Imagerie en coupe et anthropobiologie : applications médico-légales pour la détermination de l'âge

Le but de ce travail était d'évaluer d'une part, et de valider d'autre part les possibilités offertes par l'imagerie en coupe dans le domaine de l'estimation de l'âge d'individus vivants ou de l'estimation de l'âge au décès. Ce travail a ainsi porté sur l'étude d'individus vivants et de pièces osseuses préparées. Pour ce faire, plusieurs moyens d'imagerie ont été utilisés : la tomodensitométrie multicoupe et l'imagerie par résonance magnétique. Ce travail était en premier lieu basé sur la transposition en tomodensitométrie de critères ostéoscopiques utilisés en anthropologie physique lorsqu'une problématique de détermination d'âge au décès d'un individu non identifié vient à se poser, ainsi que la validation de ces critères. Parallèlement, des critères propres à l'imagerie en coupe ont également été recherchés et validés. Plusieurs éléments anatomiques ont été retenus : les premières et quatrièmes côtes droites, l'os coxal par l'étude de la surface auriculaire et de la symphyse pubienne, et enfin l'articulation fémoro-tibiale. Ce travail a permis la mise en évidence d'un réel apport de l'imagerie en coupe en terme d'estimation d'âge d'individus, qu'ils soient vivants ou décédés. Son application pratique sur des momies est une aide précieuse de part le caractère non invasif de l'exploration par imagerie. La réalisation d'examens en coupe à visée anthropologique présente de nombreux avantages. Les images sont stockables, interprétables a posteriori, transférables par le biais d'internet ou l'envoi de supports. De plus, les reconstructions effectuées peuvent être, si elles sont rassemblées sur un site internet, un véritable musée virtuelThe goal of this work was to evaluate on the one hand, and to validate on the other hand the possibilities offered by the modern cross-sectional imaging in the field of the age estimation of living persons or the estimation of the age-at-death of deceased. This work concerned the study of living individuals and prepared bone pieces. With this intention, several kinds of imaging were used: the multislice computed tomography and the magnetic resonance imaging. This work was initially based on the transposition in multislice computed tomography of osteoscopic criteria used in physical anthropology when problems of determination of age-at-death of not identified individuals is encountered, as well as the validation of these criteria. In parallel, proper criteria for modern cross-sectional imaging were sought and validated. Several anatomical elements were retained: right first and fourth ribs, the innominate bone by the study of the auricular surface and the pubic symphysis, and finally the knee joint. This work allowed the description of a real contribution of modern cross-sectional imaging in term of age estimation of individuals, alive or died. The practical application on mummies is an invaluable help because of the non invasive character of the imaging exploration. The realization of modern cross-sectional imaging explorations with anthropological aims has many advantages. The images are storable, retrospectively interpretable, and transferable by Internet or the sending of supports. Moreover, the reconstructions carried out can be, if they are gathered on an Internet site, a real virtual anthropological museu

Bone age estimation based on multislice computed tomography study of the scapula

Progress in medical imaging has opened new areas of research in forensic anthropology, especially in the context of the study of bone age assessment. The study of bone age has become a useful tool for age estimation at death or age of young adult migrants in an anthropological context. We retrospectively evaluated multislice computed tomography (MSCT) explorations focused on scapulae of 232 individuals (123 males; 109 females) aged between 8 and 30 years old. Computed tomography (CT) scans were viewed in axial and multiplanar reconstructed images using OsiriX 5.9 (64 bit)®. The ossification centers of the scapula studied were as follows: acromial, sub-coracoid, glenoid, coracoid, coracoid apex, and inferior angle epiphyses. Fusion status was scored based on a five-stage system (stage 1: no ossification, stage 2: visualization of an ossification center, stage 3: partial ossification, stage 4: full ossification associated to an epiphyseal scar, and stage 5: full ossification without epiphyseal scar). Intra-observer variability was excellent, and inter-observer variability was good, demonstrating the reliability of this MSCT staging system. The fusion of scapular ossification centers was statistically associated with age (p  0.05). In conclusion, MSCT of the scapula is an efficient method for age assessment, which is complementary to preexisting methods particularly for specifying the 18-year threshold. Further studies with larger groups are needed to support our results

An unusual intracardiac foreign body following penetrating thoracic injury

Foreign bodies in the heart after thoracic trauma may result in fatal outcome. We report a pendant inside the pericardium after penetrating injury that did not cause major cardiac injury with a favorable outcome

Blended learning of radiology improves medical students’ performance, satisfaction, and engagement

Purpose To evaluate the impact of blended learning using a combination of educational resources (flipped classroom and short videos) on medical students’ (MSs) for radiology learning. Material and methods A cohort of 353 MSs from 2015 to 2018 was prospectively evaluated. MSs were assigned to four groups (high, high-intermediate, low-intermediate, and low achievers) based on their results to a 20-MCQs performance evaluation referred to as the pretest. MSs had then free access to a self-paced course totalizing 61 videos based on abdominal imaging over a period of 3 months. Performance was evaluated using the change between posttest (the same 20 MCQs as pretest) and pretest results. Satisfaction was measured using a satisfaction survey with directed and spontaneous feedbacks. Engagement was graded according to audience retention and attendance on a web content management system. Results Performance change between pre and posttest was significantly different between the four categories (ANOVA, P = 10−9): low pretest achievers demonstrated the highest improvement (mean ± SD, + 11.3 ± 22.8 points) while high pretest achievers showed a decrease in their posttest score (mean ± SD, − 3.6 ± 19 points). Directed feedback collected from 73.3% of participants showed a 99% of overall satisfaction. Spontaneous feedback showed that the concept of “pleasure in learning” was the most cited advantage, followed by “flexibility.” Engagement increased over years and the number of views increased of 2.47-fold in 2 years. Conclusion Learning formats including new pedagogical concepts as blended learning, and current technologies allow improvement in medical student’s performance, satisfaction, and engagement

