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Park, Lee, Choi, Yang, Park, Won, Choi, Lee, Kim, Kang, and Choi: Usefulness of Near-infrared Spectroscopy for Diagnosis of Traumatic Intracranial Hemorrhage in Postmortem Inspection
Original Article

Korean J Leg Med 2020;44(1):24-30.

Published online: 8 January 2020

DOI: https://doi.org/10.7580/kjlm.2020.44.1.24

Usefulness of Near-infrared Spectroscopy for Diagnosis of Traumatic Intracranial Hemorrhage in Postmortem Inspection

Jong-Pil Park1, Tak Su Lee2, Minsung Choi2, Kyung-moo Yang3, Jeongwoo Park2, Yujin Won2, Seung Gyu Choi2, Kyunghong Lee2, Jeong Hwan Kim4, Chae Lin Kang5, Seung Woo Choi6

1Department of Forensic Medicine, Yonsei University College of Medicine, Seoul, Korea

2Division of Forensic Medicine Investigation, National Forensic Service Seoul Institute, Seoul, Korea

3Medical Examiner's Office, National Forensic Service, Wonju, Korea

4Division of Forensic Medicine, National Forensic Service Daejeon Institute, Daejeon, Korea

5Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Korea

6Korea 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

      Revised 5 February 202013 February 2020       Accepted 21 February 2020

Copyright © 2020 The Korean Society for Legal Medicine

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.

Keywords: Near-infrared spectroscopy, Intracranial hemorrhages, Postmortem changes

REFERENCES

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Fig. 1.
Receiver operating characteristic (ROC) curve of difference in optical density (ΔOD) for postmortem diagnosis of traumatic intracranial hemorrhage.
kjlm-44-24f1.tif
Table 1.
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.

Table 2.
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.

Table 3.
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.

Table 4.
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.

Table 5.
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.

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