Smaller but denser: postmortem changes alter the CT characteristics of subdural hematomas
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ORIGINAL ARTICLE
Smaller but denser: postmortem changes alter the CT characteristics of subdural hematomas Nicole Berger • Lars C. Ebert • Garyfalia Ampanozi Patricia M. Flach • Dominic Gascho • Michael J. Thali • Thomas D. Ruder
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Accepted: 4 December 2014 / Published online: 8 January 2015 Ó Springer Science+Business Media New York 2015
Abstract Purpose The aim of this study was to investigate if (1) the volume of subdural hematomas (SDH), midline shift, and CT density of subdural hematomas are altered by postmortem changes and (2) if these changes are dependent on the postmortem interval (PMI). Materials and Methods Ante mortem computed tomography (AMCT) of the head was compared to corresponding postmortem CT (PMCT) in 19 adults with SDH. SDH volume, midline shift, and hematoma density were measured on both AMCT and PMCT and their differences assessed using Wilcoxon-Signed Rank Test. Spearman’s Rho Test was used to assess significant correlations between the PMI and the alterations of SDH volume, midline shift, and hematoma density. Results Mean time between last AMCT and PMCT was 109 h, mean PMI was 35 h. On PMCT mean midline displacement was decreased by 57 % (p \ 0.001); mean SDH volume was decreased by 38 % (p \ 0.001); and mean hematoma density was increased by 18 % (p \ 0.001) in comparison to AMCT. There was no correlation between
N. Berger L. C. Ebert G. Ampanozi P. M. Flach D. Gascho M. J. Thali T. D. Ruder (&) Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, 8057 Zurich, Switzerland e-mail: [email protected]; [email protected] N. Berger P. M. Flach Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Raemistrasse 100, 8006 Zurich, Switzerland T. D. Ruder Institute of Diagnostic, Interventional and Pediatric Radiology, University Hospital Bern, Freiburgstrasse, 3010 Bern, Switzerland
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the PMI and the normalization of the midline shift (p = 0.706), the reduction of SDH volume (p = 0.366), or the increase of hematoma density (p = 0.140). Conclusions This study reveals that normal postmortem changes significantly affect the extent and imaging characteristics of subdural hematoma and may therefore affect the interpretation of these findings on PMCT. Radiologists and forensic pathologists who use PMCT must be aware of these phenomena in order to correctly interpret PMCT findings in cases of subdural hemorrhages. Keywords Forensic radiology Postmortem computed tomography Head CT Subdural hematoma Virtopsy
Introduction Over the past 15 years, postmortem computed tomography (PMCT) has become an important tool in forensic death investigations [1–3]. PMCT images differ from clinical, ante mortem CT (AMCT) images, and feature a number of normal postmortem findings which must be distinguished from true pathology such as posterior sedimentation, gas formation, or tissue decomposition [4, 5]. In the brain, these findings also include an overall decreased attenuation of
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