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Farooq M, Belair JA, Desai V. Pediatric Shoulder Girdle. Semin Musculoskelet Radiol 2024; 28:384-395. [PMID: 39074722 DOI: 10.1055/s-0044-1779717] [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: 07/31/2024]
Abstract
The pediatric shoulder girdle is a complex anatomical structure uniting the upper extremity and trunk. The osseous structures, their articulations, and the surrounding soft tissue support structures (muscles, tendons, and ligaments) allow for a wide range of motion at the shoulder. Growth and maturation of the components at the shoulder girdle vary, particularly the osseous structures. This characteristic renders interpretation of imaging of the pediatric shoulder girdle more challenging because normal or variant anatomy can be confused for pathology. We review the physiologic growth and maturation of the shoulder girdle with special emphasis on the development of the bones and their articulations. The role of various imaging modalities and the common osseous and soft tissue variants in the pediatric shoulder are also discussed.
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Affiliation(s)
- Mobeen Farooq
- Department of Radiology, Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Jeffrey A Belair
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Vishal Desai
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania
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Schlégl ÁT, O’Sullivan I, Varga P, Than P, Vermes C. Alternative methods for skeletal maturity estimation with the EOS scanner—Experience from 934 patients. PLoS One 2022; 17:e0267668. [PMID: 35522608 PMCID: PMC9075679 DOI: 10.1371/journal.pone.0267668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 04/12/2022] [Indexed: 11/19/2022] Open
Abstract
Background Hand-wrist bone age assessment methods are not possible on typical EOS 2D/3D images without body position modifications that may affect spinal position. We aimed to identify and assess lesser known bone age assessment alternatives that may be applied retrospectively and without the need for extra imaging. Materials and methods After review of 2857 articles, nine bone age methods were selected and applied retrospectively in pilot study (thirteen individuals), followed by evaluation of EOS images of 934 4-24-year-olds. Difficulty of assessment and time taken were recorded, and reliability calculated. Results Five methods proved promising after pilot study. Risser ‘plus’ could be applied with no difficulty in 89.5% of scans (836/934) followed by the Oxford hip method (78.6%, 734/934), cervical (79.0%, 738/934), calcaneus (70.8%, 669/934) and the knee (68.2%, 667/934). Calcaneus and cervical methods proved to be fastest at 17.7s (95% confidence interval, 16.0s to 19.38s & 26.5s (95% CI, 22.16s to 30.75s), respectively, with Oxford hip the slowest at 82.0 s (95% CI, 76.12 to 87.88s). Difficulties included: regions lying outside of the image—assessment was difficult or impossible in upper cervical vertebrae (46/934 images 4.9%) and calcaneus methods (144/934 images, 15.4%); position: lower step length was associated with difficult lateral knee assessment & head/hand position with cervical evaluation; and resolution: in the higher stages of the hip, calcaneal and knee methods. Conclusions Hip, iliac crest and cervical regions can be assessed on the majority of EOS scans and may be useful for retrospective application. Calcaneus evaluation is a simple and rapidly applicable method that may be appropriate if consideration is given to include full imaging of the foot.
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Affiliation(s)
- Ádám Tibor Schlégl
- Department of Orthopaedics, University of Pécs, Medical School, Pécs, Hungary
- * E-mail:
| | - Ian O’Sullivan
- Department of Orthopaedics, University of Pécs, Medical School, Pécs, Hungary
| | - Péter Varga
- Department of Orthopaedics, University of Pécs, Medical School, Pécs, Hungary
- Department of Primary Health Care, University of Pécs, Medical School, Pécs, Hungary
| | - Péter Than
- Department of Orthopaedics, University of Pécs, Medical School, Pécs, Hungary
| | - Csaba Vermes
- Department of Orthopaedics, University of Pécs, Medical School, Pécs, Hungary
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Lu T, Qiu LR, Ren B, Shi L, Fan F, Deng ZH. Forensic age estimation based on magnetic resonance imaging of the proximal humeral epiphysis in Chinese living individuals. Int J Legal Med 2021; 135:2437-2446. [PMID: 34232354 DOI: 10.1007/s00414-021-02653-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 06/27/2021] [Indexed: 10/20/2022]
Abstract
Forensic age estimation in living individuals is mainly based on radiological features, but direct radiography and computed tomography lead to a rise in ethical concerns due to radiation exposure. Thus, the contribution of magnetic resonance imaging (MRI) to age estimation of living individuals is a subject of ongoing research. In the current study, MRIs of shoulder were retrospectively collected from a modern Chinese Han population and data from 835 individuals (599 males and 236 females) in the age group 12 to 30 years were obtained. A staging technique based on (Schmidt et al. Int J Legal Med 121(4):321-324, 2007) and (Kellinghaus et al. Int J Legal Med 124(4):321-325, 2010) was used and all images were evaluated with T1-wieghted turbo spin echo (T1-TSE) sequence and T2-weighed fat suppression (T2-FS) sequence. One-sided images were assessed because data from both sides were considered coincidental, as no significant differences were found (P > 0.05). Two MRI sequences were evaluated separately and subsequently compared. Regression models and supportive vector classification (SVC) models were established accordingly. The intraobserver and interobserver agreement levels were good. Compared with T1-TSE sequence, the R2 values of T2-FS sequence were generally higher, while the mean absolute deviation (MAD) values were slightly lower. For T2-FS sequence, the MAD value was 1.49 years in males and 2.19 years in females. With two MRI sequences incorporated, the SVC model obtained with 85.7% correctly classified minors and 96.2% correctly classified adults in males, while 83.3% and 98.0% respectively in females. In conclusion, T2-FS sequence may slightly outperform the T1-TSE sequence in shoulder MRI analysis for age estimation, while shoulder MRIs could be a reliable prediction indicator for the 18-year threshold and two MRI sequences incorporated are encouraged.
