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Cummaudo M, Obertova Z, Lynnerup N, Petaros A, de Boer H, Baccino E, Steyn M, Cunha E, Ross A, Adalian P, Kranioti E, Fracasso T, Ferreira MT, Lefèvre P, Tambuzzi S, Peckitt R, Campobasso CP, Ekizoglu O, De Angelis D, Cattaneo C. Age assessment in unaccompanied minors: assessing uniformity of protocols across Europe. Int J Legal Med 2024; 138:983-995. [PMID: 38279991 DOI: 10.1007/s00414-024-03157-8] [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: 09/01/2023] [Accepted: 01/05/2024] [Indexed: 01/29/2024]
Abstract
Age assessment of migrants is crucial, particularly for unaccompanied foreign minors, a population facing legal, social, and humanitarian challenges. Despite existing guidelines, there is no unified protocol in Europe for age assessment.The Forensic Anthropology Society of Europe (FASE) conducted a comprehensive questionnaire to understand age estimation practices in Europe. The questionnaire had sections focusing on the professional background of respondents, annual assessment numbers, requesting parties and reasons, types of examinations conducted (e.g., physical, radiological), followed protocols, age estimation methods, and questions on how age estimates are reported.The questionnaire's findings reveal extensive engagement of the forensic community in age assessment in the living, emphasizing multidisciplinary approaches. However, there seems to be an incomplete appreciation of AGFAD guidelines. Commonalities exist in examination methodologies and imaging tests. However, discrepancies emerged among respondents regarding sexual maturity assessment and reporting assessment results. Given the increasing importance of age assessment, especially for migrant child protection, the study stresses the need for a unified protocol across European countries. This can only be achieved if EU Member States wholeheartedly embrace the fundamental principles outlined in EU Directives and conduct medical age assessments aligned with recognized standards such as the AGFAD guidelines.
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Affiliation(s)
- Marco Cummaudo
- LABANOF, Laboratorio Di Antropologia E Odontologia Forense, Sezione Di Medicina Legale, Dipartimento Di Scienze Biomediche Per La Salute, Università Degli Studi Di Milano, Via Mangiagalli 37, 20133, Milan, Italy.
| | - Zuzana Obertova
- Centre for Forensic Anthropology, School of Social Sciences, The University of Western Australia, 35 Stirling Hwy, Crawley, Perth, WA, Australia
| | - Niels Lynnerup
- Department of Forensic Medicine, University of Copenhagen, Frederik V's Vej 11, 2100, Copenhagen, Denmark
| | - Anja Petaros
- Department of Legal Medicine Linköping, National Board of Forensic Medicine, Linköping, Sweden
| | - Hans de Boer
- Victorian Institute of Forensic Medicine, Department of Forensic Medicine, Monash University, Melbourne, Australia
| | - Eric Baccino
- EDPFM, Department of Forensic Medicine, University of Montpellier, CHU Montpellier, 34000, Montpellier, France
| | - Maryna Steyn
- Human Variation and Identification Research Unit, School of Anatomical Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Eugenia Cunha
- National Institute of Legal Medicine and Forensic Sciences, Coimbra, Portugal
| | - Ann Ross
- Human Identification & Forensic Analysis Laboratory, Department of Biological Sciences, North Carolina State University, Raleigh, NC, 276995, USA
| | - Pascal Adalian
- Aix Marseille University, CNRS, EFS, ADES, 13007, Marseille, France
| | - Elena Kranioti
- Forensic Medicine Unit, Department of Forensic Sciences, Medical School, University of Crete, 700 13, Heraklion, Greece
| | - Tony Fracasso
- University Center of Legal Medicine (CURML), Geneva University Hospital, Geneva, Switzerland
| | - Maria Teresa Ferreira
- Laboratory of Forensic Anthropology, Department of Life Sciences, University of Coimbra, Calçada Martim de Freitas, 3000-456, Coimbra, Portugal
| | - Philippe Lefèvre
- Institute of Information and Communication Technologies, Electronics and Applied Mathematics (ICTEAM), and Institute of Neuroscience (IoNS), Université Catholique de Louvain, 1348 Louvain-la-Neuve, 1200, Brussels, Belgium
| | - Stefano Tambuzzi
- LABANOF, Laboratorio Di Antropologia E Odontologia Forense, Sezione Di Medicina Legale, Dipartimento Di Scienze Biomediche Per La Salute, Università Degli Studi Di Milano, Via Mangiagalli 37, 20133, Milan, Italy
| | - Robin Peckitt
- LABANOF, Laboratorio Di Antropologia E Odontologia Forense, Sezione Di Medicina Legale, Dipartimento Di Scienze Biomediche Per La Salute, Università Degli Studi Di Milano, Via Mangiagalli 37, 20133, Milan, Italy
| | - Carlo Pietro Campobasso
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", Via Luciano Armanni 5, 80138, Naples, Italy
| | - Oguzhan Ekizoglu
- Department of Forensic Medicine, Tepecik Training and Research Hospital, Güney Mahallesi 1140/1 Yenisehir, Konak, Izmir, Turkey
| | - Danilo De Angelis
- LABANOF, Laboratorio Di Antropologia E Odontologia Forense, Sezione Di Medicina Legale, Dipartimento Di Scienze Biomediche Per La Salute, Università Degli Studi Di Milano, Via Mangiagalli 37, 20133, Milan, Italy
| | - Cristina Cattaneo
- LABANOF, Laboratorio Di Antropologia E Odontologia Forense, Sezione Di Medicina Legale, Dipartimento Di Scienze Biomediche Per La Salute, Università Degli Studi Di Milano, Via Mangiagalli 37, 20133, Milan, Italy
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Karaman G, Can IO, Cekdemir YE, Ekizoglu O, Guleryuz H. Age Estimation Based on Computed Tomography Analysis of the Scapula. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:581. [PMID: 38674226 PMCID: PMC11052407 DOI: 10.3390/medicina60040581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 03/27/2024] [Accepted: 03/29/2024] [Indexed: 04/28/2024]
Abstract
Background and Objectives: Age estimation from skeletal remains and in living individuals is an important issue for human identification, and also plays a critical role in judicial proceedings for migrants. Forensic analysis of ossification centers is the main evaluation method for age estimation, and ossification degree can be determined using computed tomography analysis. The purpose of this study is to investigate the applicability of CT (computed tomography) in the analysis of left scapula ossification centers, for forensic age estimation in Turkish society. Materials and Methods: We analyzed six ossification centers of the left scapula and these ossification centers are the coracoid, subcoracoid, coracoid apex, acromial, glenoid, and inferior angle ossification centers. A pediatric radiologist analyzed these six ossification centers of the scapula by using a staging method defined by Schmeling et al. in 2004. Two months after the first assessment, 20 randomly selected cases was reanalyzed by the first observer and by another pediatric radiologist. Correlation between the age and ossification stage was assessed using Spearman's nonparametric correlation test. Linear regression analysis was performed using a backwards model. Cohen's kappa coefficient was used for evaluating interobserver and intraobserver variability. Results: In this retrospective study, 397 (248 male and 149 female) cases were evaluated. Ages ranged between 7.1 and 30.9. The mean age was 19.83 ± 6.49. We determined a positive significant correlation between the age and the ossification stages of ossification centers analyzed in both sexes. In each ossification center, except inferior angle, all of the stage 1 and 2 cases in both sexes were under 18 years old. Intraobserver and interobserver evaluations showed that reproducibility and consistency of the method was relatively good. Conclusions: The present study indicated that CT analysis of scapula ossification centers might be helpful in forensic age assessment of living individuals and dry bones.
