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Suzuki S, Ohtani M, Matsuo Y, Fukuda M, Mimasaka S. Age estimation using postmortem computed tomography-based Hounsfield unit values of the palate and mandibular condyle and the Eichner classification. Leg Med (Tokyo) 2024; 69:102446. [PMID: 38640872 DOI: 10.1016/j.legalmed.2024.102446] [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: 02/11/2024] [Revised: 03/17/2024] [Accepted: 04/15/2024] [Indexed: 04/21/2024]
Abstract
Age estimation is important in forensic investigations of unidentified human remains. This study assessed the correlation between age and Hounsfield unit (HU) values of the palate and mandibular condyle based on postmortem computed tomography (CT) and analyzed the influence of occlusal support in developing an age estimation method for Japanese individuals, including older adults. The sample consisted of a training dataset (357 cadavers) and a validation dataset (300 cadavers) that underwent postmortem CT. Three measurements were selected: the respective HU values of the palate and mandibular condyle and the Eichner classification. The correlation coefficients between age and HU values were also evaluated. Multiple stepwise regression analysis was performed to evaluate the significance of four parameters (sex, respective HU values of the palate and mandibular condyle, and the Eichner classification) for age estimation and to determine the best age estimation formula. In the validation tests, inaccuracy and bias were calculated for the groups aged ≥65 or <65 years. Significant correlations between age and HU values of the palate and mandibular condyle were observed, regardless of sex. In multiple stepwise regression analysis, all variables except sex were significantly correlated with age. The age estimation formula from the regression analysis was useful, and the validation test exhibited high accuracy, especially in older adults. The HU values of the palate and mandibular condyle and the Eichner classification are useful for age estimation in Japanese individuals.
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Affiliation(s)
- Shoken Suzuki
- Department of Forensic Sciences, Akita University Graduate School of Medicine, Akita, Japan; Department of Dentistry and Oral Surgery, Akita University Graduate School of Medicine, Akita, Japan.
| | - Maki Ohtani
- Department of Forensic Sciences, Akita University Graduate School of Medicine, Akita, Japan.
| | - Yuhei Matsuo
- Department of Forensic Sciences, Akita University Graduate School of Medicine, Akita, Japan.
| | - Masayuki Fukuda
- Department of Dentistry and Oral Surgery, Akita University Graduate School of Medicine, Akita, Japan.
| | - Sohtaro Mimasaka
- Department of Forensic Sciences, Akita University Graduate School of Medicine, Akita, Japan; Division of Forensic Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.
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2
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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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3
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Lopatin O, Barszcz M, Bolechała F, Woźniak K. Analysis of various radiological age-assessment methods in children, adolescents and young adults regarding the differences between the sexes and sides of the body - A comparative review. Leg Med (Tokyo) 2023; 65:102329. [PMID: 37832470 DOI: 10.1016/j.legalmed.2023.102329] [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: 10/06/2022] [Revised: 07/17/2023] [Accepted: 09/27/2023] [Indexed: 10/15/2023]
Abstract
A total of 76 articles published within the last twenty years, indexed in the PubMed and ResearchGate databases, were reviewed in order to compare medical imaging-based methods of age estimation of children, adolescents and young adults. The evaluated studies were analyzed for any statistically significant differences between the sexes and sides of the body, sample sizes, and population age. Irrespective of the evaluation method, there were some studies that showed a statistically significant differences in ossification stages between the male and female groups. Most of the studies whose authors conducted a statistical analysis demonstrated no significant differences between the left and right side of the body.
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Affiliation(s)
- Oleksiy Lopatin
- Chair and Department of Forensic Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Marta Barszcz
- Chair and Department of Forensic Medicine, Jagiellonian University Medical College, Krakow, Poland; Doctoral School of Medical and Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | - Filip Bolechała
- Chair and Department of Forensic Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Krzysztof Woźniak
- Chair and Department of Forensic Medicine, Jagiellonian University Medical College, Krakow, Poland.