Imagerie en coupe et anthropobiologie (applications médico-légales pour la détermination de l'âge)

TOULOUSE3-BU Sciences (315552104) / SudocSudocFranceF

Epidémiologie des décès médico-légaux : une nécessité ? (réflexion à propos de trois ans et six mois d'activité de l'Unité Médico-Judiciaire de Toulouse)

TOULOUSE3-BU Santé-Centrale (315552105) / SudocSudocFranceF

Etude tomodensitométrique du dimorphisme sexuel de l'os coxal immature en géométrie morphométrique

Les récents développements de la morphométrie géométrique ouvrent de nouvelles voies de recherche en anthropobiologie, notamment dans le cadre de l'étude du dimorphisme sexuel. Les données de la littérature concernant le dimorphisme de l'os coxal immature sont moins nombreuses que chez les individus matures, et présentent surtout des conclusions discordantes. Cette étude évalue le degré de dimorphisme de l'os coxal immature par morphométrie géométrique, à partir d'une série de 188 examens tomodensitométriques. Les variations de taille et de conformation ainsi identifiées, sont quantifiées, visualisées et discutées. Le dimorphisme sexuel de l'os coxal immature est un phénomène dépendant de l'âge, se manifestant à la fois par des différences de taille et/ou de conformation.TOULOUSE3-BU Santé-Centrale (315552105) / SudocSudocFranceF

Diagnosis of drowning using post-mortem computed tomography – state of the art

Aim of the study: Recent studies using post-mortem computed tomography (PMCT) have suggested this imaging modality is of value in the positive diagnosis of drowning. We summarize the data from the literature regarding the diagnostic value of CT in cases of drowning. Material and methods: We performed an all-language search of literature published from 1999 to 2013 with the key words “post-mortem CT scan”, “drowning and CT scan”, “near-drowning diagnosis”, and “drowning diagnosis”. Results : Only 11 articles, whose data enabled complementary statistical analysis, were included. The presence of fluid and sediment in paranasal sinuses appear to be the determinants of the diagnosis of drowning. The presence of fluid in the sinuses had a sensitivity of 100%, and of 90% in the trachea and main bronchi. The results were completed by the high specificity of the presence of sediment in the paranasal sinuses, upper airways and stomach, which was 100% for all three. Haemodilution was present in cases of drowning (p < 0.001). The values made it possible to formulate a decision algorithm for the diagnosis of drowning

Virtual anthropological study of the skeletal remains of San Fortunato (Italy, third century AD) with multislice computed tomography

In June 2010, the priests of the church of Santa Maria in Silvis in Serracapriola, Italy, asked the University of Foggia to study skeletal remains which they believed to be those of San Fortunato. San Fortunato lived in Rome in the third century AD and little is known about his life and death. For forensic and anthropological study to determine the geographical origin, sex, age, stature and diagnose any diseases, multislice computed tomography (MSCT) was performed. Due to time and administrative constraints (we had access to the remains for only one day, and no biological sampling was permitted), dry bone and DNA analyses were not performed. The remains, thought to be 17 centuries old, were severely damaged and conventional anthropological methods already transposed to MSCT could not be used. However, considerable information for reconstructive identification was obtained. The skeletal remains were those of an Italian male, of height between 1.53 m and 1.56 m, with age at death estimated between 20 and 40 years. The effects of taphonomic processes were also visible. No historical physical description of San Fortunato is available so we were unable to compare our results. To the best of our knowledge, this is the first case in which MSCT has been used to examine the presumed skeletal remains of a Saint. It also demonstrates that reconstructive identification can be performed independently of dry bone study and illustrates the value of MSCT when skeletal remains must be preserved

Evolution of Late Pliocene Hominin Midfacial Morphology. An Approach using Three-Dimensional Surface Registration

International audienceThe three-dimensional (3D) morphology of the facial skeleton is complex because it comprises several curved and small localized surfaces which form may help to differentiate masticatory patterns, species and phylogenetic relationships among fossil hominins. We quantified and visualized the facial shape variation in Late Pliocene hominins using the cutting-edge computational, similarity-based methods of 3D surface fine registration and 3D inspection colour mapping. Samples included specimens from Sterkfontein and Kromdraai B, South Africa. For comparative purposes, we added 10 adult chimpanzees and 10 adult bonobos with equal numbers of males and females, as well as some Early Pleistocene hominins from South and East Africa. Computed tomography data were used to generate three-dimensional triangulated mesh models which midfacial components were then converted into smooth NonUniform Rational B-Spline (NURBS) surfaces. In addition to the overall study of the midface, four separate analyses were conducted, each focused on a surface patch representing an area of morphology which have raised interest in the past (/e.g/., infraorbital region, zygomatic process, anterior pillar ...). Preliminary results suggest that the adult midfacial remains represented in our sample from Sterkfontein show a greater range of morphological differences when compared to the shape differences observed within each of our two extant samples (chimpanzees and bonobos). We discuss the implications of our results for the understanding of the facial differentiation and evolution among the Late Pliocene hominins (particularly, the gracile/robust lineage)