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Estimation of age at death is important in forensic investigations of unknown remains. There have been several reports on applying the degree of osteophyte formation—an age-related change in the vertebral body—for age estimation; however, this method is not yet established. This study investigated a method for age estimation of modern Japanese individuals using osteophytes measured on CT images. The sample included 250 cadavers (125 males) aged 20–95 years. The degree of osteophyte formation was evaluated as score O (0–5 points), and the degree of fusion of the osteophytes between the upper and lower vertebrae was evaluated as score B (0–2 points). Age estimation equations were developed using regression analyses with seven variables, determined by scores O and B, and the equation with the smallest standard error of estimate (SEE) was obtained when the number of vertebrae with score O ≥ 2 was used as the explanatory variable. Age estimation with SEE of about 10 years was possible even when partial vertebrae with a high degree of osteophyte formation were used, showing its potential for practical application. The cutoff value for age estimation was established using the receiver operating characteristic curve analysis, wherein good results were obtained for all variables (area under the curve ≥ 0.8). The combination of the estimation equation and the cutoff value can narrow the range of age estimates.

[Abstract] In this study, we aimed to identify risk factors that predict the postoperative need for advanced or prolonged airway management in patients with severe odontogenic deep neck infections (DNIs). This retrospective case-control study included patients of both sexes aged >=18 years who had undergone surgical drainage including debridement of necrotic tissues of odontogenic deep neck abscesses and necrotizing soft tissue infection under general anesthesia between April 2016 and September 2023 at a single center. The patients' characteristics, laboratory tests, and computed tomography (CT) findings were analyzed and compared between the difficult postoperative airway group, which required prolonged intubation or tracheostomy, and the short-term intubation group. Statistical significance was set at P < 0.05. Sixty-four patients required surgical drainage including debridement under general anesthesia. Of them, 7 (10.9%) patients were included in the difficult postoperative airway group. In addition to increased inflammatory markers, the presence of arytenoid edema among laryngeal edema and retro- and parapharyngeal space abscesses on preoperative CT images were identified as risk factors. The presence of pharyngeal space abscesses was significantly associated with laryngeal edema, and the intubation period was longer in patients with more elements relevant to these two factors. Thus, the presence of pharyngeal space abscesses and degree of laryngeal edema on preoperative CT images can be used to predict the complexity of postoperative airway management. Our results suggest that tracheostomy is preferable for patients with retropharyngeal space abscesses, and that patients with parapharyngeal space abscesses and laryngeal edema are desirable to undergo prolonged intubation.

ObjectiveTo elucidate postmortem computed tomography (PMCT) and postmortem magnetic resonance (PMMR) imaging findings suggesting massive fat embolism.Materials and methodsConsecutive forensic cases with PMCT and PMMR scans of subjects prior to autopsy were assessed. For PMCT, 16- or 64-row multidetector CT scans were used; for PMMR, a 1.5 T system was used. MRI sequences of the chest area included T2- and T1-weighted fast spin-echo imaging, T2*-weighted imaging, T1-weighted 3-dimensional gradient-echo imaging with or without a fat-suppression pulse, short tau inversion recovery, and in-phase/opposed-phase imaging. At autopsy, forensic pathologists checked for pulmonary fat embolism with fat staining; Falzi’s grading system was used for classification.ResultsOf 31 subjects, four were excluded because fat staining for histopathological examination of the lung tissue could not be performed. In three of the remaining 27 subjects, histology revealed massive fat embolism (Falzi grade III) and the cause of death was considered to be associated with fat embolism. CT detected a “fat-fluid level” in the right heart or intraluminal fat in the pulmonary arterial branches in two subjects. MRI detected these findings more clearly in both subjects. In one subject, CT and MRI were both negative. There were no positive findings in the 24 subjects that were fat embolism–negative by histology.Discussion and conclusionIn some subjects, a massive fat embolism can be suggested by postmortem imaging with a “fat-fluid level” in the right heart or intraluminal fat in the pulmonary arterial branches. PMMR potentially suggests fat embolism more clearly than PMCT.

