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Bhardwaj V, Kumar I, Aggarwal P, Singh PK, Shukla RC, Verma A. Demystifying the Radiography of Age Estimation in Criminal Jurisprudence: A Pictorial Review. Indian J Radiol Imaging 2024; 34:496-510. [PMID: 38912231 PMCID: PMC11188726 DOI: 10.1055/s-0043-1778651] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/25/2024] Open
Abstract
Skeletal radiographs along with dental examination are frequently used for age estimation in medicolegal cases where documentary evidence pertaining to age is not available. Wrist and hand radiographs are the most common skeletal radiograph considered for age estimation. Other parts imaged are elbow, shoulder, knee, and hip according to suspected age categories. Age estimation by wrist radiographs is usually done by the Tanner-Whitehouse method where the maturity level of each bone is categorized into stages and a final total score is calculated that is then transformed into the bone age. Careful assessment and interpretation at multiple joints are needed to minimize the error and categorize into age-group. In this article, we aimed to summarize a suitable radiographic examination and interpretation for bone age estimation in living children, adolescents, young adults, and adults for medicolegal purposes.
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Affiliation(s)
- Vritika Bhardwaj
- Department of Radiodiagnosis and Imaging, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Ishan Kumar
- Department of Radiodiagnosis and Imaging, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Priyanka Aggarwal
- Department of Pediatrics, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Pramod Kumar Singh
- Department of Radiodiagnosis and Imaging, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Ram C. Shukla
- Department of Radiodiagnosis and Imaging, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Ashish Verma
- Department of Radiodiagnosis and Imaging, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
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Alzyoud JAM, Rababah E, Almuhaisen MHO, Al-Qtaitat AI. Bone Age Determination of Epiphyseal Fusion at Knee Joint and Its Correlation with Chronological Age. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:779. [PMID: 38792962 PMCID: PMC11122822 DOI: 10.3390/medicina60050779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 04/21/2024] [Accepted: 04/29/2024] [Indexed: 05/26/2024]
Abstract
Background and Objectives: Bone age determination is a valuable method for forensic and disaster identifications of unknown human remains, as well as for medical and surgical procedural purposes. This retrospective research study aimed to determine the age based on epiphyseal fusion stages and investigate differences related to gender. Materials and Methods: X-rays of the knee were collected from medical imaging centers in hospitals in the south of Jordan and examined by two observers who determined the bone epiphyseal phase of closure for the femur, tibia, and fibula bone ends close to the knee based on a three-stage classification. Results: The main results revealed that females showed earlier epiphyseal union (Stage II) at the lower end of the femur and the upper ends of the tibia and fibula compared to males. In males, the start of complete union (Stage III) at knee bones was seen at the age of 17-18 years, while in females, it was seen at the age of 16-17 years. Additionally, knee bones showed complete union in 100% of males and females in the age groups 21-22 years and 20-21 years, respectively. Although females showed an earlier start and end of epiphyseal complete union than males, analysis of collected data showed no significant age differences between males and females at the three stages of epiphyseal union of the knee bones. Conclusions: Findings of the radiographic analysis of bone epiphyseal fusion at the knee joint are a helpful method for chronological age determination. This study supports the gender and ethnicity variation among different geographical locations. Studies with a high sample number would be needed to validate our findings.
