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Malokaj V, Mf W, Sn K, Beer M, Daniel V. Forensic age estimation by MRI of the knee - comparison of two classifications for ossification stages in a German population. Int J Legal Med 2024:10.1007/s00414-024-03281-5. [PMID: 38960912 DOI: 10.1007/s00414-024-03281-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 06/23/2024] [Indexed: 07/05/2024]
Abstract
AIM AND OBJECTIVES In forensic age estimation e.g. for judicial proceedings surpassed age thresholds can be legally relevant. To examine age related differences in skeletal development the recommendations by the Study Group on Forensic Age Diagnostics (AGFAD) are based on ionizing radiation (among others orthopantomograms, plain x-rays of the hand). Vieth et al. and Ottow et al. proposed MRI-classifications for the epiphyseal-diaphyseal fusion of the knee joint to define different age groups in healthy volunteers. The aim of the present study was to directly compare these two classifications in a large German patient population. MATERIALS AND METHODS MRI of the knee joint of 900 patients (405 female, 495 male) from 10 to 28 years of age were retrospectively analyzed. Acquired T1-weighted turbo spin-echo sequence (TSE) and T2-weighted sequence with fat suppression by turbo inversion recovery magnitude (TIRM) were analyzed for the two classifications. The different bony fusion stages of the two classifications were determined and the corresponding chronological ages assigned. Differences between the sexes were analyzed. Intra- and inter-observer agreements were determined using Cohen's kappa. RESULTS With the classification of Ottow et al. it was possible to determine completion of the 18th and 21st year of life in both sexes. With the classification of Vieth et al. completion of the 18th year of life for female patients and the 14th and 21st year of life in both sexes could be determined. The intra- and inter-observer agreement levels were very good (κ > 0.82). CONCLUSION In the large German patient cohort of this study it was possible to determine the 18th year of life with for both sexes with the classification of Ottow et al. and for female patients with the classification of Vieth et al. It was also possible to determine the 21st year of life for all bones with the classification of Ottow et al. and for the distal femur with the classification of Vieth et al.
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Affiliation(s)
- V Malokaj
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Wernsing Mf
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Kunz Sn
- Institute of Forensic Medicine, Ulm University, Ulm, Germany
| | - M Beer
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Vogele Daniel
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany.
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Jiao YS, Tuerhong Y, Chen CX, Dai XH, Lu T, Peng Z, Deng ZH, Fan F. Bone age assessment based on different MRI modalities of the proximal humerus epiphysis: the comparisons of T 1WI, T 2WI, and PDWI. Int J Legal Med 2024; 138:1509-1521. [PMID: 38332350 DOI: 10.1007/s00414-024-03182-7] [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: 08/08/2023] [Accepted: 02/01/2024] [Indexed: 02/10/2024]
Abstract
Bone age assessment (BAA) is crucial in various fields, including legal proceedings, athletic competitions, and clinical medicine. However, the use of X-ray methods for age estimation without medical indication is subject to ethical debate, especially in forensic and athletic fields. The application of magnetic resonance imaging (MRI) with non-ionizing radiation can overcome this limitation in BAA. This study aimed to compare the application value of several MRI modalities of proximal humeral in BAA. A total of 468 patients with shoulder MRIs were retrospectively collected from a Chinese Han population aged 12-30 years (259 males and 209 females) for training and testing, including T1 weighted MRI (T1WI), T2 weighted MRI (T2WI), and Proton density weighted MRI (PDWI). Optimal regression models were established for age estimation, yielding mean absolute error (MAE) values below 2.0 years. The MAE values of T1WI were the lowest, with 1.700 years in males and 1.798 years in females. The area under the curve (AUC) and accuracy values of different MRI modalities of 16-year and 18-year thresholds were all around 0.9. For the 18-year threshold, T1WI outperformed T2WI and PDWI. In conclusion, the three MRI modalities of the proximal humerus can serve as reliable indicators for age assessment, while the T1WI performed better in age assessment and classification.
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Affiliation(s)
- Yu-Su Jiao
- West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Yilitabier Tuerhong
- West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Cheng-Xu Chen
- West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Xin-Hua Dai
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Ting Lu
- West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Zhao Peng
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Zhen-Hua Deng
- West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu, 610041, People's Republic of China.
| | - Fei Fan
- West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu, 610041, People's Republic of China.
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Qiu L, Liu A, Dai X, Liu G, Peng Z, Zhan M, Liu J, Gui Y, Zhu H, Chen H, Deng Z, Fan F. Machine learning and deep learning enabled age estimation on medial clavicle CT images. Int J Legal Med 2024; 138:487-498. [PMID: 37940721 DOI: 10.1007/s00414-023-03115-w] [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: 07/30/2023] [Accepted: 10/29/2023] [Indexed: 11/10/2023]
Abstract
The medial clavicle epiphysis is a crucial indicator for bone age estimation (BAE) after hand maturation. This study aimed to develop machine learning (ML) and deep learning (DL) models for BAE based on medial clavicle CT images and evaluate the performance on normal and variant clavicles. This study retrospectively collected 1049 patients (mean± SD: 22.50±4.34 years) and split them into normal training and test sets, and variant training and test sets. An additional 53 variant clavicles were incorporated into the variant test set. The development stages of normal MCE were used to build a linear model and support vector machine (SVM) for BAE. The CT slices of MCE were automatically segmented and used to train DL models for automated BAE. Comparisons were performed by linear versus ML versus DL, and normal versus variant clavicles. Mean absolute error (MAE) and classification accuracy was the primary parameter of comparison. For BAE, the SVM had the best MAE of 1.73 years, followed by the commonly-used CNNs (1.77-1.93 years), the linear model (1.94 years), and the hybrid neural network CoAt Net (2.01 years). In DL models, SE Net 18 was the best-performing DL model with similar results to SVM in the normal test set and achieved an MAE of 2.08 years in the external variant test. For age classification, all the models exhibit superior performance in the classification of 18-, 20-, 21-, and 22-year thresholds with limited value in the 16-year threshold. Both ML and DL models produce desirable performance in BAE based on medial clavicle CT.
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Affiliation(s)
- Lirong Qiu
- West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Anjie Liu
- West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu, 610041, People's Republic of China
- University of Electronic Science and Technology of China, Chengdu, 611731, People's Republic of China
| | - Xinhua Dai
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Guangfeng Liu
- West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Zhao Peng
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Mengjun Zhan
- West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Junhong Liu
- West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Yufan Gui
- West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Haozhe Zhu
- College of Computer Science, Sichuan University, Chengdu, 610064, People's Republic of China
| | - Hu Chen
- College of Computer Science, Sichuan University, Chengdu, 610064, People's Republic of China
| | - Zhenhua Deng
- West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu, 610041, People's Republic of China.
| | - Fei Fan
- West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu, 610041, People's Republic of China.
