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Virtual Autopsy: Preliminary Experience in High-Velocity Gunshot Wound Victims¹

¹ From the Department of Radiologic Pathology, Armed Forces Institute of Pathology, Alaska and Fern Streets NW, Washington, DC 20306-6000 (A.D.L., R.M.A., H.T.H.); Office of the Armed Forces Medical Examiner, Armed Forces Institute of Pathology, Rockville, Md (C.T.M., J.M.G., L.P.); Department of Radiology, University of Maryland School of Medicine, Baltimore, Md (R.M.A.); Departments of Radiology and Nuclear Medicine (A.D.L., R.M.A., H.T.H.) and Surgery and Military and Emergency Medicine (H.R.C.), Uniformed Services University of the Health Sciences, Bethesda, Md. Received June 13, 2005; revision requested August 2; revision received August 3; accepted September 6; final version accepted October 4. Supported by a grant from the Defense Advanced Research Projects Agency. Address correspondence to A.D.L. (e-mail: levya{at}afip.osd.mil).

Purpose: To retrospectively assess virtual autopsy performed with multidetector computed tomography (CT) for the forensic evaluation of gunshot wound victims.

Materials and Methods: The institutional review board approved this HIPAA-compliant study and did not require informed consent of the next of kin. Thirteen consecutive male gunshot wound victims (mean age, 27 years) were scanned with 16-section multidetector CT prior to routine autopsy. Retrospectively, the total-body nonenhanced scans were interpreted at a three-dimensional workstation by radiologists blinded to autopsy findings. Images were evaluated for lethal wound, number and location of wound tracks, injured structures, and metal fragment location. After image review, autopsy reports and photographs were compared with the images and interpretations to validate the multidetector CT determinations.

Results: Multidetector CT aided in correct identification of all lethal wounds, and metallic fragment location was always precise. In four cases, multidetector CT aided in accurate assessment of organ injuries and lethal wounds but led to underestimation of the number of wounds if comingling paths occurred. In two cases of a chest wound, multidetector CT aided in accurate assessment of the chest as having the lethal wound but failed to help identify specific sites of hemorrhage. In two cases of craniofacial injury, the path of the wound was not clear. Autopsy revealed a total of 78 wound tracks (mean, 6; range, 1–24). Ten (13%) wound tracks were not identified at multidetector CT (six upper extremity wounds and four thigh wounds). In two cases, findings missed at autopsy (fracture of the cervical spine, bullet fragments in the posterior area of the neck) were identified at multidetector CT.

Conclusion: Multidetector CT can aid prediction of lethal wounds and location of metallic fragments.

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