Director of MRI and Neuroradiology Section, department of Diagnostic Imaging, Assaf Harofeh Medical Center
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2 Sigal Tal MD Director of MRI and Neuroradiology Section, department of Diagnostic Imaging, Assaf Harofeh Medical Center Fields of interest: Neuroradiology & Forensic imaging Clinical fellowships in Neuroradiology at NYU, NY, USA Academic staff Sackler faculty of Medicine, Tel Aviv and Ariel University, Ariel. Published multiple articles in peer reviewed scientific journals. Presented Multiple scientific communications in international congresses and numerous lectures in national and international meetings
3 Conflicts of Interest The authors have no conflicts of interest to declare
4 How to read CT-PM: Normal and abnormal findings Dr. Sigal Tal Assaf Harofeh Medical Center
5 The Role of Forensic Radiology View anatomy without dissection View difficult to reach anatomical areas Better the understanding of injury patterns via 3-D visualizations Detect occult injuries and disease Triage full autopsy-required cases
6 Virtopsy Virtopsy Virtual Autopsy It is a way of performing a non- or minimally-invasive autopsy by scanning a corpse Virtopsy is a registered name of the research team lead by Michael J. Thali in Bern, Switzerland
7 Methods Full body CT: A 256 Slice CT (Phillips) 3 mm reconstruction soft tissue 1 mm bone reconstruction MRI when further examination or greater tissue contrast was deemed necessary by radiologist A 1.5T clinical MRI (Siemens Aera) T1, T2, FLAIR, STIR, SWI, GRE, and DTI
8 Methods 1.5 Tesla MRI 48 channels Conventional parameters as for patients Brain- T1, T2, FLAIR, DTI, GRE, SWI Neck T1, T2, STIR Chest T1, T2
9 Fun Facts for the Day Normal post-mortem changes Pathologies Disease Outside intervention / trauma What we have difficulty with
10 Normal after death Livor Mortis blood content flows to lowest point Rigor Mortis muscles contract Algor Mortis body cooling Decomposition Tissue into fluid and gas
11 Livor Mortis Hemo-concentration results in increased attenuation Easily observed in large caliber arteries, veins and cardiac chambers Vascular collapse Hyperdensity of dependant sagittal sinus and cerebral veins
12 Livor Mortis Hemo-concentration results in increased attenuation Easily observed in large caliber arteries, veins and cardiac chambers Vascular collapse Found dead lying on his left side
13 Internal livor mortis of lung
14 Hemo-concentration results in increased attenuation Easily observed in large caliber arteries, veins and cardiac chambers Vascular collapse Livor Mortis
15 Livor Mortis Increased attenuation
16 Hemo-concentration results in increased attenuation Easily observed in large caliber arteries, veins and cardiac chambers Vascular collapse Notice hyper-dense wall Livor Mortis
17 Hemo-concentration results in increased attenuation Easily observed in large caliber arteries, veins and cardiac chambers Vascular collapse Notice hyper-dense wall Livor Mortis contraction of the aortic wall luminal loss of pressure dilution of blood / infusion / sedimentation
18 Rigor & Algor Mortis Rigor - No specific CT findings but practical difficulty with corpse placement into bore lead to position changes for placement breaking rigor for scan iatrogenic findings Algor - MRI protocol needs to take temperature into account
19 Early Cerebral autolysis Early Decomposition Intestinal distention and mural gas Intravascular gas Loss of cortico-medullary differentiation and brain swelling
20 Early Cerebral autolysis Intestinal distention and mural gas Early Decomposition Intravascular gas Loss of cortico-medullary differentiation and brain swelling
21 Loss of Cortico-Medullary Differentiation and Brain Swelling
22 Brain Swelling - Tonsilar Herniation
23 Early Decomposition Early Cerebral autolysis Intestinal distention and mural gas Intravascular gas
24 Early Cerebral autolysis Intestinal distention and mural gas Early Decomposition Intravascular gas
25 Early Cerebral autolysis Intestinal distention and mural gas Intravascular gas. starting in the hepatobiliary system Early Decomposition
26 Early Cerebral autolysis Intestinal distention and mural gas Early Decomposition Intravascular gas Mostly intravascular, intrabiliary or trapped along tissue boundaries Diffuse distribution in contrast to the localized air embolism.
