Evidence map›Paper›PMID 40956439›Full record

ArticleInternational journal of legal medicine2026

Diagnostic accuracy of rib fracture detection in forensic post-mortem photon counting CT.

Paolo Lombardo, Conny Hartmann, Chantal Fridle, Hendrik von Tengg-Kobligk, Thomas D Ruder, Wolf-Dieter Zech

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Article in International journal of legal medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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1 · What the graph read from it

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4 · The record

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5 · Who and what money

Authors and funding

6 authors.

Paolo LombardoInstitute of Forensic Medicine, University of Bern, Bern, Switzerland.
Conny HartmannInstitute of Forensic Medicine, University of Bern, Bern, Switzerland.
Chantal FridleInstitute of Forensic Medicine, University of Bern, Bern, Switzerland.
Hendrik von Tengg-KobligkDepartment of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Thomas D RuderDepartment of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Wolf-Dieter ZechInstitute of Forensic Medicine, University of Bern, Bern, Switzerland. wolf-dieter.zech@irm.unibe.ch.ORCID http://orcid.org/0000-0002-3527-4891

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundRecently, post-mortem photon-counting CT (PMPCCT) has been introduced to forensic imaging. Compared to conventional energy integrating post-mortem CT (PMCT), PMPCCT enables ultra-high resolution (UHR) imaging, which is particularly suitable for visualizing fine fractures and fissures. These are often found in rib trauma, which is usually relevant in forensic medicine. The aim of this study was to evaluate the diagnostic accuracy of rib fracture detection using PMPCCT compared to PMCT and forensic autopsy.

methodsA total of n = 20 bodies that had suffered blunt chest trauma before death and n = 5 non-trauma control cases were investigated. PMCT and PMPCCT were conducted prior to forensic autopsy. Two observers (radiologist and forensic pathologist) analyzed PMCT images (reconstructed with a slice thickness of 0.5 mm in a 512 matrix) and PMPCCT images (reconstructed with slice thicknesses of 0.5 mm and 0.2 mm (UHR) in a 1024 matrix). Imaging diagnosis of rib fractures was compared to autopsy diagnosis as gold standard. The diagnosis of different types of rib fractures assessed at imaging was compared between PMCT and PMPCCT.

resultsInter-rater agreement between the two observers was good (κ = 0.79). Both PMCT and PMPCCT diagnosed less rib fractures than the autopsy (n = 356 fractures). Compared to PMCT, UHR-PMPCCT demonstrated slightly higher sensitivity (e.g., 92% vs. 82% in observer 1), slightly higher specificity (e.g., 97% vs. 95%), and lower positive predictive value (e.g., 75% vs. 82%) for the diagnosis of all rib fractures. Chi-squared tests showed significant differences (p-value < 0.05 in both observers) between UHR-PMPCCT and PMCT for the diagnosis of incomplete rib fractures with visible dehiscence of one cortical line.

conclusionBased on the results, it is questionable whether PMPCCT offers additional forensic value over PMCT for the specific forensic issue of diagnosing rib fractures.

Indexed as

Rib FracturesTomography, X-Ray ComputedAdultAgedAged, 80 and overAutopsyCase-Control StudiesFemaleForensic PathologyHumansMaleMiddle AgedObserver VariationPhotonsSensitivity and SpecificityWounds, NonpenetratingDiagnostic accuracyPhoton-counting CTPost-mortem computed tomographyRib fractures

Identifiers

PMID40956439
PMCPMC12808174

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.