Abstract：
To determine the diagnostic bias between clinical and forensic radiology in cases of nonfatal hanging and determine and describe typical underreported imaging findings. In a retrospective, single-center study, all patients admitted for attempted suicide with near-hanging or fatal hanging between January 2008 and December 2020 who received CT or MRI of head and neck were reviewed and missed findings in the original report were documented. A binary regression with disagreement as dependent variable was fitted for the imaging modality, fatality, age, and sex. A total of 123 hanging incidents were retrospectively analyzed. The vast majority (n = 108; 87.8%) had attempted suicide with a nonfatal outcome. Fatal outcome occurred in 15 (12.0%). The extra- and intracranial injuries documented on CT and MRI scans were laryngeal (n = 8; 6.5%), soft tissue (n = 42; 34.1%), and vascular injuries (n = 1; 0.8%). Intracranial pathology was evident on 18 (14.6%) scans. Disagreement occurred in 36 (29.3%) cases and represented 52 (69.2%) of all cases with a radiological finding. Disagreement was strongly associated with fatality (OR: 2.7-44.9.4, p = 0.0012). In most cases, nonfatal hangings cause no or only minor injuries. Fatal cases are associated with a greater probability of missed minor imaging findings. This suggests that findings deemed clinically irrelevant are probably not reported in such severe emergency cases. This association indicates that minor abnormalities are underreported when major pathologies are evident on imaging in victims of strangulation.
摘要：
确定非致命性悬挂病例中临床和法医放射学之间的诊断偏差，并确定和描述典型的漏报影像学发现。在回顾中，单中心研究,我们回顾了2008年1月至2020年12月期间因自杀未遂且近乎悬吊或致命悬吊而接受头颈部CT或MRI检查的所有患者,并记录了原始报告中的漏诊结果.对成像模态进行了以不一致为因变量的二元回归拟合，死亡,年龄,和性爱。对123起吊装事件进行回顾性分析。绝大多数（n=108;87.8％）曾尝试自杀，结果非致命。15例(12.0%)发生致命结局。CT和MRI扫描记录的颅内外损伤为喉部（n=8；6.5％），软组织（n=42；34.1%），血管损伤（n=1；0.8%）。颅内病理在18（14.6％）扫描中明显。在36例（29.3％）病例中发生了分歧，在所有有放射学发现的病例中，有52例（69.2％）发生了分歧。分歧与病死率密切相关（OR：2.7-44.9.4，p=0.0012）。在大多数情况下,非致命的绞刑不会造成或仅造成轻伤。致命病例与较小的影像学发现遗漏的可能性更大相关。这表明，在如此严重的紧急情况下，可能没有报告被认为与临床无关的发现。这种关联表明，当在勒死受害者的影像学上明显出现主要病理时，轻微的异常被低估了。
