Changes in the cholesterol profile of patients with rheumatoid arthritis treated with biologics or Janus kinase inhibitors

Objective@#To assess the effects of biological and targeted synthetic disease-modifying antirheumatic drugs (DMARDs) on lipid profiles in patients with moderate-to-severe rheumatoid arthritis (RA). @*Methods@#This retrospective single-center observational study included patients with RA taking a tumor necrosis factor-α inhibitor (TNFi), abatacept, tocilizumab, or a Janus kinase inhibitor (JAKi) for at least 6 months. Changes in lipid profile were assessed at 6 months after the start of treatment, and associations between changes in lipid profiles and clinical efficacy, concomitant medications, and comorbidities were evaluated. @*Results@#This study included 114 patients treated with TNFi, 81 with abatacept, 103 with tocilizumab, and 89 with JAKi. The mean percentage change (from baseline to 6 months) in total cholesterol, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and non-HDL-C levels was higher in those taking tocilizumab and JAKi than in those taking TNFi and abatacept. A significant change in non-HDL-C was associated with JAKi (versus TNFi: odds ratio [OR], 3.228; 95% confidence interval [CI], 1.536~6.785), tocilizumab (versus TNFi: OR, 2.203; 95% CI, 1.035~4.689), and statins (OR, 0.487; 95% CI, 0.231~1.024). However, changes in disease activity in 28 joints were not associated with a significant change in non-HDL-C. @*Conclusion@#Tocilizumab- and JAKi-associated increases in serum non-HDL-C levels were observed regardless of changes in disease activity. Statins are recommended for RA patients showing a significant increase in cholesterol levels after initiating biological and targeted synthetic DMARDs.

Analysis of Cases of Infants and Children Asphyxia at Day Care Center: Cases of Asphyxia in the Process of Teachers Putting the Infants and Children to Sleep / 대한법의학회지

In the cases of infants and children, there is a special form of accidental asphyxia that occurs in an unsafe sleeping environment. Rarely, some infants and children unexpectedly die in the day care centers. This also occurs during the process when teachers put the infants and children to sleep. This analysis was performed on national forensic autopsy cases from January 1, 2001, to October 31, 2022. The 97,402 cases were selected to provide their incident overview, the cause of death and the manner of death. The cases of infants and children asphyxia at day care centers were 43 cases (0.04%). The major cause of death was sudden infants and children death syndrome which included the possibility of accidental asphyxia (31 cases). This was followed by chocking (8 cases), complicated asphyxia (2 cases), smothering (1 case), and positional asphyxia (1 case). Two cases were a result of homicide, 10 cases were accidents, and 31 cases had unknown manner of death. There were four cases of asphyxia that occurred in the process of teachers putting infants and children to sleep. In all cases, there were no specific findings in the autopsy and there were CCTV footage including contact with the day care center teacher while taking a nap. Reporting these results provides information and awareness to social members related with infants and children, specially day care centers, and serves as basis for establishing social systems such as mandatory of CCTVs, helping to reduce the occurrence of similar death on infants and children.

A Statistical Analysis on Forensic Autopsies Performed in Korea in 2017 / 대한법의학회지

Statistical analysis was performed on national forensic autopsy data collected in the Republic of Korea, with the exception of Ulsan, during 2017. A total of 8,777 cases were categorized based on the region; information was provided by the Police Agency and the Coast Guard regarding sex, age, manner of death, and cause of death. Analysis of the manner of death revealed that 3,971 cases (45.2%) were unnatural deaths, 3,679 cases (41.9%) were natural deaths, and 1,127 cases (12.8%) were unknown deaths. Among the unnatural deaths, the majority of the cases (1,740 cases, 43.8%) were accidents, 1,316 cases (33.1%) were suicide, 385 cases (9.7%) were homicide, and 530 cases (13.3%) were undetermined deaths. Among the unnatural deaths, the majority of the cases (1,575 cases, 39.7%) were trauma, followed by 793 cases (20.0%) of poisoning and 689 cases (17.4%) of asphyxia. Falling down was the major cause of death by trauma (737 cases, 46.8%). As a result of the classification of asphyxia based on previous study, strangulation was the major cause, with 538 cases (78.1%). Among the natural deaths, heart disease was the major cause (1,790 cases, 48.7%), followed by vascular disease (697 cases, 18.9%).

