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Postmortem Imaging of Blunt Chest Trauma

Using CT and MRI: Comparison With Autopsy
ARTICLE in JOURNAL OF THORACIC IMAGING MARCH 2008
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ORIGINAL ARTICLE

Postmortem Imaging of Blunt Chest Trauma Using

CT and MRI
Comparison With Autopsy
Emin Aghayev, MD,*w Andreas Christe, MD,*z Martin Sonnenschein, MD,zy Kathrin Yen, MD,*
Christian Jackowski, MD,* Michael J. Thali, MD,* Richard Dirnhofer, MD,*
and Peter Vock, MDz

Objective: Postmortem examination of chest trauma is an

important domain in forensic medicine, which is today
performed using autopsy. Since the implementation of crosssectional imaging methods in forensic medicine such as
computed tomography (CT) and magnetic resonance imaging
(MRI), a number of advantages in comparison with autopsy
have been described. Within the scope of validation of crosssectional radiology in forensic medicine, the comparison of
ndings of postmortem imaging and autopsy in chest trauma
was performed.
Methods: This retrospective study includes 24 cases with chest
trauma that underwent postmortem CT, MRI, and autopsy.
Two board-certied radiologists, blind to the autopsy ndings,
evaluated the radiologic data independently. Each radiologist
interpreted postmortem CT and MRI data together for every
case. The comparison of the results of the radiologic assessment
with the autopsy and a calculation of interobserver discrepancy
was performed.
Results: Using combined CT and MRI, between 75% and 100%
of the investigated ndings, except for hemomediastinum (70%),
diaphragmatic ruptures (50%; n = 2) and heart injury (38%),
were discovered. Although the sensitivity and specicity regarding pneumomediastinum, pneumopericardium, and pericardial
eusion were not calculated, as these ndings were not
mentioned at the autopsy, these ndings were clearly seen
radiologically. The averaged interobserver concordance was
90%.
Conclusion: The sensitivity and specicity of our results
demonstrate that postmortem CT and MRI are useful
diagnostic methods for assessing chest trauma in forensic
From the *Institute of Forensic Medicine, University of Bern; wInstitute
for Evaluative Research in Orthopedic Surgery, MEM Research
Center; zInstitute of Diagnostic Radiology, Inselspital; and
yDepartment of Diagnostic Radiology, Sonnenhof Spital AG,
Bern, Switzerland.
Conict of Interest: None of the authors has any conicts of interest for
this study.
Reprints: Emin Aghayev, MD, University of Bern, Institute of
Evaluative Research in Orthopedic Surgery, Stauacherstrasse 78,
CH-3014 Bern, Switzerland (e-mail: emin.aghayev@memcenter.
unibe.ch).
Copyright r 2008 by Lippincott Williams & Wilkins

20

medicine as a supplement to autopsy. Further radiologicpathologic case studies are necessary to dene the role of
postmortem CT and MRI as a single examination modality.
Key Words: virtopsy, virtual autopsy, postmortem, blunt chest
trauma, CT, MRI
(J Thorac Imaging 2008;23:2027)

pproximately one-third of the time required for an

autopsy is dedicated to examining the chest and one
of the important chest examination issues with autopsy is
the diagnosis of traumatic injuries. The majority of blunt
chest trauma occurs due to motor vehicle accidents (90%)
together with falls and work-related accidents (7%).1 In
the last several years, the mortality rate for chest trauma
was approximately 16%.2
The current gold standard for forensic postmortem
chest examination is forensic autopsy. This allows for the
direct gaining of information by inspection and palpation. The main limitations of autopsy are that it is
subjective and observer-dependent. In addition, it can
hardly be the basis for a second opinion owing to the fact
that the topographic relations are changed and the body
tissues and organs are cut and cannot be stored for a
longer time except for small specimens.
Presently, the use of postmortem computed tomography (CT) and magnetic resonance imaging (MRI) is
growing in forensic medicine from year to year.36 Up to
now, publications on postmortem cross-sectional imaging
in the literature either simply describe the postmortem
radiologic appearance of forensically relevant ndings,4,7,8 report on the abilities of CT and MRI in
forensic routine9 or, rarely, present small studies on the
comparison between radiologic methods and autopsy
regarding some specic forensic issues.5 However, for
validation purposes of cross-sectional radiology in
forensic medicine a direct comparison of the radiologic
methods and autopsy, aimed at determining the advantages and limitations of both methods, is necessary.
The aim of the following study was to evaluate the
usefulness and to dene the benets and limitations of
postmortem CT and MRI of chest injuries in forensic
J Thorac Imaging

