Imaging of alert patients after non-self-inflicted strangulation: MRI is superior to CT
type: Article
item type: journalArticle
is part of: Eur Radiol
authors: Person
  surname: Ruder
  given name: T. D.
authors: Person
  surname: Gonzenbach
  given name: A.
authors: Person
  surname: Heimer
  given name: J.
authors: Person
  surname: Arneberg
  given name: L.
authors: Person
  surname: Klukowska-Rotzler
  given name: J.
authors: Person
  surname: Blunier
  given name: S.
authors: Person
  surname: Exadaktylos
  given name: A. K.
authors: Person
  surname: Zech
  given name: W. D.
authors: Person
  surname: Wagner
  given name: F.
subject: *Asphyxia/diagnostic imaging
subject: *Magnetic Resonance Imaging/methods
subject: *Sensitivity and Specificity
subject: *Tomography, X-Ray Computed/methods
subject: Adolescent
subject: Adult
subject: Aged
subject: Blunt cerebrovascular injury
subject: Emergency radiology
subject: Female
subject: Humans
subject: Intimate Partner Violence
subject: Larynx fracture
subject: Male
subject: Middle Aged
subject: Neck Injuries/diagnostic imaging
subject: Non-accidental injury
subject: Non-fatal strangulation
subject: Retrospective Studies
subject: Young Adult
subject: products or services may be related to the subject matter of the article.
abstract: OBJECTIVE: To assess the accuracy of CT and MRI reports of alert patients presenting after non-self-inflicted strangulation (NSIS) and evaluate the appropriateness of these imaging modalities in NSIS. MATERIAL AND METHODS: The study was a retrospective analysis of patient characteristics and strangulation details, with a comparison of original radiology reports (ORR) to expert read-outs (EXR) of CT and MRI studies of all NSIS cases seen from 2008 to 2020 at a single centre. RESULTS: The study included 116 patients (71% women, p < .001, chi(2)), with an average age of 33.8 years, mostly presenting after manual strangulation (97%). Most had experienced intimate partner violence (74% of women, p < .001, chi(2)) or assault by unknown offender (88% of men, p < 0.002 chi(2)). Overall, 132 imaging studies (67 CT, 51% and 65 MRI, 49%) were reviewed. Potentially dangerous injuries were present in 7%, minor injuries in 22%, and no injuries in 71% of patients. Sensitivity and specificity of ORR were 78% and 97% for MRI and 30% and 98% for CT. Discrepancies between ORR and EXR occurred in 18% of all patients, or 62% of injured patients, with a substantial number of unreported injuries on CT. CONCLUSIONS: The results indicate that MRI is more appropriate than CT for alert patients presenting after non-self-inflicted strangulation and underline the need for radiologists with specialist knowledge to report these cases in order to add value to both patient care and potential future medico-legal investigations. CLINICAL RELEVANCE STATEMENT: MRI should be preferred over CT for the investigation of strangulation related injuries in alert patients because MRI has a higher accuracy than CT and does not expose this usually young patient population to ionizing radiation. KEY POINTS: * Patients presenting after strangulation are often young women with a history of intimate partner violence while men typically present after assault by an unknown offender. * Expert read-outs of CT and MRI re…
date: 2023-11-13
pages: 3813-3822
coverage: 37953368

Eur Radiol
type: Journal
volume: 34
number: 6
identifier: DOI 10.1007/s00330-023-10354-3
identifier: ISSN 1432-1084 (Electronic) 0938-7994 (Print) 0938-7994 (Linking)