Death due to Aspergillus Tracheobronchitis: An Autopsy Case / 대한법의학회지

Aspergillus infection is the most common cause of death due to fungi in immunocompromised hosts. Aspergillus tracheobronchitis is an uncommon but severe form of invasive pulmonary aspergillosis, which is limited entirely or mainly to the tracheobronchial tree and can often be life-threatening. We report a case of a 54-year-old man who died from Aspergillus tracheobronchitis without an underlying disease. Autopsy revealed an extensive yellowish plaque adhering to the trachea and bronchial wall. The microscopic examination of the trachea and bronchus revealed septate branching hyphae of Aspergillus.

A Statistical Analysis on Forensic Autopsies Performed in Korea in 2016 / 대한법의학회지

A statistical analysis was performed on national forensic autopsy data collected in the Republic of Korea during 2016 to overcome regional limitations and limitations from the number of unusual deaths as reported in the literature over the previous year. A total of 8,335 cases were categorized based on the region, based on requests by the Police Agency and the Coast Guard, gender, age, manner of death, and cause of death. Analysis of the manner of death revealed that 4,028 cases (48.3%) were of unnatural death, 3,447 cases (41.4%) were of natural death, and 860 cases (10.3%) were of unknown death. Among the unnatural deaths, the majority of the manner of deaths (1,584 cases, 39.3%) was accidents, 1,378 cases (34.2%) were suicides, 428 cases (10.6%) were homicides, and 638 cases (15.8%) were undetermined deaths. Among the unnatural deaths, the majority of the cause of deaths (1,518 cases, 37.7%) was due to trauma, followed by 827 cases (20.5%) of poisoning and 732 cases (18.2%) of asphyxia. Falling was the major cause of death by trauma (668 cases, 44.0%). Based on a previous study about asphyxia, strangulation was the major cause, with 569 cases (77.7%). Among the natural deaths, heart disease was the major cause (1,727 cases, 50.1%), followed by vascular disease (587 cases, 17.0%).

Retrospective Genetic Analysis of 200 Cases of Sudden Infant Death Syndrome and Its Relationship with Long QT Syndrome in Korea

BACKGROUND: There has been a campaign by the National Education on Sleeping Habits and Living Environment, to reduce the incidence of sudden infant death syndrome (SIDS). However, more than 100 infants die suddenly and unexplainably before the age of 1 year in Korea. Long QT syndrome (LQTS), an inheritable cardiac disease, has been reported to likely be associated with up to 14% of SIDS cases. However, genetic studies of the association between SIDS and LQTS have not yet been conducted in Korea. METHODS: We conducted genetic analysis using genomic DNA extracted from paraffin-embedded tissue blocks from 200 SIDS cases autopsied between 2005 and 2013. We analyzed the following genetic mutations associated with LQTS, KCNQ1, SCN5A, KCNE1, KCNE2, KCNJ2, and CAV3. RESULTS: Of the 200 SIDS cases, 58% involved male infants (116 male and 84 female infants, respectively), the mean age was 140 days (median, 107 days; range, 24–270 days), and they were all of Asian-Korean ethnicity. SIDS IA category criteria comprised 45 cases (22.5%) while the rest were SIDS IB. Fifteen infants (7.5%) had R1193Q in SCN5A, of doubtful pathogenicity, and no pathogenic LQTS variants were observed. CONCLUSION: This genetic investigation of LQTS in SIDS showed a low diagnostic yield. These findings suggest that LQTS molecular autopsy could be cautiously conducted in selected cases with family involvement to improve the available genetic counseling information. Meanwhile, a national SIDS registry should be established to document and evaluate the genetic risk of SIDS in Korea.

A Statistical Analysis on Forensic Autopsies Performed in Korea in 2017 / 대한법의학회지

Statistical analysis was performed on national forensic autopsy data collected in the Republic of Korea, with the exception of Ulsan, during 2017. A total of 8,777 cases were categorized based on the region; information was provided by the Police Agency and the Coast Guard regarding sex, age, manner of death, and cause of death. Analysis of the manner of death revealed that 3,971 cases (45.2%) were unnatural deaths, 3,679 cases (41.9%) were natural deaths, and 1,127 cases (12.8%) were unknown deaths. Among the unnatural deaths, the majority of the cases (1,740 cases, 43.8%) were accidents, 1,316 cases (33.1%) were suicide, 385 cases (9.7%) were homicide, and 530 cases (13.3%) were undetermined deaths. Among the unnatural deaths, the majority of the cases (1,575 cases, 39.7%) were trauma, followed by 793 cases (20.0%) of poisoning and 689 cases (17.4%) of asphyxia. Falling down was the major cause of death by trauma (737 cases, 46.8%). As a result of the classification of asphyxia based on previous study, strangulation was the major cause, with 538 cases (78.1%). Among the natural deaths, heart disease was the major cause (1,790 cases, 48.7%), followed by vascular disease (697 cases, 18.9%).