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Wittschieber D, Hahnemann ML, Mentzel HJ. Forensic Diagnostics of the Skeletal Age in the Living - Backgrounds and Methodology. ROFO-FORTSCHR RONTG 2024; 196:254-261. [PMID: 37699433 DOI: 10.1055/a-2130-3162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/14/2023]
Abstract
BACKGROUND The expert opinions on forensic age diagnostics requested by state institutions are used to show the exceeding of legally relevant age thresholds, especially the completed 18th year of life. According to the recommendations of the Study Group on Forensic Age Diagnostics (AGFAD), this requires - among other things - a determination of skeletal age. METHOD Considering recent scientific knowledge, the current conditions and established skeletal age diagnostics methods are presented. Additionally, this review article sheds light on the influence of ethnicity and socioeconomic status, questions regarding indication, as well as alternative and future developments. RESULTS AND CONCLUSION In forensic age diagnostics, particularly hand radiography and thin-slice CT of the medial clavicular epiphysis are relevant for determining skeletal age. The Atlas method of Greulich and Pyle (1959) and the clavicular stages by Schmeling et al. (2004) and Kellinghaus et al. (2010) are primarily used for this. This spectrum of methods, which is based on a very solid database, might be supplemented by MRI studies of the knee joint in the near future. KEY POINTS · Determining skeletal age is an essential part of forensic age diagnostics commissioned by state authorities and courts.. · Hand radiography and CT of the medial clavicular epiphysis form the core of the spectrum of methods recommended by the Study Group of Forensic Age Diagnostics (AGFAD).. · Since the radiological studies required for forensic age diagnostics are not medically indicated, it must be ensured that the legal basis is specifically named in each case when commissioning expert opinions.. · MRI studies of the knee joint might increase the spectrum of methods in the near future.. CITATION FORMAT · Wittschieber D, Hahnemann ML, Mentzel H. Forensic Diagnostics of the Skeletal Age in the Living - Backgrounds and Methodology. Fortschr Röntgenstr 2024; 196: 254 - 261.
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Affiliation(s)
| | | | - Hans-Joachim Mentzel
- Institute of Diagnostic and Interventional Radiology, Section of Pediatric Radiology, Jena University Hospital, Jena, Germany
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Coreelman H, Hillewig E, Verstraete KL, de Haas MB, Thevissen PW, De Tobel J. Skeletal age estimation of living adolescents and young adults: A pilot study on conventional radiography versus magnetic resonance imaging and staging technique versus atlas method. Leg Med (Tokyo) 2023; 65:102313. [PMID: 37633179 DOI: 10.1016/j.legalmed.2023.102313] [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: 04/10/2023] [Revised: 07/27/2023] [Accepted: 08/03/2023] [Indexed: 08/28/2023]
Abstract
OBJECTIVE To compare conventional radiography (CR) and magnetic resonance imaging (MRI) of the left hand/wrist and both clavicles for forensic age estimation of adolescents and young adults. MATERIALS AND METHODS CR and MRI were prospectively conducted in 108 healthy Caucasian volunteers (52 males, 56 females) aged 16 to 21 years. Skeletal development was assessed by allocating stages (wrist, clavicles) and atlas standards (hand/wrist). Inter- and intra-observer agreements were quantified using linear weighted Cohen's kappa, and descriptive statistics regarding within-stage/standard age distributions were reported. RESULTS Inter- and intra-observer agreements for hand/wrist CR (staging technique: 0.840-0.871 and 0.877-0.897, respectively; atlas method: 0.636-0.947 and 0.853-0.987, respectively) and MRI (staging technique: 0.890-0.932 and 0.897-0.952, respectively; atlas method: 0.854-0.941 and 0.775-0.978, respectively) were rather similar. The CR atlas method was less reproducible than the staging technique. Inter- and intra-observer agreements for clavicle CR (0.590-0.643 and 0.656-0.770, respectively) were lower than those for MRI (0.844-0.852 and 0.866-0.931, respectively). Furthermore, although shifted, wrist CR and MRI within-stage age distribution spread were similar, as were those between staging techniques and atlas methods. The possibility to apply (profound) substages to clavicle MRI rendered a more gradual increase of age distributions with increasing stages, compared to CR. CONCLUSIONS For age estimation based on the left hand/wrist and both clavicles, reference data should be considered anatomical structure- and imaging modality-specific. Moreover, CR is adequate for hand/wrist evaluation and a wrist staging technique seems to be more useful than an atlas method. By contrast, MRI is of added value for clavicle evaluation.
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Affiliation(s)
- Heleen Coreelman
- Department of Diagnostic Sciences - Radiology, Ghent University, Corneel Heymanslaan 10, 9000 Ghent, Belgium.
| | - Elke Hillewig
- Department of Diagnostic Sciences - Radiology, Ghent University, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - Koenraad Luc Verstraete
- Department of Diagnostic Sciences - Radiology, Ghent University, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - Michiel Bart de Haas
- Division of Special Services and Expertise - Forensic Anthropology, Netherlands Forensic Institute, Laan van Ypenburg 6, 2497 GB The Hague, The Netherlands
| | - Patrick Werner Thevissen
- Department of Imaging and Pathology - Forensic Odontology, KU Leuven, Kapucijnenvoer 7 blok a bus 7001, 3000 Leuven, Belgium
| | - Jannick De Tobel
- Department of Diagnostic Sciences - Radiology, Ghent University, Corneel Heymanslaan 10, 9000 Ghent, Belgium; Department of Surgery - Oral and Maxillofacial Surgery, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 14, Switzerland
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6
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Chitavishvili N, Papageorgiou I, Malich A, Hahnemann ML, Mall G, Mentzel HJ, Wittschieber D. The distal femoral epiphysis in forensic age diagnostics: studies on the evaluation of the ossification process by means of T1- and PD/T2-weighted magnetic resonance imaging. Int J Legal Med 2023; 137:427-435. [PMID: 36565316 PMCID: PMC9902329 DOI: 10.1007/s00414-022-02927-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 11/30/2022] [Indexed: 01/16/2023]
Abstract
The age of majority, which corresponds to the age of 18 years in most European countries, plays a crucial role for a large number of legal decisions. Accordingly, an increasing number of requests by authorities to forensic age estimation experts comprise the question of whether the age of 18 years has been reached by an individual. In recent years, novel study data suggested that magnetic resonance imaging (MRI) of the knee might likewise allow for the determination of majority beyond reasonable doubt. However, the data basis, especially concerning the distal femoral epiphysis (DFE), is still poor. For this reason, 392 routine MRI cases of the knee (204 males and 188 females of a Western Caucasian population, aged between 12 and 25 years) were retrospectively analyzed. T1-weighted and water-selective fat-saturated PD/T2-weighted sequences, generated at 1.5 and 3.0 T clinical MR scanners, were available. Ossification stages of the DFE were determined by means of the classification system by Vieth et al. (Eur Radiol 2018; 28:3255-3262). Both the intra-observer agreement and inter-observer agreement were found to be "very good" (κ = 0.899 and κ = 0.830). The present study confirmed that MRI of the DFE is suitable to determine majority in both sexes when stage 6 is present as the study revealed minimum ages above the age of 18 years for this stage (20.40 years in males and 20.60 years in females). Accordingly, the data represent a strong support for the so far existing database. Hence, the investigation of the knee using routine MRI appears to become a realistic alternative for forensic age estimation practice in the near future.
