Imaging of alert patients after non-self-inflicted strangulation: MRI is superior to CT

Thomas D Ruder; Alexandra Gonzenbach; Jakob Heimer; Leonie Arneberg; Jolanta Klukowska-Rötzler; Simone Blunier; Aristomenis K Exadaktylos; Wolf-Dieter Zech; Franca Wagner

doi:10.1007/s00330-023-10354-3

Imaging of alert patients after non-self-inflicted strangulation: MRI is superior to CT

Eur Radiol. 2023 Nov 13. doi: 10.1007/s00330-023-10354-3. Online ahead of print.

Authors

Affiliations

¹ Institute of Diagnostic, Interventional and Pediatric Radiology, InselspitaI, Bern University Hospital, University of Bern, CH-3010 Bern, Freiburgstrasse, Switzerland. thomas.ruder@insel.ch.
² Department of Emergency Medicine, InselspitaI, Bern University Hospital and University of Bern, Bern, Switzerland.
³ Department of General Surgery, Hospital Linth, Uznach, Switzerland.
⁴ Department of Mathematics, Seminar for Statistics, ETH Zurich, Zurich, Switzerland.
⁵ Department of Medicine, Hospital Emmental, Burgdorf, Switzerland.
⁶ Institute of Forensic Medicine, University of Bern, Bern, Switzerland.
⁷ Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.

PMID: 37953368
DOI: 10.1007/s00330-023-10354-3

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, χ²), 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, χ²) or assault by unknown offender (88% of men, p < 0.002 χ²). 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 revealed potentially dangerous injuries in one of 14 patients. • MRI has a significantly higher sensitivity than CT and appears to be more appropriate for the diagnostic workup of alert patients after strangulation.

Keywords: Blunt cerebrovascular injury; Emergency radiology; Larynx fracture; Non-accidental injury; Non-fatal strangulation.