Age estimation in U-20 football players using 3.0 tesla MRI of the clavicle

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.

The use of magnetic resonance imaging to examine ossification of the proximal tibial epiphysis for forensic age estimation in living individuals

The establishment of radiation-free examination procedures in the field of forensic age diagnostics in living persons is to be considered of special scientific interest so as to minimize necessary exposure to X-rays while facilitating additional assessment of skeletal development in all cases. To this end, the advantages offered by magnetic resonance imaging in securing a practical application which is as unrestricted and complication-free as possible should be among the methods exploited in investigating such indicators of skeletal maturity. Within the framework of a retrospective study, we investigated the ossification status of the proximal tibial epiphysis on the MRI scans of 124 females and 166 males aged between 10 and 30 years. All the images had been generated on a 3.0 T scanner using a T1-weighted turbo spin-echo sequence. When evaluating the ossification stage, a combination of modified classifications proposed by Schmeling et al. and by Kellinghaus et al. was used. The statistical evaluation included calculation of a variety of measures to describe specific ossification stages as well as kappa coefficients to assess intra- and inter-observer agreement on diagnoses of individual stages. In forensic contexts, completion of the 14th year of life can be adequately evidenced in females with an ossification stage IV according to Schmeling et al. and in males with an ossification stage III c according to Kellinghaus et al. or an ossification stage IV according to Schmeling et al. In forensic contexts, the presence of an ossification stage IV according to Schmeling et al. can prove that the age of 16 years has been exceeded only in the male sex, whereby for age estimation purposes the diagnosis should be in line with other skeletal maturity indicators. The results available displayed a high degree of intra- and inter-observer agreement. Examination of the ossification status of the proximal tibial epiphysis using magnetic resonance imaging represents an effective additional tool for use in radiation-free forensic age diagnostics in living persons.

Forensic age estimation in living subjects based on ultrasound examination of the ossification of the olecranon

Radiation-free imaging procedures for the purposes of forensic age diagnosis are highly desirable, especially for children. With this in mind, the stage of ossification of the olecranon was prospectively determined in 309 male and 307 female healthy volunteers aged between 10 and 25 years, based on ultrasound. A four-stage classification system was used for this purpose. This stage classification system takes into account whether an isolated secondary ossification centre, an epiphyseal cartilage or an epiphysis which is completely fused with the diaphysis can be detected. The earliest observation of stage 2 was at 10.0 years in males and 10.1 years in females. Both findings are determined by the lower age limit of the sample and are thus not representative of the minimum age for ossification stage 2. Stage 3 was first noticed at age 13.5 years in males and 10.6 years in females. Stage 4 was first reached at age 13.7 years in males and 12.3 years in females. Hence, in our sample, ossification stage 3 can be seen as evidence that females have reached the age of 10 years and males the age of 13 years. In our sample, stage 4 provides evidence that a female individual has reached the age of 12 years. It was concluded that the results of our study should be validated using other samples.

Influence of the examiner's qualification and sources of error during stage determination of the medial clavicular epiphysis by means of computed tomography

Computed tomography (CT) of the medial clavicular epiphysis has been well established in forensic age estimations of living individuals undergoing criminal proceedings. The present study examines the influence of the examiner's qualification on the determination of the clavicular ossification stage. Additionally, the most frequent sources of error made during the stage assessment process should be uncovered. To this end, thin-slice CT scans of 1,420 clavicles were evaluated by one inexperienced and two experienced examiners. The latter did the evaluations in consensus. Two classification systems, a five-stage system and a substaging system for the main stages 2 and 3, were used. Prior to three of his six assessment sessions, the inexperienced examiner was specifically taught staging of clavicles. Comparison of the examiners' results revealed increasing inter- and intraobserver agreements with increasing state of qualification of the inexperienced examiner (from κ= 0.494 to 0.674 and from κ= 0.634 to 0.783, respectively). The attribution of a not-assessable anatomic shape variant to an ossification stage was identified as the most frequent error during stage determination (n= 349), followed by the overlooking of the epiphyseal scar defining stage 4 (n= 144). As to the clavicular substages, classifying substage 3a instead of 3b was found to be the most frequent error (n= 69). The data of this study indicate that κ values must not be considered as objective measures for inter- and intraobserver agreements. Furthermore, a high degree of specific qualification, particularly the knowledge about the diversity of anatomic shape variants, appears to be mandatory and indispensable for reliable evaluation of the medial clavicular epiphysis.