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4
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Ruder TD, Kuhnen SC, Zech WD, Klaus JB, Lombardo P, Ith M. Standards of practice in forensic age estimation with CT of the medial clavicular epiphysis-a systematic review. Int J Legal Med 2023; 137:1757-1766. [PMID: 37691040 PMCID: PMC10567934 DOI: 10.1007/s00414-023-03061-7] [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: 03/20/2023] [Accepted: 07/08/2023] [Indexed: 09/12/2023]
Abstract
The AGFAD (Arbeitsgemeinschaft für Forensische Alterdiagnostik, Study Group on Forensic Age Diagnostics) has published several recommendations regarding both technical aspects of computed tomography (CT) of the medial clavicular epiphysis (MCE) and the process of reading and interpreting the CT images for forensic age estimations (FAE). There are, however, no published recommendations regarding CT scan protocols and no dose reference values for CT of the MCE. The objective of this analysis was to assess adherence to AGFAD recommendations among practitioners of FAE and analyse reported dose-relevant CT scan parameters with the objective of helping to establish evidence-based dose reference values for FAE. A systematic literature search was conducted in PubMed and in Google Scholar with specific MeSH terms to identify original research articles on FAE with CT of the MCE from 1997 to 2022. A total of 48 studies were included. Adherence to AGFAD recommendations among practitioners of FAE is high regarding the use of Schmeling main stages (93%), bone window (79%), ≤ 1 mm CT slices (67%), axial/coronal CT images (65%), and Kellinghaus sub-stages (59%). The reporting of CT technique and CT dose-relevant scan parameters is heterogeneous and often incomplete in the current literature. Considering the success achieved by the AGFAD in creating standards of practice of FAE in living subjects, there is potential for the AGFAD to establish standards for radiation protection in FAE as well.
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Affiliation(s)
- Thomas D Ruder
- Institute of Diagnostic, Interventional and Pediatric Radiology, InselspitaI, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010, Bern, Switzerland.
| | - Saskia C Kuhnen
- Institute of Diagnostic, Interventional and Pediatric Radiology, InselspitaI, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010, Bern, Switzerland
| | - Wolf-Dieter Zech
- Institute of Forensic Medicine, University of Bern, Bern, Switzerland
| | - Jeremias B Klaus
- Institute of Diagnostic, Interventional and Pediatric Radiology, InselspitaI, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010, Bern, Switzerland
- Institute of Forensic Medicine, University of Bern, Bern, Switzerland
- Roentgen Institute Thun, Thun, Switzerland
| | - Paolo Lombardo
- Institute of Diagnostic, Interventional and Pediatric Radiology, InselspitaI, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010, Bern, Switzerland
| | - Michael Ith
- Institute of Diagnostic, Interventional and Pediatric Radiology, InselspitaI, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010, Bern, Switzerland
- Radiation Protection, Image Processing Systems & Radiological Processes, Hirslanden Private Hospital Group, Zurich, Switzerland
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5
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Lopatin O, Barszcz M, Jurczak A, Woźniak KJ. Postmortem computed tomography assessment of skeletal and dental age in Polish children, adolescents, and young adults. Forensic Sci Med Pathol 2023:10.1007/s12024-023-00662-x. [PMID: 37428292 DOI: 10.1007/s12024-023-00662-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2023] [Indexed: 07/11/2023]
Abstract
This paper presents a retrospective analysis of postmortem computed tomography (PMCT) scans of secondary ossification centers in the medial clavicular epiphysis, iliac crest apophysis, proximal humeral epiphysis, distal femoral epiphysis, proximal tibial epiphysis, and distal tibial epiphysis. At the same time, we analyzed PMCT scans of the maxillary and mandibular incisors, canines, premolars, and molars. We assessed 203 corpses, whose age ranged from 2 to 30 years, including 156 males and 47 females. The purpose of our study was to compare the processes of secondary ossification center fusion and permanent tooth maturation. Our research hypothesis was that certain stages of skeletal and dental maturation occur along consistent timelines that can be related to the chronological age. Secondary ossification center fusion was evaluated based on Kreitner and also McKern and Steward's classifications. The process of permanent tooth maturation was evaluated with Demirjian's method. Spearman's correlation coefficients (Rho) were positive in all analyses, which indicates that epiphyseal fusion progresses with age. The strongest relationship between the age and the stages of ossification was observed in the proximal tibial epiphysis (p < 0.001; Rho = 0.93) in females and in the medial clavicular epiphysis (p < 0.001; Rho = 0.77) in males. Studies show the importance of concomitant analysis of skeletal and dental maturation with a subsequent comparison of the results to achieve a greater precision in age estimation. A comparison of the results obtained in the study population of Polish children, adolescents, and young adults with the results of other studies in populations of similar ages showed a number of similarities in the time windows of dental and skeletal maturation. These similarities may help in age estimation.