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Affiliation(s)
- Natia Chitavishvili
- Section of Pediatric Radiology, Department of Radiology, Jena University Hospital, Friedrich Schiller University Jena, Jena, Germany ,Department of Radiology, Jena University Hospital, Jena, Germany
| | - Ismini Papageorgiou
- Department of Radiology, Jena University Hospital, Jena, Germany ,Institute of Radiology, Südharz Klinikum Nordhausen, Nordhausen, Germany
| | - Ansgar Malich
- Institute of Radiology, Südharz Klinikum Nordhausen, Nordhausen, Germany
| | - Maria L. Hahnemann
- Institute of Legal Medicine, Jena University Hospital, Friedrich Schiller University Jena, Am Klinikum 1, 07747 Jena, Germany
| | - Gita Mall
- Institute of Legal Medicine, Jena University Hospital, Friedrich Schiller University Jena, Am Klinikum 1, 07747 Jena, Germany
| | - Hans-Joachim Mentzel
- Section of Pediatric Radiology, Department of Radiology, Jena University Hospital, Friedrich Schiller University Jena, Jena, Germany
| | - Daniel Wittschieber
- Institute of Legal Medicine, Jena University Hospital, Friedrich Schiller University Jena, Am Klinikum 1, 07747, Jena, Germany.
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Widek T, De Tobel J, Ehammer T, Genet P. Forensic age estimation in males by MRI based on the medial epiphysis of the clavicle. Int J Legal Med 2022; 137:679-689. [PMID: 36534129 PMCID: PMC10085911 DOI: 10.1007/s00414-022-02924-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 12/01/2022] [Indexed: 12/23/2022]
Abstract
AbstractIncreasing cross-border migration has brought forensic age assessment into focus in recent decades. Forensic age estimation is based on the three pillars: physical and medical constitution, bone age, and tooth age. Part of the bone age examination includes the assessment of the medial end of the clavicles when the hand bones are already fully developed and a minority must be excluded. Recent research has brought MRI to the forefront as a radiation-free alternative for age assessment. However, there exits only a few studies with large sample size regarding the clavicles and with controversies about staging, motion artifacts, and exclusion based on anatomic norm variants. In the current prospective study, 338 central European male individuals between 13 and 24 years of age underwent MRI examination of the sternoclavicular region. Development was assessed by three blinded raters according to the staging system described by Schmeling et al. and Kellinghaus et al. and related to age by descriptive statistics and transition analyses with a cumulative probit model. In addition, reliability calculations were performed. No statistically significant developmental difference was found between the left and right clavicles. Inter-rater agreement was only moderate, but intra-rater agreement, on the other hand, was good. Stage 3c had a minimum age of 19.36 years and appears to be a good indicator of proof of majority. The minimum age of stage 4 was lower compared with other studies, 20.18 years, and therefore seems not to be an indicator of age of 21 years. In conclusion, we confirmed the value of clavicular MRI in the age estimation process. The transition analysis model is a good approach to circumvent the problems of age mimicry and samples that are not fully equilibrated. Given the moderate agreement between raters, a consensus reading is recommended.
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Affiliation(s)
- Thomas Widek
- Diagnostic and Research Institute of Forensic Medicine, Medical University of Graz, Graz, Austria.
- BioTechMed, Graz, Austria.
| | - Jannick De Tobel
- Department of Diagnostic Sciences - Radiology, Ghent University, Ghent, Belgium
- Department of Oral and Maxillofacial Surgery, Geneva University Hospital, Geneva, Switzerland
| | | | - Pia Genet
- University Centre of Legal Medicine Lausanne, Lausanne University Hospital, Lausanne, Switzerland
- University Centre of Legal Medicine Geneva, Geneva University Hospital, Geneva, Switzerland
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Ottow C, Schmidt S, Schulz R, Sottmann L, Heindel W, Krähling T, Pfeiffer H, Vieth V, Schmeling A. Forensische Altersdiagnostik mittels Niederfeld-Magnetresonanztomographie. Rechtsmedizin (Berl) 2022. [DOI: 10.1007/s00194-022-00588-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Zusammenfassung
Hintergrund
Ein rechtlich zulässiges medizinisches Altersfeststellungsverfahren mit möglichst schonenden und zuverlässigen Methoden bei unbegleiteten und fraglich minderjährigen Ausländern ist erforderlich, um den tatsächlich Minderjährigen den für sie gesetzlich vorgesehenen besonderen Schutz zukommen zu lassen.
Ziel der Arbeit
Studiendesign und erste Ergebnisse einer Studie zur forensischen Altersdiagnostik mittels Niederfeld-Magnetresonanztomographie werden vorgestellt.
Material und Methoden
Geplant ist die prospektive Untersuchung von 650 Studienteilnehmenden, gleichmäßig verteilt innerhalb der Altersgruppe 12 bis 24 Jahre zu je 25 Personen je Geschlecht. Es sollen Entwicklungsstadien von distalem Radius, distaler Ulna, distalem Femur und proximaler Tibia mithilfe eines 0,31-Tesla(T)-Niederfeld-MRT-Scanners erfasst und mittels Anwendung der Vieth-Klassifikation ausgewertet werden.
Ergebnisse
Nach Auswertung der Untersuchungen der bisher 487 untersuchten Studienteilnehmenden ist ersichtlich, dass die gewählten Sequenzen die für die Vieth-Klassifikation relevanten Charakteristika der Ossifikation der untersuchten Epiphysen erfassen. Die Untersuchungen erweisen sich überdies als einfach in der Durchführung.