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Affiliation(s)
- Jihad A. M. Alzyoud
- Faculty of Medicine, The Hashemite University, Zarqa 13133, Jordan
- Department of Basic Dental Sciences, Faculty of Dentistry, The Hashemite University, Zarqa 13133, Jordan
| | - Eman Rababah
- Faculty of Applied Medical Sciences, The Hashemite University, Zarqa 13133, Jordan;
| | | | - Aiman I. Al-Qtaitat
- Department of Anatomy and Histology, Faculty of Medicine, Mutah University, Karak 61710, Jordan;
- Faculty of Dentistry, Zarqa University, Zarqa 13110, Jordan
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Mao Y, Li J, Li Y, Zhu J, Xiong Y, Li J. A Combined Surgical Approach for Recurrent Patellar Dislocation in Adolescents With Patella Alta and Increased Tibial Tuberosity-Trochlear Groove Distance: Improved Clinical Outcomes but Decreased Posterior Tibial Slopes in Skeletally Immature Patients at Minimum 4-Year Follow-Up. Arthroscopy 2024; 40:1529-1540. [PMID: 37714440 DOI: 10.1016/j.arthro.2023.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 09/01/2023] [Accepted: 09/02/2023] [Indexed: 09/17/2023]
Abstract
PURPOSE (1) To report the clinical and radiological outcomes of a surgical technique combining anatomic medial patellofemoral ligament reconstruction and tibia tuberosity transfer in adolescents with patella alta and elevated tibial tuberosity-trochlear groove (TT-TG) distance in the treatment of recurrent patellar dislocation; and (2) to investigate the potential risks of growth arrest or developmental deformities associated with this combined technique. METHODS Medical records of patients who underwent the combined surgery from 2015 to 2019 were reviewed. This study included adolescents aged between 14 and 18 years with a Caton-Deschamps index (CDI) > 1.30 and TT-TG distance >20 mm, with a minimum follow-up of 4 years. Radiological examinations including lateral views and full-length posteroanterior standing radiographs were investigated to assess patella height by CDI, posterior tibial slope (PTS) angle, side-to-side difference in bone length, and lower extremity alignment by hip-knee-ankle angle; computed tomography scans and magnetic resonance imaging profiles were investigated to evaluate TT-TG distance and staging of growth plate closure. Other evaluations included preoperative and postoperative physical examination, Kujala score, and Tegner activity score. The patients were stratified into 3 subgroups according to an magnetic resonance imaging-based staging system of the growth plate closure, and each outcome was analyzed. A cohort-specific minimal clinically important difference estimation was performed using standard error of measurement. RESULTS The average age at the time of surgery was 16.1 years (range, 14.1-17.8). The average follow-up was 5.6 years (range, 4.0-7.6). No recurrent dislocation occurred, and no clinically significant deformity or axis deviation was encountered. Postoperative patellar height by CDI was 1.00 ± 0.11 (range, 0.81-1.15). No significant differences were found in the preoperative and postoperative hip-knee-ankle angle or side-to-side difference in femur/tibia length among all subgroups. A significantly decreased PTS angle was found in patients with open growth plates, from 10.2° ± 1.7° before surgery to 8.1° ± 1.0° after surgery (P = .015). The Kujala score and Tegner score both significantly improved, from 65.5 ± 13.9 before surgery to 90.4 ± 7.2 after surgery in the Kujala score (P < .001) and from 4.0 ± 1.1 before surgery to 4.7 ± 1.3 after surgery in the Tegner score (P < .001). Of the whole cohort, 63.1%, 100%, 47.1%, and 94.1% of patients achieved the minimal clinically important difference for PTS angle, CDI, Tegner score, and Kujala score, respectively. CONCLUSIONS This combined technique is safe and effective in treating recurrent patellar dislocation in skeletally mature adolescents with concurrent patella alta (CDI > 1.30) and TT-TG distance >20 mm, permitting patients to have improved knee function and low complication rates. Nonetheless, patients with open growth plates demonstrated a decrease in PTS, which might predispose the knee to recurvatum and osteoarthritis in the long term. LEVEL OF EVIDENCE Level IV, controlled case series.
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Affiliation(s)
- Yunhe Mao
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, PR China
| | - Junqiao Li
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, PR China
| | - Yinghao Li
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, PR China
| | - Jianwei Zhu
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, PR China
| | - Yan Xiong
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, PR China; Department of Orthopedics, Sports Medicine Center, West China Hospital, Sichuan University, Chengdu, PR China
| | - Jian Li
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, PR China; Department of Orthopedics, Sports Medicine Center, West China Hospital, Sichuan University, Chengdu, PR China.
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Khatam-Lashgari A, Harving ML, Villa C, Lynnerup N, Larsen ST. Forensic age estimation of the knee by post-mortem DR, CT, and MR imaging: a comparative study. Int J Legal Med 2024; 138:971-981. [PMID: 38240840 PMCID: PMC11004047 DOI: 10.1007/s00414-024-03158-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 01/08/2024] [Indexed: 04/11/2024]
Abstract
It is believed by many that reference data for age estimation purposes must be imaging-modality specific. A study from our department has however proven otherwise. We therefore found it interesting to investigate this further by looking at the level of agreement between different imaging modalities. The aim of this study was to investigate the level of agreement between the three radiological modalities, computed tomography (CT), magnetic resonance imaging (MRI), and digital radiography (DR), in assessing the ossification of the epiphyses of the knee. A total of 34 deceased individuals of 10-25 years of age, brought in for a medicolegal autopsy at our department, were scanned by CT, MRI, and DR. The ossification stages of the three bones of the right knee, distal femoral, proximal tibial, and proximal fibular epiphysis were assessed using the established combined staging method by Schmeling et al. and Kellinghaus et al. Analysis of the results by Cohen's weighted kappa showed a good agreement between CT and DR (K = 0.61-0.70), and MRI and DR (K = 0.68-0.79) but only moderate agreement between CT and MRI (K = 0.55-0.57). This leads us to conclude that different radiological images cannot be used interchangeably for age estimation purposes, so reference material needs to be imaging-modality specific. However, to make a more general conclusion research on a larger population is needed.