Sonographic examination of the apophysis of the iliac crest for forensic age estimation in living persons

The present study examines the applicability of ultrasound diagnostics in assessing the ossification processes of the apophysis of the Crista iliaca of the pelvis for the purposes of forensic age diagnostics in living persons. To this end, the apophyseal ossification stages were determined in 307 female and 309 male study participants aged between 10 and 25 years. In females, ossification stage I was identifiable at an age of 10.1 years at the earliest (x¯=11.8), ossification stage II at 11.2 years at the earliest (x¯=14.6), ossification stage III at 14.7 years at the earliest (x¯ =18.6), and ossification stage IV at 17.9 years at the earliest (x¯=22.7). In males, ossification stage I was observable from an age of 10.0 years (x¯=11.8), ossification stage II from 10.5 years (x¯=14.9), ossification stage III from 15.6 years (x¯=18.9), and ossification stage IV from 17.4 years (x¯=22.6). In forensic age estimation procedures in living persons, sonographic examination of the iliac crest apophysis makes it possible to minimise exposure of the individual to radiation in accordance with the existing legal basis for the use of X-rays on humans. In application areas with no legal basis to justify X-ray examinations, the accuracy of an age diagnosis can be improved by integrating skeletal maturity as a criterion.

[History, present situation and perspectives of forensic age diagnostics of living persons]

Although age estimations of living persons have been carried out for a long time already, the importance of forensic age diagnostics has increased considerably since the beginning of the 1980s. The Study Group on Forensic Age Diagnostics of the German Society of Legal Medicine founded under the chairmanship of Prof. Dr. Gunther Geserick in March 2000 has published recommendations for age assessments in criminal proceedings, in pension matters as well as in civil and asylum proceedings. Based on regular meetings and proficiency tests, this study group makes an important contribution to quality assurance in age assessment. The introduction of radiation-free imaging procedures in age estimation practice is to be expected in the near future.

[About the Geserick sign--a literature study]

Fractures of the medial and basal orbital wall as well as the petrous part of the temporal bone were described first in 1980 by a Berlin-based study group led by Geserick as new cranium findings resulting from a contrecoup mechanism. Experimental and comparative examinations revealed that indirect fractures of the orbital walls are caused by a coup action of the eyeballs, whereas the mechanogenesis of the petrous bone fractures continues to be unclear. The frequently combined occurrence with the orbital sign nonetheless permits an allocation to the contrecoup mechanism. Both signs are important criteria for forensic and clinical assessment of craniocerebral injuries.

[Sonographic examination on the time frame of ossification of the distal fibula epiphysis]

In order to increase the reliability of forensic age estimations in living adolescents and young adults without justification for X-ray examinations, the establishment of radiation-free imaging procedures is desirable. In this study, the ossification stage of the right-hand distal fibula epiphysis was sonographically determined prospectively in 309 male and 307 female healthy volunteers. For this purpose a four-stage classification system was used. A sonographically determined ossification stage 3 permits the proof of completion of age 13 in boys and the proof of completion of age 12 in girls. In case of an ossification stage 4 the completion of age 14 in boys and the completion of age 13 in girls can be certified. In order to increase the level of reliability of age estimates, findings should be collected by at least two independent examiners who are experienced in the sonography of skeletons, followed by consensus-building.

Sonographic assessment of the ossification of the medial clavicular epiphysis in 616 individuals

Establishing radiation-free imaging methods for the assessment of clavicular ossification in forensic age determination is desirable as it reduces radiation exposure in living individuals. For this purpose the stage of ossification of the right medial clavicular epiphysis was determined prospectively using sonography in 309 male and 307 female healthy volunteers. The classification of stages according to Schulz et al. was used for this purpose. Stage 2 was first noticed at the age of 14.4 years in males, and at the age of 14.1 years in females. Stage 3 was first achieved by males at the age of 17.6 years and by females at the age of 17.4 years. Stage 4 first occurred in males at the age of 19.3 years and at the age of 18.9 years in females. The mean age for stage 1 was 13.6 years. The mean age of stage 2 ranged between 17.3 and 17.6 years. For stage 3 the mean age varied from 20.7 to 21.2 years, and for stage 4 from 23.3 to 23.5 years. It was concluded that sonographically determined stage 4 clavicular ossification provides evidence for the completion of the nineteenth year of life in males and the eighteenth year of life in females. In order to increase the reliability of age determination using this method it is recommended that findings be recorded by at least two experienced independent examiners who then reach a consensus.

The Risser sign for forensic age estimation in living individuals: a study of 643 pelvic radiographs

Due to increasing international migratory movements, forensic age estimations of living individuals in criminal proceedings are gaining increasing significance for forensic physicians and radiologists involved in delivering expert opinions. The present study examines the suitability of the radiologically well-known Risser sign grading as a possible new criterion in forensic age diagnostics. For this purpose, anteroposterior pelvic radiographs of 643 patients aged between 10 and 30 years were retrospectively evaluated by means of two different Risser sign grading systems (US and French), each with 5 stages. The left and right sides of the pelvis were assessed separately. The data was analyzed with separation of the sexes. Reliable Risser sign determination was possible in 566 cases. In both sexes, stage 4 of both the US and the French grading systems was predominantly first noted at age 14 years. In the US grading system, stage 5 was also first achieved at age 14 years in the majority of both sexes. In the French grading system, females manifested stage 5 at a minimum of 16 years, whereas in males it was first observed at 17 years. As to the nature of iliac crest maturation, interesting deviations were observed at stages 1 and 5, raising doubts about Risser's ossification process. To conclude, both Risser sign grading systems are suitable for forensic age diagnostics, especially to determine whether the 14th year of life has been completed or not. The French Risser sign system additionally allows for statements as to the completion of the 16th year of age.

