Conventional radiography allows for the overall assessment of skeletal injuries. Radiographic findings provide limited information about the causes of death, whereas findings related to the concomitant causes of death are more frequent. Conventional radiography should be considered inadequate, especially if the potential of the modern software tools available on current computed tomography and magnetic resonance images is considered.

The Gargano, also known as the ‘Spur of Italy’, is a sub-region of Italy which is located in North of Puglia, in the Province of Foggia. A ravine located in this area was used as a dumping ground in past. During a clearing operation, a team of speleologists discovered human skeletal remains, which led to an official investigation by the local prosecutor’s office. The prosecutor called a team of forensic specialist for a scene investigation to recover and identify the human skeletal remains. Four different human skeletal remains located at four different levels of depth underground were found and were in different conditions. A complete forensic investigation was initiated and comprised of radiological imaging with DNA profiling. Three of the four human skeletal remains that were found were identified as those belonging to men who vanished mysteriously in the nineties. The studies conducted have demonstrated that the victims found were murdered and the murders were attributed to the ‘‘Mafia of Gargano’’. The Mafia of Gargano was officially recognized as a criminal organization dating back to 2009 and their criminal activities included the smuggling of firearms and cigarettes, human trafficking, and smuggling of undocumented immigrants. Murders in which corpses are made to disappear is common practice in criminal activities including that of the Italian Mafia. The ‘‘Lupara Bianca’’ is a colloquial term commonly used in Sicily to refer to concealed murders. To the best of our knowledge, this is the first reported study describing the discovery of one of the locations used extensively by the local Mafia as a ‘‘cemetery’’ for victims of ‘‘Lupara Bianca’’ homicides. Based on evidences collected at the site, an explanation of this homicidal modality will be provided.

A man attempted suicide by shooting seven nails into his head with a nail gun; five in the right temporal region and two in the left. He subsequently presented at the emergency department with complaints of headache. He was found to be oriented in space and time, with no focal neurological deficits. The patient handed the nail gun to the doctors and informed them that he had earlier attempted suicide. Radiological studies showed the presence of nails arranged like a ‘martyr’s crown’. The man died six days after the surgical removal of the nails. Autopsy was refused by Italian authorities. We conclude that imaging techniques are an adjuvant to forensic medical diagnosis and forensic autopsies.

Imaging techniques (plain radiographs, multi slice computed tomography (MSCT), and magnetic resonance (MRI)) are being increasingly implemented in forensic pathology. These methods may serve as an adjuvant to classic forensic medical diagnosis and as support to forensic autopsies. It is well noted that various post-processing techniques can provide strong forensic evidence for use in legal proceedings. This chapter reviews vertebral morphometry application in forensic, expressly used in the case of semi-automatic digital recognition of vertebral heights in fractures, by means of vertebral shape analysis which relies on six or more points positioned over the margins of each vertebrae T5 to L4 used to calculate anterior, medial, and posterior heights and statistical shape models. This approach is quantitative, more reproducible, and more feasible for large-scale data analysis, as in drug trials, where assessment may be performed by a variety of clinicians with different levels of experience. As a result, a number of morphometric methodologies for characterisation of osteoporosis have been developed. Current morphometric methodologies have the drawback of relying upon manual annotations. The manual placement of morphometric points on the vertebrae is time consuming, requiring more than 10 min per radiograph and can be quite subjective. Several semi-automated software have been produced to overcome this problem, but they are mainly applicable to dual X-ray absorptiometry (DXA) scans. Furthermore, this chapter aims to verify by an experimental model if the technique could contribute, in present or in future, to investigate the modality of traumatic vertebral injuries which may explain the manner of death.

In June 2010, the priests of the church of Santa Maria in Silvis in Serracapriola, Italy, asked the University of Foggia to study skeletal remains which they believed to be those of San Fortunato. San Fortunato lived in Rome in the third century AD and little is known about his life and death. For forensic and anthropological study to determine the geographical origin, sex, age, stature and diagnose any diseases, multislice computed tomography (MSCT) was performed. Due to time and administrative constraints (we had access to the remains for only one day, and no biological sampling was permitted), dry bone and DNA analyses were not performed. The remains, thought to be 17 centuries old, were severely damaged and conventional anthropological methods already transposed to MSCT could not be used. However, considerable information for reconstructive identification was obtained. The skeletal remains were those of an Italian male, of height between 1.53 m and 1.56 m, with age at death estimated between 20 and 40 years. The effects of taphonomic processes were also visible. No historical physical description of San Fortunato is available so we were unable to compare our results. To the best of our knowledge, this is the first case in which MSCT has been used to examine the presumed skeletal remains of a Saint. It also demonstrates that reconstructive identification can be performed independently of dry bone study and illustrates the value of MSCT when skeletal remains must be preserved.