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Affiliation(s)
- Gokçe Karaman
- Turgutlu Forensic Medicine Department, Council of Forensic Medicine, 45400 Manisa, Turkey
| | - Ismail Ozgur Can
- Forensic Medicine Department, Faculty of Medicine, Dokuz Eylül University, 35220 İzmir, Turkey;
| | - Yasin Ertug Cekdemir
- Radiology Department, Faculty of Medicine, Dokuz Eylül University, 35220 İzmir, Turkey; (Y.E.C.); (H.G.)
| | - Oguzhan Ekizoglu
- Unit of Forensic Imaging and Anthropology, University Centre of Legal Medicine Lausanne-Geneva, Geneva University Hospital and University of Geneva, 1015 Lausanne, Switzerland;
- Department of Forensic Medicine, Tepecik Training and Research Hospital, 35180 Izmir, Turkey
| | - Handan Guleryuz
- Radiology Department, Faculty of Medicine, Dokuz Eylül University, 35220 İzmir, Turkey; (Y.E.C.); (H.G.)
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Qiu L, Liu A, Dai X, Liu G, Peng Z, Zhan M, Liu J, Gui Y, Zhu H, Chen H, Deng Z, Fan F. Machine learning and deep learning enabled age estimation on medial clavicle CT images. Int J Legal Med 2024; 138:487-498. [PMID: 37940721 DOI: 10.1007/s00414-023-03115-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 10/29/2023] [Indexed: 11/10/2023]
Abstract
The medial clavicle epiphysis is a crucial indicator for bone age estimation (BAE) after hand maturation. This study aimed to develop machine learning (ML) and deep learning (DL) models for BAE based on medial clavicle CT images and evaluate the performance on normal and variant clavicles. This study retrospectively collected 1049 patients (mean± SD: 22.50±4.34 years) and split them into normal training and test sets, and variant training and test sets. An additional 53 variant clavicles were incorporated into the variant test set. The development stages of normal MCE were used to build a linear model and support vector machine (SVM) for BAE. The CT slices of MCE were automatically segmented and used to train DL models for automated BAE. Comparisons were performed by linear versus ML versus DL, and normal versus variant clavicles. Mean absolute error (MAE) and classification accuracy was the primary parameter of comparison. For BAE, the SVM had the best MAE of 1.73 years, followed by the commonly-used CNNs (1.77-1.93 years), the linear model (1.94 years), and the hybrid neural network CoAt Net (2.01 years). In DL models, SE Net 18 was the best-performing DL model with similar results to SVM in the normal test set and achieved an MAE of 2.08 years in the external variant test. For age classification, all the models exhibit superior performance in the classification of 18-, 20-, 21-, and 22-year thresholds with limited value in the 16-year threshold. Both ML and DL models produce desirable performance in BAE based on medial clavicle CT.
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Affiliation(s)
- Lirong Qiu
- West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Anjie Liu
- West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu, 610041, People's Republic of China
- University of Electronic Science and Technology of China, Chengdu, 611731, People's Republic of China
| | - Xinhua Dai
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Guangfeng Liu
- West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Zhao Peng
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Mengjun Zhan
- West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Junhong Liu
- West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Yufan Gui
- West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Haozhe Zhu
- College of Computer Science, Sichuan University, Chengdu, 610064, People's Republic of China
| | - Hu Chen
- College of Computer Science, Sichuan University, Chengdu, 610064, People's Republic of China
| | - Zhenhua Deng
- West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu, 610041, People's Republic of China.
| | - Fei Fan
- West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu, 610041, People's Republic of China.
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Wittschieber D, Hahnemann ML, Mentzel HJ. Forensic Diagnostics of the Skeletal Age in the Living - Backgrounds and Methodology. ROFO-FORTSCHR RONTG 2024; 196:254-261. [PMID: 37699433 DOI: 10.1055/a-2130-3162] [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: 09/14/2023]
Abstract
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.
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Affiliation(s)
| | | | - Hans-Joachim Mentzel
- Institute of Diagnostic and Interventional Radiology, Section of Pediatric Radiology, Jena University Hospital, Jena, Germany
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Coreelman H, Hillewig E, Verstraete KL, de Haas MB, Thevissen PW, De Tobel J. Skeletal age estimation of living adolescents and young adults: A pilot study on conventional radiography versus magnetic resonance imaging and staging technique versus atlas method. Leg Med (Tokyo) 2023; 65:102313. [PMID: 37633179 DOI: 10.1016/j.legalmed.2023.102313] [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: 04/10/2023] [Revised: 07/27/2023] [Accepted: 08/03/2023] [Indexed: 08/28/2023]
Abstract
OBJECTIVE To compare conventional radiography (CR) and magnetic resonance imaging (MRI) of the left hand/wrist and both clavicles for forensic age estimation of adolescents and young adults. MATERIALS AND METHODS CR and MRI were prospectively conducted in 108 healthy Caucasian volunteers (52 males, 56 females) aged 16 to 21 years. Skeletal development was assessed by allocating stages (wrist, clavicles) and atlas standards (hand/wrist). Inter- and intra-observer agreements were quantified using linear weighted Cohen's kappa, and descriptive statistics regarding within-stage/standard age distributions were reported. RESULTS Inter- and intra-observer agreements for hand/wrist CR (staging technique: 0.840-0.871 and 0.877-0.897, respectively; atlas method: 0.636-0.947 and 0.853-0.987, respectively) and MRI (staging technique: 0.890-0.932 and 0.897-0.952, respectively; atlas method: 0.854-0.941 and 0.775-0.978, respectively) were rather similar. The CR atlas method was less reproducible than the staging technique. Inter- and intra-observer agreements for clavicle CR (0.590-0.643 and 0.656-0.770, respectively) were lower than those for MRI (0.844-0.852 and 0.866-0.931, respectively). Furthermore, although shifted, wrist CR and MRI within-stage age distribution spread were similar, as were those between staging techniques and atlas methods. The possibility to apply (profound) substages to clavicle MRI rendered a more gradual increase of age distributions with increasing stages, compared to CR. CONCLUSIONS For age estimation based on the left hand/wrist and both clavicles, reference data should be considered anatomical structure- and imaging modality-specific. Moreover, CR is adequate for hand/wrist evaluation and a wrist staging technique seems to be more useful than an atlas method. By contrast, MRI is of added value for clavicle evaluation.
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Affiliation(s)
- Heleen Coreelman
- Department of Diagnostic Sciences - Radiology, Ghent University, Corneel Heymanslaan 10, 9000 Ghent, Belgium.
| | - Elke Hillewig
- Department of Diagnostic Sciences - Radiology, Ghent University, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - Koenraad Luc Verstraete
- Department of Diagnostic Sciences - Radiology, Ghent University, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - Michiel Bart de Haas
- Division of Special Services and Expertise - Forensic Anthropology, Netherlands Forensic Institute, Laan van Ypenburg 6, 2497 GB The Hague, The Netherlands
| | - Patrick Werner Thevissen
- Department of Imaging and Pathology - Forensic Odontology, KU Leuven, Kapucijnenvoer 7 blok a bus 7001, 3000 Leuven, Belgium
| | - Jannick De Tobel
- Department of Diagnostic Sciences - Radiology, Ghent University, Corneel Heymanslaan 10, 9000 Ghent, Belgium; Department of Surgery - Oral and Maxillofacial Surgery, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 14, Switzerland
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Ruder TD, Kuhnen SC, Zech WD, Klaus JB, Lombardo P, Ith M. Standards of practice in forensic age estimation with CT of the medial clavicular epiphysis-a systematic review. Int J Legal Med 2023; 137:1757-1766. [PMID: 37691040 PMCID: PMC10567934 DOI: 10.1007/s00414-023-03061-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 07/08/2023] [Indexed: 09/12/2023]
Abstract
The AGFAD (Arbeitsgemeinschaft für Forensische Alterdiagnostik, Study Group on Forensic Age Diagnostics) has published several recommendations regarding both technical aspects of computed tomography (CT) of the medial clavicular epiphysis (MCE) and the process of reading and interpreting the CT images for forensic age estimations (FAE). There are, however, no published recommendations regarding CT scan protocols and no dose reference values for CT of the MCE. The objective of this analysis was to assess adherence to AGFAD recommendations among practitioners of FAE and analyse reported dose-relevant CT scan parameters with the objective of helping to establish evidence-based dose reference values for FAE. A systematic literature search was conducted in PubMed and in Google Scholar with specific MeSH terms to identify original research articles on FAE with CT of the MCE from 1997 to 2022. A total of 48 studies were included. Adherence to AGFAD recommendations among practitioners of FAE is high regarding the use of Schmeling main stages (93%), bone window (79%), ≤ 1 mm CT slices (67%), axial/coronal CT images (65%), and Kellinghaus sub-stages (59%). The reporting of CT technique and CT dose-relevant scan parameters is heterogeneous and often incomplete in the current literature. Considering the success achieved by the AGFAD in creating standards of practice of FAE in living subjects, there is potential for the AGFAD to establish standards for radiation protection in FAE as well.
