Kantonsspital St.Gallen

Value of 3T craniocervical magnetic resonance imaging following nonfatal strangulation

Jakob Heimer, Carlo Tappero, Dominic Gascho, Patricia Flach, Thomas D Ruder, Michael J Thali & Sabine Franckenberg


The aims of this study were (1) to provide an overview of craniocervical magnetic resonance imaging (MR) findings following nonfatal strangulation (NFS), (2) to detect the time dependency of the presence of these findings, and (3) to explore the additional value of MR with regard to the forensic interpretation of NFS.

All 633 victims of manual strangulation between October 2011 and March 2018 were examined, including the case history and external findings. Following written consent, 114 cases were included in the study. The duration between the event, clinical forensic examination, and MR was noted. Radiologic images were reviewed by a clinical and a forensic radiologist.

The case group consisted of 90 women and 24 men with a mean age of 32.5 years. Delimitable external findings were present in 93% (N = 106) of cases. MR yielded a positive finding in 43% of cases (N = 49). There was no significant difference in the mean time interval between examinations between MR-positive and MR-negative cases. Perilaryngeal fluid accumulation was associated with difficulty swallowing and victims put in a chokehold. All cerebral MR were unremarkable, except for one patient with edema of the corpus callosum.

The role of craniocervical MR following NFS is currently limited, particularly with regard to the forensic interpretation of NFS. MR may reveal internal injury in victims who report subjective symptoms of airway compression and in those who were placed in a chokehold. The presence of MR findings is not dependent on immediate examinations following the assault.

• Magnetic resonance imaging does not currently provide additional value for the estimation of the severity of nonfatal manual strangulation. • Magnetic resonance imaging of the neck may reveal internal injury in cases without external findings, particularly in victims placed in a chokehold and with symptoms of airway compression. • The incidence of carotid artery dissections and laryngeal fractures is low in victims of nonfatal manual strangulation.
citation Heimer J, Tappero C, Gascho D, Flach P, Ruder T D, Thali M J, Franckenberg S. Value of 3T craniocervical magnetic resonance imaging following nonfatal strangulation. Eur Radiol 2019; 29:3458-3466.
type journal paper/review (English)
date of publishing 22-02-2019
journal title Eur Radiol (29/7)
ISSN electronic 1432-1084
pages 3458-3466
PubMed 30796576
DOI 10.1007/s00330-019-06033-x