Volume 23, Number 1, February 2008

J Thorac Imaging

Volume 23, Number 1, February 2008

cases and to compare these with conventional autopsy in

its role as the current gold standard.

MATERIAL AND METHODS

This study was approved by the responsible justice
department and also by the ethics committee of the
University of Bern.

Subjects
Between July 2000 and 2005, 30 forensic cases with
chest trauma were examined at our Institute of Forensic
Medicine in collaboration with the Department of
Diagnostic Radiology at the local University Hospital
using postmortem CT and MRI before autopsy. Six cases
that showed putrefaction (n = 5) or the ones not
examined using standard MRI sequences (n = 3) were
excluded from the study. Thus, 24 cases with chest trauma
that were examined using CT, standard MRI sequences,
and autopsy were included in this retrospective study.
The mean age of the 22 adult cases was 50 (age
range 18 to 80 y) and the remaining 2 cases were children
of 2 and 3 years of age. The mean weight of the 22 adult
cases was 75 kg (range 43 to 100 kg) and the mean height
was 174 cm (range 153 to 193 cm). The 2-year-old child
weighted 9 kg and was 71 cm tall; the 3-year-old child
weighted 12 kg and was 96 cm tall. There were 15 males
and 9 females in the group. The manner of death is
presented in Table 1. In all cases, the individuals died at
the accident scene or within the rst 2 to 3 hours in
hospital.

Postmortem Cross-sectional Imaging

Postmortem cross-sectional imaging of the body
using CT and MRI was performed before autopsy after
the virtopsy approach.3 Radiologic examinations were
carried out at an average of 1.3 days after death (range 0
to 5 d).
Full body CT scanning was performed on a 4-row
or 8-row scanner (Lightspeed QX/I unit, GE, USA) using
a collimation of 4  1.25 or 8  1.25 mm, respectively.
During the thorax CT scanning, both arms were
completely elevated to avoid imaging artifacts from
extremity bones. A CT scan of the full body took
between 5 and 20 minutes. On a dedicated workstation,
continuous multiplanar reconstructions using 1.25-mm
reconstruction intervals were obtained. For case examinations, sagittal and coronal reformations were also
used.
MRI of the thorax was carried out after CT on a
1.5-T scanner (Signa Echospeed Horizon, 5.8 unit, GE,
USA). Axial and coronal planes of the T2-weighted fast
spin echo sequence [TE/TR 98/4000 ms; slice thickness
5 mm (range 3 to 7 mm); gap 1 mm] with (n = 22) and/or
without (n = 9) fat saturation were most frequently used.
Axial planes of the T1-weighted fast spin echo sequence
(TE/TR 14/400 ms; slice thickness 5 mm; gap 1 mm)
(n = 11) and of the STIR sequence (TE/TR/TI 14/3000/
130 or 22/4120/150 ms; slice thickness 5 mm; gap 1 mm)
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2008 Lippincott Williams & Wilkins

Postmortem Imaging of Blunt Chest Trauma

(n = 8) were also obtained. MRI examinations of the

thorax required between 45 minutes and 1.5 hours.

Autopsy
All 24 cases underwent conventional autopsy with
opening of all cavities approximately 12 hours after
radiologic scanning. Autopsy was carried out by 1 or 2
board-certied forensic pathologists, who obtained a
rough knowledge of preliminary radiologic diagnoses
supplied by a forensic resident, sometimes together with a
board-certied radiologist during the scan procedure.