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Affiliation(s)
- Thomas D Ruder
- Institute of Diagnostic, Interventional and Pediatric Radiology, InselspitaI, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010, Bern, Switzerland.
| | - Saskia C Kuhnen
- Institute of Diagnostic, Interventional and Pediatric Radiology, InselspitaI, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010, Bern, Switzerland
| | - Wolf-Dieter Zech
- Institute of Forensic Medicine, University of Bern, Bern, Switzerland
| | - Jeremias B Klaus
- Institute of Diagnostic, Interventional and Pediatric Radiology, InselspitaI, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010, Bern, Switzerland
- Institute of Forensic Medicine, University of Bern, Bern, Switzerland
- Roentgen Institute Thun, Thun, Switzerland
| | - Paolo Lombardo
- Institute of Diagnostic, Interventional and Pediatric Radiology, InselspitaI, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010, Bern, Switzerland
| | - Michael Ith
- Institute of Diagnostic, Interventional and Pediatric Radiology, InselspitaI, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010, Bern, Switzerland
- Radiation Protection, Image Processing Systems & Radiological Processes, Hirslanden Private Hospital Group, Zurich, Switzerland
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Gurses MS, Has B, Altinsoy HB, Suzen HS. Evaluation of distal tibial epiphysis and calcaneal epiphysis according to the Vieth method in 3.0 T magnetic resonance images: a pilot study. Int J Legal Med 2023:10.1007/s00414-023-03010-4. [PMID: 37145316 DOI: 10.1007/s00414-023-03010-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 04/25/2023] [Indexed: 05/06/2023]
Abstract
In forensic medicine practice, age estimation-both in living and deceased individuals-can be requested due to legal requirements. Radiologic methods, such as X-rays, for the estimation of bone age have been discussed, and ethical concerns have been raised. Given these factors, radiologic methods that reduce radiation exposure have gained importance and have become one of the research topics in forensic medicine. In this study, the MR images of the ankles of patients aged between 8 and 25 years, obtained with a 3.0 T MR scanner, were evaluated retrospectively according to the staging method defined by Vieth et al. In the study, the ankle MR images of 201 cases (83 females and 118 males) with sagittal T1-weighted turbo spin echo and T2-weighted short tau inversion recovery sequences were evaluated independently by two observers. According to the results of our study, the intra- and inter-observer agreements are at a very good level for both the distal tibial and calcaneal epiphyses. All the cases detected as stages 2, 3, and 4 in both sexes for both the distal tibial and the calcaneal epiphyses have been determined to be under the age of 18 years. According to the data obtained from our study, we consider that stage 5 for males and stage 6 for both sexes in the distal tibial epiphysis and stage 6 for males in the calcaneal epiphysis can be used to estimate the age of 15 years. As far as we know, our study is the first to evaluate ankle MR images with the method defined by Vieth et al. Further studies should be conducted to evaluate the validity of the procedure.
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Affiliation(s)
| | - Busra Has
- Department of Radiology, Nevsehir State Hospital, Nevsehir, Turkey.
| | - Hasan Baki Altinsoy
- Department of Radiology, Faculty of Medicine, Duzce University, Duzce, Turkey
| | - Halit Sinan Suzen
- Department of Toxicology, Faculty of Pharmacy, Ankara University, Ankara, Turkey
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8
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Mentzel HJ, Wittschieber D. [Radiological methods for age diagnostics : Clinical and forensic aspects]. RADIOLOGIE (HEIDELBERG, GERMANY) 2023; 63:129-140. [PMID: 36656310 DOI: 10.1007/s00117-022-01110-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/15/2022] [Indexed: 06/17/2023]
Abstract
Age diagnostics play an increasing role in radiology. Medical and forensic questions are indications for the application of age diagnostics. In addition to X‑rays of the hand in childhood, panoramic tomography and computed tomography are currently the standard procedures. Alternative modalities without ionizing radiation (sonography, magnetic resonance imaging) have not (yet) been established. The purpose of this article is to present the indications and methods of age diagnostics in the clinical and forensic contexts and to familiarize you with their advantages and disadvantages as well as the possibility of determining the final length.
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Affiliation(s)
- Hans-Joachim Mentzel
- Sektion Pädiatrische Radiologie, Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Deutschland.
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Chitavishvili N, Papageorgiou I, Malich A, Hahnemann ML, Mall G, Mentzel HJ, Wittschieber D. The distal femoral epiphysis in forensic age diagnostics: studies on the evaluation of the ossification process by means of T1- and PD/T2-weighted magnetic resonance imaging. Int J Legal Med 2023; 137:427-435. [PMID: 36565316 PMCID: PMC9902329 DOI: 10.1007/s00414-022-02927-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 11/30/2022] [Indexed: 01/16/2023]
Abstract
The age of majority, which corresponds to the age of 18 years in most European countries, plays a crucial role for a large number of legal decisions. Accordingly, an increasing number of requests by authorities to forensic age estimation experts comprise the question of whether the age of 18 years has been reached by an individual. In recent years, novel study data suggested that magnetic resonance imaging (MRI) of the knee might likewise allow for the determination of majority beyond reasonable doubt. However, the data basis, especially concerning the distal femoral epiphysis (DFE), is still poor. For this reason, 392 routine MRI cases of the knee (204 males and 188 females of a Western Caucasian population, aged between 12 and 25 years) were retrospectively analyzed. T1-weighted and water-selective fat-saturated PD/T2-weighted sequences, generated at 1.5 and 3.0 T clinical MR scanners, were available. Ossification stages of the DFE were determined by means of the classification system by Vieth et al. (Eur Radiol 2018; 28:3255-3262). Both the intra-observer agreement and inter-observer agreement were found to be "very good" (κ = 0.899 and κ = 0.830). The present study confirmed that MRI of the DFE is suitable to determine majority in both sexes when stage 6 is present as the study revealed minimum ages above the age of 18 years for this stage (20.40 years in males and 20.60 years in females). Accordingly, the data represent a strong support for the so far existing database. Hence, the investigation of the knee using routine MRI appears to become a realistic alternative for forensic age estimation practice in the near future.
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Affiliation(s)
- Natia Chitavishvili
- Section of Pediatric Radiology, Department of Radiology, Jena University Hospital, Friedrich Schiller University Jena, Jena, Germany ,Department of Radiology, Jena University Hospital, Jena, Germany
| | - Ismini Papageorgiou
- Department of Radiology, Jena University Hospital, Jena, Germany ,Institute of Radiology, Südharz Klinikum Nordhausen, Nordhausen, Germany
| | - Ansgar Malich
- Institute of Radiology, Südharz Klinikum Nordhausen, Nordhausen, Germany
| | - Maria L. Hahnemann
- Institute of Legal Medicine, Jena University Hospital, Friedrich Schiller University Jena, Am Klinikum 1, 07747 Jena, Germany
| | - Gita Mall
- Institute of Legal Medicine, Jena University Hospital, Friedrich Schiller University Jena, Am Klinikum 1, 07747 Jena, Germany
| | - Hans-Joachim Mentzel
- Section of Pediatric Radiology, Department of Radiology, Jena University Hospital, Friedrich Schiller University Jena, Jena, Germany
| | - Daniel Wittschieber
- Institute of Legal Medicine, Jena University Hospital, Friedrich Schiller University Jena, Am Klinikum 1, 07747, Jena, Germany.