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Affiliation(s)
- Apameh Khatam-Lashgari
- Department of Forensic Medicine, Section of Forensic Pathology, University of Copenhagen, Copenhagen, Denmark.
| | | | - Chiara Villa
- Department of Forensic Medicine, Section of Forensic Pathology, University of Copenhagen, Copenhagen, Denmark
| | - Niels Lynnerup
- Department of Forensic Medicine, Section of Forensic Pathology, University of Copenhagen, Copenhagen, Denmark
| | - Sara Tangmose Larsen
- Department of Forensic Medicine, Section of Forensic Pathology, University of Copenhagen, Copenhagen, Denmark
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Scendoni R, Giuseppe C, Zolotenkova GV, Zolotenkov DD, Rosamaria DV, Giulio D, Recchia L, Cameriere R. Medico-legal indicators and cut-offs in different age classes through quantitative analysis of epiphyseal fusion segments on knee CT scans. Leg Med (Tokyo) 2023; 65:102318. [PMID: 37639821 DOI: 10.1016/j.legalmed.2023.102318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 08/14/2023] [Accepted: 08/21/2023] [Indexed: 08/31/2023]
Abstract
Scientists are interested in determining age in subadults for several forensic purposes. High- resolution instrumental techniques are being increasingly used for age estimation, driven by the need to minimize errors; in this context, several studies have focused on the knee joint, recognized as a potential site for age examination in late adolescence. We analyzed 200 CT scans performed on Russian subjects (106 males and 94 females) between 13 and 20 years, without growth diseases, endocrine disorders, or osteodystrophy. Each subject underwent two scans, one for each leg. Two indicators were measured for each bone (femur, tibia and fibula): the entire length of the epiphyseal scar and the length of the part/s that is/are fused with metaphysis. Intra class Correlation Coefficient (ICC) was performed to evaluate the intra-operator reproducibility. The ratio between the two lengths was calculated for each bone (FemurR, TibiaR and FibulaR). The first aim was to evaluate a correlation between the ratios of the three bones and the three bones treated as a single parameter (given by the sum of the ratios) versus age. The results showed good correlations in both cases (τ a = 0.74, 0.64, 0.57 and 0.67). The second aim was to estimate the cut-offs derived from the sum of the three ratios respect to four age classes (14-15 years: cut-off ≤ 0.63, 15-16 years: cut-off ≤ 1.19, 16-17 years: cut-off ≥ 0.68 and 17-18 years: cut-off ≥ 1.49. The results from this research encourage further studies of the knee joint as an indicator of legal adult age.
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Affiliation(s)
- Roberto Scendoni
- Department of Law, Institute of Legal Medicine, University of Macerata, Macerata, Italy.
| | - Campagna Giuseppe
- Department of Medical-Surgical Sciences and Translational Medicine, University of Rome "Sapienza", Rome, Italy
| | - Galina V Zolotenkova
- Department of Forensic Medicine, First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Dmitry D Zolotenkov
- Department of Forensic Medicine, First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - De Vivo Rosamaria
- Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy
| | - D'Aguanno Giulio
- Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy
| | - Laura Recchia
- Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy
| | - Roberto Cameriere
- Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy
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Ording Muller LS, Adolfsson J, Forsberg L, Bring J, Dahlgren J, Domeij H, Gornitzki C, Wernersson E, Odeberg J. Magnetic resonance imaging of the knee for chronological age estimation-a systematic review. Eur Radiol 2023; 33:5258-5268. [PMID: 37042982 PMCID: PMC10326106 DOI: 10.1007/s00330-023-09546-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 12/15/2022] [Accepted: 02/22/2023] [Indexed: 04/13/2023]
Abstract
INTRODUCTION Radiographs of the hand and teeth are frequently used for medical age assessment, as skeletal and dental maturation correlates with chronological age. These methods have been criticized for their lack of precision, and magnetic resonance imaging (MRI) of the knee has been proposed as a more accurate method. The aim of this systematic review is to explore the scientific and statistical evidence for medical age estimation based on skeletal maturation as assessed by MRI of the knee. MATERIALS AND METHODS A systematic review was conducted that included studies published before April 2021 on living individuals between 8 and 30 years old, with presumptively healthy knees for whom the ossification stages had been evaluated using MRI. The correlation between "mature knee" and chronological age and the risk of misclassifying a child as an adult and vice versa was calculated. RESULTS We found a considerable heterogeneity in the published studies -in terms of study population, MRI protocols, and grading systems used. There is a wide variation in the correlation between maturation stage and chronological age. CONCLUSION Data from published literature is deemed too heterogenous to support the use of MRI of the knee for chronological age determination. Further, it is not possible to assess the sensitivity, specificity, negative predictive value, or positive predictive value for the ability of MRI to determine whether a person is over or under 18 years old. KEY POINTS • There is an insufficient scientific basis for the use of magnetic resonance imaging of the knee in age determination by skeleton. • It is not possible to assess the predictive value of MRI of the knee to determine whether a person is over or under 18 years of age.