Death due to Aspergillus Tracheobronchitis: An Autopsy Case / 대한법의학회지

Aspergillus infection is the most common cause of death due to fungi in immunocompromised hosts. Aspergillus tracheobronchitis is an uncommon but severe form of invasive pulmonary aspergillosis, which is limited entirely or mainly to the tracheobronchial tree and can often be life-threatening. We report a case of a 54-year-old man who died from Aspergillus tracheobronchitis without an underlying disease. Autopsy revealed an extensive yellowish plaque adhering to the trachea and bronchial wall. The microscopic examination of the trachea and bronchus revealed septate branching hyphae of Aspergillus.

A Statistical Analysis on Forensic Autopsies Performed in Korea in 2016 / 대한법의학회지

A statistical analysis was performed on national forensic autopsy data collected in the Republic of Korea during 2016 to overcome regional limitations and limitations from the number of unusual deaths as reported in the literature over the previous year. A total of 8,335 cases were categorized based on the region, based on requests by the Police Agency and the Coast Guard, gender, age, manner of death, and cause of death. Analysis of the manner of death revealed that 4,028 cases (48.3%) were of unnatural death, 3,447 cases (41.4%) were of natural death, and 860 cases (10.3%) were of unknown death. Among the unnatural deaths, the majority of the manner of deaths (1,584 cases, 39.3%) was accidents, 1,378 cases (34.2%) were suicides, 428 cases (10.6%) were homicides, and 638 cases (15.8%) were undetermined deaths. Among the unnatural deaths, the majority of the cause of deaths (1,518 cases, 37.7%) was due to trauma, followed by 827 cases (20.5%) of poisoning and 732 cases (18.2%) of asphyxia. Falling was the major cause of death by trauma (668 cases, 44.0%). Based on a previous study about asphyxia, strangulation was the major cause, with 569 cases (77.7%). Among the natural deaths, heart disease was the major cause (1,727 cases, 50.1%), followed by vascular disease (587 cases, 17.0%).

Discrepancy of the Cause of Death in Autopsy Cases of Cardiovascular Disease with a Focus on Cause of Death Statistics / 대한법의학회지

Determining the cause of death (COD) is important not only as personal information, but also as social statistical data. An autopsy is the gold standard for investigating death and determining the COD. CODs determined by an autopsy in countries with low autopsy rates, such as Korea, can serve as important data in constructing nationwide statistics. We compared and analyzed cases of CODs corresponding with the same cases of cardiovascular disease determined by autopsy and CODs from Statistics Korea. Among autopsies performed in Korea during 2015, the present study selected 1,920 cases of cardiovascular disease as the COD and analyzed 1,468 of those that could be confirmed by Statistics Korea. Main CODs included ischemic heart disease, acute myocardial infarction, sudden cardiac death, intracerebral hemorrhage, subarachnoid hemorrhage, aortic aneurysm and dissection, pulmonary embolism, and esophageal varix. Among these, COD by autopsy was confirmed with Statistics Korea data in more than 90% of cases involving acute myocardial infarction, intracerebral hemorrhage, subarachnoid hemorrhage, and aortic aneurysm and dissection, whereas cases involving ischemic heart disease, sudden cardiac death, pulmonary embolism, and esophageal varix showed a relatively wide variety of CODs from Statistics Korea. It is believed that forensic autopsies should be effectively reflected for more accurate COD statistics. Thus, final CODs from Statistics Korea should be determined based on careful discussions between the forensic pathologist and staff in charge at Statistics Korea, and a systematic upgrade that would allow for reconfirmation of the final COD is necessary.