Purpose Ropinirole is an antiparkinsonian  drug and has recently been suggested to be effective in amyotrophic lateral sclerosis. It is expected that ropinirole prescriptions will increase in the near future. However, the fatal concentration in blood is unclear at this time. Therefore, we report a fatal case involving ropinirole intoxication and discuss the fatal concentrations with reference to several autopsy cases involving ropinirole. Methods Ropinirole was quantified in femoral vein blood, cardiac blood, and urine from five autopsy cases in which ropinirole was detected by drug screening in our laboratory. One is a ropinirole intoxication case (this report) and the others  were non-intoxication cases. Their ropinirole concentrations were compared and discussed. Results The ropinirole concentration in this case was 100 ng/mL in femoral blood, 160 ng/mL in cardiac blood, and 1840 ng/mL in urine. The ropinirole concentrations in the four non-ropinirole poisoning cases were 7–35 ng/mL (mean: 24 ng/mL) in femoral blood, 13–100 ng/mL (mean: 60 ng/mL) in cardiac blood, and 140–1090 ng/mL (mean: 640 ng/mL) in urine. Cardiac/peripheral ratios were in the range of 1.6–2.1 (mean 1.8). Conclusions There were no obvious signs of overdose, and the high cardiac/peripheral blood ratio suggested that postmortem redistribution may have occurred, but the  peripheral blood ropinirole concentration (100 ng/mL) was obviously higher than that reported in the previous fatal case of ropinirole poisoning (64 ng/mL). Based on these results, the cause of death in this case was considered to be shock and fatal arrhythmia due to ropinirole poisoning. This case provides important data on postmortem blood and urinary levels of ropinirole poisoning.

Although coronary computed tomography (CT) angiography is a useful tool for evaluating coronary artery lesions both ante- and postmortem, accurate evaluation of the lumen is difficult when highly calcified lesions are present, owing to overestimation of stenosis caused by blooming and partial volume artifacts. In clinical practice, to overcome this diagnostic problem, a subtraction method has been devised to remove calcification by subtracting the precontrast image from the contrast image. In this report, we describe a calcification subtraction method using image analysis software for postmortem coronary CT angiography. This method was devised based on preliminary experimental results showing that the most accurate subtraction was achieved using images reconstructed with a narrower field of view and bone kernel, resulting in higher spatial resolution. This subtraction method allowed evaluation of lumen patency and the degree of stenosis on contrast-enhanced images in a verification using actual specimens where evaluation of the lumen had been difficult because of high calcification. The results were morphologically similar to the macroscopic findings. This method allows more rapid and reliable lesion retrieval and is expected to be useful for postmortem coronary angiography in forensic practice.

Abstract Stature estimation is one of the most basic and important methods of personal identification. The long bones of the limbs provide the most accurate stature estimation, with the femur being one of the most useful. In all the previously reported methods of stature estimation using computed tomography (CT) images of the femur, laborious manual measurement was necessary. A semi-automatic bone measuring method can simplify this process, so we firstly reported a stature estimation process using semi-automatic bone measurement software equipped with artificial intelligence. Multiple measurements of femurs of adult Japanese cadavers were performed using automatic three-dimensional reconstructed CT images of femurs. After manually setting four points on the femur, an automatic measurement was acquired. The relationships between stature and five femoral measurements, with acceptable intraobserver and interobserver errors, were analyzed with single regression analysis using the standard error of the estimate (SEE) and the coefficient of determination (R2). The maximum length of the femur (MLF) provided the lowest SEE and the highest R2; the SEE and R2 in all cadavers, males and females, respectively, were 3.913 cm (R2 = 0.842), 3.664 cm (R2 = 0.705), and 3.456 cm (R2 = 0.686) for MLF on the right femur, and 3.837 cm (R2 = 0.848), 3.667 cm (R2 = 0.705), and 3.384 cm (R2 = 0.699) for MLF on the left femur. These results were non-inferior to those of previous reports regarding stature estimation using the MLF. Stature estimation with this simple and time-saving method would be useful in forensic medical practice.

The image contrast of postmortem magnetic resonance imaging (MRI) may differ from that of antemortem MRI because of circulator arrest, changes in postmortem tissue, and low-body-temperature scanning conditions. In fact, we have found that the signal intensity of white matter (WM) on T1-weighted spin-echo (T1WSE) images of the postmortem brain was lower than that of gray matter (GM), which resulted in image contrast reversal between GM and WM relative to the living brain. However, the reason for this phenomenon is unclear. Therefore, the aim of this study is to clarify the reason why image contrast reversal occurs between GM and WM of the postmortem brain. Twenty-three corpses were included in the study (mean age, 60.6 years; range: 19–60 years; mean rectal temperature at scan, 6.9℃; range: 4–11℃). On a 1.5 T MRI system, postmortem T1W-SE MRI of the brain was conducted in the 23 corpses prior to medico-legal autopsy. Next, T1 and T2 of the GM and WM at the level of the basal ganglia were determined in the same participants using inversion recovery and multiple SE sequences, respectively. The proton density (PD) was also calculated from the T1 and T2 images (in the same slice). T1W-SE image contrast between the GM and WM of all postmortem brains was inverted relative to the living brain. T1 (579 ms in GM and 307 ms in WM) and PD (64 in GM and 44 in WM) of the postmortem brain decreased compared with the living brain. While T1 of WM/GM remained below 1 even postmortem, the PD of WM/GM decreased. T2 (110 ms in GM and 98 ms in WM) of the postmortem brain did not differ from the living brain. The decrease in PD of WM/GM in the postmortem brain may be the major driver of contrast reversal between the GM and WM relative to the living brain. •WM/GM is preserved in postmortem brain T1W-SE images.•Postmortem brain T1 and PD are decreased.•Rates of postmortem water reduction differ between WM and GM.•Lower PD of postmortem brain WM drives contrast inversion between the GM and WM.

