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Duncombe P, Ng PTT, Izatt MT, Duncombe G, Tucker K. Using B-mode ultrasound to evaluate Risser grading for the determination of skeletal maturity in adolescents. Radiography (Lond) 2024; 30:1297-1305. [PMID: 39038406 DOI: 10.1016/j.radi.2024.07.001] [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: 03/05/2024] [Revised: 06/02/2024] [Accepted: 07/01/2024] [Indexed: 07/24/2024]
Abstract
INTRODUCTION Rapid adolescent growth is associated with an increased risk of disease and disease progression. This study assesses the reliability and validity of non-ionising B-mode ultrasound for the assessment of skeletal maturity (Risser Grade) and offers procedural guidelines for its use. METHODS Twenty-three female adolescents with primary-right-thoracic scoliosis (age: 13.8 (1.6) years) and twenty age-matched female control participants without scoliosis (age: 13.1 (1.8) years) were recruited. Skeletal maturity was determined from (i) a series of nine B-mode ultrasound images collected at sites equally spaced between the anterior and posterior superior iliac spines of the pelvis and (ii) clinical spine radiographs obtained as part of standard scoliosis care. Inter-rater reliability was assessed between a novice researcher and an experienced medical doctor. Concurrent-validity was assessed by comparing the location and degree of apophysis growth and fusion obtained via ultrasound with that obtained using radiograph Risser grading for scoliosis participants only. RESULTS The inter-rater reliability of ultrasound Risser grading was strong [ICC(2,1): 0.99, p < 0.001]. High concurrent-validity was determined, with no difference in Risser grading identified between the radiograph and ultrasound grading methods (Wilcoxon signed-rank: Z = -1.93, p = 0.053). CONCLUSION Ultrasound provides a reliable non-ionising alternative to the gold standard of Risser grading from radiographs to determine and monitor skeletal maturity. This study provides a detailed methodology for using ultrasound to assess skeletal maturity. IMPLICATIONS FOR PRACTICE Rapid adolescent growth is associated with an increased risk of disease and disease progression. Therefore, accurately determining and monitoring skeletal maturity in these adolescents is crucial. This study assesses the reliability and validity of non-ionising B-mode ultrasound for the assessment of skeletal maturity and offers procedural guidelines for its use.
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Affiliation(s)
- P Duncombe
- The University of Queensland, School of Biomedical Sciences, Brisbane, Queensland, Australia.
| | - P T T Ng
- The University of Queensland, School of Biomedical Sciences, Brisbane, Queensland, Australia; KK Women's and Children's Hospital, Physiotherapy Department, Singapore
| | - M T Izatt
- Queensland University of Technology at the Centre for Children's Health Research, Biomechanics and Spine Research Group, Brisbane, Queensland, Australia; Orthopaedics Department, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - G Duncombe
- Department of Obstetrics and Gynaecology, Logan and Beaudesert Hospital, Brisbane, Queensland, Australia; The University of Queensland, Faculty of Medicine, Brisbane, Queensland, Australia
| | - K Tucker
- The University of Queensland, School of Biomedical Sciences, Brisbane, Queensland, Australia
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Kenawey M, Howard A, Tile M. Pediatric-Specific Lesions in Unstable Pelvic Ring Fractures of Skeletally Immature Children: Impact on Diagnosis and Management Decisions. J Am Acad Orthop Surg 2024; 32:e683-e694. [PMID: 38967987 DOI: 10.5435/jaaos-d-23-01249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Indexed: 07/07/2024] Open
Abstract
Surgical fixation of pediatric pelvic ring injuries is gaining popularity to avoid the poor long-term outcomes of pelvic asymmetry. The surgical techniques and fixation choices depend on the individual injuries affecting the anterior and posterior pelvic ring areas. The immature bony pelvis of young children has anatomic differences including soft bones, elastic ligaments, and the presence of growth centers. Understanding the unique pediatric lesions with unstable pelvic fractures is essential for treatment decisions. Anterior lesions include pubic symphysis disruption through the pubic apophysis, single ramus fractures, pubic rami fractures through the triradiate cartilage, and/or the ischiopubic synchondrosis; ischiopubic ramus infolding injury; or the unstable superior and inferior quadrant lesions. Posterior pelvic lesions include iliac wing infolding and sacroiliac joint dislocation or transiliac (crescent) fracture/dislocations through the iliac apophysis growth plate. Pubic symphysis and sacroiliac disruptions are physeal injuries in children, and they have excellent healing potential. External fixation is an ideal choice for anterior ring fixation including bony and pubic symphysis injuries. Posterior lesions are mostly sacroiliac joint disruptions with iliac apophysis separation that can serve as a landmark for vertical displacement correction. Posterior lesions can be treated by percutaneous iliosacral screw fixation or open reduction techniques.