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Affiliation(s)
- Oleksiy Lopatin
- Chair and Department of Forensic Medicine, Faculty of Medicine, Jagiellonian University Medical College, Grzegorzecka 16, 31-531, Krakow, Poland
| | - Marta Barszcz
- Chair and Department of Forensic Medicine, Faculty of Medicine, Jagiellonian University Medical College, Grzegorzecka 16, 31-531, Krakow, Poland
- Doctoral School of Medical and Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | - Anna Jurczak
- Doctoral School of Medical and Health Sciences, Jagiellonian University Medical College, Krakow, Poland
- Department of Environmental Health, Institute of Public Health, Faculty of Health Science, Jagiellonian University Medical College, Krakow, Poland
| | - Krzysztof Jerzy Woźniak
- Chair and Department of Forensic Medicine, Faculty of Medicine, Jagiellonian University Medical College, Grzegorzecka 16, 31-531, Krakow, Poland.
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6
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Kobayashi S, Makino Y, Torimitsu S, Mizuno S, Yamaguchi R, Chiba F, Tsuneya S, Iwase H. Age estimation by palatal suture using modified Kamijo's method. Forensic Sci Int 2023; 348:111706. [PMID: 37137211 DOI: 10.1016/j.forsciint.2023.111706] [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: 01/23/2023] [Revised: 03/21/2023] [Accepted: 04/20/2023] [Indexed: 05/05/2023]
Abstract
The present study aimed to investigate the correlation between palatal suture obliteration and age in modern Japanese and to develop an age estimation equation by modifying Kamijo's (1949) method. The subjects were 195 Japanese skeletal remains (155 males and 40 females) whose age and sex were known. First, obliteration score (OS) was obtained by measuring palatal suture obliteration from photographic images taken at the time of forensic autopsy, and the correlation with age was examined; no significant correlation was found in females. Second, the palatal sutures were divided into 14 sections, and each section was scored from 0 to 4 points according to the degree of the suture obliteration. Suture scores (SS) were then calculated for each of the four sutures, and the sum of the 14 scores (TSS: total suture score) was used to perform regression analysis for age. For male and all subjects (male and female), age significantly increased (p < 0.001) according to increment of SSs for all sutures. TSS has the highest regression coefficient (r = 0.540), and the lowest standard error of estimation (13.54 years) for all of the patients. The intra- and inter-observer agreement scoring showed high reliability. Validation study using the formulae showed a high percentage of correct responses (80 %). In conclusion, age estimation regression formula by palatal suture using modified Kamijo's method was established for Japanese population, and the study showed the formula might be valid for age estimation.
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Affiliation(s)
- Susumu Kobayashi
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan.
| | - Yohsuke Makino
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan; Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba Prefecture 260-8670, Japan
| | - Suguru Torimitsu
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan; Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba Prefecture 260-8670, Japan
| | - Satomi Mizuno
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Rutsuko Yamaguchi
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan; Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba Prefecture 260-8670, Japan
| | - Fumiko Chiba
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan; Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba Prefecture 260-8670, Japan
| | - Shigeki Tsuneya
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan; Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba Prefecture 260-8670, Japan
| | - Hirotaro Iwase
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan; Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba Prefecture 260-8670, Japan
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7
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Kobayashi S, Makino Y, Torimitsu S, Yamaguchi R, Chiba F, Tsuneya S, Iwase H. Age estimation by evaluating median palatine suture closure using postmortem CT. Int J Legal Med 2023:10.1007/s00414-023-02994-3. [PMID: 37074412 DOI: 10.1007/s00414-023-02994-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 03/14/2023] [Indexed: 04/20/2023]
Abstract
This study sought to develop an age-estimation formula to evaluate the extent of median palatine suture (MP) closure using postmortem computed tomographic (PMCT) images. The PMCT images of 634 Japanese subjects (mean age, 54.5 years; standard deviation [SD], 23.2 years) with known age and sex were examined. The degree of suture closure of the MP, anterior median palatine suture (AMP), and posterior median palatine suture (PMP) was measured and scored (suture closure score, SCS), and a single linear regression analysis was conducted with age at death. On the analysis, SCS of MP, AMP, and PMP showed a significant correlation with age (p < 0.001). The correlation coefficient of MP was higher (0.760, male; 0.803, female; and 0.779, total) than that of AMP (0.726, male; 0.745, female; and 0.735, total) or PMP (0.457, male; 0.630, female; and 0.549, total). The regression formula and standard error of estimation (SEE) of MP were calculated as Age = 100.95 × SCS + 20.51 (SEE 14.87 years) for male subjects, Age = 91.93 × SCS + 26.65 (SEE 14.12 years) for female subjects, and Age = 95.17 × SCS + 24.09 (SEE 14.59 years) for the total, respectively. In addition, another 50 Japanese subjects were randomly selected to validate the age-estimation formula. In this validation, the actual age of 36 subjects (72%) was within the estimated age ± SEE. This study showed that the age estimation formula using PMCT images of MPs was potentially useful for estimating the age of unidentified corpses.