Schlussfolgerung
Untersuchungen zur forensischen Altersschätzung am Lebenden unter Anwendung der Vieth-Klassifikation sind mit Niederfeld-MRT-Scannern bei einer Feldstärke von 0,31 T durchführbar. Es bleibt zu klären, ob die mit einem 0,31-T-Niederfeld-MRT-Scanner nachweisbaren Ossifikationsmerkmale am Handgelenk und am Knie einen zweifelsfreien Volljährigkeitsnachweis erlauben.
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Scendoni R, Ribeiro ILA, Cingolani M, Giovagnoni A, Curzi M, Fedeli P, Cameriere R. A new analytical cut-off point for determining 18 years of age using MRI on medial clavicular epiphysis. Leg Med (Tokyo) 2022; 54:102010. [PMID: 34979460 DOI: 10.1016/j.legalmed.2021.102010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 12/19/2021] [Accepted: 12/24/2021] [Indexed: 11/19/2022]
Abstract
Evaluation of the ossification of the medial clavicular epiphysis plays a key role in forensic age estimation. The purpose of the present study was to assess a new numerical cut-off at the age of 18 years, taking into consideration Magnetic Resonance (MR) images of the medial clavicular epiphysis. We analyzed 163 MR scans of Italian subjects aged between 14 and 25 years. Using the data obtained we calculated two ratios: REM-1 (ratio between the length of the whole epiphysis and the length of the metaphysis) and REM-2 (ratio between the length of epiphyseal-metaphyseal fusion and the length of the metaphysis). In 68 out of 163 cases it was not possible to measure REM-2. The reproducibility was demonstrated using the Intraclass Correlation Coefficient (ICC) (Cronbach's alpha > 0.80). REM-1 and REM-2 were compared in each category of age (adult and minor) by the Wilcoxon signed-rank test. The cut-off points for measurements of REM-1 and REM-2 were determined by logistic regression. For REM-1, the cut-off scores were 0.83 for all individuals (accuracy = 94.77%) and males (accuracy = 96.05%), and 0.86 for females (accuracy = 92.30%). For REM-2, the cut-off values were 0.40 for all individuals and males (accuracy = 100.00%), and 0.41 for females (accuracy = 100.00%). Finally, receiver operating characteristic (ROC) curves for age classification based on REM-1 and REM-2 were constructed, showing that REM-2 had the highest discriminative power. Thus, a new cut-off model for predicting the age of majority has been introduced, conducting a quantitative analysis thanks to the use of a high-resolution imaging tool.
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Affiliation(s)
- Roberto Scendoni
- Department of Law, Institute of Legal Medicine (AgEstimation Project), University of Macerata, Macerata, Italy.
| | | | - Mariano Cingolani
- Department of Law, Institute of Legal Medicine (AgEstimation Project), University of Macerata, Macerata, Italy
| | - Andrea Giovagnoni
- Department of Radiological Sciences, Ospedali Riuniti, Marche Polytechnic University, Ancona, Italy
| | - Martina Curzi
- Department of Radiological Sciences, Ospedali Riuniti, Marche Polytechnic University, Ancona, Italy
| | | | - Roberto Cameriere
- Department of Forensic Medicine, IM Sechenov First Moscow State Medical University, Moscow, Russian Federation; AgEstimation Project, Department of Forensic Medicine, University of Molise, Italy
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10
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Forensic age assessment by 3.0 T MRI of the wrist: adaption of the Vieth classification. Eur Radiol 2022; 32:7956-7964. [PMID: 35505118 PMCID: PMC9668800 DOI: 10.1007/s00330-022-08819-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 04/05/2022] [Accepted: 04/14/2022] [Indexed: 01/03/2023]
Abstract
OBJECTIVES In order to find a reliable method to correctly assess majority in both sexes by MRI, a study was conducted to evaluate the applicability of the recently presented Vieth classification in wrist MRI, after it had originally been proposed for knee MRI. METHODS After receiving a positive vote by the ethics committee, the left-hand wrists of 347 male and 348 female volunteers of German nationality in the age bracket 12-24 years were scanned. Before conducting the prospective, cross-sectional examinations, an informed consent was obtained from each volunteer. A 3.0 T MRI scanner was used, acquiring a T1 turbo spin-echo sequence (TSE) and a T2 TSE sequence with fat suppression by spectral presaturation with inversion recovery (SPIR). The images were assessed by applying the Vieth classification. Minimum, maximum, mean ± standard deviation, and median with lower and upper quartiles were defined. Intra- and interobserver agreements were determined by calculating the kappa coefficients. Differences between the sexes were analyzed using the Mann-Whitney U test. RESULTS By applying the unmodified Vieth classification with corresponding schematics, it was possible to assess majority in both sexes via the epiphyseal-diaphyseal fusion of the distal radius and in males also via the epiphyseal-diaphyseal fusion of the distal ulna. The Mann-Whitney U test implied significant sex-related differences for all stages. For both epiphyses, the intra- and interobserver agreement levels were very good (κ > 0.8). CONCLUSION If confirmed by further studies, it would be possible to determine the completion of the 18th year of life in both sexes by 3.0 T MRI of the wrist and using the Vieth classification. KEY POINTS • The Vieth classification allows determining majority in males and females alike based on the distal radius' epiphysis by 3.0 T MRI of the wrist. • The Vieth classification also allows determining majority in males based on the distal ulna's epiphysis by 3.0 T MRI of the wrist, but not in females. • The presented data can be deemed referential within certain discussed boundaries.
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Age estimation in the living: A scoping review of population data for skeletal and dental methods. Forensic Sci Int 2021; 320:110689. [PMID: 33561788 DOI: 10.1016/j.forsciint.2021.110689] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 01/07/2021] [Accepted: 01/11/2021] [Indexed: 11/22/2022]
Abstract
Age estimation of living individuals has become a crucial part of the forensic practice, especially due to the global increase in cross-border migration. The low rate of birth registration in many countries, hence of identification documents of migrants, especially in Africa and Asia, highlights the importance of reliable methods for age estimation of living individuals. Despite the fact that a number of skeletal and dental methods for age estimation have been developed, their main limitation is that they are based on specific reference samples and there is still no consensus among researchers on whether these methods can be applied to all populations. Though this issue remains still unsolved, population information at a glance could be useful for forensic practitioners dealing with such issues. This study aims at presenting a scoping review and mapping of the current situation concerning population data for skeletal (hand-wrist and clavicle) and dental methods (teeth eruption and third molar formation) for age estimation in the living. Two hundred studies on the rate of skeletal maturation and four hundred thirty-nine on the rate of dental maturation were found, covering the period from 1952 and 2020 for a total of ninety-eight countries. For most of the western and central African countries there are currently no data on the rate of skeletal and dental maturation. The same applies to the countries of the Middle East, as well as the eastern European countries, especially as regard the skeletal development.