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Affiliation(s)
- Mohamed Kenawey
- From the Department of Paediatric Orthopaedic Surgery, Royal Manchester Children's Hospital, Manchester University NHS Foundation Trust, Manchester, United Kingdom (Kenawey), the Department of Orthopaedic Surgery, Sohag University Faculty of Medicine, Sohag, Egypt (Kenawey), the Department of Paediatric Orthopaedic Surgery, Division of Orthopaedic Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada (Howard), the Department of Surgery, University of Toronto, Toronto, Ontario, Canada (Howard), the Department of Surgery (Emeritus), University of Toronto, Ontario, Canada (Tile), and the Department of Orthopaedic Surgery, (Honorary), Sunnybrook HSC, Toronto, Ontario, Canada (Tile)
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Warrier V, Shedge R, Garg PK, Dixit SG, Krishan K, Kanchan T. Machine learning and regression analysis for age estimation from the iliac crest based on computed tomographic explorations in an Indian population. MEDICINE, SCIENCE, AND THE LAW 2024; 64:204-216. [PMID: 37670580 DOI: 10.1177/00258024231198917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/07/2023]
Abstract
Age estimation constitutes an integral parameter of identification. In children, sub-adults, and young adults, accurate age estimation is vital on various aspects of civil, criminal, and immigration law. The iliac crest presents as a suitable age marker within these age cohorts, and the modified Risser method constitutes a relatively novel and unexplored method for iliac crest age estimation. The present study attempted to ascertain the applicability of this modified method for age estimation in the Indian population, an aspect previously unexplored, through computed tomographic examination of the iliac crest. Computed tomography scans of consenting individuals undergoing routine examinations of the pelvis/ abdomen for various clinically indicated reasons were collected and scored using the modified Risser stages. Computed tomographic examinations of the iliac crest indicate that the recalibrated method accurately depicts the temporal progression of ossification and fusion changes. Different regression and machine learning models were subsequently derived and/or trained to evaluate the accuracy and precision associated with the method. Amongst the ten regression models derived herein, compound regression exhibited the lowest inaccuracy (4.78 years) and root mean squared error values (5.46 years). Machine learning yielded further reduced error rates, with decision tree regression achieving inaccuracy and root mean squared error values of 1.88 years and 2.28 years, respectively. A comparative evaluation of error computations obtained from regression analysis and machine learning illustrates the statistical superiority of machine learning for forensic age estimation. Error computations obtained with machine learning suggest that the modified Risser method is capable of permitting reliable age estimation within criminal and civil proceedings.
