Neuroimaging in Non-fatal Strangulation: a Retrospective Analysis of Injury Patterns, Clinical Features and Diagnostic Utility.

PURPOSE: To assess the incidence and patterns of injuries after non-fatal self-inflicted (SIS) and non-self-inflicted strangulation (NSIS) and evaluate diagnostic utility of computed tomography (CT) and magnetic resonance imaging (MRI).

METHODS

Single-center retrospective analysis (2013-2024) of patients undergoing CT and/or MRI following SIS/NSIS. Demographics, psychiatric comorbidity, strangulation mechanism, clinical symptoms and imaging findings were analyzed. Imaging was assessed for strangulation-associated injuries (e.g., fractures of the hyoid-larynx-complex [HLC], soft tissue hematoma [STH], blunt cervicovascular injury [BCVI]). Descriptive statistics were performed to detect risk factors for strangulation-associated injuries.

RESULTS

106 patients (55.7% female; mean age 40.2 years) and 124 events of strangulation with subsequent neuroimaging were included (CT: 96.8%, MRI: 3.2%). SIS comprised 80.6% of cases, mostly ligature strangulation (68.0%), followed by near-hanging (29.0%). NSIS accounted for 18.5% of cases. Eleven patients sustained strangulation-associated injuries, primarily HLC fractures and STH (6 cases each), but no BCVI. Older age (odds ratio: 1.04; 95% confidence interval: 1.01-1.07; p = 0.021) showed a weak association and male sex (6.32, 1.31-30.59, p = 0.022), near-hanging (12.36, 3.19-47.81, p < 0.001) and intubation (8.65, 2.04-36.78, p < 0.001) a moderate association with strangulation-associated injuries. We identified a distinct patient subgroup with recurrent SIS, characterized by predominant female sex, younger age and psychiatric disorders presenting with emotional instability. Injuries were not detected in any of these cases.

CONCLUSION

Severe strangulation-associated injuries are rare. CT should be used selectively, particularly in alert patients lacking relevant clinical findings. MRI may be preferable in younger patients and for forensic evaluation, particularly in NSIS.