To evaluate forensic identification of individuals through visual comparison of sphenoid sinus anatomical configuration using ante- and post-mortem CT-scans.

Ante- and post-mortem head CT-scan of 33 individuals were retrospectively collected. Ten head CT-scans were randomly selected from various neurological contexts and added to the ante-mortem group. Ten other head CT-scans were randomly selected from our post-mortem PACS and added to the post-mortem group. These CT-scans were assigned into 2 groups for analysis: an ante-mortem group (33 + 10) and a post-mortem group (33 + 10). For ethics and to avoid identification bias, CT-scans were anonymized – not showing any head structure but only sphenoid sinuses. An anatomical based classification system using the sphenoid sinuses anatomical variations was created according to anatomical and surgical literature. This classification was used by readers to identify in two different steps a maximum of matched and then unmatched scans.

The first reader had a sensitivity of 100% [CI: 89.4%–100%] and a specificity of 100% [CI: 99.8%–100%]. Sensitivity and specificity were respectively 93.9% [CI: 79.8%–99.3%] and 99.9% [CI: 99.6%–100%] for the second reader. Positive and negative predictive values were respectively 100% [CI: 89.4%–100%] and 100% [CI: 99.8%–100%] for the first reader. Positive and negative values were respectively 96.9% [CI: 83.8%–99.9%] and 99.9% [CI: 99.7%–100%] for the second reader. Inter-reader variability was estimated by Cohen's kappa and an excellent agreement was found.

We reported an excellent validity and reliability of subjective visual comparison of ante- and post-mortem CT-data using an anatomical based classification of the sphenoid sinus.