In this paper, the authors study and compare the efficacy of Post-Mortem Computed Tomography (PMCT) and Post-Mortem Magnetic Resonance Imaging (PMMRI) as well as examine how to improve their use in the investigation of fatalities involving suspected head trauma.
This study of Post-Mortem Computed Tomography (PMCT) and Post-Mortem Magnetic Resonance Imaging (PMMRI) suggests that in cases of high legal or public health importance, PMMRI should be considered. The results also suggest that PMCT and PMMRI are complementary and that PMCT is a sufficient imaging modality in most medicolegal death investigations and is the preferred modality for detecting a variety of non-fatal findings, which may be related to the cause of death or are important to the medicolegal investigation, public health, or the decedent’s family. The authors first systematically evaluated the accuracy of previous PMCT imaging findings in cases of adult blunt force injury and pediatric trauma to better define the causes and implications of observed discordance between PMCT and Autopsy. Second, the authors evaluated whether PMMRI of the head and neck, in addition to whole body PMCT, can further improve the radiological detection of injuries in fatalities involving suspected head trauma. The long-term goal of this research is to define best practices for effective and efficient integration of Advanced Radiological Imaging methods into the practice of Forensic Pathology. The authors’ over-arching hypothesis is that the use of Advanced Radiological Imaging and Autopsy will result in death investigations that are demonstrably more comprehensive and reliable, particularly in cases for which complete injury documentation has legal importance, such as suspected abuse, medical malpractice, or workplace injury. The data show that the addition of PMMRI resulted in a 40% increase in the number of fatal (Level 1) findings in the head and neck (46 detected by PMCT; 64 detected by PMCT+PMMRI) in a cohort of 94 medical examiner cases with possible head or neck trauma. In one case, a new Level 1 finding reported at PMMRI would likely have changed the cause of death.