27 Moderate Decomposition Moderate Cerebral settling Cavity and subcutaneous fluid / Gas
28 Moderate Decomposition Moderate Cerebral settling Cavity and subcutaneous fluid / Gas
29 Late Decomposition Late Cerebral liquifaction Diffuse subcutaneous and visceral gas with organ collapse. Insects/predation
30 Late Decomposition Late Cerebral liquifaction Diffuse subcutaneous and visceral gas with organ collapse. Insects/predation
31 Late Decomposition Late Cerebral liquifaction Diffuse subcutaneous and visceral gas with organ collapse. Insects/predation
32 Late Decomposition
33 Late Decomposition Late Cerebral liquifaction Diffuse subcutaneous and visceral gas with organ collapse. Insects/ predation Maggots
34 Forensic Radiology Changes Non-traumatic Foreign bodies and medical devices Tissue infiltrative fluid Free cavity fluid and air Organ hematomas Fully distended urinary bladder as a sequela of intoxication and poisoning Miscellaneous: hypoxic-anoxic brain injury
35 Forensic Radiology Changes Traumatic Fractures and other skeletal pathologies Foreign bodies (bullets, shrapnel) Tissue infiltrative fluid (blood, edema) Free cavity fluid and air Bleeding in various organs
36 Forensic Radiology Changes Anatomical variants and diseases Anatomical variants Background disease: Tuberculosis Fatty liver Cirrhosis Calculi Hernia Tumors Skeletal pathology, osteopenia
37 What We Can t Recognize Vascular filling defects (PE, DVT, emboli) Small tears in internal organs (liver, spleen, pancreas, kidneys) Difficulty in differentiating various focal lesions due to lack of contrast injection Pulmonary imaging is difficult Heart attack may be missed Stroke, depends on time from even to death Air embolism vs diffuse gas, depends on size
38 Pathologies - Disease
39 Old infarct Imaging of the head
40 Hydrocephalus Imaging of the head
41 Imaging of the head Intracranial hemorrhage No difference in imaging intracranial hemorrhage between the living and the dead
42 Imaging of the head Herniation due to SOL Sudden death 2 months pregnant
43 Thoracic imaging Vanishing aorta - bleeding Fatal hemorrhage (exsanguination) leads to collapse Greater than normal volume loss
44 Thoracic imaging Cardiac tamponade 89HU
45 SIDS pulmonary consolidations 1 year old female Found Nonresponsive in daycare Intially suspected abuse/neglect Thoracic Imaging
46 SIDS Thoracic Imaging pulmonary consolidations 1 year old female Found nonresponsive in daycare Intially suspected abuse/neglect
47 Pulmonary TB Thoracic Imaging
48 Drowning Fluid or froth in the airways emphysema aqeuosum mosaic pattern of the lung resorption of fresh-water in the lung results in hemodilution aspiration of saltwater leads to pulmonary edema Swallowed water distends stomach and duodenum Inflow of water always fills the paranasal sinuses
49 Thali et al Legal Medicine 2010
50 One of our first cases Young female Cadaver discarded in field. Discovered with advanced decomposition On inspection multiple injuries
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55 A few of our our LATER CASES
56 5 year old Found dead in play-ground. Suspected fall from carousel - trauma
57 5 year old Found dead in play-ground. Suspected fall from carousel - trauma
58 5 year old Found dead in play-ground. Suspected fall from carousel - trauma
59 5 year old Found dead in play-ground. Suspected fall from carousel - trauma
60 5 year old Found dead in play-ground. Suspected fall from carousel - trauma
61 5 year old Found dead in play-ground. Suspected fall from carousel - trauma
62 5 year old Found dead in play-ground. Suspected fall from carousel - trauma
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68 50 year old male Found dead Signs of strangulation
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77 50 year old male Found dead Signs of strangulation
78 50 year old male Found dead Signs of strangulation
79 20 year old female Dyspnea after meal Loss of consciousness Resuscitation
80 20 year old female Dyspnea after meal Loss of consciousness Resuscitation
81 20 year old female Dyspnea after meal Loss of consciousness Resuscitation
82 20 year old female Dyspnea after meal Loss of consciousness Resuscitation
83 20 year old female Dyspnea after meal Loss of consciousness Resuscitation
84 20 year old female Dyspnea after meal Loss of consciousness Resuscitation
85 Thank you to Dr Nadav Berkovitz Dr Boris Makogon Dr Laurian Copel Dr Margaritta Vasserman Dr Yoav Cohen-Sivan Technical team Secretarial team
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