Radiologic Evaluation and Data Analysis

The radiologic data were independently evaluated
by 2 board-certied radiologists, blind to the autopsy
ndings. Each radiologist interpreted postmortem CT
and MRI data together for every case. Both radiologists
were specialists in clinical radiology with approximately 6
months experience in postmortem CT and MRI imaging.
The diagnoses, which were evaluated in the postmortem radiologic data of the chest, were the following:
subcutaneous fat tissue hemorrhage (FatH), muscle tissue
hemorrhage (MusH), fracture of the ribs or the sternum
(RFx), the dorsal spine (SFx), mediastinal shift (MedSh),
rupture of the diaphragm (Diaph), pleural eusion
(PleEf), soft tissue emphysema (STEm), pneumothorax
(Pneu), pneumomediastinum (PnMed), pneumopericardium (PnPer), pulmonary laceration (PuLac), pulmonary
contusion (PuCon), pulmonary aspiration (PuAs), pulmonary atelectasis including compression atelectasis
(PuAt), pericardial eusion (PeEf), contusion or rupture
of the heart (Heart), hemomediastinum (HeMed), and
rupture of the aorta (Aorta) (Table 1).
Statistical analyses of the results of the radiologic
imaging with calculations of sensitivity and specicity in
comparison with autopsy results were performed. The
interobserver discrepancy was also assessed.

RESULTS
Radiologic Evaluation Versus Autopsy Results
The results of the autopsy and radiologic examinations are presented in Table 1. In most of the cases, the
ndings were diagnosed with autopsy and using radiologic methods (Table 1). Some ndings, such as fractures
of the spine, mediastinal shift and the ndings of gas were
more frequently found via imaging rather than with
autopsy. In contrast, two-thirds of all cases with a heart
lesion remained radiologically undetected.
The number of the ndings diagnosed with autopsy
and by the radiologists is shown in Diagram 1. Except for
the ndings of diaphragm, the heart and the hemomediastinum, the number of ndings detected by imaging
methods was equal to or higher than the number
diagnosed with autopsy (Diagram 1).
The sensitivity and specicity of the results of the
rst and second radiologist in comparison with autopsy
are shown in Diagram 2. The sensitivity and specicity
regarding pneumomediastinum, pneumopericardium, and