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Affiliation(s)
- Varsha Warrier
- Department of Forensic Medicine and Toxicology, All India Institute of Medical Sciences, Jodhpur, India
| | - Rutwik Shedge
- School of Forensic Sciences, National Forensic Sciences University, Tripura, India
| | - Pawan Kumar Garg
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, India
| | - Shilpi Gupta Dixit
- Department of Anatomy, All India Institute of Medical Sciences, Jodhpur, India
| | - Kewal Krishan
- Department of Anthropology, (UGC Centre of Advanced Study), Panjab University, Chandigarh, India
| | - Tanuj Kanchan
- Department of Forensic Medicine and Toxicology, All India Institute of Medical Sciences, Jodhpur, India
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Warrier V, Shedge R, Garg PK, Dixit SG, Krishan K, Kanchan T. Age estimation from iliac auricular surface using Bayesian inference and principal component analysis: a CT-based study in an Indian population. Forensic Sci Med Pathol 2024; 20:370-386. [PMID: 37277663 DOI: 10.1007/s12024-023-00637-y] [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] [Accepted: 04/19/2023] [Indexed: 06/07/2023]
Abstract
Age estimation constitutes one of the pillars of human identification. The auricular surface of the ilium presents as a durable and robust structure within the human skeletal framework, capable of enabling accurate age estimation in older adults. Amongst different documented auricular age estimation methods, the Buckberry-Chamberlain method offers greater objectivity through its component-based approach. The present study aimed to test the applicability of the Buckberry-Chamberlain method in an Indian population through a CT-based examination of the auricular surface. CT scans of 435 participants undergoing CT examinations following the advice of their treating physicians were scrutinized for different age-related auricular changes. Three of the five morphological features described by Buckberry-Chamberlain could be appreciated on CT scans, and thus further statistical analysis was restricted to these features. Transition analysis coupled with Bayesian inference was undertaken individually for each feature to enable age estimation from individual features, while circumventing age mimicry. A Bayesian analysis of individual features yielded highest accuracy percentages (98.64%) and error rates (12.99 years) with macroporosity. Transverse organization and apical changes yielded accuracy percentages of 91.67% and 94.84%, respectively, with inaccuracy computations of 10.18 years and 11.74 years, respectively. Summary age models, i.e. multivariate age estimation models, derived by taking this differential accuracy and inaccuracy into consideration yielded a reduced inaccuracy value of 8.52 years. While Bayesian analysis undertaken within the present study enables age estimation from individual morphological features, summary age models appropriately weigh all appreciable features to yield more accurate and reliable estimates of age.
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Affiliation(s)
- Varsha Warrier
- Department of Forensic Medicine and Toxicology, All India Institute of Medical Sciences, Jodhpur, 342005, India.
| | - Rutwik Shedge
- School of Forensic Sciences, National Forensic Sciences University, Agartala, Tripura, 799001, India
| | - Pawan Kumar Garg
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, 342005, India
| | - Shilpi Gupta Dixit
- Department of Anatomy, All India Institute of Medical Sciences, Jodhpur, 342005, India
| | - Kewal Krishan
- Department of Anthropology (UGC Centre of Advanced Study), Panjab University, Chandigarh, 160014, India
| | - Tanuj Kanchan
- Department of Forensic Medicine and Toxicology, All India Institute of Medical Sciences, Jodhpur, 342005, India
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Warrier V, Shedge R, Garg PK, Dixit SG, Krishan K, Kanchan T. An evaluation of the three-component pubic symphyseal human age estimation method: a CT-based exploration in an Indian population. THE SCIENCE OF NATURE - NATURWISSENSCHAFTEN 2023; 110:21. [PMID: 37199770 DOI: 10.1007/s00114-023-01851-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 05/09/2023] [Accepted: 05/10/2023] [Indexed: 05/19/2023]
Abstract
Age estimation constitutes an important facet of human identification within forensic, bioarchaeological, repatriation, and humanitarian contexts. Within the human skeletal framework, the pubic symphysis comprises one of the more commonly utilized structures for age estimation. The present investigation was aimed at establishing the applicability of the McKern-Stewart pubic symphyseal age estimation method in males and females of an Indian population, an aspect previously unreported. Three hundred and eighty clinical CT scans of the pubic symphysis were collected and scored in accordance with the McKern-Stewart method. An overall accuracy of 68.90% was obtained on applying the method to males, demonstrating a limited applicability of the method in its primal form. Subsequently, Bayesian analysis was undertaken to enable accurate age estimation from individual components in both sexes. Bayesian parameters obtained with females suggest that McKern-Stewart's components fail to accommodate for age-related changes within the female pubic bone. Improved accuracy percentages and reduced inaccuracy values were obtained with Bayesian analysis in males. With females, the error computations were high. Weighted summary age models were utilized for multivariate age estimation, and furnished inaccuracy values of 11.51 years (males) and 17.92 years (females). Error computations obtained with descriptive analysis, Bayesian analysis, and principal component analysis demonstrate the limited applicability of McKern-Stewart's components in generating accurate age profiles for Indian males and females. The onset and progression of age-related changes within the male and female pubic bone may be of interest to biological anthropologists and anatomists involved in exploring the underlying basis for aging.