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Widek T, De Tobel J, Ehammer T, Genet P. Forensic age estimation in males by MRI based on the medial epiphysis of the clavicle. Int J Legal Med 2022; 137:679-689. [PMID: 36534129 PMCID: PMC10085911 DOI: 10.1007/s00414-022-02924-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 12/01/2022] [Indexed: 12/23/2022]
Abstract
AbstractIncreasing cross-border migration has brought forensic age assessment into focus in recent decades. Forensic age estimation is based on the three pillars: physical and medical constitution, bone age, and tooth age. Part of the bone age examination includes the assessment of the medial end of the clavicles when the hand bones are already fully developed and a minority must be excluded. Recent research has brought MRI to the forefront as a radiation-free alternative for age assessment. However, there exits only a few studies with large sample size regarding the clavicles and with controversies about staging, motion artifacts, and exclusion based on anatomic norm variants. In the current prospective study, 338 central European male individuals between 13 and 24 years of age underwent MRI examination of the sternoclavicular region. Development was assessed by three blinded raters according to the staging system described by Schmeling et al. and Kellinghaus et al. and related to age by descriptive statistics and transition analyses with a cumulative probit model. In addition, reliability calculations were performed. No statistically significant developmental difference was found between the left and right clavicles. Inter-rater agreement was only moderate, but intra-rater agreement, on the other hand, was good. Stage 3c had a minimum age of 19.36 years and appears to be a good indicator of proof of majority. The minimum age of stage 4 was lower compared with other studies, 20.18 years, and therefore seems not to be an indicator of age of 21 years. In conclusion, we confirmed the value of clavicular MRI in the age estimation process. The transition analysis model is a good approach to circumvent the problems of age mimicry and samples that are not fully equilibrated. Given the moderate agreement between raters, a consensus reading is recommended.
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Affiliation(s)
- Thomas Widek
- Diagnostic and Research Institute of Forensic Medicine, Medical University of Graz, Graz, Austria.
- BioTechMed, Graz, Austria.
| | - Jannick De Tobel
- Department of Diagnostic Sciences - Radiology, Ghent University, Ghent, Belgium
- Department of Oral and Maxillofacial Surgery, Geneva University Hospital, Geneva, Switzerland
| | | | - Pia Genet
- University Centre of Legal Medicine Lausanne, Lausanne University Hospital, Lausanne, Switzerland
- University Centre of Legal Medicine Geneva, Geneva University Hospital, Geneva, Switzerland
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Gunacar DN, Bayrak S, Sinanoglu EA. Three-dimensional verification of the radiographic visibility of the root pulp used for forensic age estimation in mandibular third molars. Dentomaxillofac Radiol 2022; 51:20210368. [PMID: 34762520 PMCID: PMC8925871 DOI: 10.1259/dmfr.20210368] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES The aim of this study was to assess the reliability of panoramic radiography (OPG) using age estimation method using cone beam computed tomography (CBCT) verification in the evaluation of radiographic visibility of root pulp (RPV) of mandibular third molars for age estimation. METHODS CBCT and OPG images of 429 mandibular third molars from 290 patients were evaluated. RPV of fully mineralized mandibular third molars was evaluated as stages 0, 1, 2, and 3 for both imaging methods. Descriptive statistics were performed separately for stages by age for both genders. The consistency of these scores with chronological age was evaluated for both imaging methods. The reliability of OPG evaluation was also analyzed with CBCT scores.Results Spearman's rho correlation demonstrated a positive correlation between RPV and chronological age for both genders and for OPG and CBCT evaluation. Considering the minimum ages of both imaging methods, all stages were above the age of 18 except for the female group of Stage 2 and all Stage 0. For the comparison of OPG and CBCT RPV Staging scores, the κ score was found to be 0.312 (p < 0.001), indicating a fair agreement. CONCLUSION In conclusion, the absence of Stage 3 at age of 18 and under might have a forensic value for RPV age estimation method. Considering the fair agreement in the verification of OPG scores, it is not possible to determine the exact age with the RPV detected in OPG images, the use of CBCT for the RPV evaluation is recommended to available cases.
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Affiliation(s)
- Dilara Nil Gunacar
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Recep Tayyip Erdogan University, Rize, Turkey
| | - Seval Bayrak
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Bolu Abant İzzet Baysal University, Bolu, Turkey
| | - Enver Alper Sinanoglu
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Kocaeli University, Kocaeli, Turkey
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Contribution of the use of clavicle bone density in age estimation. Int J Legal Med 2022; 136:1017-1025. [PMID: 34988616 DOI: 10.1007/s00414-021-02741-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 10/29/2021] [Indexed: 10/19/2022]
Abstract
Age estimation is an essential element in the field of forensics and is also of judicial interest in forensic medicine of the living. Despite all the methods, age estimation is often imprecise with many biases, especially in mature individuals. The main objective of our study is to assess the correlation between age and computed tomography bone mineral density of the medial end of the clavicle. A sample of 180 chest multi-slice computed tomography scans without contrast injection performed in living individuals, with suspected respiratory infection, aged 15 to 100 years was used. Bone density measurement was performed on the medial meta-epiphyseal region of the clavicles. A significant negative correlation was found between bone density and age of individuals (p-value < 0.05). The mean absolute error was calculated for men at 13.4 years and 13.1 years for women, which was associated with an absence of bias. Good precision of the estimate for both sexes was also calculated on a subgroup of individuals whose age was greater than 40 years, with average absolute errors of about 12 years, which was associated with an absence of relative error. In view of our preliminary results, the study of bone density of the medial end of the clavicle could be of interest in the estimation of age. Several studies will be necessary to evaluate the reproducibility of these results on independent bone samples and in the estimation of age in the living individual.
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Wittschieber D, Chitavishvili N, Papageorgiou I, Malich A, Mall G, Mentzel HJ. Magnetic resonance imaging of the proximal tibial epiphysis is suitable for statements as to the question of majority: a validation study in forensic age diagnostics. Int J Legal Med 2021; 136:777-784. [PMID: 34962588 PMCID: PMC9005400 DOI: 10.1007/s00414-021-02766-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 12/15/2021] [Indexed: 11/28/2022]
Abstract
Determining majority plays a key role for forensic age diagnostics in living individuals. Recent data suggest that magnetic resonance imaging (MRI) of the proximal tibial epiphysis (PTE) may be a suitable alternative or at least an additional tool to clarify whether an individual has reached majority. However, the reference data situation is still sparse. Hence, the present dual center study retrospectively analyzed routine MRI of the knee in 413 cases (214 males and 199 females) of a Western Caucasian population aged between 12 and 25 years. MRI was performed at 1.5 and 3.0 T clinical scanners using T1- and T2-weighted sequences. The classification system by Vieth et al. (Eur Radiol 2018; 28:3255-3262) was applied for determining the ossification stages of the PTE. Intra-observer agreement was "very good" (κ = 0.931), and inter-observer agreement was "good" (κ = 0.798). Minimum ages above the age of 18 years were observed with the final stage (stage 6) in either sex (20.27 years in males and 18.55 years in females). The results are not in contradiction with the previous data and can be considered a strong and valuable support of the so far existing database. Therefore, the investigation of the PTE using routine MRI (either at 1.5 or 3.0 T) could be taken into consideration for application in forensic age estimation practice in near future.
