目的:在溺水的情况下,蝶窦液的存在是非特异性尸检结果。然而,研究报告说,在溺水的受害者中,鼻旁窦中的液体积聚更常见。此外,一些实验室测试,如硅藻和电解质分析,可以作为辅助诊断工具诊断溺水。因此,准确的蝶窦液体采样是怀疑溺水病例尸检的一个重要方面。这项研究的目的是确定在溺水的情况下通过PMCT图像评估蝶窦液的意义。
方法:我们回顾性分析了54名接受PMCT和法医尸检的溺水受害者。尸检期间使用带刻度的注射器测量蝶窦中的液体量,并使用基于PMCT图像的三维(3D)工作站进行比较。采用Mann-WhitneyU检验和Spearman's秩相关系数评价差异和相关性。此外,Bland-Altman地块用于评估PMCT和尸检之间的一致性。
结果:在PMCT和尸检中,中位体积分别为1.65(范围0.00-12.4)ml和1.55(范围0.00-7.00)ml,分别,显示统计学上无统计学差异(p=0.294)和显著相关性(Rs=0.896)。在35个案例中,PMCT比尸检更高估了液体量,而在14个案例中,PMCT低估了液体量。在尸检过程中没有发现七例液体,而在五名患者中,在PMCT和尸检中均未发现液体.通过分析Bland-Altman的阴谋,对于蝶窦液体体积测量,观察到偏差为0.73±1.4ml,一致界限为-2.04至3.51ml.
结论:基于尸检期间蝶窦传统液体量测量的局限性,我们建议在尸检前利用PMCT体积分析作为一种手段,以增强溺水病例中蝶窦液的检测。
OBJECTIVE: In cases of drowning, the presence of sphenoid sinus fluid is a non-specific autopsy finding. However, studies have reported that fluid accumulation in the paranasal sinuses is more commonly observed in drowning victims. Furthermore, some laboratory tests, such as diatom and electrolyte analysis, can serve as supplementary diagnostic tools for diagnosing drowning. Therefore, accurate sphenoid sinus fluid sampling is an important aspect of an autopsy in suspected drowning cases. The aim of this study was to identify the significance of evaluating sphenoid sinus fluid by PMCT images in cases of drowning.
METHODS: We retrospectively reviewed 54 drowning victims who underwent PMCT and forensic autopsy. Fluid volume in the sphenoid sinus was measured using a graduated syringe during autopsy and a three-dimensional (3D) workstation based on PMCT images was used for the purpose of comparison. The Mann-Whitney U test and Spearman\'s rank correlation coefficient was used to evaluate statistically significant differences and correlations. Additionally, a Bland-Altman plot was employed to assess the agreement between PMCT and autopsy.
RESULTS: The median volume was 1.65 (range 0.00-12.4) ml and 1.55 (range 0.00-7.00) ml in the PMCT and autopsy, respectively, showing a statistically insignificant difference (p = 0.294) and a significant correlation (Rs = 0.896). In 35 cases, the PMCT overestimated the fluid volume more than the autopsy, whereas in 14 cases, the PMCT underestimated the fluid volume. No fluid was identified in seven cases during the autopsy, whereas in five patients, no fluid was found in both PMCT and autopsy. By analyzing the Bland-Altman plot, a bias of 0.73 ± 1.4 ml and limits of agreement ranging from -2.04 to 3.51 ml were observed for sphenoid sinus fluid volume measurements.
CONCLUSIONS: Based on the limitations of traditional fluid volume measurement in the sphenoid sinus during autopsy, we propose the utilization of PMCT volumetric analysis prior to autopsy as a means to enhance the detection of sphenoid sinus fluid in cases of drowning.