Journal
INTERNATIONAL JOURNAL OF LEGAL MEDICINE
Volume 135, Issue 5, Pages 1903-1912Publisher
SPRINGER
DOI: 10.1007/s00414-021-02593-0
Keywords
Cardiothoracic ratio; Three-dimensional (3D); Cause of death; Segmentation; Postmortem computed tomography; Virtopsy
Categories
Funding
- Universitat Zurich
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The aim of this study was to measure the mediastinal-thoracic volume ratio (CTR_VOL) on PMCT to assess the relationship between the heart and lungs in different causes of death. The results showed significant differences among various cause of death categories, with CTR_VOL positively associated with age and BMI, but not gender.
Objectives The aim of this study was to measure the mediastinal-thoracic volume ratio (CTR_VOL) on PMCT as a more accurate version of traditional CTR, in order to assess the terminal positional relationship between the heart and lungs in the different causes of death with regard to age, gender, BMI, cardiomegaly, and lung expansion. Materials Two hundred fifty consecutive postmortem cases with pre-autopsy PMCT and full forensic autopsy were retrospectively evaluated. The lungs and the mediastinum were manually segmented on the PMCT data and the correspondent volumes were estimated in situ. CTR_VOL was calculated as the ratio of the mediastinal to the thoracic volume. The volume measurements were repeated by the same rater for the evaluation of the intrarater reliability. Age, gender, body weight and height, heart weight at autopsy, and cause of death were retrieved from the autopsy reports. Presence of lung expansion was radiologically evaluated in situ. Results CTR_VOL was positively associated with age and BMI but not with gender and was higher for cardiomegaly compared to normal hearts, lower for asphyxiation-related deaths compared to cardiac deaths and intoxications, and lower for cases with lung expansion. The intrarater reliability was excellent for the calculated volumes of both lungs and mediastinum. Conclusion The results of the present study support CTR_VOL as a tool to assess the relationship between the heart and lungs in situ, which differs significantly between the studied cause of death categories.
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