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Atlanto-axial rotatory subluxations in postmortem CT: radiologists be aware of a common pitfall
Linköping University, Center for Medical Image Science and Visualization, CMIV. Linköping University, Department of Medical and Health Sciences, Radiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Diagnostics, Department of Radiology in Linköping.ORCID iD: 0000-0002-9446-6981
Linköping University, Center for Medical Image Science and Visualization, CMIV. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Clinical and Experimental Medicine, Forensic Medicine. Linköping University, Faculty of Health Sciences.
University of Bern, Switzerland.
2013 (English)In: Forensic Science International, ISSN 0379-0738, E-ISSN 1872-6283, Vol. 225, no 1-3, 9-14 p.Article in journal (Refereed) Published
Abstract [en]

The aim of the present study was to determine the frequency of atlanto-axial rotatory subluxations (AARS) in multi detector computed tomography (MDCT) performed on human corpses for forensic purposes and to investigate whether these are a physiological postmortem finding or indicate a trauma to the neck region.

80 forensic cases examined with MDCT from November 2003 to March 2007 were included in the study. The study was approved by the regional ethics committee. For each case volumes were rendered and investigated with reference to suspected AARS and any other anomalies of the head and neck region. The rotation of the head as well as in the atlanto-axial joint were measured and occurring AARS were judged according Fielding's classification. The finding of AARS was correlated to case criteria such as postmortem head rotation, sex, age, cause of death, time since death and further autopsy results. Statistical analysis was performed using Fisher's exact test, Wilcoxon's rank sums test and Chi-square test with Pearson approximation.

70% (n = 56) of the cases included in the study presented with an AARS. A strong correlation (P < .0001) between suspected AARS and postmortem head rotation was found. Two cases presented with an atlanto-axial rotation greater than the head rotation. One showed an undiscovered lateral dislocation of the atlas, and one an unfused atlas-ring. There was no correlation to any further investigated case criteria. Ipsilateral AARS with head rotation alone does not indicate trauma to the neck.

PmCT can substantially support forensic examinations of the skeleton, especially in body regions, which are elaborate to access at autopsy, such as the cervical spine. Isolated AARS (Fielding type I) on pmCT is usually a normal finding associated with ipsilateral head rotation.

Place, publisher, year, edition, pages
Elsevier, 2013. Vol. 225, no 1-3, 9-14 p.
Keyword [en]
Computed tomography, Postmortem spine imaging, Atlanto-axial rotatory subluxations
National Category
Medical and Health Sciences
URN: urn:nbn:se:liu:diva-90221DOI: 10.1016/j.forsciint.2013.01.001ISI: 000314872500003OAI: diva2:612351

Funding Agencies|National Board of Forensic Medicine||

Available from: 2013-03-21 Created: 2013-03-21 Last updated: 2013-10-21

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Persson, Anders
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Center for Medical Image Science and Visualization, CMIVRadiologyFaculty of Health SciencesDepartment of Radiology in LinköpingForensic Medicine
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