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Affiliation(s)
- Susumu Kobayashi
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
| | - Yohsuke Makino
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba Prefecture, 260-8670, Japan
| | - Suguru Torimitsu
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba Prefecture, 260-8670, Japan
| | - Rutsuko Yamaguchi
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba Prefecture, 260-8670, Japan
| | - Fumiko Chiba
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba Prefecture, 260-8670, Japan
| | - Shigeki Tsuneya
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba Prefecture, 260-8670, Japan
| | - Hirotaro Iwase
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba Prefecture, 260-8670, Japan
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8
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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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9
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Corron LK, Broehl KA, Chu EY, Vlemincq-Mendieta T, Wolfe CA, Pilloud MA, Scott GR, Spradley MK, Stull KE. Agreement and error rates associated with standardized data collection protocols for skeletal and dental data on 3D virtual subadult crania. Forensic Sci Int 2022; 334:111272. [DOI: 10.1016/j.forsciint.2022.111272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 02/15/2022] [Accepted: 03/11/2022] [Indexed: 11/04/2022]
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10
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Chiba F, Inokuchi G, Hoshioka Y, Sakuma A, Makino Y, Torimitsu S, Yamaguchi R, Saitoh H, Kono M, Iwase H. Age estimation by evaluation of osteophytes in thoracic and lumbar vertebrae using postmortem CT images in a modern Japanese population. Int J Legal Med 2021; 136:261-267. [PMID: 34642821 DOI: 10.1007/s00414-021-02714-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 09/26/2021] [Indexed: 10/20/2022]
Abstract
Estimation of age at death is important in forensic investigations of unknown remains. There have been several reports on applying the degree of osteophyte formation-an age-related change in the vertebral body-for age estimation; however, this method is not yet established. This study investigated a method for age estimation of modern Japanese individuals using osteophytes measured on CT images. The sample included 250 cadavers (125 males) aged 20-95 years. The degree of osteophyte formation was evaluated as score O (0-5 points), and the degree of fusion of the osteophytes between the upper and lower vertebrae was evaluated as score B (0-2 points). Age estimation equations were developed using regression analyses with seven variables, determined by scores O and B, and the equation with the smallest standard error of estimate (SEE) was obtained when the number of vertebrae with score O ≥ 2 was used as the explanatory variable. Age estimation with SEE of about 10 years was possible even when partial vertebrae with a high degree of osteophyte formation were used, showing its potential for practical application. The cutoff value for age estimation was established using the receiver operating characteristic curve analysis, wherein good results were obtained for all variables (area under the curve ≥ 0.8). The combination of the estimation equation and the cutoff value can narrow the range of age estimates.
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Affiliation(s)
- Fumiko Chiba
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba Prefecture, 260-8670, Japan. .,Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8654, Japan.