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Affiliation(s)
- Varsha Warrier
- Department of Forensic Medicine and Toxicology, All India Institute of Medical Sciences, Jodhpur, 342005, India
| | - Rutwik Shedge
- School of Forensic Sciences, National Forensic Sciences University, Tripura, 799001, India
| | - Pawan Kumar Garg
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, 342005, India
| | - Shilpi Gupta Dixit
- Department of Anatomy, All India Institute of Medical Sciences, Jodhpur, 342005, India
| | - Kewal Krishan
- Department of Anthropology (UGC Centre of Advanced Study), Panjab University, Chandigarh, 160014, India
| | - Tanuj Kanchan
- Department of Forensic Medicine and Toxicology, All India Institute of Medical Sciences, Jodhpur, 342005, India.
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Lewis ME. Exploring adolescence as a key life history stage in bioarchaeology. AMERICAN JOURNAL OF BIOLOGICAL ANTHROPOLOGY 2022; 179:519-534. [PMCID: PMC9825885 DOI: 10.1002/ajpa.24615] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 08/05/2022] [Accepted: 08/17/2022] [Indexed: 04/16/2024]
Abstract
Adolescence is a unique period in the life history of an individual. It is characterized by a myriad of changes that bioarchaeologists are only just coming to appreciate, related to sexual maturation, linear growth, immunological transformation, and emotional and cognitive development. New methods allow us to measure this age of transition through the stages of the adolescent growth, as a proxy for the physical development associated with sexual maturation (puberty). This review outlines ways bioarchaeologists may draw on research developments from the fields of human biology, evolutionary theory and neurobiology to advance a more holistic approach to the study of adolescence in the past. It considers current theoretical and analytical approaches to highlight the research potential of this critical stage of life history. This synthesis integrates the most recent research in the medical sciences concerned with body and brain development, and outlines the biological processes involved with sexual and physical maturation of the adolescent. The goal of this review is to help inform potentially rewarding areas of research that bioarchaeologists can contribute to and draw from, as well as the challenges and limitations, theoretical and methodological questions, and ways in which we can develop the study of adolescence in the discipline going forward.
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Affiliation(s)
- Mary E. Lewis
- Department of ArchaeologyUniversity of ReadingReadingUK
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Blythe CS, Reynolds MS, Gregory LS. Quantifying the ossification and fusion of the calcaneal apophysis using computed tomography. J Anat 2022; 241:484-499. [PMID: 35468228 PMCID: PMC9296023 DOI: 10.1111/joa.13677] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 03/04/2022] [Accepted: 04/08/2022] [Indexed: 11/28/2022] Open
Abstract
Knowledge of the anatomical development of the calcaneal apophysis is essential in clinical assessment and management of both paediatric and sub‐adult patients presenting with heel pain. Despite this, the current understanding of calcaneal apophyseal development is constrained by the limitations of the imaging modalities used to examine the apophysis, with no current literature reporting the development of the medial and lateral processes. This study aimed to overcome these limitations by investigating the ossification and fusion of the calcaneal apophysis using three‐dimensional computed tomography analysis, and statistically predicting the apophyseal developmental stage in contemporary Australian children. The development and fusion status of the apophysis was scored using a novel 11‐stage scoring system on 568 multi‐slice computed tomography scans (295 females; 274 males) and 266 lateral radiographic scans (119 females; 147 males) from the Queensland Children's Hospital. Multinomial logistic regression along with classification tables and predictive probabilities were then utilised to assess developmental stage likelihood from known age and sex. The apophysis commenced ossification at a mean age of 5.2 years for females and 7.2 years for males, and then elongated to form the apophyseal cap around 10 years for females and 12.4 years for males. Fusion of the apophysis commenced at a mean age of 11.18 years for females and 13.3 years for males, with the earliest age of complete fusion observed at 10 years for females and 14 years for males. The results demonstrate significant sexual dimorphism in ossification and fusion with females developing and fusing significantly earlier. Furthermore, the use of computed tomography in this study allowed for the first time evaluation of the ossification and fusion of the medial and lateral processes of the calcaneus. The medial process formed at a mean age of 9.5 years for females and 10.9 years for males while the lateral process formed at around 9.8 years for females and 11.7 years for males. The medial process demonstrated slower rates of fusion compared to the lateral process. The present study provides Queensland specific standards for assessing the calcaneal apophyseal developmental stage as well as novel predictive regression models for apophyseal stage estimation using known age and sex to aid in the diagnosis of heel pain conditions such as apophysitis or screen for developmental delays in children and subadults.
