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Distinction between salt water drowning and freshwater

drowning by assessment of the sinus fluid on post-mortem
computed tomography.
Poster No.:

C-0370

Congress:

ECR 2014

Type:

Scientific Exhibit

Authors:

Y. Kawasumi, A. Usui, Y. Hosokai, M. Sato, Y. Hayashizaki, H.
Saito, T. Ishibashi, M. Funayama; Sendai/JP

Keywords:

Forensics, Diagnostic procedure, CT, Forensic / Necropsy studies

DOI:

10.1594/ecr2014/C-0370

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Page 1 of 9

The interval between death and CT was less than 2 days in all cases. 18 males.75 s. and the reconstruction interval was 0. Typical CT images of drowning victims are shown in Figure 1. and matrix size was 512 × 512 pixels. the tube voltage was 120 kVp. freshwater drowning. we selected 22 cases of drowning in the sea: 10 females. and the helical beam pitch Page 2 of 9 . Each cause of death was diagnosed at autopsy. All cases were scanned in a body bag while fully clothed and no contrast material was administered.0 mm. In the present study. First. Tokyo. We excluded infant cases and pronounced decomposition cases.Aims and objectives The utility of post-mortem computed tomography (CT) has become widely recognized and is commonly used in forensic medicine [1.0 and 8. Toshiba Medical Systems. and matrix size was 512 ´ 512 pixels. The field of view was S-size. Furthermore. Japan) was used. The table speed was 14 mm per rotation. The rotation time was 1.5 (range 35-87) years. The rotation time was 0. The collimation was 4. The field of view was S-size. CT and autopsy An eight-channel multi-detector row CT (MDCT) scanner (Aquilion 8.2]. and the tube current was arbitrarily changed based on the installed mode. median age 67. e. Finally. and 26 cases of drowning in a river: 8 females. the tube voltage was 120 kVp and the tube current was changed arbitrarily based on the installed mode. median age 59. Methods and materials Study cases We retrospectively reviewed 641 cases that had undergone post-mortem CT and a forensic autopsy between May 2009 and January 2013 at our institution. the head was subject to conventional CT.5 (range 19-87) years. All drowning cases were diagnosed as wet drowning at autopsy and had fluid accumulation in either the maxillary or sphenoid sinuses. saltwater drowning vs. These results prompted the question as to whether fluid volume and density in the sinuses was different between drowning cases. 12 males. we previously demonstrated that the volume and density of fluid accumulation in the maxillary or sphenoid sinuses differed significantly between drowning and non-drowning cases [6]. CT was performed with two scans. Previous studies have reported that fluid accumulation in the maxillary or sphenoid sinuses is one of the most notable CT findings in drowning victims [3-5]. The second scan was from the head to the pelvis using the helical mode. The reconstruction filter was FC27. we analysed the sinus fluid volume and density of drowning victims and evaluated the difference between drowning in the sea and drowning in a river.g.5 s.

Tokyo. In all cases. Images for this section: Fig. The reconstructed slice thickness of the images was 2.was 0.0 mm. A forensic pathologist who had more than 30 years of experience performing forensic autopsies carried out all post-mortem examinations. a conventional autopsy was performed shortly after forensic CT. Page 3 of 9 . Statistical analysis Differences in volume and density between sea drowning and river drowning cases were evaluated using the Mann-Whitney U test. Regions of fluid in the maxillary and sphenoid sinuses on axial images were extracted manually for each slice.875. 1: A typical drowning case showing fluid accumulation in the maxillary and sphenoid sinuses (arrows). and the reconstruction interval was 0. Image assessment All CT images were sent to a three-dimensional DICOM workstation (ziostation2. The reconstruction filter was FC10. Ziosoft. Additionally. Japan). The workstation automatically built volume data from the extracted regions and calculated the volume and average density. receiver operating characteristic (ROC) analysis was performed to determine the cut-off value and evaluate diagnostic performance.