| | - Go Inokuchi
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba Prefecture, 260-8670, Japan.,Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8654, Japan
| | - Yumi Hoshioka
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba Prefecture, 260-8670, Japan
| | - Ayaka Sakuma
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba Prefecture, 260-8670, Japan
| | - Yohsuke Makino
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba Prefecture, 260-8670, Japan.,Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8654, Japan
| | - Suguru Torimitsu
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba Prefecture, 260-8670, Japan.,Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8654, Japan
| | - Rutsuko Yamaguchi
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba Prefecture, 260-8670, Japan.,Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8654, Japan
| | - Hisako Saitoh
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba Prefecture, 260-8670, Japan
| | - Mei Kono
- Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8654, Japan
| | - Hirotaro Iwase
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba Prefecture, 260-8670, Japan.,Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8654, Japan
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11
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Corron LK, Stock MK, Cole SJ, Hulse CN, Garvin HM, Klales AR, Stull KE. Standardizing ordinal subadult age indicators: Testing for observer agreement and consistency across modalities. Forensic Sci Int 2021; 320:110687. [PMID: 33461006 DOI: 10.1016/j.forsciint.2021.110687] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 01/02/2021] [Accepted: 01/08/2021] [Indexed: 11/16/2022]
Abstract
Skeletal and dental data for subadult analyses obtained from dry bones or various types of medical images, such as computed tomography (CT) scans or conventional radiographs/x-rays, should be consistent and repeatable to ensure method applicability across modalities and support combining study samples. The present study evaluates observer agreement of epiphyseal fusion and dental development stages obtained on CT scans of a U.S. sample and the consistency of epiphyseal fusion stages between CT scans and projected scan radiographs/scout images (U.S. CT sample), and between dry bones and conventional x-rays (Colombian osteological sample). Results show that both intra- and interobserver agreements of scores on CT scans were high (intra: mean Cohen's kappa=0.757-0.939, inter: mean Cohen's kappa=0.773-0.836). Agreements were lower for dental data (intra: mean Cohen's kappa=0.757, inter: mean Cohen's kappa=0.773-0.0.820) compared to epiphyseal fusion data (intra: mean Cohen's kappa=0.939, inter: mean Cohen's kappa=0.807-0.836). Consistency of epiphyseal fusion stages was higher between dry bones and conventional x-rays than between CT scans and scout images (mean Cohen's kappa=0.708-0.824 and 0.726-0.738, respectively). Differences rarely surpassed a one-stage value between observers or modalities. The complexity of some ossification patterns and superimposition had a greater negative impact on agreement and consistency rates than observer experience. Results suggest ordinal subadult skeletal data can be collected and combined across modalities.
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Affiliation(s)
- L K Corron
- Department of Anthropology, University of Nevada, Reno, United States.
| | - M K Stock
- Department of Sociology and Anthropology, Metropolitan State University of Denver, United States
| | - S J Cole
- Department of Anthropology, University of Nevada, Reno, United States
| | - C N Hulse
- Department of Anthropology, University of Nevada, Reno, United States
| | - H M Garvin
- Department of Anatomy, Des Moines University, United States
| | - A R Klales
- Forensic Anthropology Program, Washburn University, United States
| | - K E Stull
- Department of Anthropology, University of Nevada, Reno, United States; University of Pretoria, South Africa
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12
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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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13
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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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14
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Monum T, Makino Y, Prasitwattanaseree S, Yajima D, Chiba F, Torimitsu S, Hoshioka Y, Yoshida M, Urabe S, Oya Y, Iwase H. Age estimation from ossification of sternum and true ribs using 3D post-mortem CT images in a Japanese population. Leg Med (Tokyo) 2019; 43:101663. [PMID: 31954957 DOI: 10.1016/j.legalmed.2019.101663] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Revised: 11/19/2019] [Accepted: 12/17/2019] [Indexed: 10/25/2022]
Abstract
Age estimation of cadavers from post-mortem "chest plate" using conventional radiography, which involves radiographic assessment of ossification around the sternum and rib ends, has been evaluated without fruitful results. This study examined the value of images of the chest plate obtained by three-dimensional post-mortem CT for estimation of age at time of death in a Japanese population. Five chest plate ossification scores were evaluated in 320 subjects, including ossification of the first costal cartilage (OF), ossification of the second to seventh costal cartilages at the rib (OR) and sternal (OS) ends, fusion of the manubriosternal joint (FM), and fusion of the xiphisternal joint (FX). OS was found to have the highest correlation with age while FM had no significant correlation. The best composite score for age estimation was the summative score for both sides of the OS and the right side of the OF and FX, for which the coefficient of determination (R2) and the standard error of estimation (SEE) were 0.608 and 12.44 years, respectively, for men and 0.590 and 14.65 years for women. The accuracy of the model was tested in a further 26 male and 24 female subjects, and the accuracy rate within the first SEE was 57.69% and 70.83%, respectively. This rapid and non-invasive method of age estimation in the chest plate area is superior to conventional methods and could be useful for estimation of age at time of death in the Japanese population.