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Affiliation(s)
- Daniel Wittschieber
- Institute of Legal Medicine, Jena University Hospital, Friedrich Schiller University Jena, Am Klinikum 1, 07747, Jena, Germany.
| | - Natia Chitavishvili
- Section of Pediatric Radiology, Department of Radiology, Jena University Hospital, Friedrich Schiller University Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Ismini Papageorgiou
- Institute of Diagnostic and Interventional Radiology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany.,Institute of Radiology, Südharz Klinikum Nordhausen, Dr.-Robert-Koch-Straße 39, 99734, Nordhausen, Germany
| | - Ansgar Malich
- Institute of Radiology, Südharz Klinikum Nordhausen, Dr.-Robert-Koch-Straße 39, 99734, Nordhausen, Germany
| | - Gita Mall
- Institute of Legal Medicine, Jena University Hospital, Friedrich Schiller University Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Hans-Joachim Mentzel
- Section of Pediatric Radiology, Department of Radiology, Jena University Hospital, Friedrich Schiller University Jena, Am Klinikum 1, 07747, Jena, Germany
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Zur Anwendbarkeit der dentalen Methode von Roberts et al. aus dem Jahr 2016 zum Nachweis der Vollendung des 18. Lebensjahres lebender Personen. Rechtsmedizin (Berl) 2021. [DOI: 10.1007/s00194-021-00535-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ZusammenfassungEs sollte die Methode von Roberts et al. aus dem Jahr 2016 zum Nachweis der Vollendung des 18. Lebensjahres überprüft werden.Dazu wurden 603 Orthopantomogramme (OPG) von 300 Frauen und 303 Männern im Alter von 16,01 bis 25,99 Jahren von 3 Untersuchern ausgewertet, wobei ein Hauptuntersucher alle OPGs zweimal begutachtet hat. Durch die 3 Untersucher wurde eine konsensuale Bestimmung für die Fälle vorgenommen, bei denen mindestens ein Untersucher ein Stadium zugeordnet hatte.In 31 Fällen (11 Frauen, 20 Männer) konnte konsensuell ein Stadium bestimmt werden. Hauptursache für die Nichtauswertbarkeit war die nicht abgeschlossene Entwicklung des Zahnes 38 [FDI] (30,18 %), gefolgt von Karies, Restaurationen oder anderen Pathologien (20,56 %) und dem Fehlen des Zahnes 38 (19,57 %). Das Stadium „RCW‑C“ konnte bei den Frauen konsensual nicht, die Stadien „RCW‑B“ und „RCW‑C“ konnten bei den Männern nur 4‑mal (3x „RCW-C“, 1x „RCW-B“) bestimmt werden. Der Cohen’s-Kappa-Wert für die Binnenbeobachterübereinstimmung für die 47 Fälle, in denen der Hauptuntersucher in mindestens einem Durchgang ein Stadium zugeordnet hatte, lag im moderaten bzw. guten Bereich (Frauen: 0,44; Männer: 0,62). Der Fleiss’-Kappa-Wert für die Zwischenbeobachterübereinstimmung der 3 Untersucher für die 69 Fälle, bei denen mindestens ein Untersucher ein Stadium zugeordnet hatte, lag im mangelhaften Bereich (Frauen: 0,07; Männer: 0,11), wobei die 95%-Konfidenzintervalle für den Kappa-Wert auch die „0“ einschlossen.Alle Personen, bei denen ein Stadium zugeordnet wurde, waren über 18 Jahre alt. Aktuell kann eine Anwendung der Methode nicht empfohlen werden. Es wird die Frage aufgeworfen, ob den Stadien eine allgemeingültige Entwicklungsabfolge zu Grunde zu liegt, da bei 30 Fällen der Befund nicht mit den Stadien in Deckung zu bringen war.
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Cekdemir YE, Mutlu U, Karaman G, Guleryuz H. Evaluation of the Ossification Stage of Proximal Humeral Epiphysis by 1.5-T Magnetic Resonance Imaging for Determination of Skeletal Age. Am J Forensic Med Pathol 2021; 42:36-41. [PMID: 33346970 DOI: 10.1097/paf.0000000000000636] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of the study was to investigate whether the skeletal age can be evaluated assessed by means of analysis of ossification stage at proximal humeral epiphysis using magnetic resonance imaging (MRI). METHODS This retrospective study was carried out in the radiology department of a tertiary healthcare center and 1.5-T MRI views of the shoulder obtained from 203 patients aged 8 to 29 years were evaluated. The ossification stage of proximal humeral epiphysis was evaluated on T1-weighted MRI sequences, and its correlation with age was sought. RESULTS Our series consisted of 77 women (37.9%) and 126 men (62.1%). One hundred forty-seven right humerus (72.4%) and 56 (27.6%) left humerus were examined. The mean age of the patients was 20.60 ± 4.41 years. The patients were in stages 4 (n = 148, 72.9%), 3c (n = 18, 8.9%), 3b (n = 14, 6.9%), 2c (n = 13, 6.4%), and 3a (n = 10, 4.9%). Analysis of the relationship between age and ossification stage of proximal humerus epiphysis indicated that stage increased with the advancement of age. There was a significant correlation between the stage and age variables at a rate of 77% in the positive direction (P < 0.001). CONCLUSIONS Our results demonstrated that MRI of proximal humeral epiphysis can have valuable implications for estimation of the skeletal age. Future prospective studies must be implemented with patients grouped according to socioeconomic status, nutritional habits, and physical activities to explore the actual investigative potential of MRI.
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Affiliation(s)
- Yasin Ertug Cekdemir
- From the Department of Radiology, Dokuz Eylul University Faculty of Medicine, Izmir
| | - Uygar Mutlu
- From the Department of Radiology, Dokuz Eylul University Faculty of Medicine, Izmir
| | | | - Handan Guleryuz
- From the Department of Radiology, Dokuz Eylul University Faculty of Medicine, Izmir
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Age estimation in the living: A scoping review of population data for skeletal and dental methods. Forensic Sci Int 2021; 320:110689. [PMID: 33561788 DOI: 10.1016/j.forsciint.2021.110689] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 01/07/2021] [Accepted: 01/11/2021] [Indexed: 11/22/2022]
Abstract
Age estimation of living individuals has become a crucial part of the forensic practice, especially due to the global increase in cross-border migration. The low rate of birth registration in many countries, hence of identification documents of migrants, especially in Africa and Asia, highlights the importance of reliable methods for age estimation of living individuals. Despite the fact that a number of skeletal and dental methods for age estimation have been developed, their main limitation is that they are based on specific reference samples and there is still no consensus among researchers on whether these methods can be applied to all populations. Though this issue remains still unsolved, population information at a glance could be useful for forensic practitioners dealing with such issues. This study aims at presenting a scoping review and mapping of the current situation concerning population data for skeletal (hand-wrist and clavicle) and dental methods (teeth eruption and third molar formation) for age estimation in the living. Two hundred studies on the rate of skeletal maturation and four hundred thirty-nine on the rate of dental maturation were found, covering the period from 1952 and 2020 for a total of ninety-eight countries. For most of the western and central African countries there are currently no data on the rate of skeletal and dental maturation. The same applies to the countries of the Middle East, as well as the eastern European countries, especially as regard the skeletal development.
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Timme M, Karch A, Shay D, Ottow C, Schmeling A. Zur Altersdiagnostik lebender Personen: der Einfluss des sozioökonomischen Status auf die Skelett- und Zahnentwicklung in einer deutschen Studienkohorte. Rechtsmedizin (Berl) 2020. [DOI: 10.1007/s00194-020-00444-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
ZusammenfassungDie forensische Altersdiagnostik kann ein entscheidendes Instrument zur Durchführung rechtstaatlicher Verfahren sein. Bei der Altersdiagnostik wird die Entwicklung von Skelett- und Zahnmerkmalen einer zu begutachtenden Person mit Daten von Referenzpopulationen verglichen. Als möglicher Einflussfaktor auf die Altersdiagnose ist der sozioökonomische Status (SES) der zu begutachtenden Person zu berücksichtigen. Allerdings ist die Studienlage zu diesem Einflussfaktor bislang spärlich. Prospektiv wurde der Zusammenhang zwischen der Skelett- bzw. Zahnentwicklung und dem SES innerhalb einer deutschen Studienpopulation aus freiwilligen Teilnehmern ermittelt. Dazu wurde die Entwicklung der medialen Epiphyse des Schlüsselbeins, der distalen Epiphyse des Radius, der distalen Epiphyse des Femurs, der proximalen Epiphyse der Tibia und des linken unteren dritten Molaren bei 294 Frauen und 287 Männern im Alter von 12 bis 24 Jahren mittels 3‑Tesla-Magnetresonanztomographie (MRT) untersucht. Zusätzlich wurde der SES der Teilnehmer erfasst. Hierzu wurde das Bildungsniveau der Eltern erfragt. Der Einfluss des SES auf die Einzelmerkmale sowie die Gesamtheit der untersuchten Skelettmerkmale wurde mittels linearer Regression ermittelt. Für alle untersuchten Merkmale und Kombinationen konnte keine Evidenz für einen Zusammenhang festgestellt werden. Es wurde geschlussfolgert, dass sich die Lebensumstände der Studienteilnehmer offenbar nicht ausreichend stark unterschieden, um einen Einfluss des SES auf das Skelettalter darzustellen.