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Affiliation(s)
- Connor S Blythe
- Clinical Anatomy and Paediatric Imaging Research Laboratory, School of Biomedical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Mikaela S Reynolds
- Clinical Anatomy and Paediatric Imaging Research Laboratory, School of Biomedical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Laura S Gregory
- Clinical Anatomy and Paediatric Imaging Research Laboratory, School of Biomedical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
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Corron LK, Santos F, Adalian P, Chaumoitre K, Guyomarc'h P, Marchal F, Brůžek J. How low can we go? A skeletal maturity threshold for probabilistic visual sex estimation from immature human os coxae. Forensic Sci Int 2021; 325:110854. [PMID: 34091409 DOI: 10.1016/j.forsciint.2021.110854] [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: 02/02/2021] [Revised: 04/23/2021] [Accepted: 05/25/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVES The appearance of sexually dimorphic traits varies depending on the type of bone, age, environmental and genetic factors and is closely linked to skeletal maturation sequence. Subadult sex estimation currently shows inconsistent accuracy and methods do not incorporate indicators of maturation. The goal of this study is to apply the Santos et al. (2019) adult sex estimation method on virtually reconstructed subadult os coxae and account for pelvic maturation. MATERIAL AND METHODS The right os coxae of 194 female and male individuals aged 11-30 years from Marseille, France were virtually reconstructed from computed tomography (CT) scans. Santos et al.'s (2019) 11 traits were scored as female, male, or indeterminate. Maturation of 10 pelvic epiphyseal sites was scored using a four-stage system (0-3) to obtain a composite maturity score from 1 to 30. RESULTS Three maturity groups were identified based on composite maturity scores ranging from 0 to 30. Individuals with a composite maturity score of 15 or higher showed 98 % sex estimation accuracy and a 6 % indeterminate rate. Scores of 2 for the ischiatic tuberosity or 1 for the anterior superior iliac spine can be used as proxies for a composite maturity score of 15 and application on incomplete bones. DISCUSSION Sexual dimorphism was observed in the epiphyseal maturation sequence and the development of sexually dimorphic pelvic traits. The Santos et al. (2019) method is applicable on immature individuals who meet a maturation threshold with comparable accuracy to adults, without relying on known or estimated age.
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Affiliation(s)
- Louise K Corron
- Department of Anthropology, University of Nevada, Reno, USA.
| | - Frédéric Santos
- PACEA - De la Préhistoire à l'Actuel: Culture, Environnement et Anthropologie, UMR 5199, CNRS, Université de Bordeaux, CS 50023, Pessac 33615, France.
| | - Pascal Adalian
- ADES - Anthropologie bioculturelle, Droit, Ethique et Santé, UMR 7268, Aix Marseille Univ, CNRS, EFS, Faculté de Médecine - secteur Nord, CS80011, Bd Pierre Dramard, 13 344 Marseille cedex 15, France.
| | - Kathia Chaumoitre
- ADES - Anthropologie bioculturelle, Droit, Ethique et Santé, UMR 7268, Aix Marseille Univ, CNRS, EFS, Faculté de Médecine - secteur Nord, CS80011, Bd Pierre Dramard, 13 344 Marseille cedex 15, France; Department of Radiology and medical imaging, CHU Nord, Assistance Publique - Hôpitaux de Marseille, F-13915 Marseille Cedex 20, France.
| | - Pierre Guyomarc'h
- ADES - Anthropologie bioculturelle, Droit, Ethique et Santé, UMR 7268, Aix Marseille Univ, CNRS, EFS, Faculté de Médecine - secteur Nord, CS80011, Bd Pierre Dramard, 13 344 Marseille cedex 15, France.
| | - François Marchal
- ADES - Anthropologie bioculturelle, Droit, Ethique et Santé, UMR 7268, Aix Marseille Univ, CNRS, EFS, Faculté de Médecine - secteur Nord, CS80011, Bd Pierre Dramard, 13 344 Marseille cedex 15, France.
| | - Jaroslav Brůžek
- PACEA - De la Préhistoire à l'Actuel: Culture, Environnement et Anthropologie, UMR 5199, CNRS, Université de Bordeaux, CS 50023, Pessac 33615, France; Department of Anthropology and Human Genetics, Faculty of Science, Charles University, Prague 2 1200, Czech Republic.
