ISFRI Guidelines Working Group: Best practice standards for non-contrast postmortem computed tomography (PMCT) of overdose

Abstract

Postmortem computed tomography (PMCT) has emerged as a valuable tool in forensic investigations, supporting the investigation of suspected overdoses. While not specific, Cerebral edema, pulmonary edema, and urinary bladder distention (the overdose triad) can suggest overdose in unsuspected cases. Furthermore, a high-density basal layer in the stomach may indicate intentional therapeutic medical overdose. Challenges include short agonal intervals and decomposition changes. Confirmatory blood toxicology is necessary. Dual-energy computed tomography (DECT) can play a role in differentiation of material contributing to dense basal layers and body packing scenarios. PMCT serves as a valuable complement to autopsy findings, aiding in the assessment of internal pathology while also offering a non-invasive alternative in specific forensic contexts where autopsy may not be performed.