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Gassenmaier S, Schaefer JF, Nikolaou K, Esser M, Tsiflikas I. Forensic age estimation in living adolescents with CT imaging of the clavicula-impact of low-dose scanning on readers' confidence. Eur Radiol 2020; 30:6645-6652. [PMID: 32725332 PMCID: PMC8203536 DOI: 10.1007/s00330-020-07079-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 04/15/2020] [Accepted: 07/16/2020] [Indexed: 12/02/2022]
Abstract
Objectives Computed tomography (CT) imaging of the clavicula displays the reference standard for forensic bone age diagnostics in adolescents and young adults. Consequently, highest efforts on radiation reduction are warranted. Therefore, the aim of this study was to investigate the feasibility of low-dose (LD) CT imaging of the clavicula for age estimation in living adolescents. Methods A total of 207 non-contrast chest CT of 144 patients born between 1988 and 2012, performed in 2018 due to various clinical indications, were included in this retrospective study. The mean patient age was 16.9 ± 6.6 years. Patients were divided into a LD (n = 146) and standard-dose (SD; n = 61) group. Image quality, confidence levels, and ossification stages (using the 5-stage classification including the subgroups 2a–3c) were assessed by two radiologists independently. Radiation dose was determined via dosimetry software. Results Dose simulation with z-axis reduction to depict the clavicula only resulted in a median exposure of 0.1 mSv (IQR: 0.0) in LD compared with 0.9 mSv (IQR: 0.6) in SD (p < 0.001). The median image quality was rated by both readers significantly worse in LD compared with SD on a Likert scale ranging from 1 to 4 with a median of 3 (IQR: 1) versus 4 (IQR: 0; p < 0.001 for both readers). There was an almost perfect agreement for the ossification stages between both readers with a Cohen’s kappa of 0.83 (p < 0.001). Median confidence levels of both readers were not significantly different between LD and SD in the decisive subgroups 2a–3c. Conclusions Low-dose CT imaging of the clavicula for age estimation in living adolescents is possible without loss of readers’ confidence. Key Points • Radiological bone age diagnostics in young delinquents with unknown exact chronological age is important as the judicial systems differentiate between youths and adults. • Low-dose computed tomography scanning of the medial clavicular joint for forensic age estimation is feasible in living adolescents without loss of readers’ confidence. • Sufficient image quality of the medial clavicular joint for forensic bone age diagnostics in living adolescents is achievable using a median dose of 0.1 mSv.
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Affiliation(s)
- Sebastian Gassenmaier
- Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen, Hoppe-Seyler-Straße 3, 72076, Tuebingen, Germany
| | - Juergen F Schaefer
- Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen, Hoppe-Seyler-Straße 3, 72076, Tuebingen, Germany
| | - Konstantin Nikolaou
- Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen, Hoppe-Seyler-Straße 3, 72076, Tuebingen, Germany
| | - Michael Esser
- Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen, Hoppe-Seyler-Straße 3, 72076, Tuebingen, Germany
| | - Ilias Tsiflikas
- Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen, Hoppe-Seyler-Straße 3, 72076, Tuebingen, Germany.
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Die Aussagekraft sozialpädagogischer Altersschätzungen im Vergleich zur forensischen Altersdiagnostik. Rechtsmedizin (Berl) 2020. [DOI: 10.1007/s00194-020-00403-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
ZusammenfassungIn der vorliegenden Studie sollte die Aussagekraft sozialpädagogischer Altersschätzungen im Vergleich zu forensischen Altersbegutachtungen, die entsprechend den Empfehlungen der Arbeitsgemeinschaft für Forensische Altersdiagnostik durchgeführt worden waren, analysiert werden. Hierfür wurden 47 Fälle ausgewertet, bei denen sowohl sozialpädagogische Altersschätzungen von in Jugendhilfeeinrichtungen betreuten unbegleiteten minderjährigen Flüchtlingen als auch forensische Altersgutachten zur Verfügung standen. In 44 Fällen, in denen die Einrichtungen von Minderjährigkeit ausgingen, bescheinigten die forensischen Altersgutachten in 12 Fällen zweifelsfreie Volljährigkeit und in 24 weiteren Fällen wahrscheinliche Volljährigkeit. In 2 Fällen, in denen die Einrichtungen die Minderjährigkeit anzweifelten, wurden im Ergebnis der forensischen Altersbegutachtung in dem einen Fall zweifelsfreie Volljährigkeit und in dem anderen Fall wahrscheinliche Volljährigkeit festgestellt. In einem Fall, in dem die Einrichtung von Volljährigkeit ausging, wurde auf der Grundlage der forensischen Altersbegutachtung wahrscheinliche Volljährigkeit mit noch möglicher Minderjährigkeit attestiert. Objektivierbare psychosoziale Kriterien, mit denen Volljährigkeit zweifelsfrei festgestellt werden kann, ließen sich nicht erkennen. Es ist davon auszugehen, dass der Anteil falsch-positiver Minderjährigkeitsfeststellungen bei sozialpädagogischen Altersschätzungen deutlich höher als bei forensischen Altersbegutachtungen ist. Ebenso scheint ein relevantes Risiko falsch-positiver Volljährigkeitsfeststellungen bei sozialpädagogischen Altersschätzungen zu bestehen. Es wurde geschlussfolgert, dass sozialpädagogische Altersschätzungen keine überzeugende Alternative zu forensischen Altersbegutachtungen darstellen.
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Juristische Aspekte der forensischen Altersdiagnostik auf der Grundlage des § 42f SGB VIII. Rechtsmedizin (Berl) 2020. [DOI: 10.1007/s00194-020-00392-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ZusammenfassungSeit Inkrafttreten des § 42f SGB VIII am 01.11.2015 ist das Verfahren zur Altersfeststellung von unbegleiteten und fraglich minderjährigen Ausländern durch Jugendämter in Deutschland gesetzlich geregelt. Hiernach hat das Jugendamt die Minderjährigkeit zunächst durch Einsichtnahme in die Ausweispapiere des jungen Menschen zu prüfen. Fehlen gültige Ausweispapiere, oder sind die in ihnen enthaltenen Geburtsdaten zweifelhaft, haben Jugendamtsmitarbeiter die Minderjährigkeit mittels einer qualifizierten Inaugenscheinnahme zu beurteilen. Lässt sich auch dadurch eine Minderjährigkeit nicht zweifelsfrei ausschließen, hat das Jugendamt eine ärztliche Untersuchung zur Altersfeststellung zu veranlassen. Eine Analyse der einschlägigen Rechtsprechung sowie der juristischen Fachliteratur ergab, dass Röntgenuntersuchungen zur forensischen Altersdiagnostik auf der Grundlage des § 42f SGB VIII nicht nur zulässig sind, sondern diese auch ausdrücklich eingefordert werden. Die Rechtsprechung erkennt zudem die medizinischen Untersuchungen nach den Empfehlungen der Arbeitsgemeinschaft für Forensische Altersdiagnostik (AGFAD) zur Altersdiagnostik unbegleiteter minderjähriger Ausländer als rechtlich zulässige, valide und zumutbare Methode an. Der von der Zentralen Ethikkommission (ZEKO) bei der Bundesärztekammer vertretenen Auffassung, dass die von der AGFAD empfohlenen Methoden nicht geeignet seien, Volljährigkeit hinreichend zuverlässig nachzuweisen, wird von der Rechtsprechung nicht gefolgt. Vielmehr wird darauf verwiesen, dass durch die Anwendung des Mindestalterkonzepts die von der ZEKO geäußerten Bedenken hinsichtlich der Schwankungsbreiten medizinischer Untersuchungen ausgeräumt werden.
