Search Results (32)

Background/Objectives: Vertebral degenerative features are promising but often subjectively scored indicators for adult age estimation. We evaluated an objective surface roughness metric, the “average distance to the fitted ellipse” score (DS), calculated automatically for every vertebra from C7 to S1 on routine CT images. Methods: CT scans of 176 adults (94 males, 82 females; 21–94 years) were retrospectively analyzed. For each vertebra, the mean orthogonal deviation of the anterior superior endplate from an ideal ellipse was extracted. Sex-specific multiple linear regression served as a baseline; support vector regression (SVR), random forest (RF), k-nearest neighbors (k-NN), and Gaussian naïve-Bayes pseudo-regressor (GNB-R) were tuned with 10-fold cross-validation and evaluated on a 20% hold-out set. Performance was quantified with the standard error of the estimate (SEE). Results: DS values correlated moderately to strongly with age (peak r = 0.60 at L3–L5). Linear regression explained 40% (males) and 47% (females) of age variance (SEE ≈ 11–12 years). Non-parametric learners improved precision: RF achieved an SEE of 8.49 years in males (R² = 0.47), whereas k-NN attained 10.8 years (R² = 0.45) in women. Conclusions: Automated analysis of vertebral cortical roughness provides a transparent, observer-independent means of estimating adult age with accuracy approaching that of more complex deep learning pipelines. Streamlining image preparation and validating the approach across diverse populations are the next steps toward forensic adoption. Full article

Deep learning has brought substantial progress to medical imaging, which has resulted in continuous improvements in diagnostic procedures. Through deep learning architecture implementations, radiology professionals achieve automated pathological condition detection, segmentation, and classification with improved accuracy. The research tackles a rarely studied clinical medical imaging issue that involves bullet identification and positioning within X-ray images. The purpose is to construct a sturdy deep learning system that will identify and classify ballistic trauma in images. Our research examined various deep learning models that functioned either as classifiers or as object detectors to develop effective solutions for ballistic trauma detection in X-ray images. Research data was developed by replicating controlled bullet damage in chest X-rays while expanding to a wider range of anatomical areas that include the legs, abdomen, and head. Special deep learning algorithms went through a process of optimization before researchers improved their ability to detect and place objects. Multiple computational systems were used to verify the results, which showcased the effectiveness of the proposed solution. This research provides new perspectives on understanding forensic radiology trauma assessment by developing the first deep learning system that detects and classifies gun-related radiographic injuries automatically. The first system for forensic radiology designed with automated deep learning to classify gunshot wounds in radiographs is introduced by this research. This approach offers new ways to look at trauma which is helpful for work in clinics as well as in law enforcement. Full article

The zygomatic major and zygomatic minor muscles play a central role in facial expression, particularly in generating the smile, one of the most essential forms of human nonverbal communication. While their function is widely recognized, the anatomical variability in these muscles remains underexplored in both clinical and surgical settings. This review provides a comprehensive, interdisciplinary analysis of the zygomaticus musculature, integrating classical anatomical insights with recent advances in imaging, developmental biology, and artificial intelligence-based analysis. By examining data from cadaveric dissection, MRI, ultrasonography, and 3D photogrammetry, we identify key morphological differences with potential clinical relevance. A novel five-type morphological classification is proposed, based on differences in the number of muscle bellies (i.e., belly number), accessory structures, insertion patterns, and population-based variation. This classification aims to offer a more functionally relevant and clinically applicable framework for use in facial surgery, aesthetic procedures, and forensic reconstruction. By moving beyond the simplistic binary categorizations that have historically defined zygomaticus morphology, this review highlights the need for a personalized approach to facial anatomy, tailored to individual morphological variation. The proposed framework may assist in refining surgical planning, improving outcomes in facial reanimation, and enhancing diagnostic accuracy in both radiological assessment and preoperative planning. By moving beyond traditional binary categorizations, this review highlights the need for a personalized approach to facial anatomy, tailored to individual morphological variations. The proposed framework may assist in refining surgical planning, improving outcomes in facial reanimation, and advancing diagnostic precision in facial imaging. A total of 75 peer-reviewed articles were selected based on a targeted search in PubMed, Scopus, and Web of Science (1995–2024). Full article

