 3D VR CT image shows comminuted burst fractures starting at the posterior prominent part of the skull (point of impact).
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Figure 20a. Direction of the creation of a gunshot wound to the head. (a) Anteroposterior 3D VR CT image shows an entrance wound with sharp external margins and a cone-shaped bone defect that enlarges from external to internal. (b) Autopsy photograph shows findings similar to those seen in a. (c) Left posterior oblique 3D VR CT image shows the exit wound and a cone-shaped defect that enlarges from internal to external. The formed fracture lines can also help determine the order in which the wounds occurred. From the entrance wound, large fracture lines course along the skull, the result of increased pressure within the water-filled (incompressible) skull caused by the projectile. The short fracture lines from the exit wound stop at the previously formed entrance wound fractures (Puppe’s rule). (d) Autopsy photograph reveals findings similar to those seen in c.
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Figure 20b. Direction of the creation of a gunshot wound to the head. (a) Anteroposterior 3D VR CT image shows an entrance wound with sharp external margins and a cone-shaped bone defect that enlarges from external to internal. (b) Autopsy photograph shows findings similar to those seen in a. (c) Left posterior oblique 3D VR CT image shows the exit wound and a cone-shaped defect that enlarges from internal to external. The formed fracture lines can also help determine the order in which the wounds occurred. From the entrance wound, large fracture lines course along the skull, the result of increased pressure within the water-filled (incompressible) skull caused by the projectile. The short fracture lines from the exit wound stop at the previously formed entrance wound fractures (Puppe’s rule). (d) Autopsy photograph reveals findings similar to those seen in c.
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Figure 20c. Direction of the creation of a gunshot wound to the head. (a) Anteroposterior 3D VR CT image shows an entrance wound with sharp external margins and a cone-shaped bone defect that enlarges from external to internal. (b) Autopsy photograph shows findings similar to those seen in a. (c) Left posterior oblique 3D VR CT image shows the exit wound and a cone-shaped defect that enlarges from internal to external. The formed fracture lines can also help determine the order in which the wounds occurred. From the entrance wound, large fracture lines course along the skull, the result of increased pressure within the water-filled (incompressible) skull caused by the projectile. The short fracture lines from the exit wound stop at the previously formed entrance wound fractures (Puppe’s rule). (d) Autopsy photograph reveals findings similar to those seen in c.
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Figure 20d. Direction of the creation of a gunshot wound to the head. (a) Anteroposterior 3D VR CT image shows an entrance wound with sharp external margins and a cone-shaped bone defect that enlarges from external to internal. (b) Autopsy photograph shows findings similar to those seen in a. (c) Left posterior oblique 3D VR CT image shows the exit wound and a cone-shaped defect that enlarges from internal to external. The formed fracture lines can also help determine the order in which the wounds occurred. From the entrance wound, large fracture lines course along the skull, the result of increased pressure within the water-filled (incompressible) skull caused by the projectile. The short fracture lines from the exit wound stop at the previously formed entrance wound fractures (Puppe’s rule). (d) Autopsy photograph reveals findings similar to those seen in c.
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Figure 21a. Pilot injury sustained in a plane crash. (a) Coronal T2-weighted MR image of the hand and forearm demonstrates local hyperintense palmar regions (solid arrow). Note also the fracture hematoma (dashed arrow) resulting from fracture of the ulna. (b) Autopsy photograph reveals palmar soft-tissue bleeding (arrow) caused by the control lever of the plane. This and other hemorrhages indicated that the blood circulation of the pilot was ongoing when the plane crashed.
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Figure 21b. Pilot injury sustained in a plane crash. (a) Coronal T2-weighted MR image of the hand and forearm demonstrates local hyperintense palmar regions (solid arrow). Note also the fracture hematoma (dashed arrow) resulting from fracture of the ulna. (b) Autopsy photograph reveals palmar soft-tissue bleeding (arrow) caused by the control lever of the plane. This and other hemorrhages indicated that the blood circulation of the pilot was ongoing when the plane crashed.