21

Aghayev et al

22
TABLE 1. The Findings Diagnosed at Autopsy (A), by the First (1) and the Second Radiologist (2)
Manner of Death

Sex

Age

FatH

MusH

RFx

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24

VA
VA
VA
Fall
BT
VA
VA
VA
VA
VA
Fall
VA
Fall
VA
VA
VA
VA
BT
VA
BT
VA
VA
VA
VA

M
M
M
M
M
M
M
M
F
M
M
F
F
F
M
F
M
M
M
F
F
F
M
F

47
67
25
33
67
40
3
52
56
32
53
65
65
40
17
2
54
80
61
42
75
52
34
47

A12

A12
2
A12
A12
A12
A12
A12
A12
A12

A12
A12

2
A12
A12
A12
A12
A12
A12
A12
2
2
A12
A12
12
2
A12
A12
A12
A12
A12
A12
A12

A12

2
2
A12
A12
12

A12
A1
A12
A12
2
A12
2
A12
A12
A12

A12
A12
A12
A12
A12
A12
A12
2

A12
A12
A12
A12
A12
A12
A12
A12

SFx

MedSh

PleEf

STEm

Pneu

PnMed

PnPer

PuLac

PuCon

PuAs

PuAt

PeEf

Heart

HeMed

12

A2
1

Diaph

A12
12

12
12

12
1

A
A12

A12

12

A12

A12

A12

A12
A12

12
A12

A12
A12

1
12

A12
A12

1
12
A1
12
A12
A12
A12
A12
2
A12
A12
A12
A12
A12
A12
A12
A12
A12
A12
A12
23
A12
A12
2

2
2

A12
A12
A12
A12
A12
A12

12
A12
A12
A12

A12
1

1
2
2

12
12
2
12

12
2

12
A12
A12

12
12
12
A12

A12

12
12
A12
A12
A12
A12

12
A12
A12
A12
A12

12
2

A12

A12
A12

A12

12
A12
A12

A12
12
2

A12
A

2
A12
2
A12
A12
A12

A12

1
A12
12
12

12
12
A12

12
12
A12
1
A12
1
A12
A12

12
A12
A12
A12
12
12
A12
A12

12
1
1
1
1
1

A12
A12
A12
12
A12
A12
1
A1
2
1

A12
A12
A12
A2
A12
A12
2
A12
A12
A12
A12
A12
A12
A12
A12
A12
A12
1

Aorta

A12

2
A12

A
1
1
A12

A12

A12
A2
A12

A12

A12

A12

A12

A12

A12
2

A2
A2

A1
A12
2

J Thorac Imaging

2008 Lippincott Williams & Wilkins

Volume 23, Number 1, February 2008

The ndings detected both at autopsy and using CT+MRI by both radiologists are additionally marked. In 18 cases out of 24, blunt chest trauma was caused by a vehicle accident, in 3 by a fall from height and in the
other 3 by blows with a body part.
Aorta indicates aortic rupture; BT, blunt trauma; Diaph, diaphragmatic rupture; FatH, fat tissue hemorrhage; Heart, heart injuries; HeMed, hemomediastinum; MedSh, mediastinal shift; MusH, muscle tissue
hemorrhage; N, numbers; PeEf, pericardial eusion; PleEf, pleural eusion; Pneu, pneumothorax; PnMed, pneumomediastinum; PnPer, pneumopericard; PuAs, pulmonary aspiration; PuAt, pulmonary atelectasis;
PuCon, pulmonary contusion; PuLac, pulmonary laceration; RFx, Rib fracture; SFx, spine fractures; STEm, soft tissue emphysema; VA, vehicle accident.

J Thorac Imaging

Volume 23, Number 1, February 2008

Postmortem Imaging of Blunt Chest Trauma

DIAGRAM 1. The diagram presents the sum of all findings detected at autopsy by the first and the second radiologist. Although
findings such as pneumomediastinum, pneumopericardium, and pericardial effusion were not documented at autopsy they were
seen using radiologic methods. Except for heart injuries, hemomediastinum, spine fracture, and diaphragmatic rupture, the
number of findings diagnosed radiologically exceeded the number diagnosed at autopsy.

pericardial eusion were not calculated as these ndings

were not found in autopsy protocols. The averaged
sensitivity of the rst radiologist was 89% and that
of the second was 90%. The averaged specicity
of the rst radiologist was 75% and that of the second
was 66%.
The rst radiologist detected all ndings with
sensitivity equal to or higher than 75% except for
hemomediastinum (70%), diaphragmatic rupture (50%,
n = 2), and heart trauma (38%); the second radiologist
described all ndings with sensitivity equal to or higher
than 75% except for diaphragmatic rupture (50%, n = 2)
and heart trauma (38%).
Regarding heart trauma, rupture of the heart with
heart dislocation in 2 cases and a contusion in 1 case were
detected. On the other hand, rupture of the heart
remained undiscovered in 5 cases and contusion in 1.
The specicity of the rst radiologist for soft tissue
emphysema, pulmonary aspiration, and pneumothorax
was between 33% and 50% followed by pulmonary
laceration (57%), pulmonary contusion (60%), pulmonary atelectasis (72%), and spine fractures (73%). For the
remaining ndings, the specicity values were at least
75% (Diagram 2).
The specicity of the second radiologist was
between 29% and 44% for muscle hemorrhage, pulmonary aspiration, and soft tissue emphysema. Pleural
eusion and pneumothorax (50%), fat tissue hemorrhage
(57%), rib fractures and pulmonary contusions (60%),
mediastinal shift (65%), pulmonary lacerations (71%),
and spine fractures (73%) followed. The specicity of the
second radiologist for the remaining ndings was equal to
or above 75% (Diagram 2).
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2008 Lippincott Williams & Wilkins

