Advances in Forensic Medical Diagnosis

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

Deadline for manuscript submissions: closed (30 April 2025) | Viewed by 6782

Special Issue Editors


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Guest Editor
San Francesco Hospital, Foggia, Italy
Interests: medical risk management; forensic sciences; forensic pathology; health and safety protection and accident prevention; occupational health medicine; clinical and forensic autopsy; crime scene investigation; histopathology; immunohistochemistry

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Guest Editor
Department of Medical, Surgical and Advanced Technologies “G.F. Ingrassia”, University of Catania, 95121 Catania, Italy
Interests: forensic sciences; clinical and forensic autopsy; crime scene investigation; post-mortem investigation; forensic pathology; histopathology; immunohistochemistry; medical risk management; ethics
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Special Issue Information

Dear Colleagues,

The volume of research in forensic medicine has increased, and new areas of forensic specialization have developed. Medical examiners have adapted to international advances, from innovative technologies to new or changed laws. Artificial intelligence (AI) is being introduced into forensic and toxicological diagnoses. AI is used in various forensic procedures, including toxin analysis, organ sampling, detecting pathological changes in different body organs, determining the weapon used in a crime, and calculating the time of death. The recognition of the type of injuries, interpretation of injuries, and documentation of witnesses and injuries (including photography) are areas where computerization is helping health professionals with forensic issues related to child abuse, sexual assault, or unexpected infant death. Scientific innovations are also widely used to solve the ancient and ever-present problem of estimating the time of death (post-mortem interval (PMI)); innovations in molecular biology, such as the use of mRNAs, has been useful in this regard. Researchers have used advanced biomedical technologies in forensic diagnosis, including histological, molecular, chemical, radiological, 3D imaging, and bioengineering applications.

This Special Issue aims to collect reports that will aid forensic diagnosis in the following areas:

  • Pathology;
  • Radiology;
  • Anthropology;
  • Toxicology;
  • Genetics.

Dr. Francesca Maglietta
Dr. Monica Salerno
Guest Editors

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Published Papers (5 papers)

