Jin-Haeng Heo

Estimation of body parameters, height and body weight, is important for biological profiling in forensic investigations. This study aimed to develop a deep learning model for automated height and weight estimation using postmortem computed tomography (PMCT) scout view images acquired in forensic practice. A retrospective analysis was conducted in 3,124 cases that underwent autopsy and PMCT. Scout view images were preprocessed with geometric correction based on PMCT table height. Three CT window settings were fused into RGB channels, enhancing anatomical and environmental information. A convolutional neural network based on a pre-trained VGG16 architecture was trained to simultaneously estimate height and weight. Model performance was evaluated on a test dataset (n = 624) using mean absolute error (MAE), mean absolute percentage error (MAPE), correlation analysis, and Bland-Altman analysis. The multi-window RGB fusion model achieved MAE values of 2.39 cm for height and 1.83 kg for weight, outperforming the single-window model. Predicted and reference values were strongly correlated. Bland-Altman analysis demonstrated narrow limits of agreement. Deep learning applied to PMCT scout view images enables automatic estimation of height and weight with high accuracy. The proposed multi-window RGB fusion with geometric correction offers a practical tool for body parameter estimation in forensic investigations.

Sphenoid sinus fluid is considered a supportive indicator of drowning in forensic medicine, but traditional manual assessment on postmortem computed tomography (PMCT) is labor-intensive and observer-dependent. Efficient, reproducible methods for quantitative evaluation are needed in forensic practice. This study developed deep learning-based approaches for the automated segmentation and volumetric estimation of sphenoid sinus fluid using PMCT images from 165 autopsy-confirmed drowning cases. Three U-Net-based models (2D, 2.5D, and 3D) were developed and evaluated against manually annotated reference standards. In the test dataset, mean Dice coefficients were 0.866 (2D), 0.869 (2.5D), and 0.798 (3D). Volumetric estimates showed no statistically significant differences from the reference standard, with strong correlations (Spearman's ρ = 0.976-0.988). Mean absolute errors were 0.218 (2D), 0.206 (2.5D), and 0.310 ml (3D). The 2.5D approach provided the most balanced performance between segmentation accuracy and volumetric estimation. These findings demonstrate the feasibility of automated PMCT-based segmentation and volumetric quantification of sphenoid sinus fluid, enabling quantitative assessment on PMCT images prior to autopsy.

Accessory sutures of the skull are uncommon anatomical variants that mimic fractures, especially in infants with incomplete ossification. Here, we report the case of a 6-month-old female infant who died after hospitalization for cardiac arrest. Postmortem computed tomography (PMCT) revealed a transverse linear lucency in the occipital bone accompanied by intracranial hemorrhage, initially raising the suspicion of a skull fracture and non-accidental injury. However, detailed examination at autopsy confirmed that the lucency represented an accessory occipital suture rather than a fracture and was unrelated to the intracranial hemorrhage. This case highlights that accurate interpretation of PMCT and autopsy findings requires knowledge of normal anatomical variants, especially in infant death investigations. Awareness of accessory sutures and the application of advanced computed tomography techniques, such as three-dimensional reconstruction, combined with histological confirmation, if necessary, are crucial to avoid diagnostic errors and unjust suspicion of child abuse.