In summary, our results show that between 75%

and 100% of autopsy ndings can be discovered using
combined CT and MRI examinations, except for hemomediastinum (70%), diaphragmatic rupture (50%;
n = 2), and heart injury (38%).

Interobserver Correlation
The correlation between the ndings of the radiologists is presented in Diagram 2. The averaged
concordance was 90%. The correlation of only 55%
was seen in diagnosing pulmonary atelectasis and no
correlation was seen in pericardial eusion. In the
remaining ndings, a correlation equal to 75% or higher
was observed.
Summarizing the ndings of both radiologists
together and correlating them with autopsy results, a
sensitivity of 93% and a specicity of 59% were attained.
This improved average sensitivity at imaging by 3% to
4% but reduced average specicity by 7% to 16%.

DISCUSSION
Currently, CT and MRI are used more and more
often for postmortem forensic examination as methods
supplementing conventional autopsy. Within the scope of
validation of cross-sectional imaging in forensic medicine,
the question of benets and limitations of postmortem
CT and MRI arises.
It is already 3 decades that cross-sectional imaging
has been used for the clinical chest assessments; especially
CT is presently the method of choice in assessing chest
trauma patients. Recently, postmortem CT ndings of
the nontraumatic lung have been reported.8 Our
collected material permitted the comparison of results

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Aghayev et al

J Thorac Imaging

Volume 23, Number 1, February 2008

DIAGRAM 2. The diagram shows the sensitivity and specificity of the first and second radiologist in comparison with autopsy.

of postmortem radiologic and autopsy examinations of

blunt chest trauma.
The pathologists performing the autopsies usually
obtained a rough knowledge about the injured body parts
as well as about some of the ndings. One can suppose
that the pathologists have had the benet of the imaging
data. However, currently, autopsy is accepted as the gold
standard for postmortem chest examinations meaning
that autopsies detect the maximum ndings. The aim of
the present study was to evaluate the usefulness and
to dene the benets and limitations of postmortem CT
and MRI of blunt chest trauma in forensic cases in
comparison with those of conventional autopsy, and the
imaging methods were compared with the autopsy
procedures.

Radiologic Evaluation Versus Autopsy

Although the formal specicity of both radiologists
was low for soft tissue emphysema, pneumothorax,
and, partly, pneumomediastinum, we believe that this
is a problem of the verication standard. Autopsy, as
generally known in clinical medicine and recently
reported in the forensic context, misses many of these
ndings related to the presence of gas in the body that
cross-sectional radiologic methods and especially CT are
superior in detecting, even in small amounts (Fig. 1).5,10
For the autopsy detection of such gas, for example,
detection of gas within the heart, special techniques that
are not regularly performed are required, such as opening
of the heart under water.11 We therefore assume that the
autopsy ndings with gas have been overlooked5,11 and
that this, by denition, articially caused a low specicity
for these ndings (Fig. 1). The fact that many of these
ndings are small may also explain the dierent