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Abstract
BACKGROUND Although complications associated with pazopanib, a multitarget tyrosine kinase inhibitor, are known, periosteal reaction as a side effect has never been reported. OBSERVATION We present a case involving a male pediatric patient with desmoid tumors treated for 6 months with pazopanib who presented with pain and periosteal reaction in the ilium and scapula. Three months after termination of pazopanib therapy, the periosteal reaction in the scapula resolved and that in the ilium improved. CONCLUSION Children receiving pazopanib presenting with focal pain should be examined for the periosteal reaction; this knowledge may facilitate correct diagnosis of symptoms as a drug-associated finding.
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Fan F, Dong X, Wu X, Li R, Dai X, Zhang K, Huang F, Deng Z. An evaluation of statistical models for age estimation and the assessment of the 18-year threshold using conventional pelvic radiographs. Forensic Sci Int 2020; 314:110350. [PMID: 32650207 DOI: 10.1016/j.forsciint.2020.110350] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 05/24/2020] [Accepted: 05/25/2020] [Indexed: 11/30/2022]
Abstract
The developmental patterns of the pelvic epiphyses are one of the anatomical markers used in the assessment of skeletal age and the legally relevant age threshold. In this study, four regression models and five classification models were developed for forensic age estimation and the determination of the 18-year threshold, respectively. A total of 2137 conventional pelvic radiographs (1215 males and 922 females) aged 10.00-25.99 years were analyzed, and the ossification and fusion of the iliac crest and ischial tuberosity epiphyses were scored separately. The epiphyses on both sides were used as inputs for all models. The accuracy of the regression models was compared using the mean absolute error (MAE) and root mean square error. The percentages of correct classifications were evaluated for the determination of the 18-year threshold. Support vector regression (SVR) and gradient boosting regression (GBR) showed higher accuracy for age estimation in both sexes. The lowest MAE was 1.38 years in males when using SVR and 1.16 years in females when using GBR. In the demarcation of minors and adults, the percentage of correct classification was over 92%, and the area under the receiver operating characteristic curves was over 0.91 in all models, except the Bernoulli naive Bayes classifier. This study demonstrated that the present models may be helpful for age estimation and the determination of the 18-year threshold. However, owing to the high effective dose of ionizing radiation used during conventional radiography of the pelvis, it is expected that these models will be tested with pelvic MRI for age estimation.
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Affiliation(s)
- Fei Fan
- West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu, 610041, China
| | - Xiaoai Dong
- West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu, 610041, China
| | - Xuemei Wu
- School of Basic Medical Sciences, Fujian Medical University, Fuzhou, 350122, China
| | - Rui Li
- College of Computer Science, Sichuan University, Chengdu, 610064, China
| | - Xinhua Dai
- West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu, 610041, China
| | - Kui Zhang
- West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu, 610041, China
| | - Feijun Huang
- West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu, 610041, China.
| | - Zhenhua Deng
- West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu, 610041, China.
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Lottering N, Alston CL, Barry MD, MacGregor DM, Gregory LS. Temporal mapping of the closure of the anterior fontanelle and contiguous sutures using computed tomography, in silico models of modern infants. J Anat 2020; 237:379-390. [PMID: 32285470 DOI: 10.1111/joa.13200] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 03/04/2020] [Accepted: 03/17/2020] [Indexed: 12/01/2022] Open
Abstract
The aim of this study is to quantify and statistically model the age-related decline in the fibrous connective tissue interface of the anterior fontanelle in modern Australian infants, using three-dimensional, semi-automated computed-assisted design protocols. Non-linear regression with variance models, using power functions, combined with quantile regression of the 5th and 95th population percentiles, were utilised to assess absolute anterior fontanelle surface area (AFSA) as a function of age, using multi-slice cranial computed tomography scans obtained from 256 infants aged < 30 months (males: n = 126, females: n = 109) from Brisbane children's hospitals. Normalised AFSA (NFSA), standardised for variation in cephalic size, followed a progressive decline from birth, the greatest velocity change occurring between the 3-6 and 6-9 month cohorts. Growth of the neurocranium is the most significant within the first 8 months postpartum, with a mean increase of 19.03 mm in maximum cranial length and 10.04 mm in breadth. Directionality of fontanelle closure, quantified using spline curves refutes fundamental assumptions that the anterior fontanelle is consistent with a quadrilateral, and contiguous sutures exhibit constant velocity of closure. The present study provides normative values for fontanelle size and diameters as well as new predictive non-linear models for age substantiation, screening of developmental abnormalities and indicators of suspected child maltreatment in modern infants aged birth to 30 months.