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Forensic age assessment of living adolescents and young adults at the Institute of Legal Medicine, Münster, from 2009 to 2018. Int J Legal Med 2020; 134:745-751. [PMID: 31907616 DOI: 10.1007/s00414-019-02239-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 12/11/2019] [Indexed: 10/25/2022]
Abstract
Due to high migration inflows to Europe, forensic age assessment of living persons has clearly gained importance. If there is a legal justification for X-ray examinations without a medical indication, the Study Group on Forensic Age Diagnostics (AGFAD) recommends the combination of a physical examination with anamnesis, an X-ray examination of the hand and a dental examination with evaluation of an orthopantomogram for age assessments of adolescents and young adults. If the development of the hand skeleton has been completed, an additional CT examination of the clavicles is to be performed. To demonstrate the outcome of forensic age assessments according to AGFAD recommendations with regard to migrants of doubtful minority declaration, this study analyzes the expert reports carried out at the Institute of Legal Medicine, Münster, from 2009 to 2018. A total of 597 age assessments were performed during the study period. A total of 227 age assessments were issued on behalf of youth welfare offices in the legal area of social law, 282 in family law proceedings, 76 in criminal proceedings, and 12 age assessments in immigration law proceedings. In 211 out of 597 cases, the stated age was compatible with the findings of the age assessment. In the remaining 386 cases, the average difference between the stated age and the minimum age was 1.9 years. The average difference between stated age and most probable age was 5.1 years. Of the 521 age assessments carried out outside criminal proceedings, 197 unaccompanied minors with questionable age minority (37.8%) have reached the age of majority beyond doubt. A total of 388 unaccompanied minors (74.5%) have most probably reached the age of majority. Forensic age assessments with the AGFAD methodology make an important contribution to legal certainty, the welfare of the child, and the fair distribution of resources.
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Sajedi H, Pardakhti N. Age Prediction Based on Brain MRI Image: A Survey. J Med Syst 2019; 43:279. [PMID: 31297614 DOI: 10.1007/s10916-019-1401-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Accepted: 06/25/2019] [Indexed: 01/13/2023]
Abstract
Human age prediction is an interesting and applicable issue in different fields. It can be based on various criteria such as face image, DNA methylation, chest plate radiographs, knee radiographs, dental images and etc. Most of the age prediction researches have mainly been based on images. Since the image processing and Machine Learning (ML) techniques have grown up, the investigations were led to use them in age prediction problem. The implementations would be used in different fields, especially in medical applications. Brain Age Estimation (BAE) has attracted more attention in recent years and it would be so helpful in early diagnosis of some neurodegenerative diseases such as Alzheimer, Parkinson, Huntington, etc. BAE is performed on Magnetic Resonance Imaging (MRI) images to compute the brain ages. Studies based on brain MRI shows that there is a relation between accelerated aging and accelerated brain atrophy. This refers to the effects of neurodegenerative diseases on brain structure while making the whole of it older. This paper reviews and summarizes the main approaches for age prediction based on brain MRI images including preprocessing methods, useful tools used in different research works and the estimation algorithms. We categorize the BAE methods based on two factors, first the way of processing MRI images, which includes pixel-based, surface-based, or voxel-based methods and second, the generation of ML algorithms that includes traditional or Deep Learning (DL) methods. The modern techniques as DL methods help MRI based age prediction to get results that are more accurate. In recent years, more precise and statistical ML approaches have been utilized with the help of related tools for simplifying computations and getting accurate results. Pros and cons of each research and the challenges in each work are expressed and some guidelines and deliberations for future research are suggested.
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Affiliation(s)
- Hedieh Sajedi
- School of Mathematics, Statistics and Computer Science, College of Science, University of Tehran, Tehran, Iran. .,School of Computer Science, Institute for Research in Fundamental Science (IPM), P.O. Box 19395-5746, Tehran, Iran.
| | - Nastaran Pardakhti
- School of Mathematics, Statistics and Computer Science, College of Science, University of Tehran, Tehran, Iran
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23
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de Cassia Silva Azevedo A, Michel-Crosato E, Haye Biazevic MG. Radiographic evaluation of dental and cervical vertebral development for age estimation in a young Brazilian population. THE JOURNAL OF FORENSIC ODONTO-STOMATOLOGY 2018; 36:31-39. [PMID: 30712029 PMCID: PMC6626535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Age estimation is guided by the evaluation of events that happen during the processes of bone and dental development. The purpose of this study was to validate the method of age estimation proposed by Lajolo et al. (2013) through oro-cervical radiographic indices in Brazilians. The study aimed to verify the effectiveness of age estimation equations through dental and cervical vertebrae examinations, in addition to including dental and cervical vertebrae data in new age estimation equations. The sample consisted of panoramic radiographs and teleradiographs from 510 subjects (8-24.9 years). Age estimation methods were applied by assessing the development of seven mandibular teeth, cervical vertebrae and third molars. Techniques used previously have been combinations of radiographic indices: Oro-Cervical Radiographic Simplified Score (OCRSS) and Oro-Cervical Radiographic Simplified Score without Wisdom Teeth (OCRSSWWT). In the second phase of the study, dental maturation, vertebral measurements, and real age were estimated by regression equations. OCRSS and OCRSSWWT had success rates of 67.4% (R2=0.64) and 70.8% (R2=0.62), respectively. When age estimation equations for tooth evaluations were applied, the average error was 1.3 years, and for cervical vertebrae measurements, the error was 1.9 years. When dental variables and the measurements of cervical vertebrae were included, the average error of equations was 1.0 year. Radiographic indices were easy to perform, and after adequate training, are reliable and can be used in forensic practice. The use of the new equations presented in this study is recommended because including cervical vertebrae and dental data provides greater accuracy for age estimation.
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Affiliation(s)
| | - E Michel-Crosato
- School of Dentistry, Universidade de São Paulo (FOUSP)-São Paulo-SP Brazil
| | - M G Haye Biazevic
- School of Dentistry, Universidade de São Paulo (FOUSP)-São Paulo-SP Brazil
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24
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Benito M, Muñoz A, Beltrán I, Labajo E, Perea B, Sánchez JA. Assessment of adulthood in the living Spanish population based on ossification of the medial clavicle epiphysis using ultrasound methods. Forensic Sci Int 2018; 284:161-166. [PMID: 29408725 DOI: 10.1016/j.forsciint.2018.01.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Revised: 12/20/2017] [Accepted: 01/08/2018] [Indexed: 10/18/2022]
Abstract
It is a fact that in recent years requests have greatly increased to obtain estimates of the legal age of undocumented individuals alleged to be minors who have been forced to enter different European Community countries for socioeconomic reasons or due to war. Spain is one of the countries most affected by this illegal immigration because of its proximity to North Africa. Therefore, it has become necessary to develop new standards which help provide a response to the demands of the justice administration. In recent years, the Superior Justice Court has rejected several pieces of expert evidence on the grounds that the age intervals therein were not sufficiently reliable and that the radiographic techniques used to determine age were invasive, potentially causing harm to the alleged minor. These sentences have caused interest in this field of work to increase within the scientific community. As a result, in order to improve age predictions and, above all, reduce minors' exposure to radiation, this study was created for completion on the Spanish population, using the ultrasound scan as a diagnostic technique. Used as a study sample were the ultrasound images of the proximal sternal epiphysis of the clavicle among 221 individuals of both sexes, of ages ranging from 5 to 30 years. All of the images were classified into 4 stages of fusion, in accordance with the development of metaphyseal closure proposed by Schulz et al. in 2008. The results show differences among the 4 proposed groups for each of the stages of fusion, with the results found in Stage II being especially important because, for both sexes, they would imply that the patient studied has reached an age of over 18 years, which is the legal age of adulthood in Spain, as established by the Spanish Constitution of 1978. Though further research is still recommended, these results, coupled with the use of ultrasound as a non-invasive diagnostic technique, could help solve some of the problems currently arising in justice courts.