24

specicities of the 2 radiologists in this regard. Interobserver dierences in the postmortem assessment easily
arise, for example, when one radiologist reads a small
mediastinal blister as a pneumomediastinum and the
other does not.
In clinical medicine, CT also is the method of choice
for detecting dicult rib and spine fractures.1113 The
high sensitivity of both radiologists in detecting bony
injuries in this study supports this statement. Again, the
dierences in specicity between the readers were unimportant and supposedly due to a dierent interpretation
of tiny ndings, for example, the inclusion of a fractured
spondylophyte among spine fractures.
One of the important advantages of postmortem
cross-sectional imaging of the body before autopsy is
the documentation of the full body in situ. By doing so,
the ndings can be assessed before any changes in the
location of the organs and tissues occur. This is primarily
important for ndings such as mediastinal shift and
pneumothorax, but also for pleural eusion (Fig. 1). It is
likely that both the appearance and the amount of these
ndings will be changed during the section of the thoracic
cavity, even before they have been recognized and
quantied. This may explain some of the dierences
between autopsy and radiologic examinations.
In detecting pulmonary laceration, contusion, and
aspiration, both radiologists showed a relatively high
sensitivity (89% to 100%) but a low-to-moderate
specicity (33% to 71%) (Diagram 2). This means that
radiologic recognition of pathologic changes to the lungs
is relatively easily performed but that dierentiation is
currently unsatisfying. This can be due to the nature of
these ndings. In laceration, contusion, and even aspiration, blood may be present in the alveoli of the lung, and
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J Thorac Imaging

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Postmortem Imaging of Blunt Chest Trauma

FIGURE 1. A, Tension pneumothorax (P) in the left thoracic cavity in a victim of blunt trauma. Note the mediastinal shift to the
right; B and C, Check for pneumothorax in the right thoracic cavity at autopsy in the same case. The usual preparation of a
window in the intercostal muscles and penetration of the parietal pleura are shown (arrow). The right lung sinks down indicating
no pneumothorax. It is well imaginable that the appearance of the mediastinal shift after use of this technique was changed owing
to the adjustment of the intrathoracic and ambient pressure. Thus, this usually used technique for the assessment of
pneumothorax might have contributed for the discrepancy in the imaging and autopsy results.

additional dierentiating features are rather discrete.

Further autopsy-radiologic correlation studies on the
dierentiation of these ndings are necessary (Fig. 2).
Both radiologists exhibited the same low sensitivity
and high specicity for heart injuries. Two cases with
ventricle rupture and dislocation of the heart as well as 1
case with ventricle contusion were detected. Two cases
with rupture of the heart ventricle, 2 cases with rupture of
heart atrium, and 1 case with heart contusion remained
radiologically undiscovered. Thus, our currently used
techniques (CT with the collimation of 4  or
8  1.25 mm, and 1.5-T MRI with the slice thickness of
5 mm) permit postmortem detection of heart injury in
only one third of the cases. This unsatisfying situation
was already mentioned in a previous study.3 Our results
seem to indicate that rupture of the heart atrium is more
dicult to detect in postmortem CT or MRI in
comparison to the rupture of the heart ventricle.
Furthermore, both dislocations of the heart were seen
by the radiologists, and we thus assume that its detection
is clearly possible using radiologic methods. In these 2

cases with heart dislocation, a rupture of the heart

ventricle was suspected and then conrmed using autopsy
results. These 2 detected ruptures of the heart ventricle
were the 2 largest ones, measuring between 3 and 4 cm at
autopsy. Accordingly, the size of heart muscle rupture
plays a role in its detection using postmortem radiology.
We assume that postmortem application of contrast
media might signicantly improve the detection of the
traumatic heart injury. According to a recent pilot study
in postmortem angiography using cross-sectional techniques, the meglumine-ioxithalamate as a contrast medium
permitted an excellent visualization of the coronary
arteries at postmortem.14

Interobserver Difference
In our assessment of chest trauma, we observed a
90% concordance between the rst and the second
radiologist. Knowing that postmortem radiology is a
very young domain combining forensic pathology and
clinical imaging methods and that in this study 2 clinically
experienced radiologists were employed, we estimate the

FIGURE 2. Pulmonary laceration (thick arrow), internal livores (double arrow) meaning livores within an organ as reported by
Jackowski et al, and blood aspiration to the main bronchus (arrow Bro) of a victim of blunt trauma. A, Axial CT image; B, Axial
T2-weighted MRI image; and C, Axial cut of the left lung after fixation in paraformaldehyde. Note pleural effusion (arrow PleEf)
in both radiologic images and the foci of aspiration in the upper left lobe on the autopsy image (dotted arrow).
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2008 Lippincott Williams & Wilkins

25

Aghayev et al

value of 90% as a fairly good interobserver concordance.

