The added value of post-mortem MRI in forensic imaging: an observational study in the Netherlands

Abstract Objectives In the Netherlands, post-mortem radiology aids forensic investigation, using a full-body post-mortem computed tomography (PMCT) scan and a post-mortem magnetic resonance imaging (PMMRI) scan in specific cases. Application of PMMRI varies between countries and institutions in the absence of international guidelines. This study analyses current use and added value of PMMRI in a single forensic imaging institution in the Netherlands. Materials and methods All post-mortem cases scanned between July 2024 and July 2025 were included, except non-accidental injury protocol cases. The (contra-)indications for additional PMMRI scans in addition to PMCT were recorded. On the same day as image evaluation, added value was scored by the forensic radiologist and consultant using the following options: additional finding, exclusion of a finding, confirmation of PMCT and no added value. Results PMMRI was conducted in 47.4% of all cases, indicated by suspected strangulation, penetrating injuries, blunt force trauma and lesions seen on PMCT. In suspected strangulation, PMMRI neck showed additional findings or exclusion of findings in 31/46 cases, while PMMRI brain had the lowest added value in 13/25 cases. PMMRI thorax and abdomen showed additional findings in 14/20 and 4/9 cases of penetrating trauma, respectively. Additional findings were found in 10/15 PMMRI brain scans and 6/8 PMMRI thorax scans, based on PMCT. Conclusion Application of PMMRI in addition to PMCT is currently used in a targeted manner. In cases of strangulation and penetrating injuries, additional or excluded findings were found. Therefore, adding PMMRI in these specific cases can be of added value. Key Points Question What is the added value of post-mortem MRI in forensic cases, in the absence of international guidelines and standardised indications? Findings Additional findings were observed in post-mortem MRI examinations indicated for soft tissue injuries caused by penetrating force and in cases of suspected strangulation. Critical Relevance Statement The criminal investigation can be optimised by using post-mortem MRI in addition to post-mortem CT, either by showing additional findings on post-mortem MRI not seen on CT, or by excluding findings with higher certainty.