Postmortem computed tomography (PMCT) is a non-invasive imaging modality used to assess injuries, pathological lesions, and postmortem changes before autopsy. Accurate interpretation of PMCT findings is crucial to avoid misinterpretation owing to postmortem changes. In this case, PMCT was performed before autopsy of a decedent who died from multiple injuries to identify various hemorrhagic findings in the torso, including those in the thoracic cavity and pericardium, which were confirmed through autopsy. PMCT revealed horizontally layered and droplet-shaped hyperdense areas along the lateral right thoracic wall, a crescent-shaped homogeneous hyperdensity in the pericardium, and obliquely layered hyperdensity in the left pulmonary artery. Lower layers of blood had >70 Hounsfield unit (HU), whereas the upper layers measured 30-40 HU. Integrated analysis with subsequent autopsy confirmed that these imaging findings reflected blood sedimentation and coagulation reactions, suggesting misinterpretation of atypical hemothorax patterns resulting from anatomical characteristics as hematomas or tumors. This approach enabled the precise determination of hemorrhage location and coagulation status, facilitating the estimation of circulatory conditions at death and timing of injury. PMCT provides valuable information for event reconstruction and autopsy guidance by visualizing hemorrhage location, morphology, density, and sedimentation. However, PMCT alone cannot definitively determine the coagulation status or distinguish antemortem from postmortem bleeding, necessitating a combined interpretation with autopsy and histopathology. This case demonstrates the use of PMCT combined with autopsy for evaluating hemorrhage, injury mechanisms, and death circumstances, thereby enhancing the objectivity and accuracy of forensic assessments.

The prevalence of bicuspid aortic valve (BAV) is approximately 0.5%-2% and is the most common congenital heart valve disease in adulthood. It is present at birth but may be asymptomatic initially, and symptoms can appear over time as various complications, such as dystrophic calcification, infective endocarditis, aortic stenosis, aortic regurgitation, and aortic dissection, occur. However, in some cases, sudden cardiac death may be the first presentation; this case will be introduced. This case report describes a 63-year-old woman with no known underlying conditions or history of heart disease, except for hypertension, who suddenly collapsed and died. Autopsy results confirmed a severely calcified BAV, and histological examination revealed calcification not only in the valve leaflets but also in the sinus wall, with interstitial fibrosis observed in the hinge of the leaflet extending downward to the interventricular septum. This anatomical distribution suggests the potential involvement of the cardiac conduction system, which could lead to fatal arrhythmias, such as atrioventricular block or ventricular tachyarrhythmia. BAV should be recognized as a potentially life-threatening condition, even in the absence of clinically apparent cardiac disease, as observed in this case. Additionally, a thorough histological examination of the heart valves and conduction system at autopsy should not be overlooked, as this will allow for clinicopathological correlations and an understanding of the mechanisms of sudden cardiac death.

Postmortem computed tomography (PMCT) is increasingly used as a noninvasive adjunct to traditional autopsies in forensic pathology. Here, we present a homicide case in which a broken knife tip embedded in the skull was detected using PMCT and subsequently recovered during autopsy. An elderly man was found dead at his workplace with multiple stab wounds on the head, face, and neck. PMCT revealed a high-density, wedge-shaped metallic fragment in the left parietal bone penetrating the cranial cavity. Three-dimensional reconstruction confirmed the morphology and location of fragments. During autopsy, the fragment was retrieved and matched to a knife submitted by the suspect, thereby enabling weapon identification and injury reconstruction. PMCT assists in the assessment of wound trajectories and visualizes other skeletal and soft tissue injuries. This case underscores the value of PMCT in visualizing injuries in situ, preserving postmortem data, and contributing to forensic investigations of sharp-force injuries. These findings support the use of PMCT as a valuable adjunct in determining the cause and manner of death and providing objective visual evidence in legal proceedings.

Toluene is a colorless, transparent liquid aromatic hydrocarbon with a sweet and pungent odor similar to that of benzene. It has a low flash point, making it easily flammable, and its vapor can form explosive mixtures with air, thus classifying it as highly flammable. Toluene inhalation can cause lung irritation, respiratory distress syndrome, acute pulmonary edema, central nervous system disorders, and symptoms such as dizziness, drowsiness, and skin and eye irritation. High concentrations can cause loss of consciousness and even death. In cases where poisoning is suspected, blood from the heart, stomach contents, and urine from the bladder are typically collected for toxicology testing during an autopsy. In cases where it is difficult to collect the aforementioned specimens, the vitreous humor, cerebrospinal fluid, hair, and bones containing bone marrow can be collected for testing. In this case, unruptured pulmonary bullae were identified using postmortem computed tomography before the autopsy, and gas from the pulmonary bullae was collected with a syringe during the autopsy. Gas chromatography analysis was conducted, and toluene was detected in the samples, including the gas within the pulmonary bullae. As in this case, when volatile gas intoxication is suspected, toxicological analysis using blood is difficult due to decomposition and other factors; however, gas sampling from the pulmonary bullae allows for the detection of toxic substances. Herein, we report a case of toluene exposure with forensic considerations and warnings regarding the work environment.