It is probable that, with more experience in forensic
pathology, both the accuracies of the individual readers
and their concordance will improve.

Autopsy
Although ndings such as pneumomediastinum,
pneumopericardium, and pericardial eusion were not
mentioned at all in the autopsy protocols, they were
detected using combined radiologic methods. We suppose
that close radiologic-autopsy casework within the scope
of the evaluation of CT and MRI as noninvasive
examination methods in forensic medicine will lead to a
quality improvement of both forensic pathologic and
radiologic examinations.
In the present study, the averaged sensitivity of the
radiologic methods by each radiologist was at least 14%
higher than the corresponding specicity. This means that
in the radiologic interpretation there are more false
positive than false negative results; thus, ndings are
sometimes detected but their exact pathologic character is
unknown. However, cross-sectional radiologic-autopsy
correlation studies are still a young approach and, as
mentioned above, we believe that they oer a great
potential for both disciplines.
Furthermore, concerning the number of false
positive ndings responsible for the low specicity of
radiologic methods, sampling distances between tissue
cuts at autopsy are much larger than the 1.25 mm between
CT or the 5 mm between MRI images; there is a
possibility that small-sized ndings might have been
overlooked at autopsy. The use of supplemental minimally invasive postmortem examination techniques, such
as angiography and biopsy, might compensate for the
missing specicity.1417
As both radiologists were clinical specialists with
approximately 6 months experience in postmortem
cross-sectional imaging, we assume that an improvement
of their performance with greater experience is certain.
The best way to further train a radiologist is with
detailed analyses of autopsy images and ndings after
the radiologic assessment. Postmortem cross-section
radiology is a very young domain in medicine, which
is precisely in between forensic pathology and
radiology. Further broad research in this domain
with close radiologic-pathologic collaboration is
necessary.
Our study has the following limitations. First, the
autopsy protocols were used as a gold standard; autopsy,
however, uses subjective and observer-dependent assessment of the ndings in many respects. Second, we used
CT and MRI, which of course are expensive in routine
forensic work. MRI is more expensive, more timeconsuming, and less available, although it provides clearly
better contrast of soft tissues. CT is much faster and
less expensive; it is currently the method of choice
for diagnosis of bone and lung pathology and for the
detection of gas within the body. Finally, despite the
assumption that autopsy as the gold standard for

26

J Thorac Imaging

Volume 23, Number 1, February 2008

postmortem chest examinations detect the maximum

ndings, a potential bias in the study might result from
the fact that the pathologists who carried out autopsy
obtained a rough knowledge about the injured body parts
and some of the radiologic ndings.
The sensitivity and specicity of the results presented here demonstrate that postmortem CT and MRI
are useful diagnostic methods for assessing chest trauma
in forensic medicine. However, further radiologic-pathologic case studies are necessary to dene the exact role of
postmortem CT and MRI as a single examination
modality; currently, these methods should be used as a
supplement to and not as a substitute of autopsy. The
recent and ongoing technical progress in radiology
promises a great potential for forensic cross-sectional
imaging.
ACKNOWLEDGMENTS
The authors are grateful to Elke Spielvogel, Carolina
Dobrowolska, and Christoph Laeser (Department of
Radiology, Bern University Hospital), Verena Beutler
and Karin Zwygart (Department of Clinical Research,
Magnetic Spectroscopy and Methodology, Bern University
Hospital) and also to Urs Koenigsdorfer and Roland Dorn
(Institute of Forensic Medicine, Bern University) for the
excellent help in data acquisition during the radiologic
examinations and the forensic autopsies. Particular thanks
go to Eva Scheurer for distinguished support in the
statistical evaluation of the results.
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