The decision to remove a bullet from a gunshot victim depends on its location and associated medical risks, with surgical extraction often not indicated. Radiological imaging plays a vital role in assessing gunshot wounds and locating bullets, and it is essential in both clinical and forensic contexts. This narrative review examines the use of computed tomography (CT) for virtual bullet analysis, providing insights into shape, design, fragmentation, and material composition. Traditional 2D X-ray imaging, though commonly used, has limitations in accurately assessing caliber and position due to magnification and its 2D nature. In contrast, CT scans generate 3D reconstructions for detailed and precise examination, overcoming challenges such as metal artifacts with techniques such as extended Hounsfield unit (HU) reconstructions. These methods enhance the visualization of metal objects, allowing for better analyses of lodged bullets. Dual-energy CT further differentiates materials, such as lead and copper, using HU value differences at two energy levels. These advancements enable the virtual classification, shape analysis, and material identification of bullets in forensic investigations, even when the bullet remains in the body. As CT technology progresses, its forensic applications are expected to improve, providing more accurate and comprehensive differentiations of bullet types in future cases. Full article

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

Background: Cause of death analysis is fundamental to forensic pathology. We present the case of a 9½-year-old girl with a genetically confirmed diagnosis of Dravet syndrome who died in her sleep with no evidence of motor seizure. She also had a lifelong history of recurrent pneumonias and, along with her family, had tested positive for COVID-19 10 days before death. Methods: Long-term clinical history of Dravet Syndrome and respiratory infections were obtained from patient’s medical charts and radiology reports. A Rapid-Antigen Test was used to confirm SARS-CoV2 infection days prior to death. At autopsy, brain, heart and lung tissues were obtained. Paraffin-embedded tissues were double-stained with H&E, and immunohistochemically stained using various antibodies. Results: Autopsy revealed evidence of previous seizure activity in the brain and cellular interstitial thickening in the lung. The brain showed edema and fibrillary gliosis without neuronal loss in neocortex and hippocampus. The lung showed inflammatory interstitial thickening with histiocytes, megakaryocytes, B-lymphocytes, and T-lymphocytes, including helper/suppressor cells and cytotoxic T-lymphocytes. Diffuse alveolar damage was observed as alveolar flooding with proteinaceous fluid. Conclusions: The cause of death may be attributed to Sudden Unexpected Death in Epilepsy (SUDEP) in Dravet syndrome, sudden death in viral pneumonia, or some combination of the two. When two independent risk factors for sudden unexpected death are identified due to co-pathology, it may not be possible to determine a single cause of death beyond a reasonable doubt. Full article

Background: Firearm wounds tend to have a precise pattern. Despite this, real-world case presentations can present uncertain elements, sometimes deviating from what is considered standard, and present uncommon features that are difficult for forensic pathologists and ballistic experts to explain. Methods: A retrospective analysis of autopsy reports from the Institute of Legal Medicine, University of Catania, covering 2019–2023, included 348 judicial inspections and 378 autopsies performed as part of the institute’s overall activities. Among these, seventeen cases of firearm deaths were identified, with three atypical cases selected for detailed analysis. An interdisciplinary approach involving forensic pathology, radiology, and ballistics was used. Results: The selected cases included: (1) A 56-year-old female with a thoracic gunshot wound involving three 7.65 caliber bullets, displaying complex trajectories and retained bullets; (2) A 48-year-old male with two cranial gunshot injuries, where initial evaluation suggested homicide staged as a suicide, later confirmed to be a single self-inflicted shot; and (3) A 51-year-old male was found in a car with two gunshot wounds to the head, involving complex forensic evaluation to distinguish between entrance and exit wounds and determine trajectory. The findings showed significant deviations from standard patterns, underscoring the critical role of radiological imaging and ballistic analysis in understanding wound morphology and projectile trajectories. Conclusions: This case series highlights the necessity for standardized yet adaptable protocols and cooperation among forensic specialists. A flexible approach allows forensic investigations to be tailored to the specific circumstances of each case, ensuring that essential examinations are conducted while unnecessary procedures are avoided. Comprehensive data collection from autopsies, gross organ examinations, and, when needed, radiological and histological analysis is essential to accurately diagnose injuries, trace bullet trajectories, retrieve retained projectiles, and determine the fatal wound, particularly in complex cases or those involving multiple shooters. Full article

