[New formula for the determination od fetal age]

Fetal facial bone growth: Post-mortem CT analysis

OBJECTIVE

To describe and model the normal growth of fetal facial bones and angles.

MATERIAL AND METHODS

A total of 118 fetal CT scans obtained at 19 to 41 weeks gestation after in utero fetal death or late miscarriage were analyzed. CT scan was followed by autopsy and pathological examination and only fetuses free from brain disease or abnormal craniofacial development were included. The measurements were taken using software for frontal, sagittal and 3D reconstruction from native axial sections. The optimal plane for bone analysis was chosen and the measurements made by multiplanar reconstruction.

RESULTS

There was a statistically significant increase (P<0.001) in all measurements regardless of gestational age (GA) except those of the mandibulo-fronto-maxillary angle (P=0.412), the naso-mandibulo-maxillary angle (P=0.828) and mandibular width (P=0.86). There was no significant difference according to fetal sex. Based on these results, the corresponding growth curves were created. The anteroposterior mandibular diameter (APD) was very strongly correlated with GA (R=0.926, P<0.001). The following equation: GA=(8.187×APD)+4.257 can be used to estimate GA with a confidence interval (CI) of±2.42. The same applies to maxillary width (MW) (R=0.922; P<0.001). The equation GA=(11.059×MW)+7.571 can be used to estimate GA with a CI of 2.17.

CONCLUSION

The growth of the mandible, maxilla, zygomatic bone and orbits was measured and the corresponding growth curves were established. Several measurements were strongly correlated with gestational age.

New models to estimate fetal and young infant age with the pars basilaris biometry

The pars basilaris of the occipital bone is often found intact when fetal or infant bones are discovered. In the literature, several methods use measurements of this bone for juvenile's age-at-death estimation, but it has already been demonstrated that they can come along methodological and statistical biases. In this study, new age prediction formulas were created from a learning sample of 208 CT scans of fetuses and infants from Marseilles (France) with normal development. The two statistically validated models, with a prediction interval of 95 % of reliability, were tested on a separate sample of 68 individuals, for which we ensured that they did not show any developmental pathology. Models show an average of 97.06 % of correct age estimates, compared to less than 26.6 % when using previously published which tend to overestimate age. The new age estimation formulas make it possible to estimate fetuses and infants age with very good results up to 2 postnatal months. Results are both reliable and precise enough for forensic practice, and we provide an automated tool (a simple excel spreadsheet) to ensure an easy and quick access to the application of this method.

Age-at-Death Estimation of Fetuses and Infants in Forensic Anthropology: A New "Coupling" Method to Detect Biases Due to Altered Growth Trajectories

Simple Summary

In forensic anthropology, estimating the age-at-death of young juvenile skeletons is crucial as a direct determinant of legal issues in many countries. Most methods published for this purpose are based on either maturation or growth processes (two essential components of development) and focus on “normal” (i.e., nonpathological) growth. However, when the osseous remains available for study are from an individual that experienced an altered growth process, age estimation may be biased, and accounting for this would be helpful for potentially avoiding inaccuracies in estimation. In this research, we developed a method based on the combined evaluation of both maturation and growth. Maturation is evaluated by the conformation of the pars basilaris, a bone at the skull base that provides an indirect estimate of brain maturation, while growth is assessed using femoral biometry. The method was tested on two medical validation samples of normal and pathological individuals. The results show that it was possible to identify “uncoupling” between maturation and growth in 22.8% of the pathological individuals. Highlighting potential uncoupling is therefore an essential step in assessing the confidence of an age estimate, and its presence should lead experts to be cautious in their conclusions in court.