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Affiliation(s)
- Tawachai Monum
- Department of Forensic Medicine, Faculty of Medicine, Chiang Mai University, 110, Intravaroros Rd, Sriphoom, Muang, Chiang 50200, Thailand; Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba 260-8670, Japan.
| | - Yohsuke Makino
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba 260-8670, Japan; Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-0033, Japan.
| | - Sukon Prasitwattanaseree
- Department of Statistics, Faculty of Science, Chiang Mai University, 110, Intravaroros Rd, Sriphoom, Muang, Chiang 50200, Thailand
| | - Daisuke Yajima
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba 260-8670, Japan.
| | - Fumiko Chiba
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba 260-8670, Japan; Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-0033, Japan.
| | - Suguru Torimitsu
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba 260-8670, Japan; Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-0033, Japan.
| | - Yumi Hoshioka
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba 260-8670, Japan.
| | - Maiko Yoshida
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba 260-8670, Japan
| | - Shumari Urabe
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba 260-8670, Japan.
| | - Yukiko Oya
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba 260-8670, Japan.
| | - Hirotaro Iwase
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba 260-8670, Japan; Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-0033, Japan.
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15
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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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16
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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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17
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Magnetic resonance imaging of third molars in forensic age estimation: comparison of the Ghent and Graz protocols focusing on apical closure. Int J Legal Med 2018; 133:583-592. [DOI: 10.1007/s00414-018-1905-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 07/18/2018] [Indexed: 10/28/2022]
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18
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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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Magnetic resonance imaging-based evaluation of ossification of the medial clavicular epiphysis in forensic age assessment. Int J Legal Med 2017; 131:1665-1673. [PMID: 28889331 DOI: 10.1007/s00414-017-1676-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Accepted: 08/30/2017] [Indexed: 10/18/2022]
Abstract
Evaluation of the degree of ossification of the medial clavicular epiphysis plays a crucial role in determining with an adequate degree of probability whether legally relevant age boundaries after the age of 17 have been crossed. In view of the need to avoid unnecessary radiation exposure, establishing non-X-ray methods for investigating the clavicle has long been a key objective in forensic age assessment research. Based on magnetic resonance imaging examinations in a large sample of healthy subjects, the current study for the first time presents statistical measures which allow inferences to be drawn for forensic age assessment in both sexes. We undertook a prospective study of a reference sample of 334 female and 335 male German volunteers aged from 12 to 24 using a 3-T MRI scanner. A 3D FFE (fast field echo) T1-weighted sequence with fat saturation was acquired. To stage ossification of the medial clavicular epiphysis, we used the clavicular ossification staging systems described by Schmeling et al. and Kellinghaus et al. Ossification stage IIIc offers a means in both sexes of demonstrating that the age of 18 has been attained prior to complete ossification of the epiphyseal plate. In both sexes, if a subject has reached ossification stage IV, it can be stated that he or she has attained the age of 21. Magnetic resonance imaging is a valid diagnostic procedure for determining the ossification stage of the medial clavicular epiphysis.
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20
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Scharte P, Vieth V, Schulz R, Ramsthaler F, Püschel K, Bajanowski T, Pfeiffer H, Schmeling A, Schmidt S, Wittschieber D. Comparison of imaging planes during CT-based evaluation of clavicular ossification: a multi-center study. Int J Legal Med 2017; 131:1391-1397. [PMID: 28608146 DOI: 10.1007/s00414-017-1615-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 05/23/2017] [Indexed: 11/26/2022]
Abstract
Determining the ossification stage of the medial clavicular epiphysis by computed tomography represents the currently recommended methodology for the question of whether a living individual has completed the 18th or 21st year of life. In the present study, thin-slice CT scans of 1078 sternoclavicular joints were reconstructed in axial and coronal image series and evaluated according to the two classification systems established for age diagnostics using the clavicle. Both image series (axial and coronal) were analyzed separately. When comparing the results of axial and coronal view, a different ossification stage was found in 35.6% of the clavicles. The results suggest an influence of the imaging plane on the process of stage determination. In order to further approximate the three-dimensional and asymmetrical structure of the epiphyseal ossification center, the usage of at least two different reformation types may be recommended. In practice, only those reference studies should be applied which exactly employed the same number and orientations of the reformation types that are going to be used in the respective routine case.
