Synopsis
Educational lecture on Diffusion MR Imaging in forensic medicine and research.Highlights
- Postmortem diffusion MRI is an emerging field of
research that yields excellent imaging data and offers unique possibilities of directly
comparing imaging and (micro-)structural tissue findings
- Forensic-radiologic diffusion MRI studies forwad
neurotraumatology dignostics from an indirect, hemorrhage based assessment
towards a direct tissue and fiber based approach
- Diffusion imaging studies demonstrated some
potential to get a better understanding of the process of dying based on
cause-of-death-related ADC changes
Target audience
Clinical radiologists and scientists interested in new
applications of diffusion imaging and novel research fields; forensic imaging
experts, neuroscientists and neuroradiologists.
Outcome
/ Objectives
In this presentation, the forensic application of diffusion
imaging in postmortem subjects will be demonstrated with focus on the
potential of such an approach and the benefits of clinical-forensic research
cooperations in this specific field. It will be shown how forensic imaging can
add highly specific knowledge to clinical research. Besides the current
state-of-the-art in postmortem diffusion imaging and its limitations and
challenges, results are shown from studies of the in-situ postmortem brain
following different causes of death and with or without previous traumatic
brain injury.
Purpose
To
give a broad overview of the state-of-the-art in post-mortem forensic diffusion
imaging, its applications, current research issues and results.
Methods
As with other MRI applications in forensic imaging, previous
studies [1-7] have demonstrated that diffusion imaging at 1.5 or 3T can well be
applied in post-mortem situations and yields good results even days after
death. However, the imaging parameters must be adjusted to the post-mortem
situation according to the cooler body temperature. The absence of movement
artifacts due to blood flow and breathing is advantageous for the image
quality. Another specific benefit of forensic diffusion imaging is the unique
possibility to compare the MRI results with the true findings from macroscopic
examination and tissue samples. In the case of e.g. traumatic fiber rupture in
the brain tissue, autopsy and histopathologic examination can be used to reveal
the exact localization, extent and type of tissue damage.
Results
Forensic diffusion MRI pilot studies in recent years mainly
focused on the post-mortem in situ brain and on characteristic post-mortem
alterations and traumatic or non-traumatic changes, respectively [1,2,4-7]. Apart from
the basic applicability of diffusion imaging in bodies that has been proven so
far, the findings that were detected reflected mechanical trauma sequelae, a
generally reduced ADC in the post-mortem brain and ADC changes that correlated
with the time since death. The ADC was also lower following mechanical and
hypoxic brain injury having caused death when compared to heart failure cases.
Discussion / Conclusion
Post-mortem diffusion imaging in forensic cases is quite
new. It has however demonstrated its potential to gain new insights into the
morphology and function of tissues and organs and to serve as a reasonable
supplement to clinical research. Hearers of this presentation should understand
the potential and limitations of post-mortem diffusion MRI, its main
applications and the usefulness of
interdisciplinary clinical-forensic research.
Acknowledgements
Special thanks goes to the Forensic Imaging Research Group from the Forensic Institute at Heidelberg and the German Cancer Research Institute for continuously high engagement and support.
References
[1] Flach PM et al., Am J Forensic Med Pathol 2015
[2] Ruder TD et al., Br J Radiol 2014
[3] Winklhofer S et al., Eur Radiol 2014
[4] Schmidt TM et al., Forensic Sci Int 2012
[5] Scheurer E et al., AJNR 2011
[6] Yen K et al., AJNR 2006