(1) Background: Femicide is an increasing phenomenon consisting of the murder of a woman for gender-related reasons. Despite the enactment of new laws aimed at controlling the phenomenon by toughening the penalties and introducing aggravating circumstances, there is an increasing trend that testifies to the persistence of a flaw in the actual measures. (2) Case Presentation. We report the case of the murder of a 32-year-old woman—perpetrated by an ex-husband who refused to accept the end of the marriage—the analysis of which allowed us to frame the case as femicide. (3) Discussion. Despite global awareness of this phenomenon, the identification of risk factors to predict and prevent femicide is of utmost importance. This can be achieved by a multidisciplinary approach involving police officers, legal professionals, hospitals, governmental and nongovernmental organizations, and medico-legal departments aimed at promoting standardized methodologies. (4) Conclusions. We evaluate the contribution of forensic investigations to the identification of key elements that can help frame the murder of a woman as a femicide. Considering the devastating consequences for children who witness this kind of violence within the domestic setting, the planning of more impactful preventive actions is, thus, mandatory to minimize effects on public health. Full article

Fire deaths present several diagnostic challenges for the forensic examiner, the most significant of which is the identification of the cause of death and the evaluation of the morphological consequences of heat injuries in the ante-mortem and post-mortem periods. Here, we describe the case of two young lovers found dead inside a travelling carousel destroyed by a fire. Circumstantial evidence of disputes between families running the town fair raised the suspicion of intentional arson. Comparative analysis of crime scene investigation, radiological, autoptic, histological, and toxicological findings revealed signs of vitality (i.e., presence of soot deposits inside the respiratory and digestive tracts, heat damage to the respiratory mucosa) and identified fatal asphyxia from haemorrhagic pulmonary oedema as the cause of death. Since the experimental burning of plastic samples collected from a similar carousel demonstrated the significant production of phosgene, the death of the two lovers was attributed to the probable inhalation of this gas. The case presented here underlines the importance of a multidisciplinary approach of any fire-related death, providing an insight into circumstantial and forensic (autopsy, toxicological, and immunohistopathological) elements useful in raising suspicion of possible toxic gas inhalation. In the presence of high levels of PVC materials at the fire scene and pulmonary oedema at the autopsy, with no alternative causes of death, the forensic pathologist must suspect a fatal exposure to phosgene. Full article

Reconstructing the face from the skull is important not only for forensic identification but also as a tool that can provide insight into the appearance of individuals from past populations. It requires a multidisciplinary approach that combines anthropological knowledge, advanced imaging methods, and artistic skills. In the present study, we demonstrate this process on the skull of an early medieval warrior from Croatia. The skeletal remains were prepared and scanned using multi-slice computed tomography (MSCT) and examined using standard anthropological and radiological methods. The analysis revealed that the remains belonged to a 35–45-year-old male individual who had suffered severe cranial trauma, probably causing his death. From MSCT images, we reconstructed a three-dimensional (3D) model of the skull, on which we digitally positioned cylinders demarking the soft tissue thickness and created the face with a realistic texture. A 3D model of the face was then optimized, printed, and used to produce a clay model. Sculpturing techniques added skin textures and facial features with scars and trauma manifestations. Finally, after constructing a plaster model, the model was painted and refined by adding fine details like eyes and hair, and it was prepared for presentation in the form of a sculpture. Full article

In age determination, different methods aiming to obtain the closest result to chronological age have been investigated so far. The most commonly used one among these is the radiological method, which is usually used to evaluate the developmental stages of wrist bones or teeth. In our study, we assessed bone age estimations using the Gilsanz–Ratib atlas (GRA), which has recently become commonly used for children aged 9 to 15 years; evaluated the dental age, determined with Cameriere’s European method; conducted morphometric measurements of the mandibular bone; and then examined their relationships with chronological age. The results of our study reveal that, in children during the puberty growth spurt, Cameriere’s EU formula might have higher accuracy in estimating chronological age in younger age groups, while the GRA might be more accurate for older ages. Additionally, we conclude that of the mandibular morphometric measurements, condylar height and tangential ramus height show strong positive correlations with age. As a result, we conclude that the morphometric measurements evaluated in the present study can be used as auxiliary methods in forensic anthropology and forensic dentistry. Full article

