kjlm The Korean Journal of Laboratory Medicine Korean J Leg Med 2383-5702 2383-5710 The Korean Society for Legal Medicine 10.7580/kjlm.2020.44.1.24 kjlm-44-24 Original Article Usefulness of Near-infrared Spectroscopy for Diagnosis of Traumatic Intracranial Hemorrhage in Postmortem Inspection ParkJong-Pil 1 LeeTak Su 2 ChoiMinsung 2 YangKyung-moo 3 ParkJeongwoo 2 WonYujin 2 ChoiSeung Gyu 2 LeeKyunghong 2 KimJeong Hwan 4 KangChae Lin 5 ChoiSeung Woo 6 Department of Forensic Medicine, Yonsei University College of Medicine, Seoul, Korea Division of Forensic Medicine Investigation, National Forensic Service Seoul Institute, Seoul, Korea Medical Examiner's Office, National Forensic Service, Wonju, Korea Division of Forensic Medicine, National Forensic Service Daejeon Institute, Daejeon, Korea Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Korea Korea Center for Disease Control and Prevention, Cheongju, Korea Correspondence to Jong-Pil Park Department of Forensic Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea Tel: +82-2-2228-2482 Fax: +82-2-362-0860 E-mail: parkjp@yuhs.ac 12020 812020 441 2430 05022020 13022020 21022020 Copyright © 2020 The Korean Society for Legal Medicine 2020 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract

Near-infrared spectroscopy is a device used to determine whether traumatic intracranial hemorrhage has occurred and is primarily used for screening in emergency situations. In this study we examined the applicability of this equipment in postmortem inspection. This study included 124 autopsy cases and 59 postmortem inspection cases performed in the National Forensic Service from July 2017 to October 2018. We carried out the test using Infrascanner Model 2000 (Infrascan Inc.). Autopsy cases were divided into four groups (epidural hemorrhage or subdural hemorrhage group, traumatic subarachnoid hemorrhage or cerebral contusion group, nontraumatic intracerebral hemorrhage group, and control group) and analyzed. There was no difference in the test results according to the presence and type of intracranial hemorrhage. The possibility that variables related to postmortem change affected the test results was considered. In conclusion, this study confirmed that near-infrared spectroscopy is not suitable for the detection of traumatic intracranial hemorrhage in postmortem inspection.

 Near-infrared spectroscopy Intracranial hemorrhages Postmortem changes REFERENCES Leon-Carrion J Dominguez-Roldan JM Leon-Dominguez U The Infrascanner, a handheld device for screening in situ for the presence of brain haematomas Brain Inj 2010241193201 Ayaz H Izzetoglu M Izzetoglu K Early diagnosis of traumatic intracranial hematomas J Biomed Opt 201924110 Bressan S Daverio M Martinolli F The use of handheld near-infrared device (Infrascanner) for detecting intracranial haemorrhages in children with minor head injury Childs Nerv Syst 20143047784 Kontojannis V Hostettler I Brogan RJ Detection of intracranial hematomas in the emergency department using near infrared spectroscopy Brain Inj 20193387583 Liang CY Yang Y Shen CS Chinese military evaluation of a portable near-infrared detector of traumatic intracranial hematomas Mil Med 2018183e31823 Peters J Van Wageningen B Hoogerwerf N Near-infrared spectroscopy: a promising prehospital tool for management of traumatic brain injury Prehosp Disaster Med 2017324148 Schober P Bossers SM Schwarte LA Intracranial hematoma detection by near infrared spectroscopy in a helicopter emergency medical service: practical experience Biomed Res Int 201720171846830 Semenova Zh B Marshintsev AV Melnikov AV Infrascanner in the diagnosis of intracranial lesions in children with traumatic brain injuries Brain Inj 2016301822 Figures and Tables

Receiver operating characteristic (ROC) curve of difference in optical density (ΔOD) for postmortem diagnosis of traumatic intracranial hemorrhage.

Success rate of near-infrared spectroscopy test by anatomical position

No. Frontal area Temporal area Parietal area Occipital area
Autopsy 124 122 (98.4) 117 (94.4) 107 (86.3) 104 (83.9)
PI 59 59 (100) 59 (100) 59 (100) 57 (96.4)

Values are presented as number (%). PI, postmortem inspection.

Comparison of difference in optical density (∆OD) according to type of intracranial hemorrhage

Group I Group II Group III Group IV P-value
No. Median (IQR) No. Median (IQR) No. Median (IQR) No. Median (IQR)
Frontal area 14 0.36 (0.52) 11 0.14 (0.52) 13 0.19 (0.24) 84 0.14 (0.19) 0.083
Temporal area 14 0.99 (1.22) 10 0.59 (0.66) 11 0.32 (0.48) 82 0.24 (0.33) 0.012
Parietal area 12 0.32 (0.55) 10 0.18 (0.24) 10 0.33 (0.31) 75 0.26 (0.39) 0.289
Occipital area 9 0.32 (1.13) 10 0.43 (1.09) 10 0.41 (0.67) 75 0.23 (0.34) 0.324

P-values were determined with use of the Kruskal-Wallis test.

Group I, epidural hemorrhage or subdural hemorrhage; Group II, traumatic subarachnoid hemorrhage or cerebral contusion; Group III, nontraumatic intracerebral hemorrhage; Group IV, control; IQR, interquartile range.

Comparison of positive rate according to type of intracranial hemorrhage

Group I Group II Group III Group IV P-value
Frontal area
 Positive 9 (64.3) 5 (45.5) 6 (46.2) 32 (38.1) 0.077
 Negative 5 (35.7) 6 (54.5) 7 (53.8) 52 (61.9)  
Temporal area
 Positive 10 (71.4) 8 (80.0) 7 (63.6) 52 (63.4) 0.364
 Negative 4 (28.6) 2 (20.0) 4 (36.4) 30 (36.6)  
Parietal area
 Positive 9 (75.0) 4 (40.0) 8 (80.0) 46 (61.3) 0.751
 Negative 3 (25.0) 6 (60.0) 2 (20.0) 29 (38.7)  
Occipital area
 Positive 6 (66.7) 7 (70.0) 7 (70.0) 43 (57.3) 0.362
 Negative 3 (33.3) 3 (30.0) 3 (30.0) 32 (42.7)  

Values are presented as number (%).

P-value were determined with use of the Mantel-Haenszel x2 test.

Group I, epidural hemorrhage or subdural hemorrhage; Group II, traumatic subarachnoid hemorrhage or cerebral contusion; Group III, nontraumatic intracerebral hemorrhage; Group IV, control.

Difference in optical density (∆OD) and false-positive rate in postmortem inspection

No. Median (IQR) False-positive rate (%)
Frontal area 59 0.12 (0.15) 27.1
Temporal area 59 0.18 (0.30) 47.5
Parietal area 59 0.20 (0.29) 50.8
Occipital area 57 0.20 (0.24) 50.9

IQR, interquartile range.

Optimal cutoff value of difference in optical density (∆OD) for postmortem test

Frontal area Temporal area Parietal area Occipital area
AUC 0.739 0.710 0.534 0.583
Cutoff value 0.45 0.99 0.29 0.69
Sensitivity (%) 50.0 57.1 66.7 44.4
Specificity (%) 89.8 97.2 56.8 84.2

AUC, area under the curve.