The diagnostic value of forensic imaging in fatal gunshot incidents:A review of literature

Introduction: Post-mortem computed tomography (PMCT) and post-mortem magnetic resonance imaging (PMMR) are frequently used as an addition to autopsy. However, there is no research that determined the diagnostic value of these imaging techniques in forensic cases. The aim of this review is to evaluate the available literature with regard to the correlation between autopsy and imaging findings in the forensic investigation of gunshot victims to arrive at an the diagnostic value of PMCT and PMMR.Materials & methods: The review process was set out as a systematic review according to the Cochrane guidelines. A systematic search was performed in MEDLINE and EMBASE to identify studies comparing autopsy and imaging techniques after fatal gunshot incidents. Autopsy and imaging techniques were compared for forensically relevant items: entrance wounds, exit wounds, trajectory of the bullet through the body, detection of metal fragments and identification of relevant injuries. The autopsy was the reference standard in all studies.Results: In each study a minimum of one and a maximum of five items could be compared between the imaging techniques and the autopsy. In total seven studies complied with the inclusion criteria. The overall quality and level of detail of these studies did not allow for a formal meta-analysis. For the detection of the entrance wound five studies provide data and the correlation between imaging and autopsy was 100% in four studies, and 69.2% in one study. Five studies provide data on the exit wound and there was a 100% correlation in four, and 52.2% in one study. Six studies provide data on the bullet path and the correlation between techniques and autopsy was 100% in four studies and respectively 72.1% and 80% in the other two studies. For the detection of metal fragments three studies provide data and all these studies showed a 100% correlation between imaging and autopsy. Two studies provide data on detecting injuries with a correlation between imaging and autopsy of 100% and 87.2% respectively.Conclusion: Despite the concerns on the quality of the reviewed studies, the literature shows that PMMCT has a high sensitivity in identifying the main forensic items in gunshot victims compared to the standard of reference; an autopsy. Forensic radiology and autopsy can be complementary in a forensic medical investigation.