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Research

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11 pages, 2544 KiB  
Article
Application of Digital Analysis for Assessment of Coronary Sub-Occlusions in Autopsy Pathology: It Is Time to Move beyond Histology Alone
by Giuseppe D’Abbronzo, Renato Franco, Cecilia Salzillo, Carlo Pietro Campobasso, Maurizio Municinò, Alessandro Feola and Andrea Ronchi
Diagnostics 2024, 14(19), 2115; https://doi.org/10.3390/diagnostics14192115 - 24 Sep 2024
Viewed by 933
Abstract
Background: Coronary artery disease (CAD) underlies most cases of myocardial infarction (MI), causing or at least contributing to oxygen supply–demand mismatch and myocardial injury, so a careful and reliable evaluation of the main coronary arteries and large branches is a key moment of [...] Read more.
Background: Coronary artery disease (CAD) underlies most cases of myocardial infarction (MI), causing or at least contributing to oxygen supply–demand mismatch and myocardial injury, so a careful and reliable evaluation of the main coronary arteries and large branches is a key moment of autopsy in order to establish the cause of death. The aim of this study is to evaluate the application of digital image analysis in the assessment of coronary artery sub-occlusions. Methods: A total of 50 coronary sections sampled during 11 consecutive autopsies, regardless of the cause of death, were analyzed. The ideal lumen and the percentage of the residual lumen were evaluated by digital pathology using QuPath v 4.3 and by an expert pathologist. The evaluations performed were compared using Lin’s concordance correlation coefficient. Results: The Lin agreement index between the two evaluation methods for all measurements showed an excellent agreement rate [0.923, with confidence interval (0.866, 0.956)]. However, in the case of critical stenosis, from 60% to 80% and from 65% to 75%, the Lin agreement index between the two evaluation methods was, respectively, 0.798 [0.603, 0.904], corresponding to good agreement, and 0.516 [0.071, 0.725], corresponding to slight agreement. The digital system has superior performance in cases where lumen occlusion falls between 60% and 80% and provides an objective assessment of the residual lumen area. Conclusions: According to the widespread availability and ease of use of these technologies, we suggest that image analysis should be considered a routine tool and established as the diagnostic gold standard in this field. Full article
(This article belongs to the Special Issue Advances in Forensic Medical Diagnosis)
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13 pages, 2410 KiB  
Article
Age Estimation through Hounsfield Unit Analysis of Pelvic Bone in the Romanian Population
by Emanuela Stan, Alexandra Enache, Camelia-Oana Muresan, Veronica Ciocan, Stefania Ungureanu, Alexandru Catalin Motofelea, Adrian Voicu and Dan Costachescu
Diagnostics 2024, 14(18), 2103; https://doi.org/10.3390/diagnostics14182103 - 23 Sep 2024
Viewed by 781
Abstract
Background: Bone density is affected by age- and sex-related changes in the os coxae, often known as the pelvic bone. Recent developments in computed tomography (CT) imaging have created new opportunities for quantitative analysis, notably regarding Hounsfield Units (HU). Objectives: The [...] Read more.
Background: Bone density is affected by age- and sex-related changes in the os coxae, often known as the pelvic bone. Recent developments in computed tomography (CT) imaging have created new opportunities for quantitative analysis, notably regarding Hounsfield Units (HU). Objectives: The study aims to investigate the possibility of using HU obtained from os coxae CT scans to estimate age in the Romanian population. Methods: A statistical analysis was conducted on a sample of 80 pelvic CT scans in order to find any significant correlation between age, sex, and variation in density among the different pelvic bone locations of interest. According to the research, pelvic radiodensity measurements varied significantly between male and female participants, with men having greater levels. This technique may be valuable for determining an individual’s sex precisely, as evidenced by the substantial association found between HU levels and changes in bone density associated with sex. Results: The analysis of variance underscores that HU values exhibit a significant negative relationship with radiodensity, with a general trend of decreasing HU with increasing age. The equation derived from the ordinary least squares OLS regression analysis can be used to estimate the age of individuals in the Romanian population based on their HU values at specific pelvic sites. Conclusions: In conclusion, the application of HU analysis in CT imaging of the coxae represents a non-invasive and potentially reliable method for age and sex estimation, and a promising avenue in the field of human identification. Full article
(This article belongs to the Special Issue Advances in Forensic Medical Diagnosis)
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Review