Post mortem hyoid bone fracture findings may be attributable to various factors, including both the onset of acute mechanical asphyxia as it happens in manual strangulation and in charred corpses. In forensic practice, the discovery of corpses burned after death to hide their real cause of death is not uncommon: in these cases, the diagnostic challenge is even greater, as the action of flames is capable of both masking previously generated lesions and/or generating new ones, as occurs for hyoid bone fractures. The case concerns a 76-year-old man found charred in his bedroom. Almost complete body charring made it impossible to evaluate any external damage. Post mortem computed tomography (PMCT) was performed, and an evident bilateral fracture of the greater horn of the hyoid bone was detected. Although the absence of typical charring signs had steered the diagnosis towards post mortem exposure to flames, PMCT proved to be very useful in increasing the accuracy in correctly determining the cause of death. In particular, making use of Maximum Intensity Projection (MIP) hyoid bone reconstructions, it was possible to measure the medial dislocation angle of the fracture fragments and then to establish the applied direction of force, which acted in a lateral–medial way. A manual strangulation diagnosis was confirmed. The increasing importance of performing post mortem radiological exams as a corollary for conventional autopsy has been further confirmed. Full article

Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a genetic disorder characterized by the progressive fibro-fatty replacement of the right ventricular myocardium, leading to myocardial atrophy. Although the structural changes usually affect the right ventricle, the pathology may also manifest with either isolated left ventricular myocardium or biventricular involvement. As ARVC shows an autosomal dominant pattern of inheritance with variable penetrance, the clinical presentation of the disease is highly heterogeneous, with different degrees of severity and patterns of myocardial involvement even in patients of the same familiar group with the same gene mutation: the pathology spectrum ranges from the absence of symptoms to sudden cardiac death (SCD) sustained by ventricular arrhythmias, which may, in some cases, be the first manifestation of an otherwise silent pathology. An evidence-based systematic review of the literature was conducted to evaluate the state of the art of the diagnostic techniques for the correct post-mortem identification of ARVC. The research was performed using the electronic databases PubMed and Scopus. A methodological approach to reach a correct post-mortem diagnosis of ARVC was described, analyzing the main post-mortem peculiar macroscopic, microscopic and radiological alterations. In addition, the importance of performing post-mortem genetic tests has been underlined, which may lead to the correct identification and characterization of the disease, especially in those ARVC forms where anatomopathological investigation does not show evident morphostructural damage. Furthermore, the usefulness of genetic testing is not exclusively limited to the correct diagnosis of the pathology, but is essential for promoting targeted screening programs to the deceased’s family members. Nowadays, the post-mortem diagnosis of ARVC performed by forensic pathologist remains very challenging: therefore, the identification of a clear methodological approach may lead to both a reduction in under-diagnoses and to the improvement of knowledge on the disease. Full article

Estimating age at death is essential to establish biological profiles from human skeletal remains in both forensic and archeological settings. Imaging studies of skeletal age changes in adults have described the metamorphosis of trabecular bone structure and bone loss in the proximal femur as well as changes in morphology during different stages of life. This study aims to assess the utility of a digital representation of conventional X-ray films of the proximal femur for the estimation of age at death in a sample of 91 adult individuals (47 females and 44 males) of the Coimbra Identified Skeletal Collection. The proposed approach showed a root mean squared error (RMSE) of 17.32 years (and mean absolute error of 13.47 years) for females and an RMSE of 14.06 years (mean absolute error of 11.08 years) for males. The main advantage of this approach is consistency in feature detection and extraction, as X-ray images projected on the femora space will always produce the same set features to be analyzed for age estimation, while more traditional methods rely heavily on operator experience that can lead to inconsistent age estimates among experts. Full article

Forensic dentistry is still an emerging field in Pakistan. The lack of scientific literature on the topic may lead to difficulties in situations where age estimation has a significant part such as in criminal and civil litigation. In mass disasters such as earthquakes and accidents, the correct investigation of the chronological age can be less troublesome if population-specific evidence is available. This is the rationale that justifies dedicated dental age estimation studies. This cross-sectional study aimed to test the time efficiency, validity and applicability of four dental age estimation methods: two invasive (Bang and Ramm and Lamendin) and two non-invasive (Kvaal and Cameriere) in an adult Pakistani population. A total of 37 teeth collected from a dental hospital in Islamabad, Pakistan, were used. Teeth included the central and lateral incisors, canines, and first and second premolars of males and females. Results were calculated using a Microsoft Office 2007 excel spreadsheet. Overall, Kvaal’s method mean absolute error between chronological and estimated ages (MAE: 12.33) showed the highest variation and Bang and Ramm showed more accurate results in comparison with other methods (MAE: 4.80). It was both time-efficient and practical to use. It can be stated that these were preliminary cross-sectional outcomes and that studies with larger samples are necessary. Full article