Results There was no significant difference in the age or the interval time between sea drowning and river drowning cases (p = 0. The median volume in sea drowning cases was 5. The fluid density in sea drowning cases was significantly higher than that in river drowning cases (p = 0.3385 and p = 0. and negative predictive value (NPV) 80. specificity 76. respectively).0%. with sensitivity 77.41-62.9%. positive predictive value (PPV) 73.3%.47 (7.9%.51) HU.8294.08-37. The median density was 46. There was no significant difference in volume between sea drowning and river drowning cases (p = 0.77 HU for the point closest to (0. Images for this section: Page 4 of 9 .98) HU and 27.05-19. respectively. ROC analysis determined the cut-off value as 33.62) mL. Figure 4 shows the ROC curve when diagnosing saltwater drowning. Figure 2 shows a Tukey boxplot of the volume distribution of fluid accumulation in the maxillary or sphenoid sinuses.795 (0.675 (range 0.26-75.0003). Figure 3 shows a Tukey boxplot of the density distribution of fluid accumulation.55) mL and that in river drowning cases was 4.1) and the Youden's index.89 (14.7879).

62) mL.05-19. There was Page 5 of 9 .55) mL and that in river drowning cases was 4. The median volume in sea drowning cases was 5.08-37. 2: Tukey boxplot of volume distribution of fluid accumulation in the maxillary or sphenoid sinuses.Fig.795 (0.675 (range 0.

Mann-Whitney U test).7879.no significant difference in volume between sea drowning and river drowning cases (p = 0. Page 6 of 9 .

0%. 4: The ROC curve when diagnosing saltwater drowning.77 HU for the point closest to (0.3%.Fig. 3: Tukey boxplot of density distribution of fluid accumulation in the maxillary or sphenoid sinuses. with sensitivity being 77.51) HU. Page 7 of 9 . Fig.1) and the Youden's index.41-62.89 (14. positive predictive value (PPV) 73. and negative predictive value (NPV) 80.26-75.47 (7. The density in sea drowning cases was significantly higher than that in river drowning cases (p = 0.98) HU and that in river drowning cases was 27.9%.9%. specificity 76. The median density in sea drowning cases was 46. Mann-Whitney U test). ROC analysis determined the cut-off value as being 33.0003.

and NPV as 80. Page 8 of 9 .. Tohoku University Graduate School of Medicine Course of Radiological Technology Clinical Imaging References 1. European Journal of Radiology 2012. Harcke HT. Drowning-post-mortem imaging findings by computed tomography.and threedimensional multidetector CT findings in drowning with autopsy comparison. Eur Radiol 2008. Sugai Y. Eur Radiol 2008. 6.26:1305-1333 Bolliger SA. Thali MJ. imaging-guided virtual autopsy.81:3953-3955 Kawasumi Y. Vock P. 3. 5. A review of the Virtopsy and similar projects.3%. ROC analysis determined the cut-off value as 33. Kawabata T. The observed difference may help forensic pathologists better diagnose the specific cause of death in drowning cases. Ph. 2. VIRTOPSY: Minimally invasive.77 HU. M.18:283-290 Levy AD. Personal information Yusuke KAWASUMI. European journal of radiology. Virtual autopsy using imaging: bridging radiologic and forensic sciences.9%.Conclusion The sinus fluid density in saltwater drowning cases was significantly higher than that in freshwater drowning cases. Radiology 2007.D.243(3):862-868 Kawasumi Y.D. RadioGraphics 2006.18:273-282 Christe A. Virtual Autopsy: Two. et al. Diagnosis of drowning using postmortem computed tomography based on the volume and density of fluid accumulation in the maxillary and sphenoid sinuses. et al. Getz JM et al.0%. et al. PPV as 73. Aghayev E. Dirnhofer R. sensitivity as 77. Fackowski C. 2013 Oct. et al. et al. Jackowski C. Sugai Y. PubMed PMID: 23891140. Kawabata T. specificity as 76.82(10):e562-6. Ross S. Assessment of the relationship between drowning and fluid accumulation in the paranasal sinuses on post-mortem computed tomography.9%. 4.

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