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12
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Diete V, Wabitsch M, Denzer C, Jäger H, Hauth E, Beer M, Vogele D. Applicability of Magnetic Resonance Imaging for Bone Age Estimation in the Context of Medical Issues. ROFO-FORTSCHR RONTG 2020; 193:692-700. [PMID: 33336355 DOI: 10.1055/a-1313-7664] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The determination of bone age is a method for analyzing biological age and structural maturity. Bone age estimation is predominantly used in the context of medical issues, for example in endocrine diseases or growth disturbance. As a rule, conventional X-ray images of the left wrist and hand are used for this purpose. The aim of the present study is to investigate the extent to which MRI can be used as a radiation-free alternative for bone age assessment. METHODS In 50 patients, 19 females and 31 males, in addition to conventional left wrist and hand radiographs, MRI was performed with T1-VIBE (n = 50) and T1-TSE (n = 34). The average age was 11.87 years (5.08 to 17.50 years). Bone age assessment was performed by two experienced investigators blinded for chronological age according to the most widely used standard of Greulich and Pyle. This method relies on a subjective comparison of hand radiographs with gender-specific reference images from Caucasian children and adolescents. In addition to interobserver and intraobserver variability, the correlation between conventional radiographs and MRI was determined using the Pearson correlation coefficient. RESULTS Between the bone age determined from the MRI data and the results of the conventional X-ray images, a very good correlation was found for both T1-VIBE with r = 0.986 and T1-TSE with r = 0.982. Gender differences did not arise. The match for the interobserver variability was very good: r = 0.985 (CR), 0.966 (T1-VIBE) and 0.971 (T1-TSE) as well as the match for the intraobserver variability for investigator A (CR = 0.994, T1-VIBE = 0.995, T1-TSE = 0.998) and for investigator B (CR = 0.994, T1-VIBE = 0.993, T1-TSE = 0.994). CONCLUSION The present study shows that MRI of the left wrist and hand can be used as a possible radiation-free alternative to conventional X-ray imaging for bone age estimation in the context of medical issues. KEY POINTS · MRI and X-ray show a very good correlation for bone age determination in medical issues.. · With short examination times, T1 VIBE shows slight advantages over T1 TSE.. · Both investigators show high intra- and interobserver variability.. CITATION FORMAT · Diete V, Wabitsch M, Denzer C et al. Applicability of Magnetic Resonance Imaging for Bone Age Estimation in the Context of Medical Issues. Fortschr Röntgenstr 2021; 193: 692 - 700.
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Affiliation(s)
- Vera Diete
- Department for Diagnostic and Interventional Radiology, University Ulm Medical Centre, Ulm, Germany
| | - Martin Wabitsch
- Division of Pediatric Endocrinology and Diabetes, University Ulm Medical Centre, Ulm, Germany
| | - Christian Denzer
- Division of Pediatric Endocrinology and Diabetes, University Ulm Medical Centre, Ulm, Germany
| | | | | | - Meinrad Beer
- Department for Diagnostic and Interventional Radiology, University Ulm Medical Centre, Ulm, Germany
| | - Daniel Vogele
- Department for Diagnostic and Interventional Radiology, University Ulm Medical Centre, Ulm, Germany
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13
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De Tobel J, van Wijk M, Alberink I, Hillewig E, Phlypo I, van Rijn RR, Thevissen PW, Verstraete KL, de Haas MB. The influence of motion artefacts on magnetic resonance imaging of the clavicles for age estimation. Int J Legal Med 2020; 134:753-768. [PMID: 31915965 DOI: 10.1007/s00414-019-02230-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE To determine how motion affects stage allocation to the clavicle's sternal end on MRI. MATERIALS AND METHODS Eighteen volunteers (9 females, 9 males) between 14 and 30 years old were prospectively scanned with 3-T MRI. One resting-state scan was followed by five intentional motion scans. Additionally, a control group of 72 resting-state scans were selected from previous research. Firstly, six observers allocated developmental stages to the clavicles independently. Secondly, they re-assessed the images, allocating developmental statuses (immature, mature). Finally, the resting-state scans of the 18 volunteers were assessed in consensus to decide on the "correct" stage/status. Results were compared between groups (control, prospective resting state, prospective motion), and between staging techniques (stages/statuses). RESULTS Inter-observer agreement was low (Krippendorff α 0.23-0.67). The proportion of correctly allocated stages (64%) was lower than correctly allocated statuses (83%). Overall, intentional motion resulted in fewer assessable images and less images of sufficient evidential value. The proportion of correctly allocated stages did not differ between resting-state (64%) and motion scans (65%), while correctly allocated statuses were more prevalent in resting-state scans (83% versus 77%). Remarkably, motion scans did not render a systematically higher or lower stage/status, compared to the consensus. CONCLUSION Intentional motion impedes clavicle MRI for age estimation. Still, in case of obvious disturbances, the forensic expert will consider the MRI unsuitable as evidence. Thus, the development of the clavicle as such and the staging technique seem to play a more important role in allocating a faulty stage for age estimation.
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Affiliation(s)
- Jannick De Tobel
- Department of Diagnostic Sciences - Radiology, Ghent University, Ghent, Belgium. .,Department of Imaging and Pathology - Forensic Odontology, KU Leuven, Leuven, Belgium. .,Department of Oral Diseases and Maxillofacial Surgery, Maastricht UMC+, Maastricht, The Netherlands. .,Department of Oral and Maxillofacial Surgery, Leuven University Hospitals, Leuven, Belgium.