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18 pages, 9445 KiB  
Review
The Role of Autopsy in Diagnosing Fatal Chest Injuries in Road Traffic Accidents: A Literature Review
by Matteo Antonio Sacco, Maria Cristina Verrina, Saverio Gualtieri, Agostinho Santos, Bárbara Ferreira Mendes, Alessandro Pasquale Tarallo, Aurora Princi, Stefano Lombardo, Pietrantonio Ricci and Isabella Aquila
Diagnostics 2025, 15(6), 778; https://doi.org/10.3390/diagnostics15060778 - 19 Mar 2025
Viewed by 443
Abstract
Road accidents are one of the leading causes of death worldwide, with significant repercussions on public health and the global economy. Fatal accidents can cause injuries in various anatomical areas with different dynamics. The thorax is one of the main sites involved in [...] Read more.
Road accidents are one of the leading causes of death worldwide, with significant repercussions on public health and the global economy. Fatal accidents can cause injuries in various anatomical areas with different dynamics. The thorax is one of the main sites involved in fatal accidents, due to the presence of vital organs such as the heart and lungs. Protective devices, such as seatbelts and airbags, also play a fundamental role in preventing chest injuries. However, external examination is often insufficient to determine the extent of internal trauma, resulting in significant difficulties in reconstructing the accident dynamics. In particular, in the absence of an autopsy, it is difficult to determine whether the driver or passengers were wearing protective devices, such as seatbelts, at the time of the accident. Diagnosing injuries secondary to protective devices, such as airbags, can also be complex without this assessment. Through a review of the literature, this work analyzes the different types of thoracic trauma that can be found at autopsy, providing indications to the forensic pathologist for the examination of these injuries. This review highlights the importance of the autopsy examination as a gold-standard investigation in the analysis of thoracic trauma from road accidents, in order to evaluate with certainty the injuries that caused death, and to facilitate the reconstruction of the dynamics for judicial purposes. Finally, an analysis of postmortem radiological investigations and of the role of protective measures in these events, such as the seatbelt and airbag, is provided. Full article
(This article belongs to the Special Issue Advances in Forensic Medical Diagnosis)
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15 pages, 12251 KiB  
Review
The Role of Autopsy in the Forensic and Clinical Evaluation of Head Trauma and Traumatic Brain Injury in Road Traffic Accidents: A Review of the Literature
by Matteo Antonio Sacco, Maria Cristina Verrina, Roberto Raffaele, Saverio Gualtieri, Alessandro Pasquale Tarallo, Santo Gratteri and Isabella Aquila
Diagnostics 2025, 15(4), 442; https://doi.org/10.3390/diagnostics15040442 - 12 Feb 2025
Viewed by 1292
Abstract
Road traffic accidents (RTAs) are a leading cause of morbidity and mortality worldwide, frequently resulting in traumatic brain injuries (TBIs), skull fractures, and spinal injuries. This manuscript examines the forensic aspects of head trauma caused by RTAs, focusing on the role of autopsy [...] Read more.
Road traffic accidents (RTAs) are a leading cause of morbidity and mortality worldwide, frequently resulting in traumatic brain injuries (TBIs), skull fractures, and spinal injuries. This manuscript examines the forensic aspects of head trauma caused by RTAs, focusing on the role of autopsy and imaging in diagnosing and characterizing injuries. Through a systematic review of the literature, the study highlights the mechanisms of injury, including high-speed collisions, whiplash, and pedestrian impacts, and explores their pathological consequences, such as subarachnoid hemorrhage, intracranial hemorrhage, and diffuse axonal injury. The differentiation between traumatic and non-traumatic conditions, such as aneurysmal subarachnoid hemorrhage, is emphasized to ensure accurate clinical and forensic assessments. Advances in imaging technologies, particularly virtopsy, are discussed for their potential in non-invasive documentation and analysis of head injuries, while limitations of this approach are acknowledged. Furthermore, the manuscript underscores the importance of preventive measures, including helmet and seatbelt use, vehicle safety innovations, and improved road design, in reducing the incidence and severity of RTAs. By integrating clinical, forensic, and preventive perspectives, this study provides a comprehensive framework for understanding and addressing the burden of head trauma related to RTAs. Full article
(This article belongs to the Special Issue Advances in Forensic Medical Diagnosis)
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16 pages, 716 KiB  
Review
Forensic Diatom Analysis: Where Do We Stand and What Are the Latest Diagnostic Advances?
by Stefano Tambuzzi, Guendalina Gentile and Riccardo Zoia
Diagnostics 2024, 14(20), 2302; https://doi.org/10.3390/diagnostics14202302 - 16 Oct 2024
Cited by 1 | Viewed by 2435
Abstract
Background: diatoms are unicellular algae that have been used for more than a century for forensic purposes to diagnose drowning, with more or less success depending on the historical era. Although many years have passed, scientific research on diatoms has never ceased, which [...] Read more.
Background: diatoms are unicellular algae that have been used for more than a century for forensic purposes to diagnose drowning, with more or less success depending on the historical era. Although many years have passed, scientific research on diatoms has never ceased, which testifies to their enduring allure in forensics. Of course, diatom research has evolved and expanded over time, changing with the availability of new techniques and technologies. The volume of articles and their production over a period of many years has resulted in old, current, and new knowledge on diatoms being scattered over a large number of books and articles. Objectives: the purpose of this narrative literature review is, therefore, to summarize all this information and bring it together in a single work that can be useful for those who are studying diatoms and their usefulness for forensics for the first time, for those who are looking for proven methods of analysis, and finally for those who are interested in exploring new frontiers of research. Methods: a comprehensive literature search that included all studies dealing with the applications of diatoms in forensic science was performed in the most popular electronic databases. Results: traditional methods have been complemented by molecular and imaging methods and, more recently, by artificial intelligence. In addition, new biological substrates have been found for the analysis of diatoms. Conclusions: all this has led, on the one hand, to the consolidation of a whole body of knowledge on diatoms, on which this forensic analysis is still based, and, on the other hand, has opened up numerous new research directions. Full article
(This article belongs to the Special Issue Advances in Forensic Medical Diagnosis)
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