The influence of impaction on the rate of third molar mineralisation in male black Africans

One of the main criteria used in dental age diagnostics in living adolescents and young adults is assessment of the mineralisation stage of the third molars. In the case of Europid populations, it has been established that impaction status has an influence on the rate of mineralisation of the third molars. In view of this, a study was undertaken to determine whether the chronological process of wisdom tooth mineralisation is dependent upon impaction status in black Africans too. Orthopantomograms (553) of 437 male and 116 female black South Africans with verified birth dates in the age group between 10 and 26 years were studied. Mineralisation stage and impaction status were determined for all third molars. Statistical measures were calculated for the mandibular wisdom teeth at stages F, G and H and for the maxillary wisdom teeth at stage H in the male gender for both impacted and non-impacted third molars. It was ascertained that the minimum age in persons with impacted third molars, depending on the wisdom tooth observed, was 0.19-2.57 years higher than in those with non-impacted wisdom teeth. Test persons with impacted mandibular wisdom teeth at stage F or G were on average between 0.32 and 1.88 years older than those with non-impacted mandibular wisdom teeth. The 50 % probability values of impacted wisdom teeth at stage H were 1.85-3.31 years higher than those in non-impacted wisdom teeth. The conclusion was drawn that in male black Africans, impacted mandibular wisdom teeth mineralise more slowly than non-impacted lower third molars. The presence of impacted mandibular wisdom teeth in mineralisation stage H in male black Africans does not, however, furnish proof of completion of the 18(th) year of life beyond reasonable doubt.

Radiographic evaluation of Gustafson's criteria for the purpose of forensic age diagnostics

The main criteria used in dental age estimation in living young individuals are mineralisation and eruption of the third molars. In order to further diversify the spectrum of characteristics after completion of third molar development, tests were undertaken to determine whether the characteristics studied by Gustafson can be ascertained with the required forensic certainty with the aid of the orthopantomogram and whether the evaluation of these could render forensic odontological age diagnoses possible beyond the 18th year of life. For this purpose, 1,299 conventionally produced orthopantomograms of 650 female and 649 male Germans aged from 15 to 40 years were studied. The characteristics of secondary dentin formation, cementum apposition, periodontal recession and attrition were evaluated in all the mandibular premolars. The correlation of the individual characteristics with chronological age was studied with the aid of a multiple regression analysis in which chronological age formed the dependent variable. Depending on the tooth studied, the R values amounted to 0.65 to 0.73; the standard error of estimate was 5.3 to 5.7 years. Basically, the regression equations calculated can be recommended for age estimation in living individuals, although it should be borne in mind that the applicability of the new method presented is limited by the quality of the X-ray images.

[Application of a modified stage classification in evaluating wisdom tooth eruption in a German population]

The evaluation of the eruption status of the wisdom teeth constitutes a significant component of the spectrum of dental methods available for purposes of forensic age diagnostics. In the present study, the status of wisdom tooth eruption was identified in 606 conventionally created orthopantomograms of 515 female and 91 male Germans, divided by sex and tooth, using a modified classification comprising four stages. Instead of the original stage C (gingival eruption) which cannot always be reliably identified on X-ray images of suboptimal quality, stage C of the modified classification was considered reached when the erupting wisdom tooth had reached at least half the length of the crown of the adjacent second molar, without however having yet reached the occlusal plane. The new stage classification is especially recommended for age estimation based on X-ray images in which a conclusive delimitation of the gingiva is not possible.

[Simon's bleedings as a vital sign of hanging--a literature review]

The intervertebral haemorrhages described by Simon in 1968 as a vital sign of hanging have been verified and endorsed by other authors. They occur in 40-50 % of hanging cases, most frequently in the lumbar spine, in younger age groups, and in cases of free suspension. The haemorrhages are not unique to hanging, but may occur in particular as a result of other traumatic elongation or overextension of the spinal column (e. g. in the course of traffic accidents). In cases of decomposition of the body, "false positive" findings are relatively common. As external findings scarcely provide any reliable vital signs of hanging, there is still a high demand for autopsies. In addition to Simon's bleedings, internal findings which are diagnostically conclusive also include microscopic examinations of the lungs and the neck musculature. More recent findings such as haemorrhages in the back and auxiliary respiratory muscles as well as the intestinal wall, if confirmed, could supplement Simon's bleedings. Frei's fibre sample and evidence of histamine in the ligature mark should not be neglected. Finally, it must be emphasized that the forensic assessment of hanging cases should always be based on a criminological and forensic evaluation of all the circumstances of the offence as well as on post-mortem findings.