Myositis ossificans (MO) is defined as a lesion where abnormal ossification forms in soft tissues, such as muscle, fascia, and ligament, usually as a result of trauma. It commonly appears in areas such as the thigh, hip, and elbow, though it can affect any part of the body. In the forensic field, MO resulting from trauma is reported to be valuable evidence of repeated physical abuse. This case report describes a deceased adult male with an intellectual disability, whose cause of death was multiple injuries from assault. Postmortem computed tomography (PMCT) and autopsy findings revealed MO of both thighs associated with repeated physical abuse. This case also showed typical findings of MO on PMCT imaging, characterized by well-defined, high-density lesions within the quadriceps. Adults with intellectual disabilities are at high risk of abuse and assault. Therefore, autopsy findings of MO can serve as important evidence in forensic practice, considering the possibility of repeated abuse.

The cause and manner of death in the Busan and Gyeongnam regions were analyzed using autopsy data performed by the National Forensic Service Busan Institute (NFS BI) for 10 years—from 2014 to 2023. In addition, changes in the number of autopsy cases of elderly individuals aged 65 and older, were analyzed in the Busan and Gyeongnam regions. A total of 6,374 cases were classified, excluding autopsies from the Ulsan area and the Coast Guard, from the NFS BI data. Analysis of the manner of death revealed that 3,203 cases (50.3%) were unnatural deaths; 2,031 cases (31.9%) were natural deaths; and 1,140 cases (17.9%) were deaths of unknown cause. Among the unnatural deaths, accidents were the most common at 1,149 cases (18.0%), followed by suicide at 979 cases (15.4%); and homicide at 583 cases (9.1%). Among natural deaths, heart disease was the most common with 764 cases (37.6%), followed by vascular disease with 351 cases (17.3%). The proportion of the population aged 65 or older in Busan and Gyeongnam has been steadily increasing from 13.7% in 2014 to 21.6% in 2023. Accordingly, the number of autopsies on people aged 65 or older has increased from 72 in 2014 to 174 in 2023, and the number of autopsies on people aged 65 or older accounted for one-quarter of the total number of forensic autopsies commissioned by Busan/Gyeongnam, and performed by NFS BI in 2023. Therefore, we plan to introduce emerging issues relating to population aging and geriatric forensic medicine.

Postmortem computed tomography (PMCT) is used in forensic medicine worldwide due to its ability to non-invasively visualize injuries, hemorrhage, and estimate volume. In the autopsy of infants, assessing nutritional conditions such as weight is crucial for identifying neglect. This study aims to evaluate the usefulness of retrospectively estimating the weight of Korean infants using PMCT-based volume and multiplication factors, even when the body has been cremated. A total of 44 cases of infant death (under 12 months) were analyzed. PMCT images were obtained before autopsy. Autopsy records and documentation provided by the police at the time of autopsy were reviewed to determine the weight (g) of the infant. PMCT-based infant volumes (mL) were estimated using a three-dimensional semi-automatic segmentation method. Multiplication factors (g/mL) were calculated by dividing the weight recorded at autopsy by the PMCT-based volume, yielding a mean of 1.047 g/mL, ranging from 1.014 g/mL to 1.085 g/mL. The mean absolute error compared to weights recorded at autopsy was 95 g. Significant discrepancies were observed between weights recorded at the scene or medical center and those measured at autopsy. This study demonstrates that PMCT-based weight estimation for Korean infants is a reliable method and has the potential for retrospectively validating incorrect weight measurements and addressing inconsistencies in recorded weight data.