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Affiliation(s)
- Ting Lu
- Department of Forensic Pathology, West China School of Basic Medical Science & Forensic Medicine, Sichuan University, Chengdu, Sichuan, 610041, People's Republic of China
| | - Li-Rong Qiu
- Department of Forensic Pathology, West China School of Basic Medical Science & Forensic Medicine, Sichuan University, Chengdu, Sichuan, 610041, People's Republic of China
| | - Bo Ren
- Department of Paediatric Orthopedics, Sichuan Provincial Orthopedics Hospital, Chengdu, Sichuan, 610041, People's Republic of China
| | - Lei Shi
- Department of Forensic Pathology, West China School of Basic Medical Science & Forensic Medicine, Sichuan University, Chengdu, Sichuan, 610041, People's Republic of China
| | - Fei Fan
- Department of Forensic Pathology, West China School of Basic Medical Science & Forensic Medicine, Sichuan University, Chengdu, Sichuan, 610041, People's Republic of China.
| | - Zhen-Hua Deng
- Department of Forensic Pathology, West China School of Basic Medical Science & Forensic Medicine, Sichuan University, Chengdu, Sichuan, 610041, People's Republic of China.
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Altinsoy HB, Gurses MS, Alatas O. Evaluation of proximal humeral epiphysis ossification in 3.0 T MR images according to the Dedouit staging method: Is it be used for age of majority? J Forensic Leg Med 2020; 77:102095. [PMID: 33338800 DOI: 10.1016/j.jflm.2020.102095] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 11/08/2020] [Accepted: 11/15/2020] [Indexed: 10/22/2022]
Abstract
Magnetic resonance imaging (MRI) for forensic age estimation is among the research issues since it does not lead to radiation exposure. In this study, the ossification stage of the proximal humeral epiphysis was determined retrospectively in 178 male and 109 female individuals in the 12 to 30-year age group using 3.0 T MRI. All images were evaluated with the proton density fat saturated turbo spin echo (PD TSE FS) sequence and the T2 TSE FS sequence. A five-stage scoring system was used following the method of Dedouit et al. The relevant statistics were defined as minimum, maximum, mean ± standard deviation, 95% confidence interval of mean and median and the intra- and interobserver agreement levels were very good (κ > 0.80). There were no significant age differences between males and females in any of the stages (all p-values>0.05). According to the present study, stage 5 was initially observed at age 22 years for both genders. According to our results, it is possible to determine the completion of the 18th year of life in either gender on the shoulder joint. Proximal humeral epiphysis ossification may be used as an additional method for forensic age estimation through MRI.
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Affiliation(s)
- Hasan Baki Altinsoy
- Department of Radiology, Faculty of Medicine, Duzce University, Duzce, Turkey
| | - Murat Serdar Gurses
- Department of Forensic Medicine, Faculty of Medicine, Sakarya University, Sakarya, Turkey.