| | - Mayonne van Wijk
- Division of Special Services and Expertise, Section of Forensic Anthropology, Netherlands Forensic Institute, The Hague, The Netherlands
| | - Ivo Alberink
- Division of Special Services and Expertise, Section of Forensic Anthropology, Netherlands Forensic Institute, The Hague, The Netherlands
| | - Elke Hillewig
- Department of Diagnostic Sciences - Radiology, Ghent University, Ghent, Belgium
| | - Inès Phlypo
- Department of Oral Health Sciences - Special Needs in Dentistry, Ghent University, Ghent, Belgium
| | - Rick R van Rijn
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | | | | | - Michiel Bart de Haas
- Division of Special Services and Expertise, Section of Forensic Anthropology, Netherlands Forensic Institute, The Hague, The Netherlands
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14
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De Tobel J, Bauwens J, Parmentier GIL, Franco A, Pauwels NS, Verstraete KL, Thevissen PW. Magnetic resonance imaging for forensic age estimation in living children and young adults: a systematic review. Pediatr Radiol 2020; 50:1691-1708. [PMID: 32734341 DOI: 10.1007/s00247-020-04709-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 03/03/2020] [Accepted: 05/10/2020] [Indexed: 12/20/2022]
Abstract
The use of MRI in forensic age estimation has been explored extensively during the last decade. The authors of this paper synthesized the available MRI data for forensic age estimation in living children and young adults to provide a comprehensive overview that can guide age estimation practice and future research. To do so, the authors searched MEDLINE, Embase and Web of Science, along with cited and citing articles and study registers. Two authors independently selected articles, conducted data extraction, and assessed risk of bias. They considered study populations including living subjects up to 30 years old. Fifty-five studies were included in qualitative analysis and 33 in quantitative analysis. Most studies had biases including use of relatively small European (Caucasian) populations, varying MR approaches and varying staging techniques. Therefore, it was not appropriate to pool the age distribution data. The authors found that reproducibility of staging was remarkably lower in clavicles than in any other anatomical structure. Age estimation performance was in line with the gold standard, radiography, with mean absolute errors ranging from 0.85 years to 2.0 years. The proportion of correctly classified minors ranged from 65% to 91%. Multifactorial age estimation performed better than that based on a single anatomical site. The authors found that more multifactorial age estimation studies are necessary, together with studies testing whether the MRI data can safely be pooled. The current review results can guide future studies, help medical professionals to decide on the preferred approach for specific cases, and help judicial professionals to interpret the evidential value of age estimation results.
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Affiliation(s)
- Jannick De Tobel
- Department of Diagnostic Sciences-Radiology, Ghent University, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
- Department of Imaging and Pathology-Forensic Odontology, KU Leuven, Leuven, Belgium.
- Department of Oral Diseases and Maxillofacial Surgery, Maastricht UMC+, Maastricht, The Netherlands.
| | - Jeroen Bauwens
- Department of Diagnostic Sciences-Radiology, Ghent University, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Griet I L Parmentier
- Department of Diagnostic Sciences-Radiology, Ghent University, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Ademir Franco
- Department of Imaging and Pathology-Forensic Odontology, KU Leuven, Leuven, Belgium
| | - Nele S Pauwels
- Ghent Knowledge Centre for Health, Ghent University, Ghent, Belgium
| | - Koenraad L Verstraete
- Department of Diagnostic Sciences-Radiology, Ghent University, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Patrick W Thevissen
- Department of Imaging and Pathology-Forensic Odontology, KU Leuven, Leuven, Belgium
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15
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De Tobel J, Ottow C, Widek T, Klasinc I, Mörnstad H, Thevissen PW, Verstraete KL. Dental and Skeletal Imaging in Forensic Age Estimation: Disparities in Current Approaches and the Continuing Search for Optimization. Semin Musculoskelet Radiol 2020; 24:510-522. [PMID: 33036039 DOI: 10.1055/s-0040-1701495] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Medical imaging for forensic age estimation in living adolescents and young adults continues to be controversial and a subject of discussion. Because age estimation based on medical imaging is well studied, it is the current gold standard. However, large disparities exist between the centers conducting age estimation, both between and within countries. This review provides an overview of the most common approaches applied in Europe, with case examples illustrating the differences in imaging modalities, in staging of development, and in statistical processing of the age data. Additionally, the review looks toward the future because several European research groups have intensified studies on age estimation, exploring four strategies for optimization: (1) increasing sample sizes of the reference populations, (2) combining single-site information into multifactorial information, (3) avoiding ionizing radiation, and (4) conducting a fully automated analysis.
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Affiliation(s)
- Jannick De Tobel
- Department of Diagnostic Sciences - Radiology, Ghent University, Ghent, Belgium.,Department of Imaging and Pathology - Forensic Odontology, KU Leuven, Leuven, Belgium.,Department of Oral and Maxillofacial Surgery, Leuven University Hospitals, Leuven, Belgium.,Unit of Head and Neck and Maxillofacial Radiology, Division of Radiology, Diagnostic Department, Geneva University Hospital, Geneva, Switzerland
| | - Christian Ottow
- Department of Clinical Radiology, University Hospital Münster, Münster, Germany
| | - Thomas Widek
- Ludwig Boltzmann Institute for Clinical Forensic Imaging, Graz, Austria.,Medical University of Graz, Graz, Austria.,BioTechMed-Graz, Graz, Austria
| | - Isabella Klasinc
- Diagnostic and Research Institute of Forensic Medicine, Medical University of Graz, Graz, Austria
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16
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The relevance of body mass index in forensic age assessment of living individuals: an age-adjusted linear regression analysis using multivariable fractional polynomials. Int J Legal Med 2020; 134:1861-1868. [PMID: 32700015 PMCID: PMC8266698 DOI: 10.1007/s00414-020-02381-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 07/17/2020] [Indexed: 11/23/2022]
Abstract
In forensic age assessment of living individuals, developmental stages of skeletal maturation and tooth mineralization are examined and compared with a reference population. It is of interest which factors can affect the development of these features. We investigated the effect of body mass index (BMI) on the developmental stages of the medial epiphysis of the clavicle, the distal epiphysis of the radius, the distal epiphysis of the femur, the proximal epiphysis of the tibia, and the left lower third molar in a total of 581 volunteers, 294 females and 287 males aged 12–24 years, using 3 T MRI. BMI values in the cohort ranged from 13.71 kg/m2 in a 12-year-old female to 35.15 kg/m2 in an 18-year-old female. The effect of BMI on the development of the characteristics was investigated using linear regression models with multivariable fractional polynomials. In the univariable analysis, BMI was associated with all feature systems (beta between 0.10 and 0.44; p < 0.001). When accounting for the physiological increase of BMI with increasing age, the effect of BMI was lower and in the majority of the models no longer clinically relevant. Betas decreased to values between 0.00 and 0.05. When adding feature variables to a model already including age, r2 values increased only minimally. For an overall bone ossification score combining all characteristics, the adjusted ß was 0.11 (p = 0.021) and 0.08 (p = 0.23) for females and males, respectively. Low ß and r2 values (0.00 (adjusted)–0.16 (crude)) were present in both models for third molar development already in the unadjusted analyses. In conclusion, our study found no to little effect of BMI on osseous development in young adults. Teeth development in both sexes was completely independent of BMI. Therefore, dental methods should be part of every age assessment.