Abstract

The coupling between maturation and growth in the age estimation of young individuals with altered growth processes was analyzed in this study, whereby the age was determined using a geometric morphometrics method. A medical sample comprising 223 fetuses and infants was used to establish the method. The pars basilaris shapes, quantified by elliptic Fourier analysis, were grouped into consensus stages to characterize the maturation process along increasing age groups. Each pars basilaris maturation stage was “coupled” to biometry by defining an associated femur length range. The method was tested on a validation sample of 42 normal individuals and a pathological sample of 114 individuals whose pathologies were medically assessed. Couplings were present in 90.48% of the normal sample and 77.19% of the pathological sample. The method was able to detect “uncoupling” (i.e., possibly altered growth) in more than 22.8% of samples, even if there was no visible traces of pathology on bones in most cases. In conclusion, experts should be warned that living conditions may cause alterations in the development of young individuals in terms of uncoupling, and that the age-at-death estimation based on long bone biometry could be biased. In a forensic context, when age has been estimated in cases where uncoupling is present, experts should be careful to take potential inaccuracies into account when forming their conclusions.

From early to late modern societies (late 16th - early 20th century): Shifts in dental health status in two populations from southeastern France

In France, bioarcheological research has long overlooked the early and late modern periods, which witnessed major transformations impacting population structure and leading to the dawn of modern industrialized societies. Two recently excavated large cemeteries in Provence present a unique opportunity to investigate on a large scale the impact on health and living conditions brought about by the Industrial Revolution and consequently track health status changes from the 16th to the early 20th century. The sample includes 642 individuals from the early modern cemetery of Saint-Jacques, La Ciotat (1581-1831) and the late modern cemetery of Les Crottes, Marseille (1784-1905). This study aims to document dental health markers and compare the results between both assemblages, considering ante-mortem tooth loss, wear, caries, abscesses, calculus, periodontitis and linear enamel hypoplasia. The available archaeological and historical sources for these recent periods provide a full documentation in which to interpret and discuss the biological analysis, thus enabling an inclusive bioarcheological approach. RESULTS: revealed similarities between both samples. Differences are more subtle than expected and are seen through the increase in carious lesions and in linear enamel hypoplasia. The former seem to indicate changes in diet with the introduction of new foodstuffs and manufacturing processes during the Industrial Revolution. The latter could reflect the increase in early childhood stress, perhaps due to new feeding practices around weaning and breastfeeding or a poorly diversified diet. Finally, the increasing number of stress events could suggest a noxious sanitary and infectious environment. During the 19th century, Marseille experienced strong demographic and urban growth, resulting in overcrowded areas where sanitation facilities were insufficient or absent. Moreover, the activity of this important trading seaport might have promoted the transmission and appearance of epidemic diseases despite scientific and medical advances, which would have a real impact only from the 20th century onwards.

Pictorial review of the postmortem computed tomography in neonaticide cases

Neonaticide is defined by the deliberate killing or homicide of a child within 24 h of its birth. In this context, three fundamental questions are generally asked of the forensic pathologist: what is the cause of death of the neonate? Was the child viable (i.e., what is the gestational age of the neonate)? Finally, was the neonate stillborn or liveborn?Postmortem imaging can help answer these questions by conducting (1) a complete lesional analysis of the body and the placenta, (2) an estimation of the gestational age by measuring the lengths of the diaphyseal long bones, and (3) an analysis of the aeration of the lungs and intestines. Using the details of 18 cases, we illustrate aspects of neonaticide cases in postmortem computed tomography (PMCT), offering detailed examples of notable postmortem changes and abnormalities, especially in the analysis of the pulmonary parenchyma. This article presents a useful iconography for the radiologist confronted with this rare yet complex forensic situation.

Cervical ribs in human early life: morphological variability and first identification as a morbidity criterion in a past population

