Skelettaltersbestimmung der Hand

Forensic Diagnostics of the Skeletal Age in the Living - Backgrounds and Methodology

BACKGROUND

 The expert opinions on forensic age diagnostics requested by state institutions are used to show the exceeding of legally relevant age thresholds, especially the completed 18th year of life. According to the recommendations of the Study Group on Forensic Age Diagnostics (AGFAD), this requires - among other things - a determination of skeletal age.

METHOD

 Considering recent scientific knowledge, the current conditions and established skeletal age diagnostics methods are presented. Additionally, this review article sheds light on the influence of ethnicity and socioeconomic status, questions regarding indication, as well as alternative and future developments.

RESULTS AND CONCLUSION

 In forensic age diagnostics, particularly hand radiography and thin-slice CT of the medial clavicular epiphysis are relevant for determining skeletal age. The Atlas method of Greulich and Pyle (1959) and the clavicular stages by Schmeling et al. (2004) and Kellinghaus et al. (2010) are primarily used for this. This spectrum of methods, which is based on a very solid database, might be supplemented by MRI studies of the knee joint in the near future.

KEY POINTS

  · Determining skeletal age is an essential part of forensic age diagnostics commissioned by state authorities and courts.. · Hand radiography and CT of the medial clavicular epiphysis form the core of the spectrum of methods recommended by the Study Group of Forensic Age Diagnostics (AGFAD).. · Since the radiological studies required for forensic age diagnostics are not medically indicated, it must be ensured that the legal basis is specifically named in each case when commissioning expert opinions.. · MRI studies of the knee joint might increase the spectrum of methods in the near future..

CITATION FORMAT

· Wittschieber D, Hahnemann ML, Mentzel H. Forensic Diagnostics of the Skeletal Age in the Living - Backgrounds and Methodology. Fortschr Röntgenstr 2024; 196: 254 - 261.

Magnetic resonance imaging of the iliac crest: age estimation in under-20 soccer players

Age assessment of living individuals represents a valuable tool in both forensic medicine and sports medicine. In soccer, age-related tournaments play an important role in guaranteeing equal chances to the competitors. However, age estimations in this field should not rely on imaging methods that include exposure to radiation. Therefore, the present study investigates the possibilities of magnetic resonance imaging (MRI) of the iliac crest apophysis for the purpose of evaluating skeletal maturation in under-20 (U-20) soccer players. To this end, gradient echo 3D sequences of the whole pelvis of 152 male tournament soccer players between 18 and 22 years of age were prospectively evaluated. A four stage classification system was applied for the assessment of the apophyseal ossification. Reliable stage determination was possible in all cases. Further sub-classification did not appear feasible due to the limitations of MRI. Analysis of the statistical parameters showed that age medians increased steadily from stage to stage. However, they did not allow for further differentiation of skeletal maturity in the cohort studied. Thus, MRI of the iliac crest appears to be generally suitable in age diagnostics of living individuals, but further investigations, especially in a cohort of individuals aged between 10 and 20 years, are needed in order to establish this method as novel criterion in sports or forensic medicine.

Projection radiography of the clavicle: still recommendable for forensic age diagnostics in living individuals?

As superimposition effects often impede the evaluation of the ossification status of the medial clavicular epiphysis in standard posterior-anterior (PA) radiographs, additional oblique images (right anterior oblique, RAO, and left anterior oblique, LAO) are currently recommended to allow for reliable stage assessments. The present study examines the influence of the radiographic projection type on stage determination. To this end, 836 sternoclavicular joints were prospectively obtained during forensic autopsies of bodies aged between 15 and 30 years. Subsequently, three different radiographs (PA, RAO, and LAO) were taken from each specimen and separately evaluated as to the developmental stage of the medial clavicular epiphysis. A forensically established five-stage classification system was used. In 25 % of the cases, the medial clavicular epiphysis depicted in an oblique projection showed a different ossification stage than in the PA projection. In at least 10 % of the cases, a higher ossification stage was observed which would have significant disadvantages in criminal proceedings (ethically unacceptable error). In conclusion, the usage of the current radiographic reference data, which rely upon chest radiographs taken as PA projections, appears to be inadmissible for oblique projections. Projection radiography of the clavicle can therefore no longer be recommended for forensic age estimation practice. As to the question of whether an individual has achieved the age of 18 or 21, computed tomography of the clavicle must be regarded as the exclusive method of choice.

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.