Email updates

Keep up to date with the latest news and content from BMC Medical Imaging and BioMed Central.

Open Access Highly Accessed Research article

A comparative study of cranial, blunt trauma fractures as seen at medicolegal autopsy and by Computed Tomography

Christina Jacobsen1*, Birthe H Bech2 and Niels Lynnerup1

Author Affiliations

1 Section of Forensic Pathology, Department of Forensic Medicine, University of Copenhagen, Frederik V Vej 11, DK-2100 Copenhagen Ø, Denmark

2 Diagnostic Centre, Department of Radiology, Copenhagen University Hospital, Blegdamsvej 9, DK-2100 Copenhagen Ø, Denmark

For all author emails, please log on.

BMC Medical Imaging 2009, 9:18  doi:10.1186/1471-2342-9-18

Published: 16 October 2009

Abstract

Background

Computed Tomography (CT) has become a widely used supplement to medico legal autopsies at several forensic institutes. Amongst other things, it has proven to be very valuable in visualising fractures of the cranium. Also CT scan data are being used to create head models for biomechanical trauma analysis by Finite Element Analysis. If CT scan data are to be used for creating individual head models for retrograde trauma analysis in the future we need to ascertain how well cranial fractures are captured by CT scan. The purpose of this study was to compare the diagnostic agreement between CT and autopsy regarding cranial fractures and especially the precision with which cranial fractures are recorded.

Methods

The autopsy fracture diagnosis was compared to the diagnosis of two CT readings (reconstructed with Multiplanar and Maximum Intensity Projection reconstructions) by registering the fractures on schematic drawings. The extent of the fractures was quantified by merging 3-dimensional datasets from both the autopsy as input by 3D digitizer tracing and CT scan.

Results

The results showed a good diagnostic agreement regarding fractures localised in the posterior fossa, while the fracture diagnosis in the medial and anterior fossa was difficult at the first CT scan reading. The fracture diagnosis improved during the second CT scan reading. Thus using two different CT reconstructions improved diagnosis in the medial fossa and at the impact points in the cranial vault. However, fracture diagnosis in the anterior and medial fossa and of hairline fractures in general still remained difficult.

Conclusion

The study showed that the forensically important fracture systems to a large extent were diagnosed on CT images using Multiplanar and Maximum Intensity Projection reconstructions. Difficulties remained in the minute diagnosis of hairline fractures. These inconsistencies need to be resolved in order to use CT scan data of victims for individual head modelling and trauma analysis.