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Diagnostics
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Advances in Pathology for Forensic Diagnosis
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Advances in Pathology for Forensic Diagnosis

A special issue of Diagnostics (ISSN 2075-4418). This special issue belongs to the section "Pathology and Molecular Diagnostics".

Deadline for manuscript submissions: 28 February 2026 | Viewed by 1698

Special Issue Editors

Dr. Cristina Mondello

E-Mail Website
Guest Editor
Legal Medicine Section, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Via Consolare Valeria, 1, 98125 Messina, Italy
Interests: forensic pathology; forensic immunohistochemistry; forensic microbiology; legal medicine; sudden cardiac death; medical liability
Special Issues, Collections and Topics in MDPI journals
Dr. Vincenzo Cianci

E-Mail Website
Guest Editor Assistant
Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Section of Legal Medicine, University of Messina, via Consolare Valeria, 1, 98125 Messina, Italy
Interests: Forensic science, forensic genetics, forensic pathology

Special Issue Information

Dear Colleagues, 

We are pleased to introduce you a Special Issue entitled “Advances in Pathology for Forensic Diagnosis”, which aims to collect high-quality papers that reflect the advances of the diagnostic tools used in both forensic pathology and clinical forensic medicine.

Notably, in forensic practice, histopathology, immunohistochemistry, toxicology, forensic radiology, molecular biology, and forensic entomology have become routinary and essential tools in supporting the postmortem diagnostic processes and are considered particularly valuable when dealing with complex cases, such as those involving decomposed remains, sudden deaths or traumatic events.

At the same time, in clinical forensic medicine, genetic and toxicological analyses undoubtedly represent an important tool for reaching a more accurate diagnosis, especially in cases of physical or sexual violence, where for instance the identification of the genetic profile represents decisive evidence. Similarly, radiological and odonatological tests are of great value in the field of age estimation and personal identification, especially in humanitarian or migratory contexts.

Increasing attention is now also paid to molecular autopsy and -omics sciences, such as genomics, proteomics, and metabolomics, which are proposed as emerging and promising tools in several areas, such as postmortem interval estimation. All these aspects highlight the importance of an integrated multidisciplinary approach, in which forensic pathologists closely collaborate with experts from other fields, such as radiology, genetics, anthropology and forensic odontology.

This Special Issue welcomes all contributions exploring innovative diagnostic methods in the forensic field, such as original research, case reports, case series, reviews and short communications, with the aim of enhancing the continuous evolution of diagnostics in forensic medicine and promoting an increasingly up to date scientific debate.

Dr. Cristina Mondello
Guest Editor

Dr. Vincenzo Cianci
Guest Editor Assistant

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Diagnostics is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • forensic pathology
  • forensic medicine
  • forensic radiology
  • forensic genetics
  • forensic toxicology
  • postmortem interval
  • forensic odontology
  • forensic entomology
  • forensic anthropology

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Further information on MDPI's Special Issue policies can be found here.

Published Papers (3 papers)