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Affiliation(s)
- Nicolene Lottering
- Skeletal Biology and Forensic Anthropology Research Laboratory, School of Biomedical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia.,Department of Health and Medical Sciences, Swinburne University of Technology, Australia
| | | | - Mark D Barry
- High Performance Computing and Research Services, Queensland University of Technology, Brisbane, QLD, Australia
| | - Donna M MacGregor
- Skeletal Biology and Forensic Anthropology Research Laboratory, School of Biomedical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
| | - Laura S Gregory
- Skeletal Biology and Forensic Anthropology Research Laboratory, School of Biomedical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
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Ubelaker DH, Khosrowshahi H. Estimation of age in forensic anthropology: historical perspective and recent methodological advances. Forensic Sci Res 2019; 4:1-9. [PMID: 30915413 PMCID: PMC6427487 DOI: 10.1080/20961790.2018.1549711] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 10/10/2018] [Accepted: 11/14/2018] [Indexed: 01/30/2023] Open
Abstract
Estimation of age represents a central focus of forensic anthropological analysis of human skeletal remains and of the living. Advances registered in recent research include the topics of taphonomic impact, new anatomical areas of interest, histology, population variation, the dental pulp chamber, technology, mathematical approaches, biochemical analysis and techniques specifically targeting the living. This article reviews the historical development of age estimation methods and considers likely future directions.
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Affiliation(s)
- Douglas H Ubelaker
- Department of Anthropology, Smithsonian Institution, Washington, DC, USA
| | - Haley Khosrowshahi
- Department of Anthropology, Smithsonian Institution, Washington, DC, USA
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Gregory LS, Jones LV, Amorosi NM. Assessing the fusion of the ischiopubic synchondrosis using predictive modeling. Clin Anat 2019; 32:851-859. [PMID: 30701593 DOI: 10.1002/ca.23345] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 01/28/2019] [Accepted: 01/28/2019] [Indexed: 11/12/2022]
Abstract
Flaring of the ischiopubic synchondrosis at the time of fusion is a common clinical observation in pediatrics and represents a normal physiological process in skeletal maturation. When presenting unilaterally, this flaring can mimic a range of serious pathological conditions such as osteomyelitis, osteal tumors, and traumatic injury. An improved understanding of ischiopubic synchondrosis fusion is therefore critical to avoid potential misdiagnosis. Retrospective multi-slice computed tomography pelvic scans of Australian individuals aged neonate to 24 years (n = 184) were assessed using a novel five stage morphological classification system of the maturation and fusion of the ischiopubic synchondrosis. Maturation scoring was conducted using both multiplanar formatting views and volume-rendered reconstructions in OsiriX™. Maturational stage was strongly related to age (P < 0.001) with fusion of the ischiopubic synchondrosis observed between the ages of 4 and 9 years in females and 7 and 13 years for males. The highest probability of fusion in our Queensland Australian population based on multinomial regression predictive modeling was between 7 and 10 years of age. We documented three variants of fusion: pubic and ischial outgrowths, appearance of a secondary ossification center, and a fusiform-shaped enlargement. This study provides the first predictive modeling of the timing of fusion of the ischiopubic synchondrosis using a reliable morphological classification system. The significant variation in timing and progression of fusion of the ischiopubic synchondrosis reported in this study, will aid in minimizing misdiagnosis and unnecessary treatment in children presenting with asymmetrical or delayed ischiopubic synchondrosis anomalies. Clin. Anat. 32:851-859, 2019. © 2019 Wiley Periodicals, Inc.