The structure and strength of a child's skull are important in accurately determining what and how external forces were applied when examining head injuries. The aims of this study were to measure skull thickness and strength in children, evaluate sex differences, and investigate the correlation between skull thickness and strength and age. Skulls were obtained from 42 Japanese dead bodies under 20 years of age. During the autopsies, bone samples were taken from each skull. The length, width, and central thickness of the skulls were measured using calipers. Three-point bending tests were conducted, and bending load and displacement were recorded. Bending stress and bending strain were calculated, and Young's modulus, 0.2% proof stress, and maximum stress were obtained. In cases under 1.5 years old, 14 out of 46 male samples and 20 out of 40 female samples did not fracture during the three-point bending test, though no significant sex differences were detected. No significant differences in age, sample thickness, Young's modulus, 0.2% proof stress, or maximum stress were detected between the sexes. The sample thickness, Young's modulus, 0.2% proof stress, and maximum stress increased significantly and logarithmically with age (R2 = 0.761–0.899). Although age correlated with thickness, Young's modulus, and maximum stress more in females than in males, 0.2% proof stress correlated slightly better in males than in females. The skulls of preschool children, in particular, are thin, have low strength, and are at high risk of fracturing even with relatively small external forces. Unlike adults, no significant sex differences in skull thickness or strength were observed in children. [Display omitted] •We assessed the thickness and strength of children’s skulls.•The thickness and strength increased significantly and logarithmically with age.•No significant differences were detected between the sexes.•The skulls of preschool children, in particular, are at high risk of fracturing.

•Post-mortem CT and autopsy detect cervical spine injuries in different way.•Post-mortem CT more efficiently detects bone fractures than autopsy.•Autopsy more efficiently detects intervertebral injuries than post-mortem CT.•Accurate evaluation for cervical spine injuries requires the use of both methods. To clarify the differences between postmortem CT (PMCT) and autopsy findings in the postmortem detection of cervical spine injuries (CSIs). Our department’s forensic pathology database was searched for CSI cases. In each case, the autopsy data and radiologists’ interpretations were reviewed for the presence of bone fractures and intervertebral injuries. The study included 42 cases. For both bone fractures and intervertebral injuries, no substantial concordance between PMCT and autopsy findings was observed (McNemar’s test: p<0.001 and p<0.001, respectively). Regarding bone fractures, more injuries were detected with CT than with autopsy (CT: 74, autopsy: 23). The percentage of CT-detected fractures that were missed at autopsy (77.0%, 57/74) was higher than the percentage of autopsy-detected fractures missed with CT (26.1%, 6/23). Regarding intervertebral injuries, fewer injuries were detected with CT than with autopsy (CT: 40, autopsy: 80). The percentage of CT-detected injuries that were missed at autopsy (35.0%, 14/40) was lower than the percentage of autopsy-detected injuries that were missed with CT (67.5%, 54/80). A substantial number of CSIs were detected by either PMCT or autopsy alone. Accurate evaluation for CSI requires the use of both methods.

Sex estimation of decomposed or skeletal remains is clearly important in forensic contexts. Recently, contemporary population-specific data has been obtained using multidetector computed tomography (MDCT) scanning. The main purpose of this study was to investigate skeletal pelvic dimorphism in a contemporary Japanese forensic sample and to quantify the accuracy of sex estimation using various pelvic measurements obtained from three-dimensional (3D) CT images. This study used a total of 208 cadavers (104 males, 104 females) of which postmortem CT scanning and subsequent forensic autopsy were conducted between December 2011 and August 2014. Eleven measurements of each pelvis were obtained from 3D CT reconstructed images that extracted only bone data. The measurements were analyzed using descriptive statistics and discriminant function analyses. All except one measurement were dimorphic in terms of sex differences. Univariate discriminant function analyses using these measurements provided sex classification accuracy rates of 62.0–98.1%. The subpubic angle was found to contribute most significantly to accurate sex estimation. Multivariate discriminant functions yielded sex prediction accuracy rates of 63.9–98.1%. In conclusion, the pelvic measurements obtained from 3D CT images of a contemporary Japanese population successfully demonstrated sexual dimorphism and may be useful for the estimation of skeletal sex in the field of forensic anthropology.