The Predictive Ratios of Intoxicated Deaths by Police's Death Scene Investigation and Doctor's Death Certificates in South Korea / 대한법의학회지

Forensic autopsies were performed on 1,821 cases in 2014 and 2,024 cases in 2015 at the National Forensic Service Seoul Institute. Based on the autopsy reports, 103 cases (5.7%) in 2014 and 130 cases (6.4%) in 2015 were selected as unnatural deaths caused by fatal intoxication. The cases were divided into five groups. The first group had ethanol intoxication, the second had drug intoxication, the third had agrochemical intoxication, the fourth had cyanide intoxication, and the fifth had miscellaneous intoxications. Of the 233 cases, 202 had death certificates. Of these 202 cases, 169 (83.7%) had an undetermined manner of death (MOD); 17 (8.4%) had an unnatrual MOD and intoxication was the cause of death (COD); nine (4.5%) had an unnatural MOD, but the COD was not intoxication; seven (3.5%) had a natural MOD and disease as a COD. The predictive ratios of intoxication as a COD were compared with the death certificates and the police death scene investigation results. The death certificates and the police investigation results showed predictive ratios of 8.4% and 55.2%, respectively, for intoxication as a COD. The discrepance in these predictive ratios and relatively low predictive ratio of police investigation results mean that intoxicated deaths have been underevaluated; thus, some homicides or intentional deaths were probably missed under South Korea's death investigation system. Doctors who specialize in forensic medicine need to supervise the entire postmortem examination process and emergency blood toxicological analysis should be performed in South Korea.

A Statistical Analysis on Forensic Autopsies Performed in Korea in 2015 / 대한법의학회지

The statistical analysis of forensic autopsies provides basic data for the postmortem investigation system and is the foundation of the statistics used in the analysis of the causes of death. A statistical analysis was performed on national forensic autopsy data collected in the Republic of Korea during 2015 to overcome regional limitations and limitations from the number of unusual deaths in the current forensic autopsy research. A total of 6,610 cases were categorized based on the region, requested Police Agency or Coast Guard, gender, age, manner of death, and cause of death. Analysis of the manner of death revealed that 3,326 cases (50.3%) were unnatural death, 2,754 cases (41.7%) were natural death, and 530 cases (8.0%) were of unknown. Of the 3,326 cases of unnatural death, the majority (1,275 cases, 38.3%) were accidents, 1,040 cases (31.3%) were suicide, 481 cases (14.5%) were homicide, and 530 cases (15.9%) were undetermined death. Among the unnatural death, the majority (1,330 cases, 40.0%) were trauma, followed by 588 cases (17.7%) of asphyxia and 566 cases (17.0%) of poisoning. Fall down were the major cause of death by trauma (538 cases, 40.5%). On the basis of a previous study, there were 588 cases of asphyxia; strangulation was the major cause, with 472 cases (80.3%). Of the 2,754 cases of natural death, heart disease was the major cause (1,417 cases, 51.5%), followed by vascular disease (503 cases, 18.3%).

Discrepancies in the Cause and Manner of Death Reported in Postmortem Inspection and Autopsy / 대한법의학회지

Currently in the Republic of Korea, most postmortem investigations occur within the context of a death scene investigation and are restricted to a postmortem inspection without a subsequent autopsy. In this study, we analyzed the discrepancies between the results of postmortem inspection and autopsy to investigate the limits of postmortem inspection. The conclusions about the cause and manner of death stated in the two reports were compared. A retrospective study was carried out on 6,126 autopsy cases performed in the Republic of Korea in 2015. Of these autopsy cases, 2,263 included postmortem inspection reports. The stated cause and manner of death conflicted with the autopsy report in 55.1% and 32.9% of the postmortem inspection reports, respectively. Among these conflicted reports, the cause and manner of death was undetermined in 66.6% and 70.3% of the postmortem inspection reports, respectively. Furthermore, different types of discrepancies were found between the causes and manner of death that were stated in the reports by police investigators and those by forensic pathologists. This study revealed that postmortem inspection is not sufficient in the postmortem investigation and forensic autopsies need to be performed.