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Affiliation(s)
- Laura S Gregory
- School of Biomedical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia.,Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Lee V Jones
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Natasha M Amorosi
- School of Biomedical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
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Forensic age estimation for pelvic X-ray images using deep learning. Eur Radiol 2018; 29:2322-2329. [PMID: 30402703 DOI: 10.1007/s00330-018-5791-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 09/06/2018] [Accepted: 09/21/2018] [Indexed: 02/05/2023]
Abstract
PURPOSE To develop a deep learning bone age assessment model based on pelvic radiographs for forensic age estimation and compare its performance to that of the existing cubic regression model. MATERIALS AND METHOD A retrospective collection data of 1875 clinical pelvic radiographs between 10 and 25 years of age was obtained to develop the model. Model performance was assessed by comparing the testing results to estimated ages calculated directly using the existing cubic regression model based on ossification staging methods. The mean absolute error (MAE) and root-mean-squared error (RMSE) between the estimated ages and chronological age were calculated for both models. RESULTS For all test samples (between 10 and 25 years old), the mean MAE and RMSE between the automatic estimates using the proposed deep learning model and the reference standard were 0.94 and 1.30 years, respectively. For the test samples comparable to those of the existing cubic regression model (between 14 and 22 years old), the mean MAE and RMSE for the deep learning model were 0.89 and 1.21 years, respectively. For the existing cubic regression model, the mean MAE and RMSE were 1.05 and 1.61 years, respectively. CONCLUSION The deep learning convolutional neural network model achieves performance on par with the existing cubic regression model, demonstrating predictive ability capable of automated skeletal bone assessment based on pelvic radiographic images. KEY POINTS • The pelvis has considerable value in determining the bone age. • Deep learning can be used to create an automated bone age assessment model based on pelvic radiographs. • The deep learning convolutional neural network model achieves performance on par with the existing cubic regression model.
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Reynolds MS, MacGregor DM, Alston-Knox CL, Meredith M, Barry MD, Schmutz B, Gregory LS. Bayesian modeling predicts age and sex are not required for accurate stature estimation from femoral length. Forensic Sci Int 2018; 289:452.e1-452.e14. [PMID: 29885921 DOI: 10.1016/j.forsciint.2018.04.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 03/09/2018] [Accepted: 04/06/2018] [Indexed: 11/24/2022]
Abstract
Despite the recognized flaws in applying traditional stature estimation equations such as those of Trotter and Gleser (1952) [5] to a contemporary population, there are currently no available alternatives for stature estimation in Australia that address these limitations. Post mortem computed tomography (PMCT) DICOM scans of the left and right femora were acquired from 76 Australian deceased individuals aged 17-76 years for metric analysis. Femoral bicondylar length, femoral epicondylar breadth and anterior-posterior (AP) diameter, medial-lateral (ML) diameter, circumference and cortical area at the femoral midshaft were measured on three-dimensional (3D) models to build statistical models for estimating stature. In addition, Australian individuals aged 16-63 years (n=111) were measured in standing and supine positions to aid in the adjustment of supine stature of deceased individuals utilized in this study to standing stature. The results of this preliminary evaluation strongly indicate that the optimal model for estimating stature includes bicondylar femoral length and epicondylar breadth, that the effect of sex as an independent variable is very low, and there is limited practical benefit in including age in the estimation of stature. Our study indicates that the Australian population sampled represents a small yet significant shift in stature from the original Trotter and Gleser sample. Additionally, in the case of fragmentary remains, it was found that epicondylar breadth and AP diameter had the highest probability of accurate stature estimation in the absence of bicondylar femoral length. As stature forms a significant component of a biological profile and therefore aids in the personal identification of human remains, it is important that forensic anthropologists utilize the most accurate methodologies available. Stature estimation of Australian individuals is therefore achieved with higher accuracy through utilizing the femoral equations proposed in this study.
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Affiliation(s)
- Mikaela S Reynolds
- School of Biomedical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia.
| | - Donna M MacGregor
- School of Biomedical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Clair L Alston-Knox
- Griffith Social and Behavioural Research College, Griffith University, Mt. Gravatt, QLD, Australia
| | - Matthew Meredith
- Forensic Pathology, Queensland Health Forensic and Scientific Services, Coopers Plains, Queensland, Australia
| | - Mark D Barry
- Visualisation Facilities, Faculty of Science, Health, Education and Engineering, University of the Sunshine Coast, Sippy Downs, Queensland, Australia
| | - Beat Schmutz
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Laura S Gregory
- School of Biomedical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
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