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17
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The four-minute approach revisited: accelerating MRI-based multi-factorial age estimation. Int J Legal Med 2019; 134:1475-1485. [PMID: 31858261 PMCID: PMC7295718 DOI: 10.1007/s00414-019-02231-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 12/09/2019] [Indexed: 11/10/2022]
Abstract
Objectives This feasibility study aimed to investigate the reliability of multi-factorial age estimation based on MR data of the hand, wisdom teeth and the clavicles with reduced acquisition time. Methods The raw MR data of 34 volunteers—acquired on a 3T system and using acquisition times (TA) of 3:46 min (hand), 5:29 min (clavicles) and 10:46 min (teeth)—were retrospectively undersampled applying the commercially available CAIPIRINHA technique. Automatic and radiological age estimation methods were applied to the original image data as well as undersampled data to investigate the reliability of age estimates with decreasing acquisition time. Reliability was investigated determining standard deviation (SSD) and mean (MSD) of signed differences, intra-class correlation (ICC) and by performing Bland-Altman analysis. Results Automatic age estimation generally showed very high reliability (SSD < 0.90 years) even for very short acquisition times (SSD ≈ 0.20 years for a total TA of 4 min). Radiological age estimation provided highly reliable results for images of the hand (ICC ≥ 0.96) and the teeth (ICC ≥ 0.79) for short acquisition times (TA = 16 s for the hand, TA = 2:21 min for the teeth), imaging data of the clavicles allowed for moderate acceleration (TA = 1:25 min, ICC ≥ 0.71). Conclusions The results demonstrate that reliable multi-factorial age estimation based on MRI of the hand, wisdom teeth and the clavicles can be performed using images acquired with a total acquisition time of 4 min.
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18
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De Tobel J, Fieuws S, Hillewig E, Phlypo I, van Wijk M, de Haas MB, Politis C, Verstraete KL, Thevissen PW. Multi-factorial age estimation: A Bayesian approach combining dental and skeletal magnetic resonance imaging. Forensic Sci Int 2019; 306:110054. [PMID: 31778924 DOI: 10.1016/j.forsciint.2019.110054] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 10/19/2019] [Accepted: 11/12/2019] [Indexed: 12/20/2022]
Abstract
PURPOSE To study age estimation performance of combined magnetic resonance imaging (MRI) data of all four third molars, the left wrist and both clavicles in a reference population of females and males. To study the value of adding anthropometric and sexual maturation data. MATERIALS AND METHODS Three Tesla MRI of the three anatomical sites was prospectively conducted from March 2012 to May 2017 in 14- to 26-year-old healthy Caucasian volunteers (160 females, 138 males). Development was assessed by allocating stages, anthropometric measurements were taken, and self-reported sexual maturation data were collected. All data was incorporated in a continuation-ratio model to estimate age, applying Bayes' rule to calculate point and interval predictions. Two performance aspects were studied: (1) accuracy and uncertainty of the point prediction, and (2) diagnostic ability to discern minors from adults (≥18 years). RESULTS Combining information from different anatomical sites decreased the mean absolute error (MAE) compared to incorporating only one site (P<0.0001). By contrast, adding anthropometric and sexual maturation data did not further improve MAE (P=0.11). In females, combining all three anatomical sites rendered a MAE equal to 1.41 years, a mean width of the 95% prediction intervals of 5.91 years, 93% correctly classified adults and 91% correctly classified minors. In males, the corresponding results were 1.36 years, 5.49 years, 94%, and 90%, respectively. CONCLUSION All aspects of age estimation improve when multi-factorial MRI data of the three anatomical sites are incorporated. Anthropometric and sexual maturation data do not seem to add relevant information.
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Affiliation(s)
- Jannick De Tobel
- Department of Diagnostic Sciences - Radiology, Ghent University, Corneel Heymanslaan 10, 9000 Ghent, Belgium; Department of Imaging and Pathology - Forensic Odontology, KU Leuven, Kapucijnenvoer 7 blok a bus 7001, 3000 Leuven, Belgium; Department of Oral and Maxillofacial Surgery, Leuven University Hospitals, Kapucijnenvoer 33, 3000 Leuven, Belgium.
| | - Steffen Fieuws
- KU Leuven - Leuven University & Hasselt University, Department of Public Health and Primary Care, l-BioStat, Leuven, Kapucijnenvoer 35 blok d bus 7001, 3000 Leuven, Belgium.
| | - Elke Hillewig
- Department of Diagnostic Sciences - Radiology, Ghent University, Corneel Heymanslaan 10, 9000 Ghent, Belgium.
| | - Inès Phlypo
- Department of Oral Health Sciences - Special Needs in Dentistry, Ghent University, Corneel Heymanslaan 10, 9000 Ghent, Belgium.
| | - Mayonne van Wijk
- Division of Special Services and Expertise, Section of Forensic Anthropology, Netherlands Forensic Institute, Laan van Ypenburg 6, 2497 GB The Hague, the Netherlands.
| | - Michiel Bart de Haas
- Division of Special Services and Expertise, Section of Forensic Anthropology, Netherlands Forensic Institute, Laan van Ypenburg 6, 2497 GB The Hague, the Netherlands.
| | - Constantinus Politis
- Department of Oral and Maxillofacial Surgery, Leuven University Hospitals, Kapucijnenvoer 33, 3000 Leuven, Belgium.
| | - Koenraad Luc Verstraete
- Department of Diagnostic Sciences - Radiology, Ghent University, Corneel Heymanslaan 10, 9000 Ghent, Belgium.
| | - Patrick Werner Thevissen
- Department of Imaging and Pathology - Forensic Odontology, KU Leuven, Kapucijnenvoer 7 blok a bus 7001, 3000 Leuven, Belgium.
