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Реальные возможности посмертной лучевой диагностики в практике судебно-медицинского эксперта
Реальные возможности посмертной лучевой диагностики в практике судебно-медицинского эксперта
Ковалев А.В., Кинле А.Ф., Коков Л.С. и др. Реальные возможности посмертной лучевой диагностики в практике судебно-медицинского эксперта. Consilium Medicum. 2016; 18 (13): 9–25. DOI: 10.26442/2075-1753_2016.13.9-25
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Аннотация
Цель исследования. В обзоре проанализированы результаты исследований по проблеме использования компьютерной томографии (КТ) и магнитно-резонансной томографии (МРТ) в судебно-медицинской экспертизе (СМЭ) взрослых лиц. Целью настоящего обзора является ознакомление судебно-медицинских экспертов и рентгенологов с ситуациями, наиболее распространенными в посмертной визуализации, а также с ее сильными и слабыми сторонами.
Материал и методы. Использованы основные интернет-ресурсы: Российская научная электронная библиотека (elibrary.ru), Embase, Medline, Web of Science, Cochrane database.
Результаты и выводы. Методы посмертной визуализации в СМЭ находятся на стадии активного изучения и формирования доказательной базы. «Золотым стандартом» посмертной диагностики остается традиционная аутопсия. Но роль томографических методов исследования постоянно растет. Для практических целей СМЭ трупов взрослых в большей степени подходит КТ. В ряде случаев следует комбинировать с аутопсией разные лучевые методы диагностики – КТ, КТ-ангиографию и МРТ. Посмертная лучевая диагностика может оказать большую помощь в визуализации механических повреждений, а также в установлении причины в ряде случаев скоропостижной смерти. Посмертная визуализация может быть востребована и в некоторых других распространенных в практике СМЭ ситуациях: механической асфиксии, утоплении, действии высокой и низкой температуры, исследовании гнилостно измененных и неопознанных трупов, выявлении инородных тел.
Ключевые слова: посмертная визуализация, компьютерная томография трупа, магнитно-резонансная томография трупа, аутопсия, виртопсия, обзор.
Material and methods. The basic Internet resources used: Russian Scientific Electronic Library (elibrary.ru), Embase, Medline, Web of Science, Cochrane database.
Results and conclusions. Methods for FE postmortem imaging are under active study and formation of the evidence base. "The gold standard" postmortem diagnosis is a traditional autopsy. But the role of tomographic methods of research is growing. For practical purposes, the FE adult cadavers more suitable for CT. In some cases, autopsy should be combined with different methods of beam diagnostics – CT, CT angiography and MRI. Posthumous ray diagnosis can be of great help in the visualization of mechanical damage, as well as to determine the cause in some cases, sudden death. Posthumous imaging may be required in some other common situations in the practice of FE: mechanical asphyxia, drowning, action of high and low temperature, research rotten modified and unidentified bodies, detection of foreign bodies.
Key words: postmortem CT, postmortem CT-angiography, postmortem MRI, postmortem imaging, postmortem biopsies, autopsy, virtopsy, systematic review.
Материал и методы. Использованы основные интернет-ресурсы: Российская научная электронная библиотека (elibrary.ru), Embase, Medline, Web of Science, Cochrane database.
Результаты и выводы. Методы посмертной визуализации в СМЭ находятся на стадии активного изучения и формирования доказательной базы. «Золотым стандартом» посмертной диагностики остается традиционная аутопсия. Но роль томографических методов исследования постоянно растет. Для практических целей СМЭ трупов взрослых в большей степени подходит КТ. В ряде случаев следует комбинировать с аутопсией разные лучевые методы диагностики – КТ, КТ-ангиографию и МРТ. Посмертная лучевая диагностика может оказать большую помощь в визуализации механических повреждений, а также в установлении причины в ряде случаев скоропостижной смерти. Посмертная визуализация может быть востребована и в некоторых других распространенных в практике СМЭ ситуациях: механической асфиксии, утоплении, действии высокой и низкой температуры, исследовании гнилостно измененных и неопознанных трупов, выявлении инородных тел.
Ключевые слова: посмертная визуализация, компьютерная томография трупа, магнитно-резонансная томография трупа, аутопсия, виртопсия, обзор.
________________________________________________
Material and methods. The basic Internet resources used: Russian Scientific Electronic Library (elibrary.ru), Embase, Medline, Web of Science, Cochrane database.
Results and conclusions. Methods for FE postmortem imaging are under active study and formation of the evidence base. "The gold standard" postmortem diagnosis is a traditional autopsy. But the role of tomographic methods of research is growing. For practical purposes, the FE adult cadavers more suitable for CT. In some cases, autopsy should be combined with different methods of beam diagnostics – CT, CT angiography and MRI. Posthumous ray diagnosis can be of great help in the visualization of mechanical damage, as well as to determine the cause in some cases, sudden death. Posthumous imaging may be required in some other common situations in the practice of FE: mechanical asphyxia, drowning, action of high and low temperature, research rotten modified and unidentified bodies, detection of foreign bodies.
