脑梗死的尸体影像学诊断研究  

Diagnosis of cerebral infarcts on postmortem imaging

作　　者：夏志远 沈海斌 晋文举 余亚蕾 刘蓓蓓 顾嘉渊 何治疾 张蔚 刘四杰 丁锡联 张毓锵 龚群[4] 何光龙 Xia Zhiyuan;Shen Haibin;Jin Wenju;Yu Yalei;Liu Beibei;Gu Jiayuan;He Zhiji;Zhang Wei;Liu Sijie;Ding Xilian;Zhang Yuqiang;Gong Qun;He Guanglong(Dian Research Center for Postmortem Imaging&Angiography,Zhejiang Dian Institute of Forensic Sciences,Hangzhou 310007,China;Forensic Science Center of Deqing County's Public Security Bureau,Huzhou 313200,China;Forensic Science Center of Huzhou City's Public Security Bureau,Huzhou 313000,China;Forensic Science Center of Zhejiang Province's Public Security Department,Hangzhou 310009,China;Institute of Forensic Science of China,Ministry of Public Security,Beijing 100038,China)

机构地区：[1]浙江迪安鉴定科学研究院迪安鉴定虚拟解剖研究中心,浙江杭州310007 [2]浙江省德清县公安司法鉴定中心,浙江湖州313200 [3]湖州市公安司法鉴定中心,浙江湖州313000 [4]浙江省公安厅物证鉴定中心,浙江杭州310009 [5]公安部鉴定中心,北京100038

出　　处：《中国法医学杂志》2023年第4期351-354,359,共5页Chinese Journal of Forensic Medicine

基　　金：迪安鉴定虚拟解剖专项研究基金(DIFS202201A);国家留学基金(201707070113)。

摘　　要：目的初步探究尸体影像学方法在脑梗诊断方面的应用价值。方法对3例脑梗案例尸体影像资料(PMCT和PMCTA)进行回顾性研究,分析讨论尸体影像学方法用于陈旧性脑梗或急性脑梗的系统诊断能力。结果PMCT可用于陈旧性脑梗塞区域大小、部位和形态的记录,死后变化引起的脑组织密度改变无法完全掩盖生前陈旧性脑梗死。PMCTA能进一步满足狭窄、闭塞脑动脉血管的精准定位,通过观察狭窄闭塞血管对应供血区域是否出现低密度梗死灶,可用于是否存在急性脑梗(<24 h)的判断。利用尸体影像学单一方法判断脑血管狭窄闭塞的原因尚具有挑战性,未来通过影像学引导进行尸体脑病变血管的精准解剖及组织病理学检查,有望解决这一难题。结论尸体影像学方法(PMCT和PMCTA)在尸体脑梗诊断方面具有一定的应用价值,建议有条件的实验室将其作为法医尸体脑血管病理学检查的常规手段。Objective To preliminarily study the feasibility of applying postmortem imaging method to cerebral infarcts diagnosis.Methods Postmortem imaging(PMCT and PMCTA)data of three cerebral infarct individuals were retrospectively reviewed.Systematic diagnosing capacities of acute or old cerebral infarcts by postmortem imaging method were further investigated and discussed.Results PMCT is useful in documentation of the sizes,locations and morphological features of old cerebral infarcts.Postmortem cerebral density changes does not overshadow old cerebral infarcts.PMCTA can be used to visualize the precise sites of the cerebral arteries with stenosis or occlusion.By further checking whether low intensity spots appear or not in the blood supplying regions of the diseased vessels,presence or absence of acute cerebral infarcts can be diagnosed.Diagnosing the causes of the stenosis or occlusion of cerebral arteries by postmortem imaging method alone is still challenging,but this problem can potentially be solved by precise autopsy and histopathology of postmortem cerebral arteries guided by postmortem imaging method.Conclusion Postmortem imaging method is very useful in the postmortem diagnosis of cerebral infarcts which is recommended to be routinely used in forensic pathology examinations of cerebral vascular if possible.

关 键 词：脑梗 尸体影像学 虚拟解剖 PMCT PMCTA 

分 类 号：D919.4[医药卫生—法医学]