| | - Ozkan Alatas
- Department of Radiology, Faculty of Medicine, Dokuzeylul University, Izmir, Turkey
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Bermúdez de Castro JM, Martínez de Pinillos M, López-Polín L, Martín-Francés L, García-Campos C, Modesto-Mata M, Rosell J, Martinón-Torres M. A descriptive and comparative study of two Early Pleistocene immature scapulae from the TD6.2 level of the Gran Dolina cave site (Sierra de Atapuerca, Spain). J Hum Evol 2020; 139:102689. [PMID: 31902740 DOI: 10.1016/j.jhevol.2019.102689] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 10/03/2019] [Accepted: 10/09/2019] [Indexed: 11/26/2022]
Abstract
Here we present the descriptive and comparative study of two immature scapulae recovered from the TD6.2 level of the Gran Dolina cave site (Sierra de Atapuerca, Spain) and assigned to Homo antecessor. This is the first time that data on the morphology and dimensions of the scapulae of a European late Early Pleistocene hominin population are provided. Considering the state of development and the linear dimensions, the scapula ATD6-116 could belong to a child of about 2-4 years. The morphology of ATD6-116 clearly departs from that of the Australopithecus afarensis juvenile specimen DIK-1-1, pointing to functional differences in locomotor behavior between Australopithecus and the late Early Pleistocene hominins. The immature scapula ATD6-118 belonged to an immature individual with a development of the scapula equivalent to that of adolescents of recent human populations. The scapulae ATD6-118 and KNM-WT 15000 present a similar state of development. Although the scapula KNM-WT 15000 is clearly larger than ATD6-118, these two specimens share some characteristics such as their relative narrowness and the value of the axilloglenoid and spinoglenoid angles. The glenoid fossa of ATD6-116 show a lateral orientation, whereas in ATD6-118 the glenoid fossa is slightly cranially oriented, but still within the range of variation of modern humans. The glenoid index of both ATD6-116 and ATD6-118 is low in accordance to the values usually observed in other early hominins, thus showing the primitive condition for this feature. Both scapulae show a ventrally placed axillary sulcus. The presence of this primitive feature in ATD-116 confirms that the shape of the axillary border has a genetic basis and it is not related to physical activity.
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Affiliation(s)
- José María Bermúdez de Castro
- Centro Nacional de Investigación sobre la Evolución Humana (CENIEH), Paseo de la Sierra de Atapuerca 3, 09002 Burgos, Spain; Anthropology Department, University College London, 14 Taviton Street, London WC1 H 0BW, UK.
| | - Marina Martínez de Pinillos
- Centro Nacional de Investigación sobre la Evolución Humana (CENIEH), Paseo de la Sierra de Atapuerca 3, 09002 Burgos, Spain.
| | - Lucía López-Polín
- IPHES, Institut Català de Paleoecologia Humana i Evolució Social, Unit Associated to CSIC, C/Marcel.lí Domingo s/n-Campus Sescelades URV (Edifici W3), 43007 Tarragona, Spain.
| | - Laura Martín-Francés
- Univ. Bordeaux, CNRS, MCC, PACEA, UMR 5199, F-33615 Pessac Cedex, France; Centro Nacional de Investigación sobre la Evolución Humana (CENIEH), Paseo de la Sierra de Atapuerca 3, 09002 Burgos, Spain.
| | - Cecilia García-Campos
- Centro Nacional de Investigación sobre la Evolución Humana (CENIEH), Paseo de la Sierra de Atapuerca 3, 09002 Burgos, Spain.
| | - Mario Modesto-Mata
- Equipo Primeros Pobladores de Extremadura, Casa de la Cultura Rodríguez Moñino, Avda. Cervantes s/n., 10003 Cáceres, Spain.
| | - Jordi Rosell
- Área de Prehistoria, Universitat Rovira i Virgili (URV), Avinguda de Catalunya 35, 43002 Tarragona, Spain; IPHES, Institut Català de Paleoecologia Humana i Evolució Social, Unit Associated to CSIC, C/Marcel.lí Domingo s/n-Campus Sescelades URV (Edifici W3), 43007 Tarragona, Spain.
| | - María Martinón-Torres
- Centro Nacional de Investigación sobre la Evolución Humana (CENIEH), Paseo de la Sierra de Atapuerca 3, 09002 Burgos, Spain; Anthropology Department, University College London, 14 Taviton Street, London WC1 H 0BW, UK.