Key words: postmortem CT, postmortem CT-angiography, postmortem MRI, postmortem imaging, postmortem biopsies, autopsy, virtopsy, systematic review.
Полный текст
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Авторы
А.В.Ковалев*1, А.Ф.Кинле2, Л.С.Коков3,4, В.А.Синицын5,6, В.А.Фетисов1, Б.А.Филимонов2
1 ФГБУ Российский центр судебно-медицинской экспертизы Минздрава России. 125284, Россия, Москва, ул. Поликарпова, д. 12/13;
2 ФГБОУ ДПО Российская медицинская академия непрерывного профессионального образования Минздрава России. 125993, Россия, Москва, ул. Баррикадная, д. 2/1;
3 ГБУЗ НИИ скорой помощи им. Н.В.Склифосовского Департамента здравоохранения г. Москвы. 129090, Россия, Москва, Б. Сухаревская пл., д. 3;
4 ФГБОУ ВО Первый Московский государственный медицинский университет им. И.М.Сеченова Минздрава России. 119991, Россия, Москва, ул. Трубецкая, д. 8, стр. 2;
5 ФГАУ Лечебно-реабилитационный центр Минздрава России. 125367, Россия, Москва, Иваньковское ш., д. 3;
6 ФГБОУ ВПО Московский государственный университет им. М.В.Ломоносова. 119192, Россия, Москва, Ломоносовский пр., д. 31, корп. 5
*mail@rc-sme.ru
1 Russian Center of Judicial Medical Expertise of the Ministry of Health of the Russian Federation. 125284, Russian Federation, Moscow, ul. Polikarpova, d. 12/13;
2 Russian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian Federation. 125995, Russian Federation, Moscow, ul. Barrikadnaia, d. 2/1;
3 N.V.Sklifosovsky Research Institute of Emergency Medicine of the Department of Health of Moscow. 129090, Russian Federation, Mosсow, B. Sukharevskaya pl., d. 3;
4 I.M.Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation. 119991, Russian Federation, Moscow, ul. Trubetskaia, d. 8, str. 2;
5 Treatment and Rehabilitation Center of the Ministry of Health of the Russian Federation. 125367, Russian Federation, Moscow, Ivan'kovskoe sh., d. 3;
6 M.V.Lomonosov Moscow State University. 119192, Russian Federation, Moscow, Lomonosovskii pr., d. 31, korp. 5
*mail@rc-sme.ru
1 ФГБУ Российский центр судебно-медицинской экспертизы Минздрава России. 125284, Россия, Москва, ул. Поликарпова, д. 12/13;
2 ФГБОУ ДПО Российская медицинская академия непрерывного профессионального образования Минздрава России. 125993, Россия, Москва, ул. Баррикадная, д. 2/1;
3 ГБУЗ НИИ скорой помощи им. Н.В.Склифосовского Департамента здравоохранения г. Москвы. 129090, Россия, Москва, Б. Сухаревская пл., д. 3;
4 ФГБОУ ВО Первый Московский государственный медицинский университет им. И.М.Сеченова Минздрава России. 119991, Россия, Москва, ул. Трубецкая, д. 8, стр. 2;
5 ФГАУ Лечебно-реабилитационный центр Минздрава России. 125367, Россия, Москва, Иваньковское ш., д. 3;
6 ФГБОУ ВПО Московский государственный университет им. М.В.Ломоносова. 119192, Россия, Москва, Ломоносовский пр., д. 31, корп. 5
*mail@rc-sme.ru
________________________________________________
1 Russian Center of Judicial Medical Expertise of the Ministry of Health of the Russian Federation. 125284, Russian Federation, Moscow, ul. Polikarpova, d. 12/13;
2 Russian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian Federation. 125995, Russian Federation, Moscow, ul. Barrikadnaia, d. 2/1;
3 N.V.Sklifosovsky Research Institute of Emergency Medicine of the Department of Health of Moscow. 129090, Russian Federation, Mosсow, B. Sukharevskaya pl., d. 3;
4 I.M.Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation. 119991, Russian Federation, Moscow, ul. Trubetskaia, d. 8, str. 2;
5 Treatment and Rehabilitation Center of the Ministry of Health of the Russian Federation. 125367, Russian Federation, Moscow, Ivan'kovskoe sh., d. 3;
6 M.V.Lomonosov Moscow State University. 119192, Russian Federation, Moscow, Lomonosovskii pr., d. 31, korp. 5
*mail@rc-sme.ru
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