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Affiliation(s)
- Lil-Sofie Ording Muller
- Division of Radiology and Nuclear Medicine, Department of Paediatric Radiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
| | - Jan Adolfsson
- Swedish Agency for Health Technology Assessment and Assessment of Social Services, Stockholm, Sweden
- Department of Clinical Science, Intervention and Technology-CLINTEC, Karolinska Institutet, Stockholm, Sweden
| | - Lisa Forsberg
- Swedish Agency for Health Technology Assessment and Assessment of Social Services, Stockholm, Sweden
- Department of Clinical Science, Intervention and Technology-CLINTEC, Karolinska Institutet, Stockholm, Sweden
| | | | - Jovanna Dahlgren
- Department of Pediatrics, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Helena Domeij
- Swedish Agency for Health Technology Assessment and Assessment of Social Services, Stockholm, Sweden
| | - Carl Gornitzki
- Swedish Agency for Health Technology Assessment and Assessment of Social Services, Stockholm, Sweden
| | - Emma Wernersson
- Swedish Agency for Health Technology Assessment and Assessment of Social Services, Stockholm, Sweden
| | - Jenny Odeberg
- Swedish Agency for Health Technology Assessment and Assessment of Social Services, Stockholm, Sweden
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Lopatin O, Barszcz M, Bolechala F, Wozniak KJ. The fusion of ossification centers - A comparative review of radiographic and other imaging modalities of age assessment in living groups of children, adolescents, and young adults. Leg Med (Tokyo) 2023; 61:102185. [PMID: 36521210 DOI: 10.1016/j.legalmed.2022.102185] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 12/04/2022] [Indexed: 12/13/2022]
Abstract
A total of 227 articles published within the last twenty years, indexed in the PUBMED and Researchgate databases, were reviewed for the purpose of comparing medical imaging-based methods of age estimation. The evaluated studies were analyzed in terms of the assessed parts of the body, age, and epiphyseal fusion ages in children, adolescents, and young adults. Our analysis showed that an overwhelming majority of studies had been based on computed tomography and magnetic resonance imaging. A comparison of the studies showed that, irrespective of the imaging modality and the nationality of study population cohorts, the rates of development and the ages at which the process of ossification begins and ends show certain trends.
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Affiliation(s)
- Oleksiy Lopatin
- Department of Forensic Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Marta Barszcz
- Department of Forensic Medicine, Jagiellonian University Medical College, Krakow, Poland; Doctoral School of Medical and Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | - Filip Bolechala
- Department of Forensic Medicine, Jagiellonian University Medical College, Krakow, Poland
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Rüeger E, Hutmacher N, Eichelberger P, Löcherbach C, Albrecht S, Romann M. Ultrasound Imaging-Based Methods for Assessing Biological Maturity during Adolescence and Possible Application in Youth Sport: A Scoping Review. CHILDREN (BASEL, SWITZERLAND) 2022; 9:1985. [PMID: 36553428 PMCID: PMC9776568 DOI: 10.3390/children9121985] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 12/13/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022]
Abstract
Bone maturity is an indicator for estimating the biological maturity of an individual. During adolescence, individuals show heterogeneous growth rates, and thus, differences in biological maturity should be considered in talent identification and development. Radiography of the left hand and wrist is considered the gold standard of biological maturity estimation. The use of ultrasound imaging (US) may be advantageous; however, its validity and reliability are under discussion. The aims of this scoping review are (1) to summarize the different methods for estimating biological maturity by US imaging in adolescents, (2) to obtain an overview of the level of validity and reliability of the methods, and (3) to point out the practicability and usefulness of ultrasound imaging in the field of youth sports. The search included articles published up to November 2022. The inclusion criteria stipulated that participants had to fall within the age range of 8 to 23 years and be free of bone disease and fractures in the region of interest. Nine body regions were investigated, while the hand and wrist were most commonly analyzed. US assessment methods were usually based on the estimation of a bone maturity stage, rather than a decimal bone age. Furthermore, 70% of the assessments were evaluated as applicable, 10% expressed restraint about implementation, and 20% were evaluated as not applicable. When tested, inter- and intra-rater reliability was high to excellent. Despite the absence of ionization, low costs, fast assessment, and accessibility, none of the US assessments could be referred to as a gold standard. If further development succeeds, its application has the potential to incorporate biological age into selection processes. This would allow for more equal opportunities in talent selection and thus make talent development fairer and more efficient.