Endoscopic Electrosurgery in Patients with Cardiac Implantable Electronic Devices

BACKGROUND/AIMS: Patients with cardiac implantable electronic devices (CIEDs) undergoing endoscopic electrosurgery (EE) are at a risk of electromagnetic interference (EMI). We aimed to analyze the effects of EE in CIED patients. METHODS: Patients with CIED who underwent EE procedures such as snare polypectomy, endoscopic submucosal dissection (ESD), and endoscopic retrograde cholangiopancreatography (ERCP) with endoscopic sphincterotomy (EST) were retrospectively analyzed. Postprocedural symptoms as well as demographic and outpatient follow-up data were reviewed through medical records. Electrical data, including preprocedural and postprocedural arrhythmia records, were reviewed through pacemaker interrogation, 24-hour Holter monitoring, or electrocardiogram. RESULTS: Fifty-nine procedures in 49 patients were analyzed. Fifty procedures were performed in 43 patients with a pacemaker, and nine were performed in six patients with an implantable cardioverter-defibrillator. There were one gastric and 44 colon snare polypectomies, five gastric and one colon ESDs, and eight ERCPs with EST. Fifty-five cases of electrical follow-up were noted, with two postprocedural changes not caused by EE. Thirty-one pacemaker interrogations had procedure recordings, with two cases of asymptomatic tachycardia. All patients were asymptomatic with no adverse events. CONCLUSIONS: Our study reports no adverse events from EE in patients with CIED, suggesting that this procedure is safe. However, because of the possibility of EMI, recommendations on EE should be followed.

Postmortem Diagnosis of Diabetic Ketoacidosis: An Autopsy Case / 대한법의학회지

Diabetic ketoacidosis is an acute complication of type 1 diabetes mellitus, which is observed frequently in routine autopsies. However, there are limitations of postmortem diagnosis of diabetic ketoacidosis. Clinical diagnostic criteria of the disease are not applicable to postmortem diagnosis because of the postmortem changes of the body; hence, diagnostic morphological changes cannot be observed. We report the case of a 47-year-old man that was diagnosed with diabetic ketoacidosis via routine autopsy and laboratory tests without information regarding his medical history. Additionally, we present a brief literature review.

Lung Transplantation in a Patient with Pre-transplant Colonization of Extensively Drug-resistant Acinetobacter baumannii / 대한중환자의학회지

Colonization of the pre-transplant lung by multidrug-resistant bacteria affects short- and long-term outcomes of lung transplantation. However, there are no case reports on the colonization of a pre-transplant lung by drug-resistant Acinetobacter baumannii. We report a case of extensively drug resistant (XDR) A. baumannii colonization in the tracheobronchial tree that caused severe infectious complications after bilateral lung transplantation. A 23-year-old man diagnosed with bronchiolitis obliterans syndrome (BOS) 4 years earlier with a history of allogenic bone marrow transplantation for acute lymphoblastic leukemia was admitted to the hospital with dyspnea. Due to progressive hypercapnic respiratory failure, long-term mechanical ventilation was started after a tracheostomy was performed, and the patient underwent a bilateral lung transplantation to treat end-stage BOS. After the transplantation, the colonization of XDR A. baumannii caused severe bacterial pneumonia in the early postoperative period. Combined treatment with colistin and meropenem led to recovery from the pneumonia but caused drug-induced renal failure. Because many centers are willing to transplant candidates who are on mechanical ventilation or extracorporeal life support, the incidence of XDR A. baumannii colonization of pretransplant lungs is expected to increase. Further studies are needed to examine pre-transplant management strategies in patients colonized with XDR A. baumannii.

Lung Transplantation in a Patient with Pre-transplant Colonization of Extensively Drug-resistant Acinetobacter baumannii / 대한구급학회지

Colonization of the pre-transplant lung by multidrug-resistant bacteria affects short- and long-term outcomes of lung transplantation. However, there are no case reports on the colonization of a pre-transplant lung by drug-resistant Acinetobacter baumannii. We report a case of extensively drug resistant (XDR) A. baumannii colonization in the tracheobronchial tree that caused severe infectious complications after bilateral lung transplantation. A 23-year-old man diagnosed with bronchiolitis obliterans syndrome (BOS) 4 years earlier with a history of allogenic bone marrow transplantation for acute lymphoblastic leukemia was admitted to the hospital with dyspnea. Due to progressive hypercapnic respiratory failure, long-term mechanical ventilation was started after a tracheostomy was performed, and the patient underwent a bilateral lung transplantation to treat end-stage BOS. After the transplantation, the colonization of XDR A. baumannii caused severe bacterial pneumonia in the early postoperative period. Combined treatment with colistin and meropenem led to recovery from the pneumonia but caused drug-induced renal failure. Because many centers are willing to transplant candidates who are on mechanical ventilation or extracorporeal life support, the incidence of XDR A. baumannii colonization of pretransplant lungs is expected to increase. Further studies are needed to examine pre-transplant management strategies in patients colonized with XDR A. baumannii.