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12 pages, 1014 KB  
Article
A Diagnostic Algorithm for Reconstructing the Direction of Gunshots Using OsiriX and Maya in Living Patients: A Forensic Radiology Approach
by Ginevra Malta, Stefania Zerbo, Tommaso D’Anna, Simona Pellerito, Antonina Argo, Mauro Midiri, Giuseppe Lo Re, Francesca Licitra and Angelo Montana
Diagnostics 2026, 16(2), 344; https://doi.org/10.3390/diagnostics16020344 - 21 Jan 2026
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Abstract
Background/Objectives: Gunshot wounds in living patients present significant challenges from both a clinical and a forensic perspective. Understanding the exact trajectory of a bullet is crucial not only for guiding treatment but also for providing reliable documentation in legal settings. This work introduces [...] Read more.
Background/Objectives: Gunshot wounds in living patients present significant challenges from both a clinical and a forensic perspective. Understanding the exact trajectory of a bullet is crucial not only for guiding treatment but also for providing reliable documentation in legal settings. This work introduces a practical diagnostic workflow that combines OsiriX (V. 14.1.1), a DICOM viewer with advanced 3D tools, with Autodesk Maya, a modeling platform used to recreate the external shooting scene. Methods: CT scans obtained with multidetector systems were analyzed in OsiriX using a structured, seven-step process that included multiplanar reconstructions, 3D renderings, and region-of-interest tracking. The reconstructed trajectories were then exported to Maya, where they were integrated into a virtual model of the shooting scene to correlate internal findings with the incident’s external dynamics. Results: The workflow allowed precise identification of entry and exit points, reliable reconstruction of bullet paths, and effective 3D visualization. While OsiriX provided detailed information for clinical and radiological purposes, the use of Maya enabled simulation of the external scene, improving forensic interpretation and courtroom presentation. The procedure proved reproducible across cases and compatible with emergency timelines. Conclusions: The combined use of OsiriX and Maya offers a reproducible and informative method for analyzing gunshot wounds in living patients. This approach not only supports surgical and diagnostic decisions but also enhances the forensic value of radiological data by linking internal trajectories to external shooting dynamics. Its integration into trauma imaging protocols and forensic workflows could represent a significant step toward standardized ballistic documentation. Full article
(This article belongs to the Special Issue Advances in Pathology for Forensic Diagnosis)
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15 pages, 557 KB  
Article
AI-Assisted Diagnostic Evaluation of IHC in Forensic Pathology: A Comparative Study with Human Scoring
by Francesco Sessa, Mara Ragusa, Massimiliano Esposito, Mario Chisari, Cristoforo Pomara and Monica Salerno
Diagnostics 2026, 16(1), 6; https://doi.org/10.3390/diagnostics16010006 - 19 Dec 2025
Viewed by 471
Abstract
Background/Objectives: Immunohistochemistry (IHC) is a critical diagnostic tool in forensic pathology, enabling molecular-level assessment of wound vitality, post-mortem interval, and cause of death. However, IHC interpretation is subject to variability due to its reliance on human expertise. This study investigates whether artificial [...] Read more.
Background/Objectives: Immunohistochemistry (IHC) is a critical diagnostic tool in forensic pathology, enabling molecular-level assessment of wound vitality, post-mortem interval, and cause of death. However, IHC interpretation is subject to variability due to its reliance on human expertise. This study investigates whether artificial intelligence (AI), specifically a generative model, can assist in the diagnostic evaluation of IHC slides and replicate expert-level scoring, thereby improving consistency and reproducibility. Methods: A total of 225 high-resolution IHC images were classified into five immunoreactivity categories. The AI model (ChatGPT-4V) was trained on 150 labeled images and tested blindly on 75 unseen slides. Performance was assessed using confusion matrices, per-class precision/recall/F1, overall accuracy, Cohen’s κ (unweighted and weighted), and binary metrics (sensitivity, specificity, MCC). Results: Overall accuracy was 81.3% (95% CI: 71.1–88.5%), with substantial agreement (κ = 0.767 unweighted; 0.805 linear-weighted; 0.848 quadratic-weighted). Binary classification achieved a sensitivity of 98.3%, specificity of 93.3%, MCC of 0.92. Accuracy was highest in extreme categories (− and +++, 93.3%), while intermediate classes (+ and ++) showed reduced performance (error rates up to 33%). Evaluation was rapid and consistent but lacked interpretative reasoning and struggled with borderline cases. Conclusions: AI-assisted diagnostic evaluation of IHC slides demonstrates promising accuracy and consistency, particularly in well-defined staining patterns. While not a replacement for human expertise, AI can serve as a valuable adjunct in forensic pathology, supporting rapid and standardized assessments. Ethical and legal considerations must guide its implementation in medico-legal contexts. Full article
(This article belongs to the Special Issue Advances in Pathology for Forensic Diagnosis)
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20 pages, 856 KB  
Systematic Review
Postmortem Diagnosis of Dilated Cardiomyopathy: A Systematic Review Revisiting Fundamentals
by Simona Calabrese, Vincenzo Cianci, Daniela Sapienza, Alessandro Nicolosi, Beatrice Spadaro, Antonio Ieni, Desirèe Speranza, Patrizia Gualniera, Alessio Asmundo and Cristina Mondello
Diagnostics 2025, 15(23), 3063; https://doi.org/10.3390/diagnostics15233063 - 1 Dec 2025
Viewed by 872
Abstract
Background: Dilated cardiomyopathy (DCM) is a myocardial disorder characterized by structural and functional abnormalities, in particular left or biventricular chamber dilatation and systolic dysfunction, occurring without evidence of coronary artery disease, hypertension, valvular disease, or congenital heart defects. It is a significant cause [...] Read more.
Background: Dilated cardiomyopathy (DCM) is a myocardial disorder characterized by structural and functional abnormalities, in particular left or biventricular chamber dilatation and systolic dysfunction, occurring without evidence of coronary artery disease, hypertension, valvular disease, or congenital heart defects. It is a significant cause of sudden cardiac death, particularly in young individuals, often remaining undiagnosed until autopsy. Methods: A systematic review of the literature was conducted following PRISMA guidelines to revisit the main postmortem findings (gross, microscopic, and genetic) useful to perform the postmortem diagnosis of DCM. Scientific databases (PubMed and Scopus) were searched for articles published up to February 2025 describing postmortem findings in individuals diagnosed with DCM. Inclusion criteria were focused on studies reporting macroscopic cardiac findings, and microscopic and genetic variants identified postmortem or in related familial studies. Data were extracted and categorized to identify consistent diagnostic markers and to assess the frequency and relevance of genetic findings in autopsy-confirmed DCM cases. From 2081 initial records, 30 studies met inclusion criteria. Two reviewers independently performed study selection and data extraction, and methodological limitations of the included studies were considered qualitatively to inform the synthesis. Results: Common macroscopic features included increased heart weight (often > 350 g), dilated left or biventricular chambers, and thinning of the ventricular walls. Histologically, the most consistent findings were diffuse interstitial fibrosis, myocyte hypertrophy, and nuclear atypia. Particular attention was given to morphological features essential to distinguish between genetic and nongenetic forms of DCM and, thus, useful to perform a differential diagnosis with disease having a DCM-like pattern. Notably, truncating variants in genes such as TTN, FLNC, DSP, PKP2, and MYH7 were frequently reported, particularly in young decedents with no significant history of cardiac disease. However, only about half of reviewed studies included any form of genetic analysis, reflecting a significant gap in current practice for forensic pathologists. Conclusions: DCM may cause sudden death without prior symptoms, making genetic testing essential to uncover the diagnosis, especially in cases with a negative phenotype. Therefore, molecular autopsy combined with careful macroscopic and microscopic analysis can strengthen the forensic assessment. Full article
(This article belongs to the Special Issue Advances in Pathology for Forensic Diagnosis)
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