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Affiliation(s)
- Eva Rüeger
- Department of Elite Sport, Swiss Federal Institute of Sport Magglingen, 2532 Magglingen, Switzerland
| | - Nicole Hutmacher
- School of Health Professions, Physiotherapy, Bern University of Applied Science, 3012 Bern, Switzerland
| | - Patric Eichelberger
- School of Health Professions, Physiotherapy, Bern University of Applied Science, 3012 Bern, Switzerland
| | - Claus Löcherbach
- Swiss Olympic Medical Center, Swiss Federal Institute of Sport Magglingen, 2532 Magglingen, Switzerland
| | - Silvia Albrecht
- Swiss Olympic Medical Center, Swiss Federal Institute of Sport Magglingen, 2532 Magglingen, Switzerland
| | - Michael Romann
- Department of Elite Sport, Swiss Federal Institute of Sport Magglingen, 2532 Magglingen, Switzerland
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Demircioğlu A, Quinsten AS, Forsting M, Umutlu L, Nassenstein K. Pediatric age estimation from radiographs of the knee using deep learning. Eur Radiol 2022; 32:4813-4822. [PMID: 35233665 PMCID: PMC9213267 DOI: 10.1007/s00330-022-08582-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 12/13/2021] [Accepted: 01/12/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Age estimation, especially in pediatric patients, is regularly used in different contexts ranging from forensic over medicolegal to clinical applications. A deep neural network has been developed to automatically estimate chronological age from knee radiographs in pediatric patients. METHODS In this retrospective study, 3816 radiographs of the knee from pediatric patients from a German population (acquired between January 2008 and December 2018) were collected to train a neural network. The network was trained to predict chronological age from the knee radiographs and was evaluated on an independent validation cohort of 423 radiographs (acquired between January 2019 and December 2020) and on an external validation cohort of 197 radiographs. RESULTS The model showed a mean absolute error of 0.86 ± 0.72 years and 0.9 ± 0.71 years on the internal and external validation cohorts, respectively. Separating age classes (< 14 years from ≥ 14 years and < 18 years from ≥ 18 years) showed AUCs between 0.94 and 0.98. CONCLUSIONS The chronological age of pediatric patients can be estimated with good accuracy from radiographs of the knee using a deep neural network. KEY POINTS • Radiographs of the knee can be used for age estimations in pediatric patients using a standard deep neural network. • The network showed a mean absolute error of 0.86 ± 0.72 years in an internal validation cohort and of 0.9 ± 0.71 years in an external validation cohort. • The network can be used to separate the age classes < 14 years from ≥ 14 years with an AUC of 0.97 and < 18 years from ≥ 18 years with an AUC of 0.94.
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Affiliation(s)
- Aydin Demircioğlu
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, D-45147, Essen, Germany.