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19
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De Tobel J, Hillewig E, van Wijk M, Fieuws S, de Haas MB, van Rijn RR, Thevissen PW, Verstraete KL. Staging Clavicular Development on MRI: Pitfalls and Suggestions for Age Estimation. J Magn Reson Imaging 2019; 51:377-388. [PMID: 31373087 DOI: 10.1002/jmri.26889] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 07/14/2019] [Accepted: 07/15/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND MRI of the clavicle's sternal end has been studied for age estimation. Several pitfalls have been noted, but how they affect age estimation performance remains unclear. PURPOSE/HYPOTHESIS To further study these pitfalls and to make suggestions for a proper use of clavicle MRI for forensic age estimation. Our hypotheses were that age estimation would benefit from 1) discarding stages 1 and 4/5; 2) including advanced substages 3aa, 3ab, and 3ac; 3) taking both clavicles into account; and 4) excluding morphological variants. STUDY TYPE Prospective cross-sectional. POPULATION Healthy Caucasian volunteers between 11 and 30 years old (524; 277 females, 247 males). FIELD STRENGTH/SEQUENCE 3T, T1 -weighted gradient echo volumetric interpolated breath-hold examination (VIBE) MR-sequence. ASSESSMENT Four observers applied the most elaborate staging technique for long bone development that has been described in the current literature (including stages, substages, and advanced substages). One of the observers repeated a random selection of the assessments in 110 participants after a 2-week interval. Furthermore, all observers documented morphological variants. STATISTICAL TESTS Weighted kappa quantified reproducibility of staging. Bayes' rule was applied for age estimation with a continuation ratio model for the distribution of the stages. According to the hypotheses, different models were tested. Mean absolute error (MAE) differences between models were compared, as were MAEs between cases with and without morphological variants. RESULTS Weighted kappa equaled 0.82 for intraobserver and ranged between 0.60 and 0.64 for interobserver agreement. Stages 1 and 4/5 were allocated interchangeably in 4.3% (54/1258). Age increased steadily in advanced substages of stage 3, but improvement in age estimation was not significant (right P = 0.596; left P = 0.313). The model that included both clavicles and discarded stages 1 and 4/5 yielded an MAE of 1.97 years, a root mean squared error of 2.60 years, and 69% correctly classified minors. Morphological variants rendered significantly higher MAEs (right 3.84 years, P = 0.015; left 2.93 years, P = 0.022). DATA CONCLUSION Our results confirmed hypotheses 3) and 4), while hypotheses 1) and 2) remain to be investigated in larger studies. LEVEL OF EVIDENCE 1 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2020;51:377-388.
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Affiliation(s)
- Jannick De Tobel
- Department of Diagnostic Sciences - Radiology, Ghent University, Ghent, Belgium.,Department of Imaging and Pathology - Forensic Odontology, KU Leuven, Belgium.,Department of Oral and Maxillofacial Surgery, Leuven University Hospitals, Leuven, Belgium
| | - Elke Hillewig
- Department of Diagnostic Sciences - Radiology, Ghent University, Ghent, Belgium
| | - Mayonne van Wijk
- Division of Special Services and Expertise, Section of Forensic Anthropology, Netherlands Forensic Institute, The Hague, The Netherlands
| | - Steffen Fieuws
- KU Leuven - Leuven University & Hasselt University, Department Public Health and Primary Care, I-BioStat, Leuven, Belgium
| | - Michiel Bart de Haas
- Division of Special Services and Expertise, Section of Forensic Anthropology, Netherlands Forensic Institute, The Hague, The Netherlands
| | - Rick R van Rijn
- Amsterdam UMC, University of Amsterdam, Department of Radiology and Nuclear Medicine, Amsterdam, The Netherlands
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Anatomic shape variants of extremitas sternalis claviculae as collected from sternoclavicular thin-slice CT-studies of 2820 male borderline-adults. Int J Legal Med 2019; 133:1517-1528. [PMID: 31104134 DOI: 10.1007/s00414-019-02065-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 04/05/2019] [Indexed: 10/26/2022]
Abstract
Within medical age assessment practice, the indicator "medial clavicular ossification" constitutes crucial evidence capable of excluding age minority "beyond reasonable doubt" concerning age-disputed individuals doubtfully claiming children's rights during legal procedures. Yet, one of its characteristics affects the morphological variability including a fair amount of downright peculiar appearances. As a result, inexperienced examiners are tempted to classify actually not-assessable formations according to the two established developmental typologies of Schmeling et al. and Kellinghaus et al. being at the same time the most frequent systemic error of age-related clavicular taxation. Since a respective overview appears missing, the study extracts not-assessable shape variants of the medial collar bone from a large sample of 2820 male borderline-adults as seen from thin-slice, sternoclavicular computed tomography. The two already highlighted configurations "more than one, medial, secondary ossification centres" and "medial metaphyseal concavity" are found as the most commonly encountered features impeding reliable delineation of staging criteria. In accordance with previous literature, it is emphasized that "qualified" rating of extremitas sternalis claviculae within age assessment practice presupposes "knowledge about the diversity of [its] anatomic shape variants."
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Arge S, Boldsen JL, Wenzel A, Holmstrup P, Jensen ND, Lynnerup N. Third molar development in a contemporary Danish 13–25 year old population. Forensic Sci Int 2018; 289:12-17. [DOI: 10.1016/j.forsciint.2018.05.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 03/27/2018] [Accepted: 05/02/2018] [Indexed: 11/16/2022]
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Rudolf E, Kramer J, Schmidt S, Vieth V, Winkler I, Schmeling A. Intraindividual incongruences of medially ossifying clavicles in borderline adults as seen from thin-slice CT studies of 2595 male persons. Int J Legal Med 2017; 132:629-636. [PMID: 28944440 DOI: 10.1007/s00414-017-1694-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 09/19/2017] [Indexed: 11/25/2022]
Abstract
In the past, numerous studies have documented the possibility of intraindividual differing appearances of the paired age-marker "medial clavicular ossification" in borderline adults. However, the extent of the divergences is rarely mentioned. Against that the article describes this phenomenon from a large sample of 2595 male persons by means of thin-slice CT imaging of the sternoclavicular regions. For determining the ossification stage of the medial clavicles, the two accepted classifications by Schmeling et al. (five main stages) and Kellinghaus et al. (six substages) were applied and buildings deviating from that labelled as atypical "norm variants". The longstanding observation could be confirmed that intraindividual stage discrepancies of this age indicator are generally moderate and do not exceed one main stage or two substages of the respective classifications. It is concluded that stage determination should be scrutinized, if a dissimilarity seems to show larger differences.
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Affiliation(s)
- Ernst Rudolf
- , Wiesenstr. 20, 4800, Attnang-Puchheim, Austria.
| | - Josef Kramer
- Institute for CT and MRT Diagnostics, Rainerstr. 6-8, 4020, Linz, Austria
| | - Sven Schmidt
- Institute of Legal Medicine, University Hospital Münster, Röntgenstraße 23, 48149, Münster, Germany
| | - Volker Vieth
- Department of Clinical Radiology, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany.,Clinic for Radiology, Klinikum Ibbenbüren, Große Straße 41, 49477, Ibbenbüren, Germany
| | | | - Andreas Schmeling
- Institute of Legal Medicine, University Hospital Münster, Röntgenstraße 23, 48149, Münster, Germany
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