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Affiliation(s)
- Philipp Scharte
- Institute of Legal Medicine, University Hospital Münster, Röntgenstraße 23, 48149, Münster, Germany
| | - Volker Vieth
- Institute of Clinical Radiology, University Hospital Münster, Münster, Germany
- Clinic of Radiology, Ibbenbüren Hospital, Ibbenbüren, Germany
| | - Ronald Schulz
- Institute of Legal Medicine, University Hospital Münster, Röntgenstraße 23, 48149, Münster, Germany
| | - Frank Ramsthaler
- Institute of Legal Medicine, University of the Saarland, Homburg, Saar, Germany
- Institute of Legal Medicine, University Hospital Frankfurt/Main, Frankfurt/Main, Germany
| | - Klaus Püschel
- Institute of Legal Medicine, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Bajanowski
- Institute of Legal Medicine, University Hospital Essen, Essen, Germany
| | - Heidi Pfeiffer
- Institute of Legal Medicine, University Hospital Münster, Röntgenstraße 23, 48149, Münster, Germany
| | - Andreas Schmeling
- Institute of Legal Medicine, University Hospital Münster, Röntgenstraße 23, 48149, Münster, Germany
| | - Sven Schmidt
- Institute of Legal Medicine, University Hospital Münster, Röntgenstraße 23, 48149, Münster, Germany
- Institute of Legal Medicine, Charité University Hospital, Berlin, Germany
| | - Daniel Wittschieber
- Institute of Legal Medicine, University Hospital Münster, Röntgenstraße 23, 48149, Münster, Germany.
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21
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Optimising magnetic resonance imaging-based evaluation of the ossification of the medial clavicular epiphysis: a multi-centre study. Int J Legal Med 2016; 130:1615-1621. [PMID: 27631994 DOI: 10.1007/s00414-016-1442-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Accepted: 08/19/2016] [Indexed: 10/21/2022]
Abstract
Evaluation of the ossification of the medial clavicular epiphysis plays a key role in forensic age estimation, particularly in determining whether the age of 18 has been attained. A key research objective in the forensic age estimation field at present is to establish non-X-ray methods for investigating the clavicle. This paper looks at the use of magnetic resonance imaging for evaluating the developmental state of the medial clavicular epiphysis. Clavicle specimens obtained from autopsies of 125 female and 270 male subjects aged from 10 to 30 were examined using a 3-T magnetic resonance scanner. One FFE-3D-T1 gradient echo sequence and one 2D-T2 turbo spin echo sequence were acquired. In each case, two investigators undertook a consensual determination of the ossification stage of the medial clavicular epiphysis using recognised classification systems. To determine intra-observer and inter-observer agreement, 80 clavicle specimens were subjected to repeat evaluation. We present statistics relating to the ossification stages. The inclusion of established sub-stages of clavicular ossification offers an additional option for determining whether a subject has attained the age of 18 which is applicable in both sexes. For both sexes, the minimum ages for ossification stages 4 and 5 allow conclusions to be drawn about a subject's age at a point in time lying several years in the past. Magnetic resonance imaging is a valid investigatory procedure for determining the ossification stage of the medial clavicular epiphysis. This paper makes a contribution to expanding the range of methods available for forensic age estimation.
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22
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Forensic age diagnostics using projection radiography of the clavicle: a prospective multi-center validation study. Int J Legal Med 2015; 130:213-9. [DOI: 10.1007/s00414-015-1285-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 10/21/2015] [Indexed: 10/22/2022]
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23
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Larsen ST, Arge S, Lynnerup N. The Danish approach to forensic age estimation in the living: how, how many and what's new? A review of cases performed in 2012. Ann Hum Biol 2015; 42:342-7. [PMID: 26286458 DOI: 10.3109/03014460.2015.1044469] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The resulting statement of forensic age estimations in the living is of great consequence for the examinees in question. Concerns have been raised about the nature of these examinations, e.g. the potentially harmful radiographic exposures, as well as the accuracy of the estimated age. AIM This manuscript investigates the reported age estimates performed at the Section of Forensic Pathology, Institute of Forensic Medicine, Copenhagen, in 2012. SUBJECTS AND METHODS The results of the individual assessments, i.e. the physical examination, and the radiographic examinations of bone age and dental age, were investigated as well as the correlation between the age estimates of the two latter examinations. RESULTS In 139 out of the 174 statements, a conclusive chronological age estimate of at least 18 years was given. Although bone age was assessed within the dental age-range in a total of 152 out of 162 cases, some variations in the combined assessments were seen. CONCLUSION The current procedure is not mathematically or statistically satisfactory. Instead, the most likely age including the variation and error of the age estimate should be reported in statements. The introduction of a Bayesian approach and the use of post-mortem-imaging-based databases may be used for this purpose.