Despite the medical literature on supernumerary cervical ribs in extant adult samples, little is known about their development and occurrence in early infancy. The documentation of cervical ribs in modern samples of fetuses and neonates is indeed affected by ethical as well as technical limitations. The aim of the present study was to investigate their frequencies and morphological variability in the first known archaeological collection of very young children with this anatomical variant. The study sample comes from the 8B-51 necropolis on the Saï island (Sudan) and dates to the Classic Kerma Period (XVIIIe-XVIe centuries BC). It consists of 64 individuals deceased between 24 weeks of amenorrhoea and 2 years of age. Bilateral or unilateral cervical ribs were found in 27 individuals. A total of 43 cervical ribs were identified, 38 of which are fully preserved. According to these observations, at least 42% of the individuals have unilateral or bilateral cervical ribs, with an average maximum length of < 1 cm. This frequency is very high compared to those observed in contemporary adult samples (up to 3%). First, the comparison of our results with biological and genetic research demonstrating the link between the occurrence of cervical ribs and a reduced chance of survival during infancy allows the first identification of this trait as an indicator of morbidity in an archaeological collection, a morbidity to which a genetic homogeneity or even endogamy could contribute. Second, the number of ribs studied makes it possible to propose a morphological classification based on the general shape and the shape of the articular facets, classification that can be used tos refine the analyses of the trait in future samples.

Maturation of the human foetal basioccipital: quantifying shape changes in second and third trimesters using elliptic Fourier analysis

During prenatal development, the brain is considered the best maturation criterion for the estimation of foetal physiological age, regardless of the conditions of pregnancy. Unfortunately, the brain lyses very quickly after death, but fortunately, the brain also has a major influence over osseous structures of the cranial base during development. Therefore, we considered the osseous structures of the cranial base potential indirect maturation indicators of foetal age. Because of its early formation and robustness, the basioccipital is a cranial base bone that is often used for studies in biological anthropology. Studies generally use conventional morphometry and bone size ratio to highlight morphological changes occurring during the foetal period and to create age estimation methods. These methods usually define thresholds beyond which the morphology of the basioccipital changes, but do not fully consider the form that might be valuable precisely to visualize its development or improve age estimation methods. Using geometric morphometric methods, the present study aims to analyse the development of the basioccipital during the second and third trimesters of foetal life by quantifying and visualizing shape changes in the inferior view. Basioccipital shapes are used as direct indicators of the maturation of the cranial base and as indirect indicators of the maturation of the brain and, by extension, the whole body. A sample of 221 anonymized computed tomographic (CT) scans of normal foetuses, ranging from 18 to 41 gestational weeks (GW), was used. Elliptic Fourier analysis (EFA) was used to quantify the basioccipital outline, and maturation stages were established to visualize shape changes with a principal component analysis. Our study allowed us precisely to quantify and continuously visualize shape changes occurring during prenatal life. Additionally, this study provides the first evidence of two distinct linear shape trajectories of the basioccipital. Foetuses aged between 18 and 26 GW have a rapid shape change with well-individualized stages, whereas shape changes are less visible in the second trajectory (27-41 GW). Furthermore, intra-stage shape variation is higher for the basioccipital at the beginning of the second and third trimesters than at the first trimester. By using geometric morphometric methods and EFA, this study shows that it was possible to go beyond classical methods. Indeed, the developed methodology enabled the first quantification of the overall shape changes of the basioccipital between gestational ages. The morphological shape changes throughout the foetal period can be useful for anthropological studies and provide new perspectives for immature age estimation methods.

Equations to estimate fetal age at the moment of death in the Mexican population

Metric standards are presented for the estimation of fetal age at the time of death in the Mexican population. To obtain these standards, both metric and radiological studies were conducted on 97 fetuses and complete stillborn infants of both sexes, phenotypically normal between 10 and 38 weeks of morphological age. All the fetuses used were the product of spontaneous abortions in Mexico City between 1990 and 2000. Equations were obtained by calibrating quadratic linear regression models adjusted for the diaphyseal length of the humerus, radius, ulna, femur, tibia and fibula, characterized as the most adequate indicators to represent the growth of long bones in this age group, and verified by the evaluation of the model assumptions and the coefficient of determination (R(2)). To conclude, these models facilitate a more precise prediction in fetuses of the Mexican population, constituting the first metric standards of their type at a national level.