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Figure 22a. Use of postmortem imaging to address medical-legal issues. (a) Anteroposterior MIP image displays vertebroplasty cement in the inferior vena cava (IVC) (solid arrows) and pulmonary artery branches (dashed arrows). (b) Coronal reformatted CT image shows foreign body embolism of the right pulmonary artery (arrow) as the cause of death. (c) Autopsy photograph shows cement in the IVC (arrows). The cement reached the IVC via lumbar veins into which the cement had been injected as part of the minimally invasive treatment.
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Figure 22b. Use of postmortem imaging to address medical-legal issues. (a) Anteroposterior MIP image displays vertebroplasty cement in the inferior vena cava (IVC) (solid arrows) and pulmonary artery branches (dashed arrows). (b) Coronal reformatted CT image shows foreign body embolism of the right pulmonary artery (arrow) as the cause of death. (c) Autopsy photograph shows cement in the IVC (arrows). The cement reached the IVC via lumbar veins into which the cement had been injected as part of the minimally invasive treatment.
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Figure 22c. Use of postmortem imaging to address medical-legal issues. (a) Anteroposterior MIP image displays vertebroplasty cement in the inferior vena cava (IVC) (solid arrows) and pulmonary artery branches (dashed arrows). (b) Coronal reformatted CT image shows foreign body embolism of the right pulmonary artery (arrow) as the cause of death. (c) Autopsy photograph shows cement in the IVC (arrows). The cement reached the IVC via lumbar veins into which the cement had been injected as part of the minimally invasive treatment.
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Figure 23a. Heat epidural in a burned corpse. (a) CT scan shows a soft-tissue-attenuation epidural mass (arrows). (b) Autopsy photograph reveals coagulated blood masses (arrows) in the epidural space, an unimportant but common finding in burned corpses.
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Figure 23b. Heat epidural in a burned corpse. (a) CT scan shows a soft-tissue-attenuation epidural mass (arrows). (b) Autopsy photograph reveals coagulated blood masses (arrows) in the epidural space, an unimportant but common finding in burned corpses.
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Figure 24a. Putrefaction. (a) Preautopsy photograph shows the gross appearance of the body, which was in an advanced state of putrefaction. Red lines indicate the section planes of the CT scans shown in b (top line), c (middle line), and d (bottom line). (b) Thoracic CT scan shows putrefaction gas within the heart, the vascular system, and the interstitial spaces of the soft tissues. Note also the bilateral pleural putrefaction fluid. (c) CT scan shows intraluminal and peritoneal gaseous ballooning of the abdomen as well as putrefaction gas within the intrahepatic vessels, liver, and spleen. (d) CT scan shows gaseous ballooning of the scrotum, gas accumulation within the testicles, and massive gas accumulation within the soft tissues.
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Figure 24b. Putrefaction. (a) Preautopsy photograph shows the gross appearance of the body, which was in an advanced state of putrefaction. Red lines indicate the section planes of the CT scans shown in b (top line), c (middle line), and d (bottom line). (b) Thoracic CT scan shows putrefaction gas within the heart, the vascular system, and the interstitial spaces of the soft tissues. Note also the bilateral pleural putrefaction fluid. (c) CT scan shows intraluminal and peritoneal gaseous ballooning of the abdomen as well as putrefaction gas within the intrahepatic vessels, liver, and spleen. (d) CT scan shows gaseous ballooning of the scrotum, gas accumulation within the testicles, and massive gas accumulation within the soft tissues.
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Figure 24c. Putrefaction. (a) Preautopsy photograph shows the gross appearance of the body, which was in an advanced state of putrefaction. Red lines indicate the section planes of the CT scans shown in b (top line), c (middle line), and d (bottom line). (b) Thoracic CT scan shows putrefaction gas within the heart, the vascular system, and the interstitial spaces of the soft tissues. Note also the bilateral pleural putrefaction fluid. (c) CT scan shows intraluminal and peritoneal gaseous ballooning of the abdomen as well as putrefaction gas within the intrahepatic vessels, liver, and spleen. (d) CT scan shows gaseous ballooning of the scrotum, gas accumulation within the testicles, and massive gas accumulation within the soft tissues.