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Affiliation(s)
- Sara Tangmose Larsen
- a University of Copenhagen, Forensic Medicine, Frederik V Vej 11 , Copenhagen , Denmark and
| | - Sara Arge
- a University of Copenhagen, Forensic Medicine, Frederik V Vej 11 , Copenhagen , Denmark and
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Abstract
The authors present the opportunities of the application of post-mortem imaging, focusing on post-mortem computed tomography and post-mortem computed tomography angiography in modern forensic investigation of homicide cases. The paper is based on scientific publications related to the subject from ca. the past 10 years, supplemented by the authors' own experiences. The article is illustrated with reconstructions based on the authors' own cases related to homicide due to ballistic/sharp/blunt trauma. As is shown, the results of evaluation of post-mortem computed tomography allow better diagnosis, documentation and visualisation of forensic examinations.
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Wittschieber D, Ottow C, Vieth V, Küppers M, Schulz R, Hassu J, Bajanowski T, Püschel K, Ramsthaler F, Pfeiffer H, Schmidt S, Schmeling A. Projection radiography of the clavicle: still recommendable for forensic age diagnostics in living individuals? Int J Legal Med 2014; 129:187-93. [PMID: 25135751 DOI: 10.1007/s00414-014-1067-0] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 08/08/2014] [Indexed: 11/30/2022]
Abstract
As superimposition effects often impede the evaluation of the ossification status of the medial clavicular epiphysis in standard posterior-anterior (PA) radiographs, additional oblique images (right anterior oblique, RAO, and left anterior oblique, LAO) are currently recommended to allow for reliable stage assessments. The present study examines the influence of the radiographic projection type on stage determination. To this end, 836 sternoclavicular joints were prospectively obtained during forensic autopsies of bodies aged between 15 and 30 years. Subsequently, three different radiographs (PA, RAO, and LAO) were taken from each specimen and separately evaluated as to the developmental stage of the medial clavicular epiphysis. A forensically established five-stage classification system was used. In 25 % of the cases, the medial clavicular epiphysis depicted in an oblique projection showed a different ossification stage than in the PA projection. In at least 10 % of the cases, a higher ossification stage was observed which would have significant disadvantages in criminal proceedings (ethically unacceptable error). In conclusion, the usage of the current radiographic reference data, which rely upon chest radiographs taken as PA projections, appears to be inadmissible for oblique projections. Projection radiography of the clavicle can therefore no longer be recommended for forensic age estimation practice. As to the question of whether an individual has achieved the age of 18 or 21, computed tomography of the clavicle must be regarded as the exclusive method of choice.
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Affiliation(s)
- Daniel Wittschieber
- Institute of Legal Medicine, University Hospital Münster, Röntgenstraße 23, 48149, Münster, Germany,
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Vieth V, Schulz R, Brinkmeier P, Dvorak J, Schmeling A. Age estimation in U-20 football players using 3.0 tesla MRI of the clavicle. Forensic Sci Int 2014; 241:118-22. [PMID: 24908196 DOI: 10.1016/j.forsciint.2014.05.008] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Revised: 04/29/2014] [Accepted: 05/12/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND To guarantee equal chances for participants in U-20 football tournaments, it seems desirable to verify the ages given by players with questionable dates of birth. OBJECTIVE To study the potential use of 3.0 tesla MRI of the clavicle in estimating the ages of U-20 football players. METHODS The ossification stage of the medial clavicular epiphyses was evaluated prospectively in 152 male footballers in the age group from 18 to 22 years using 3.0 tesla MRI. RESULTS Average age increased with any higher degree of fusion. The only footballer with full ossification of the medial clavicular epiphyseal plate was 21.2 years old. CONCLUSIONS The presence of a fully ossified clavicular epiphyseal plate appears to provide evidence of completion of the 20th year of life. The results of the pilot study need to be verified in a larger number of cases.
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Affiliation(s)
- Volker Vieth
- Institute of Clinical Radiology, University Hospital Münster, Albert-Schweitzer-Campus 1, Münster 48149, Germany
| | - Ronald Schulz
- Institute of Legal Medicine, University Hospital Münster, Röntgenstraße 23, Münster 48149, Germany
| | - Paul Brinkmeier
- Institute of Legal Medicine, University Hospital Münster, Röntgenstraße 23, Münster 48149, Germany
| | - Jiri Dvorak
- Department of Neurology, Schultheiss Clinic, Lengghalde 2, Zurich 8008, Switzerland
| | - Andreas Schmeling
- Institute of Legal Medicine, University Hospital Münster, Röntgenstraße 23, Münster 48149, Germany.
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