Ex-situ identification of vertebral artery injuries from stab wounds through contrast-enhanced fluoroscopy and micro-CT

Vertebral artery injuries (VAIs) are rarely observed in forensic practice and can result from either penetrating injuries or blunt force trauma to the neck. The identification of such injuries represents a pivotal challenge for forensic pathologists, due to the protected anatomical course of these vessels, particularly in their extracranial tract. Over the years, several approaches have been proposed to address this issue, including vessel gross examination through different dissection techniques, the water injection method and, more recently, post-mortem computed tomography angiography (PMCTA), which is currently deemed the gold standard approach. However, no studies have employed contrast-enhanced radiological techniques using an ex-situ approach to investigate VAIs.The aim of this study is to investigate the diagnostic potential of fluoroscopy and contrast-enhanced micro-CT in detecting extracranial vertebral artery lesions via an ex-situ approach. Cervical blocks (C1-C3) from three forensic cases of neck stab wounds were collected, and fluoroscopy and contrast-enhanced micro-CT, using Barium Sulfate and Diatrizoate Sodium as contrast agents respectively, were performed. The above radiological techniques proved accurate and reliable in identifying vascular injuries, exhibiting enhanced diagnostic performance compared to conventional macroscopic examination. Fluoroscopy provides dynamic imaging, enabling real-time detection of contrast leakages, while contrast-enhanced micro-CT allows simultaneous assessment of both vascular injuries and bone fractures. Therefore, these promising techniques could serve as complementary tools to conventional diagnostic approaches, offering an accurate and comprehensive characterization of the cervical injury pattern in cases of fatal penetrating neck trauma.