Vol 18, No 13 (2016)


Actual possibilities of postmortem imaging in forensic medicine practice

Kovalev A.V., Kinle A.F., Kokov L.S., Sinitsyn V.A., Fetisov V.A., Filimonov B.A.


Purpose of the study. The review analyzed the results of studies on the use of computed tomography (CT) and magnetic resonance imaging (MRI) in a forensic expertise (FE) of the adults. The purpose of this review is to introduce forensic radiologists and situations, the most common in postmortem imaging, as well as its strengths and weaknesses. Material and methods. The basic Internet resources used: Russian Scientific Electronic Library (elibrary.ru), Embase, Medline, Web of Science, Cochrane database. Results and conclusions. Methods for FE postmortem imaging are under active study and formation of the evidence base. "The gold standard" postmortem diagnosis is a traditional autopsy. But the role of tomographic methods of research is growing. For practical purposes, the FE adult cadavers more suitable for CT. In some cases, autopsy should be combined with different methods of beam diagnostics - CT, CT angiography and MRI. Posthumous ray diagnosis can be of great help in the visualization of mechanical damage, as well as to determine the cause in some cases, sudden death. Posthumous imaging may be required in some other common situations in the practice of FE: mechanical asphyxia, drowning, action of high and low temperature, research rotten modified and unidentified bodies, detection of foreign bodies.
Consilium Medicum. 2016;18(13):9-25
pages 9-25 views

Identification of gas accumulations in the bodies of fetuses, still-borns and dead newborns at postmortem computed tomography study

Tumanova U.N., Fedoseeva V.K., Lyapin V.M., Shchegolev A.I., Sukhikh G.T.


Posthumous computed tomography (CT) requires the differential diagnosis of postmortem and antemortem pathological processes. The most important is the issue with respect to detection of gas concentrations, as the traditional autopsy study does not allow to fully reveal the presence of intravascular intraorganic or gas except in severe air embolism. Purpose of the study. To explore the features of gas accumulation in organs and tissues of the dead fetuses, stillbirths and deaths of newbornswith the help of postmortem CT localization. Materials and methods. Examie via postmortem CT 110 fetuses, stillbirths and deaths of newborns. All observations were divided into five groups. Two groups consisted of fetuses after spontaneous (group 1, n=9) or induced abortion (group 2, n=41) on 14-21 th week of gestation. The two groups accounted body stillborn, died at gestational age 25-39 weeks prenatally (group 3, n=15) with the prescription of fetal death from 14 hours to 2 weeks or intrapartum (group 4, n=3). The 5th group included bodies of 42 infants born at 24-40 weeks and the timing of deaths between the ages of 6 hours to 166 days. After CT studies post mortem examination followed by an analysis of histological slides of tissue and organswas performed. Results. Rarer air accumulations were observed at postmortem CT baby bodies after induced (14.6%) and spontaneous (11.1%) of abortions. The most common gas visualized in cases of intrapartum death and the dead babies. On tomograms of bodies of newborns who died intrapartum, gas was visualized in all 3 cases. Only 5 (11.9%) died of gas accumulations newborn have not been determined. Conclusions. Posthumous CT is a more efficient method of detection of gas concentrations in comparison with the autopsy, however, cannot fully be an alternative to the traditional autopsy studies to carry out a comprehensive macroscopic and microscopic examination of organs and tissues.
Consilium Medicum. 2016;18(13):26-33
pages 26-33 views

Advantages and disadvantages of CT scanners and their placement options for postmortem cross-sectional imaging (UK specialists experience)

Fetisov V.A.


