The case involved a body that was found behind a car with a noose tied around its neck and the other end of the rope tied to a tree. Reconstruction of the death scenario concluded that the man committed suicide by driving away from the tree with the noose tied around his neck and was dragged out of the car through the open hatchback. In Switzerland, where this case occurred, the district attorney may request either an external examination of the body or an autopsy, for which the exterior as well as the inner organs are examined. Rarely, and only in certain cases where an involvement of a third party is highly unlikely, the district attorney will respect the deceased's relatives refusal to grant permission for an autopsy. This opposition to an autopsy by the next of kin continues to increase. This study demonstrates the value of using MSCT and MRI in addition to an external examination of the body when autopsies are refused. In the current case, these procedures were useful in showing that the cause of death was cerebral hypoxia due to classic strangulation by hanging, rather than due to a brain stem lesion that might be expected in such a dynamic scenario. Further, the MRI revealed bleeding into the clavicular insertions of the sternocleidomastoid muscles and subcutaneous neck tissue. The authors recommend further postmortem research and comparative validation. 7 figures and 34 references