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Figure 24d. Putrefaction. (a) Preautopsy photograph shows the gross appearance of the body, which was in an advanced state of putrefaction. Red lines indicate the section planes of the CT scans shown in b (top line), c (middle line), and d (bottom line). (b) Thoracic CT scan shows putrefaction gas within the heart, the vascular system, and the interstitial spaces of the soft tissues. Note also the bilateral pleural putrefaction fluid. (c) CT scan shows intraluminal and peritoneal gaseous ballooning of the abdomen as well as putrefaction gas within the intrahepatic vessels, liver, and spleen. (d) CT scan shows gaseous ballooning of the scrotum, gas accumulation within the testicles, and massive gas accumulation within the soft tissues.
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Figure 25a. Putrefaction at postmortem MR imaging in a body that had been underwater for more than 1 year. (a) Sagittal T2-weighted MR image depicts intracerebral structures in the putrefied brain, thereby allowing cross-sectional exclusion of gross pathologic cerebral findings. (b) Autopsy photograph fails to allow cerebral assessment, since the liquefied intracranial structures became indistinguishable when the skull was opened. A further sectional preparation was not possible.
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Figure 25b. Putrefaction at postmortem MR imaging in a body that had been underwater for more than 1 year. (a) Sagittal T2-weighted MR image depicts intracerebral structures in the putrefied brain, thereby allowing cross-sectional exclusion of gross pathologic cerebral findings. (b) Autopsy photograph fails to allow cerebral assessment, since the liquefied intracranial structures became indistinguishable when the skull was opened. A further sectional preparation was not possible.
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Figure 26. Experimental postmortem angiography in a dog that had died 2 days earlier. Lateral 3D reconstructed whole-body multisection CT angiographic image shows the aorta (solid yellow arrow), arteries of the head and neck (carotid arteries) (solid red arrow), the hepatic vasculature (dashed red arrow), and the mesenteric vasculature (dashed yellow arrow).
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Figure 27. Minimally invasive postmortem CT angiography in a human corpse. Oblique posterior 3D VR image shows the cranial arterial system, including both vertebral arteries, the basilar artery, the circle of Willis, the middle cerebral arteries, the anterior cerebral arteries, and parts of the left temporal artery. The image represents the cranial portion of a whole-body angiographic study performed using a right femoral artery approach.
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Figure 28a. Postmortem imaging-guided biopsy. (a) Left lateral 3D CT image clearly depicts a biopsy needle that was inserted into the brain through a hole bored into the skull. The linear blue object on the left side of the image represents a metallic part of a denture. (b) Photograph shows extracted brain specimens that were used for histologic staining.
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Figure 28b. Postmortem imaging-guided biopsy. (a) Left lateral 3D CT image clearly depicts a biopsy needle that was inserted into the brain through a hole bored into the skull. The linear blue object on the left side of the image represents a metallic part of a denture. (b) Photograph shows extracted brain specimens that were used for histologic staining.
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Figure 29a. Forensic micro-CT in a case of sharp-force injury. (a) Photograph shows a bone defect that was to be investigated and compared with a knife that was suspected to have caused the injury. (b) Photograph shows the knife. (c) On a micro-CT scan obtained orthogonal to the bone lesion, the knife’s dimensions are superimposed, allowing inclusion of the knife in the group of possible injury-causing instruments.
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Figure 29b. Forensic micro-CT in a case of sharp-force injury. (a) Photograph shows a bone defect that was to be investigated and compared with a knife that was suspected to have caused the injury. (b) Photograph shows the knife. (c) On a micro-CT scan obtained orthogonal to the bone lesion, the knife’s dimensions are superimposed, allowing inclusion of the knife in the group of possible injury-causing instruments.
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