Three placement options for CT scanners (directly in the morgue, at some distance from it, such as the mobile CT scanner, and using the clinical CT scanners), their advantages and disadvantages and organizing the postmortem cross-sectional imaging (PCSI) are shown in the article. Following each option, the problematic issues of body transportation, PSCI-research financing and medical staff working order are described in detail. Based on the National Health Service (NHS) experience, the necessity of different use of scanning equipment considering the features of every morgue or hospital pathology department is also shown. The preferred working order model for British pathologists and coroners offices, as well as for the relatives of the deceased is the direct morgue placement of the scanner (option 1). Its maximal efficacy and high quality of the research are among the main advantages of this option, just as well as the possibility of wide scope of training for medical staff, such as the doctors and lab technicians; clinical diagnostics and treatment quality control, and development of new scientific technologies. Due to the significant financial input, in the country scope, it is more advisable to use the mobile scanners (option 2), or optimizing the clinical scanners in terms of PCSI research (option 3).
Consilium Medicum. 2016;18(13):34-37
pages 34-37 views

Postmortem computed tomography and its features: what should clinical radiologists know?

Dubrova S.E., Filimonov B.A.


The data on postmortem CT in forensic-medical examination is analyzed in the current review, with the main reason of showing the clinical radiologists all the features of postmortem CT and main internet resources used in preparation of the review being: scientific electronic library (Elibrary), SciVerse (ScienceDirect), Scopus, PubMed and Discovery. The articles discussing the features of postmortem CT, important for those professionals who seldom face the postmortem visualisation in their daily work, are also included. The earlier and later postmortem changes, such as rigor mortis, autolysis, septic and other postmortem processes that change the normal perceptions in CT visualization significantly. While interpreting the postmortem CT images, radiologists should take into consideration the most frequent artefacts, taking place due to the postmortem blood clots in the heart cavities and big arteries, aspiration of the stomach contents into the airways, esophago - and gastromalacia, cadaveric hypostases in internal organs, violation of the differentiation between grey and white brain matter, putrid gases in the blood vessels, organs and tissues and many other features. Postmortem visualization requires the special training for radiologists in forensic medicine and has the features of the radial imagingintrinsic only for corpses. When lacking the special knowledge, even the most experienced and clinically competent radiologists can make serious diagnostic mistakes interpreting the postmortem CT images.
Consilium Medicum. 2016;18(13):38-47
pages 38-47 views

Issues of financing and specialist training in postmortem cross-sectional imaging in Great Britain

Fetisov V.A.


In this article, we list possible options of autopsy performance using various additional research methods, including postmortem cross-sectional imaging (PCSI), in Great Britain. Statistics show that there is no such thing as the officially approved PCSI specialists training program, and that it is available only as the joint initiative of several medical centers of the UK. The necessity of developing national standards and training programs in every professional field, creating the corresponding audit systems (checking and inspection), and outer PCSI quality control is also stated. The National Health Service institutions of the United Kingdom, with remuneration of the II category specialists’ work (forensic medical expertise analogue), mainly do implementation and keeping of tomographic data. To avoid stagnation and development deceleration of the said work, it is of the uttermost importance to have a strong academic research strategy, strengthened by the stable funding on the national level in the basis of the new scientific direction. The importance of the full-fledged PCSI funding and standards development, proving the possibility of PCSI use as the classic autopsy alternative.
Consilium Medicum. 2016;18(13):48-51
pages 48-51 views

Radiological detection of the inserted drug containers into the body’s cavities of the “drug mules”

Filimonov B.A., Dubrova S.E., Strelkov A.A.


The article discusses the possibility of using radiological methods - X-ray, computed tomography (CT), magnetic resonance imaging (MRI), and sonography in the search and detection of narcotics (NA), carried by the container method in human body cavities (drug trafficker). The review provides research (as of September 2016), showing the benefits of a standard X-ray CT to the abdomen when searching with HC containers in the gastrointestinal tract. Currently, CT, including low-dose may be considered the correct method of choice for NA containers search in human body cavities. CT should be used for primary diagnosis as well as for re-examination after extraction with HC containers. MRI and ultrasound, despite a number of obvious advantages, including the absence of radiation exposure, are of limited use.
Consilium Medicum. 2016;18(13):52-58
pages 52-58 views

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