The Statistical Analysis on Legal Autopsy Performed in Korea during 2012 Year / 대한법의학회지

This statistical analysis of 4,709 legal autopsies performed in Korea in 2012 was conducted to obtain primary data about and related variables. The analysis revealed the following: 1. Of the total number of deaths, men accounted for and women, 26.8%. Evidently, the number of deaths among men was more than twice that among women. 2. With respect to mode of death, 54.8% were recorded as unnatural deaths, 39.2% were natural deaths, and 6.0% had unknown causes. Of the 2,581 unnatural deaths, 44.8% were accidental deaths; 27.2%, suicidal; 17.5%, homicidal; and 10.3%, undetermined. 3. Of the total number of unnatural deaths, 43.0% were trauma-related deaths, for which falling down was the leading cause, accounting for 33.5% cases. Asphyxiation was accounted for 17.2%, among which the predominant cause was hanging (55.3%). Moreover, 12.5% of deaths were due to drowning; 11.5%, poisoning; 11.2%, thermal injuries; 2.7%, complications in medical procedures; and 0.3%, electrocution, starvation, or neglect. 4. Among 1,847 natural deaths, heart diseases accounted for 50.2% and vascular diseases accounted for 16.7%. 5. There were 207 cases of deaths among children under the age of 10, of which 94 were unnatural and 49 were homicidal deaths. Of all cases, 9.2% had an unknown cause of death, and of these 67.6%, were putrefied or skeletonized bodies.

An Autopsy Case of Severe Ovarian Hyperstimulation Syndrome with Multifocal Arterial and Venous Thromboembolism / 대한법의학회지

Ovarian hyperstimulation syndrome (OHSS) is a rare, serious complication of assisted reproductive procedures for fertility treatment. Although most cases of OHSS are mild to moderate in nature, its severe form causes life-threatening complications including respiratory distress, renal failure, liver dysfunction, and thromboembolism because of hemoconcentration. We herein report a rare autopsy case of severe OHSS in a 29-year-old woman who underwent controlled ovulation induction. Three days after the administration of human chorionic gonadotropin, she developed abdominal pain and distension. Two days after, she suddenly developed respiratory arrest, hypotension and semicomatose mentality and died of respiratory failure. At autopsy, multifocal thromboembolism was detected in the internal carotid arteries, internal jugular veins, pulmonary arteries, inferior vena cava, renal arteries, and deep leg veins. And there were cerebral edema, anasarca, pleural effusion, massive pulmonary edema, ascites, and bilateral ovarian enlargement. Microscopically, the bilateral ovaries showed multiple well-developed cyst formations consisting of membrana granulosa and theca interna. To the best of our knowledge, this is the first autopsy report of severe OHSS with multifocal arterial and venous thromboembolism.

Utility of Postmortem Autopsy via Whole-Body Imaging: Initial Observations Comparing MDCT and 3.0T MRI Findings with Autopsy Findings

OBJECTIVE: We prospectively compared whole-body multidetector computed tomography (MDCT) and 3.0T magnetic resonance (MR) images with autopsy findings. MATERIALS AND METHODS: Five cadavers were subjected to whole-body, 16-channel MDCT and 3.0T MR imaging within two hours before an autopsy. A radiologist classified the MDCT and 3.0T MRI findings into major and minor findings, which were compared with autopsy findings. RESULTS: Most of the imaging findings, pertaining to head and neck, heart and vascular, chest, abdomen, spine, and musculoskeletal lesions, corresponded to autopsy findings. The causes of death that were determined on the bases of MDCT and 3.0T MRI findings were consistent with the autopsy findings in four of five cases. CT was useful in diagnosing fatal hemorrhage and pneumothorax, as well as determining the shapes and characteristics of the fractures and the direction of external force. MRI was effective in evaluating and tracing the route of a metallic object, soft tissue lesions, chronicity of hemorrhage, and bone bruises. CONCLUSION: A postmortem MDCT combined with MRI is a potentially powerful tool, providing noninvasive and objective measurements for forensic investigations.