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Ekizoglu O, Inci E, Ors S, Hocaoglu E, Can IO, Basa CD, Kacmaz IE, Kranioti EF. Forensic age diagnostics by magnetic resonance imaging of the proximal humeral epiphysis. Int J Legal Med 2018; 133:249-256. [PMID: 30334085 DOI: 10.1007/s00414-018-1952-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 10/11/2018] [Indexed: 11/29/2022]
Abstract
The most commonly used radiological method for age estimation of living individuals is X-ray. Computed tomography is not commonly used due to high radiation exposure, which raises ethical concerns. This problem can be solved with the use of magnetic resonance imaging (MRI), which avoids the use of ionizing radiation. The purpose of the present study was to evaluate the utility of MRI analysis of the proximal humeral epiphyses for forensic age estimations of living individuals. In this study, 395 left proximal humeral epiphyses (patient age 12-30 years) were evaluated with fast-spin-echo proton density-weighted image (FSE PD) sequences in a coronal oblique orientation on shoulder MRI images. A five-stage scoring system was used following the method of Dedouit et al. The intra- and interobserver reliabilities assessed using Cohen's kappa statistic were κ = 0.818 and κ = 0.798, respectively. According to this study, stage five first appeared at 20 and 21 years of age in males and females, respectively. These results are not directly comparable to any other published study due to the lack of MRI data on proximal humeral head development. These findings may provide valuable information for legally important age thresholds using shoulder MRI. The current study demonstrates that MRI of the proximal humerus can support forensic age estimation. Further research is needed to establish a standardized protocol that can be applied worldwide.
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Affiliation(s)
- Oguzhan Ekizoglu
- Department of Forensic Medicine, Tepecik Training and Research Hospital, Güney mahallesi 1140/1 Yenisehir, Konak, Izmir, Turkey.
| | - Ercan Inci
- Department of Radiology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Suna Ors
- Department of Radiology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Elif Hocaoglu
- Department of Radiology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Ismail Ozgur Can
- Department of Forensic Medicine, Dokuz Eylul University, Faculty of Medicine, Izmir, Turkey
| | - Can Doruk Basa
- Department of Orthopedics, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Ismail Eralp Kacmaz
- Department of Orthopedics, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Elena F Kranioti
- Edinburgh Unit for Forensic Anthropology, School of History, Classics and Archaeology, University of Edinburgh, 4 Teviot Place, Edinburgh, EH8 9AG, UK.,Forensic Pathology Division Crete, Hellenic Republic Ministry of Justice and Human Rights, Heraklion, Crete, Greece.,Department of Medical Imaging, University Hospital of Heraklion, 711 10, Heraklion, Crete, Greece
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Ekizoglu O, Inci E, Ors S, Kacmaz IE, Basa CD, Can IO, Kranioti EF. Applicability of T1-weighted MRI in the assessment of forensic age based on the epiphyseal closure of the humeral head. Int J Legal Med 2018; 133:241-248. [PMID: 29804276 DOI: 10.1007/s00414-018-1868-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 05/16/2018] [Indexed: 10/16/2022]
Abstract
This work investigates the value of magnetic resonance imaging analysis of proximal epiphyseal fusion in research examining the growth and development of the humerus and its potential utility in establishing forensic age estimation. In this study, 428 proximal humeral epiphyses (patient age, 12-30 years) were evaluated with T1-weighted turbo spin echo (T1 TSE) sequences in coronal oblique orientation on shoulder MRI images. A scoring system was created following a combination of the Schmeling and Kellinghaus methods. Spearman's rank correlation analysis revealed a significant positive relationship between age and ossification stage of the proximal humeral epiphysis (all subjects: rho = 0.664, p < 0.001; males: 0.631, p < 0.001; females: rho = 0.651, p < 0.001). The intra- and inter-observer reliability assessed using Cohen's kappa statistic was κ = 0.898 and κ = 0.828, respectively. The earliest age of epiphysis closure was 17 years for females and 18 years for males. MRI of the proximal humeral epiphysis can be considered advantageous for forensic age estimation of living individuals in a variety of situations, ranging from monitoring public health to estimating the age of illegal immigrants/asylum seekers, minors engaged in criminal activities, and illegal participants in competitive sports, without the danger of radiation exposure.
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Affiliation(s)
- Oguzhan Ekizoglu
- Department of Forensic Medicine, Tepecik Training and Research Hospital, Güney mahallesi 1140/1 Yenisehir-Konak, Izmir, Turkey.
| | - Ercan Inci
- Department of Radiology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Suna Ors
- Department of Radiology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Ismail Eralp Kacmaz
- Department of Orthopaedics, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Can Doruk Basa
- Department of Orthopaedics, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Ismail Ozgur Can
- Department of Forensic Medicine, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Elena F Kranioti
- Unit for Forensic Anthropology, School of History, Classics and Archaeology, University of Edinburgh, 4 Teviot Place, Edinburgh, EH8 9AG, Scotland.,Forensic Pathology Division Crete, Hellenic Republic Ministry of Justice and Human Rights, Heraklion, Crete, Greece.,Department of Medical Imaging, University Hospital of Heraklion, 71110, Heraklion, Crete, Greece
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