Complementary roles of postmortem CT and MRI in forensic trauma investigations: a two-case comparison

Abstract

Background

Postmortem CT (PMCT) and MRI (PMMR) are increasingly central to post-mortem imaging, each offering distinct strengths. PMCT excels in identifying skeletal trauma and gas distribution, while PMMR provides superior characterization of soft tissues and organ injuries. Evaluating their combined use in real-case scenarios is essential for optimizing imaging workflows and supporting autopsy planning.

Postmortem CT (PMCT) and MRI (PMMR) are increasingly central to post-mortem imaging, each offering distinct strengths. PMCT excels in identifying skeletal trauma and gas distribution, while PMMR provides superior characterization of soft tissues and organ injuries. Evaluating their combined use in real-case scenarios is essential for optimizing imaging workflows and supporting autopsy planning.

Methods

Two deaths investigated with both PMCT and PMMR before autopsy were examined. Case 1 involved a sharp-force homicide with suspected multiorgan injury. Case 2 concerned a woman who fell from 7 metres, with suspected extensive skeletal trauma. For each case, PMCT and PMMR findings were compared with autopsy results and contextualized within current evidence on postmortem imaging performance.

Two deaths investigated with both PMCT and PMMR before autopsy were examined. Case 1 involved a sharp-force homicide with suspected multiorgan injury. Case 2 concerned a woman who fell from 7 metres, with suspected extensive skeletal trauma. For each case, PMCT and PMMR findings were compared with autopsy results and contextualized within current evidence on postmortem imaging performance.

Results

In the homicide case, PMCT identified the number and direction of stab wounds, but it was insufficient in defining organ involvement. PMMR revealed visceral lesions, intraparenchymal hemorrhages, and subtle soft-tissue tracts not appreciable on CT, refining the reconstruction of assault and guided targeted autopsy dissection. In the fall-from-height case, PMCT was essential, demonstrating multiple cranial and skeletal fractures, including complex skull-base disruptions not externally evident. This information shaped the autopsy approach. PMMR contributed minimal additional value due to the predominantly osseous nature of the injuries. Together, the cases illustrate the modality-specific advantages in the literature: PMCT as the first-line tool for high-energy skeletal trauma, and PMMR as a crucial adjunct when assessing soft tissue or viscera.

In the homicide case, PMCT identified the number and direction of stab wounds, but it was insufficient in defining organ involvement. PMMR revealed visceral lesions, intraparenchymal hemorrhages, and subtle soft-tissue tracts not appreciable on CT, refining the reconstruction of assault and guided targeted autopsy dissection. In the fall-from-height case, PMCT was essential, demonstrating multiple cranial and skeletal fractures, including complex skull-base disruptions not externally evident. This information shaped the autopsy approach. PMMR contributed minimal additional value due to the predominantly osseous nature of the injuries. Together, the cases illustrate the modality-specific advantages in the literature: PMCT as the first-line tool for high-energy skeletal trauma, and PMMR as a crucial adjunct when assessing soft tissue or viscera.

Conclusions

Diagnostic accuracy in post-mortem imaging derives from a strategic combination of PMCT and PMMR tailored to the suspected injury pattern. Their integrated use enhances forensic interpretation and supports more efficient, targeted autopsies. A prospective study employing post-mortem MRI as the gold standard could further clarify observational biases, both operator-dependent (skills and expertise) and those intrinsic to imaging equipment.

Diagnostic accuracy in post-mortem imaging derives from a strategic combination of PMCT and PMMR tailored to the suspected injury pattern. Their integrated use enhances forensic interpretation and supports more efficient, targeted autopsies. A prospective study employing post-mortem MRI as the gold standard could further clarify observational biases, both operator-dependent (skills and expertise) and those intrinsic to imaging equipment.

Ethics

All procedures complied with applicable legal and ethical standards.

All procedures complied with applicable legal and ethical standards.