The aim of this study is to investigate the potential use of reconstructed three-dimensional multi-detector computed tomography (3D MDCT) imagery to distinguish between perimortem cranial trauma and postmortem cranial damage. A total of 45 crania were initially examined for the purpose of this study. The postmortem group consists of 14 crania from a Medieval Scottish population while the perimortem group consists of 31 CT scans of perimortem trauma cases from the University Hospital of Heraklion, Crete. Six crania belonging to the perimortem group could not be assessed for the purposes of this study. Each of the remaining 39 crania was examined under the following criteria: preponderant texture, preponderant outline, edge morphology, fracture angle, fracture relationship to path of least resistance, evidence of plastic response and the presence of hinging. As edge morphology could not be determined for any of the crania this criterion was not considered for statistical computations. Statistical analysis demonstrated the five of the six criteria (preponderant texture, preponderant outline, fracture relationship to least resistance path, plastic response and the presence of hinging) subjected to statistical analysis bore statistical significance in distinguishing between perimortem trauma and postmortem damage when using 3D CT images. This study, therefore, demonstrated that the timing of cranial fractures can be determined using 3D CT images and thus can complement and add to existing methods for trauma assessment in both forensic and archaeological settings.