| | - Anton S Quinsten
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, D-45147, Essen, Germany
| | - Michael Forsting
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, D-45147, Essen, Germany
| | - Lale Umutlu
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, D-45147, Essen, Germany
| | - Kai Nassenstein
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, D-45147, Essen, Germany
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Möbius D, Fitzek A, Hammer N, Heinemann A, Ron A, Schädler J, Zwirner J, Ondruschka B. Ultrasound in legal medicine-a missed opportunity or simply too late? A narrative review of ultrasonic applications in forensic contexts. Int J Legal Med 2021; 135:2363-2383. [PMID: 34292383 PMCID: PMC8295453 DOI: 10.1007/s00414-021-02661-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 07/02/2021] [Indexed: 01/15/2023]
Abstract
Objectives Conventional autopsies remain the gold standard of postmortem healthcare quality assurance and help gathering extended knowledge on diseases. In answer to constantly declining autopsy rates non- or minimally invasive autopsy methods were introduced. Ultrasound is a well-established tool for imaging commonly used in clinical practice. This narrative review aims to summarize the current literature regarding the feasibility and validity of ultrasound in a forensic context. Material and methods A PubMed database search was carried out. Abstracts were scanned for pre-defined ex- and inclusion criteria, followed by a snowball search procedure applied to the primarily included articles. Results Forty-five publications met our inclusion criteria. The selected articles concern the feasibility of ultrasound in pre- or postmortem settings, forensic age estimation, and minimally invasive approaches. For imaging, ultrasound was deemed a reliable tool for the examination of epiphyses und superficial wounds, with limitations regarding internal organs and image quality due to postmortem changes. Ultrasound-guided minimally invasive approaches yielded higher success rates for adequate tissue sampling. Many investigations were carried out in low- and middle-income countries focusing on infectious diseases. Conclusion Ultrasound seems a promising but underutilized imaging tool in legal medicine to date. Promising approaches on its feasibility have been conducted. Especially for minimally invasive methods, ultrasound offered significant improvements on qualified biopsy sampling and thus appropriate diagnostics. Moreover, ultrasonic evaluation of epiphyses for age estimation offered valuable results. Nevertheless, further assessment of ultrasonic feasibility in forensic contexts is needed.
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Affiliation(s)
- Dustin Möbius
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Antonia Fitzek
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Niels Hammer
- Institute of Macroscopic and Clinical Anatomy, University of Graz, Graz, Austria.,Department of Orthopedic and Trauma Surgery, University of Leipzig, Leipzig, Germany.,Fraunhofer IWU, Dresden, Germany
| | - Axel Heinemann
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alexandra Ron
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Julia Schädler
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Johann Zwirner
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Anatomy, University of Otago, Dunedin, New Zealand
| | - Benjamin Ondruschka
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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Ekizoglu O, Er A, Buyuktoka AD, Bozdag M, Karaman G, Moghaddam N, Grabherr S. Ultrasonographic assessment of ossification of the distal radial epiphysis for estimating forensic age. Int J Legal Med 2021; 135:1573-1580. [PMID: 33611667 PMCID: PMC8206057 DOI: 10.1007/s00414-021-02521-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 01/27/2021] [Indexed: 11/30/2022]
Abstract
Since forensic age estimation is not a valid medical indication, research on the use of nonionizing methods is increasing. Ultrasonography is a radiological approach that protects patients from radiation exposure and offers special convenience to them. In this study, ultrasonography was used for age estimation by investigating the degree of ossification of the distal radial epiphysis. Its applicability on the Turkish population was investigated. The left wrist of 688 (322 males, 366 females) patients between the ages of 9 and 25 years was prospectively evaluated by ultrasonography. The intra- and interobserver reliabilities in evaluating the distal radial epiphysis and Cohen’s kappa statistics show that the interobserver error was very low, and the kappa value was found to be 0.919. Stage 3 and 4 ossification of the distal radial epiphysis was first detected at age 14.3 and 15.3 years in males and 12.7 and 14.8 years in females, respectively. The data obtained may help determine legally critical age limits of 14 and 15. Although it does not seem useful for the age of 18, ultrasonography may be recommended in selected cases as a fast, inexpensive, frequently reproducible radiological method without concern about radiation and without a predictable health risk.
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Affiliation(s)
- Oguzhan Ekizoglu
- Department of Forensic Medicine, Tepecik Training and Research Hospital, Izmir, Turkey. .,Unit of Forensic Imaging and Anthropology, University Center of Legal Medicine, Lausanne-Geneva, Switzerland.
| | - Ali Er
- Department of Radiology, Tepecik Training and Research Hospital, Izmir, Turkey
| | | | - Mustafa Bozdag
- Department of Radiology, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Gokce Karaman
- Ministry of Justice, Council of Forensic Medicine, Manisa, Turkey
| | - Negahnaz Moghaddam
- Unit of Forensic Imaging and Anthropology, University Center of Legal Medicine, Lausanne-Geneva, Switzerland.,Swiss Human Institute of Forensic Taphonomy, University Center of Legal Medicine, Lausanne-Geneva, Switzerland
| | - Silke Grabherr
- University Center of Legal Medicine, Lausanne-Geneva, Switzerland
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