Virtual anthropology: useful radiological tools for age assessment in clinical forensic medicine and thanatology

Virtual anthropology consists of the introduction of modern slice imaging to biological and forensic anthropology. Thanks to this non-invasive scientific revolution, some classifications and staging systems, first based on dry bone analysis, can be applied to cadavers with no need for specific preparation, as well as to living persons. Estimation of bone and dental age is one of the possibilities offered by radiology. Biological age can be estimated in clinical forensic medicine as well as in living persons. Virtual anthropology may also help the forensic pathologist to estimate a deceased person's age at death, which together with sex, geographical origin and stature, is one of the important features determining a biological profile used in reconstructive identification. For this forensic purpose, the radiological tools used are multislice computed tomography and, more recently, X-ray free imaging techniques such as magnetic resonance imaging and ultrasound investigations. We present and discuss the value of these investigations for age estimation in anthropology.

Virtual anthropology and forensic identification using multidetector CT

Virtual anthropology is made possible by modern cross-sectional imaging. Multislice CT (MSCT) can be used for comparative bone and dental identification, reconstructive identification and lesion identification. Comparative identification, the comparison of ante- and post-mortem imaging data, can be performed on both teeth and bones. Reconstructive identification, a considerable challenge for the radiologist, identifies the deceased by determining sex, geographical origin, stature and age at death. Lesion identification combines virtual autopsy and virtual anthropology. MSCT can be useful in palaeopathology, seeking arthropathy, infection, oral pathology, trauma, tumours, haematological disorders, stress indicators or occupational stress in bones and teeth. We examine some of the possibilities offered by this new radiological subspeciality that adds a new dimension to the work of the forensic radiologist. A multidisciplinary approach is crucial and involves communication and data exchange between radiologists, forensic pathologists, anthropologists and radiographers.

Fetal age estimation using MSCT scans of the mandible

The purpose of this study was to examine a documented fetal collection, to carry out morphometric analysis of femoral length and of the mandible, and to develop diagnostic standards for estimating fetal age at death based on multislice computed tomography (MSCT) reconstructions. The sample was composed of 81 fetuses, whose ages were recorded in weeks of amenorrhea (WA) between 20 to 40 WA. The measurements made were femoral length (FL) and six distances and four angles of the mandible. Femoral length was measured in 81 fetuses (39 females and 42 males). Morphometric study of the mandible was carried out in 65 fetuses (31 females and 34 males), as the mandible was missing in 16 fetuses. R software was used for statistical analyses. Coefficient correlation (R(2)) and linear regression formulas were calculated. Intra-observer and inter-observer variabilities were very satisfactory (intra-class correlation coefficient ≥0.95). Our method appears to be reliable and reproducible. Femoral length was most strongly correlated with age (R(2) = 0.9). The measurement of six distances and four mandible angles from four landmark positions showed a correlation similar to the femoral length correlation (R(2) ≥ 0.72). The results of this study agreed with those of the literature. We conclude that the mandible is a reliable indicator for estimating fetal age at death. Moreover, MSCT has been shown to be an innovative and reliable technology for this purpose.

Study of femoral torsion during prenatal growth: interpretations associated with the effects of intrauterine pressure

The developing fetus is protected from external environmental influences by maternal tissues. However, these structures have a limited elasticity, such that the fetus must grow in a confined space, constraining its size at the end of pregnancy. Can these constraints modify the morphology of the fetal skeleton? The intensity of these constraints increases between 5 months and birth, making it the most appropriate period to address this question. A sample of 89 fetal femora was analyzed, and results provide evidence that during this period, the torsion of the femoral shaft (quantified by means of a new three-dimensional method) increases gradually. Two explanations were considered: this increase could signal effects of constraints induced by the intrauterine cavity, developmental patterning, or some combination of these two. Different arguments tend to support the biomechanical explanation, rather than a programming pattern formation. Indeed, the identification of the femur as a first degree lever, created by the hyperflexion of the fetal lower limbs on the pelvis, could explain the increase in femoral shaft torsion during prenatal life. A comparison with femora of infants is in accordance with this mechanical interpretation, which is possible through bone modeling/remodeling. Although genetic and epigenetic mechanisms may regulate timing of fetal development, our data suggest that at birth, the fetal skeleton also has an intrauterine mechanical history through adaptive bone plasticity.