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Affiliation(s)
- María Benito
- Legal Medicine School of Madrid. University Complutense of Madrid. Avenida Complutense s/n. Pabellón 7, Ciudad Universitaria, 28040 Madrid, Spain.
| | - Alexandra Muñoz
- Legal Medicine School of Madrid. University Complutense of Madrid. Avenida Complutense s/n. Pabellón 7, Ciudad Universitaria, 28040 Madrid, Spain
| | - Isabel Beltrán
- Legal Medicine School of Madrid. University Complutense of Madrid. Avenida Complutense s/n. Pabellón 7, Ciudad Universitaria, 28040 Madrid, Spain
| | - Elena Labajo
- Legal Medicine School of Madrid. University Complutense of Madrid. Avenida Complutense s/n. Pabellón 7, Ciudad Universitaria, 28040 Madrid, Spain
| | - Bernardo Perea
- Legal Medicine School of Madrid. University Complutense of Madrid. Avenida Complutense s/n. Pabellón 7, Ciudad Universitaria, 28040 Madrid, Spain
| | - José Antonio Sánchez
- Legal Medicine School of Madrid. University Complutense of Madrid. Avenida Complutense s/n. Pabellón 7, Ciudad Universitaria, 28040 Madrid, Spain
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25
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Rudolf E, Kramer J, Schmidt S, Vieth V, Winkler I, Schmeling A. Intraindividual incongruences of medially ossifying clavicles in borderline adults as seen from thin-slice CT studies of 2595 male persons. Int J Legal Med 2017; 132:629-636. [PMID: 28944440 DOI: 10.1007/s00414-017-1694-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 09/19/2017] [Indexed: 11/25/2022]
Abstract
In the past, numerous studies have documented the possibility of intraindividual differing appearances of the paired age-marker "medial clavicular ossification" in borderline adults. However, the extent of the divergences is rarely mentioned. Against that the article describes this phenomenon from a large sample of 2595 male persons by means of thin-slice CT imaging of the sternoclavicular regions. For determining the ossification stage of the medial clavicles, the two accepted classifications by Schmeling et al. (five main stages) and Kellinghaus et al. (six substages) were applied and buildings deviating from that labelled as atypical "norm variants". The longstanding observation could be confirmed that intraindividual stage discrepancies of this age indicator are generally moderate and do not exceed one main stage or two substages of the respective classifications. It is concluded that stage determination should be scrutinized, if a dissimilarity seems to show larger differences.
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Affiliation(s)
- Ernst Rudolf
- , Wiesenstr. 20, 4800, Attnang-Puchheim, Austria.
| | - Josef Kramer
- Institute for CT and MRT Diagnostics, Rainerstr. 6-8, 4020, Linz, Austria
| | - Sven Schmidt
- Institute of Legal Medicine, University Hospital Münster, Röntgenstraße 23, 48149, Münster, Germany
| | - Volker Vieth
- Department of Clinical Radiology, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany.,Clinic for Radiology, Klinikum Ibbenbüren, Große Straße 41, 49477, Ibbenbüren, Germany
| | | | - Andreas Schmeling
- Institute of Legal Medicine, University Hospital Münster, Röntgenstraße 23, 48149, Münster, Germany
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26
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Márquez-Ruiz AB, Treviño-Tijerina MC, González-Herrera L, Sánchez B, González-Ramírez AR, Valenzuela A. Three-dimensional analysis of third molar development to estimate age of majority. Sci Justice 2017; 57:376-383. [PMID: 28889868 DOI: 10.1016/j.scijus.2017.04.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 03/31/2017] [Accepted: 04/04/2017] [Indexed: 10/19/2022]
Abstract
Third molars are one of the few biological markers available for age estimation in undocumented juveniles close the legal age of majority, assuming an age of 18years as the most frequent legal demarcation between child and adult status. To obtain more accurate visualization and evaluation of third molar mineralization patterns from computed tomography images, a new software application, DentaVol©, was developed. Third molar mineralization according to qualitative (Demirjian's maturational stage) and quantitative parameters (third molar volume) of dental development was assessed in multi-slice helical computed tomography images of both maxillary arches displayed by DentaVol© from 135 individuals (62 females and 73 males) aged between 14 and 23years. Intra- and inter-observer agreement values were remarkably high for both evaluation procedures and for all third molars. A linear correlation between third molar mineralization and chronological age was found, with third molar maturity occurring earlier in males than in females. Assessment of dental development with both procedures, by using DentaVol© software, can be considered a good indicator of age of majority (18years or older) in all third molars. Our results indicated that virtual computed tomography imaging can be considered a valid alternative to orthopantomography for evaluations of third molar mineralization, and therefore a complementary tool for determining the age of majority.
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Affiliation(s)
- Ana Belén Márquez-Ruiz
- Department of Forensic Medicine, Faculty of Medicine, University of Granada, Avenida de la Investigación 11, 18016 Granada, Spain.
| | - María Concepción Treviño-Tijerina
- Faculty of Odontology, Autonomous University of Nuevo Leon, Eduardo Aguirre Pequeño cruz con Silao, Colonia Mitras Centro, 64460 Monterrey, Nuevo Leon, Mexico
| | - Lucas González-Herrera
- Department of Forensic Medicine, Faculty of Medicine, University of Granada, Avenida de la Investigación 11, 18016 Granada, Spain
| | - Belén Sánchez
- Department of Forensic Medicine, Faculty of Medicine, University of Granada, Avenida de la Investigación 11, 18016 Granada, Spain
| | - Amanda Rocío González-Ramírez
- Biomedical Research Foundation of Eastern Andalusia (FIBAO), Biosanitary Institute of Granada (ibs.GRANADA), Calle Dr. Azpitarte 4, 18012 Granada, Spain
| | - Aurora Valenzuela
- Department of Forensic Medicine, Faculty of Medicine, University of Granada, Avenida de la Investigación 11, 18016 Granada, Spain
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27
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Magnetic resonance imaging-based evaluation of ossification of the medial clavicular epiphysis in forensic age assessment. Int J Legal Med 2017; 131:1665-1673. [PMID: 28889331 DOI: 10.1007/s00414-017-1676-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Accepted: 08/30/2017] [Indexed: 10/18/2022]
Abstract
Evaluation of the degree of ossification of the medial clavicular epiphysis plays a crucial role in determining with an adequate degree of probability whether legally relevant age boundaries after the age of 17 have been crossed. In view of the need to avoid unnecessary radiation exposure, establishing non-X-ray methods for investigating the clavicle has long been a key objective in forensic age assessment research. Based on magnetic resonance imaging examinations in a large sample of healthy subjects, the current study for the first time presents statistical measures which allow inferences to be drawn for forensic age assessment in both sexes. We undertook a prospective study of a reference sample of 334 female and 335 male German volunteers aged from 12 to 24 using a 3-T MRI scanner. A 3D FFE (fast field echo) T1-weighted sequence with fat saturation was acquired. To stage ossification of the medial clavicular epiphysis, we used the clavicular ossification staging systems described by Schmeling et al. and Kellinghaus et al. Ossification stage IIIc offers a means in both sexes of demonstrating that the age of 18 has been attained prior to complete ossification of the epiphyseal plate. In both sexes, if a subject has reached ossification stage IV, it can be stated that he or she has attained the age of 21. Magnetic resonance imaging is a valid diagnostic procedure for determining the ossification stage of the medial clavicular epiphysis.
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28
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Guo YC, Li MJ, Olze A, Schmidt S, Schulz R, Zhou H, Pfeiffer H, Chen T, Schmeling A. Studies on the radiographic visibility of the periodontal ligament in lower third molars: can the Olze method be used in the Chinese population? Int J Legal Med 2017; 132:617-622. [PMID: 28812130 DOI: 10.1007/s00414-017-1664-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 08/04/2017] [Indexed: 10/19/2022]
Abstract
The purpose of the present research is to study the radiographic visibility of the periodontal ligament in third molars from a northern Chinese population to determine if this methodology could be used for the 18-year threshold. A total of 1300 conventional orthopantomograms from 650 males and 650 females of northern Chinese subjects aged between 15 and 40 years were analyzed. The radiographic visibility of the periodontal membrane of fully mineralized third molars was assessed using the stages described by Olze et al. (2010). Stage 0 first appeared at the age of 17.05 years in males and at the age of 18.76 years in females. Stage 1 was first detected at 18.52 years in males and 19.59 years in females. Stage 2 was first achieved by males at the age of 22.33 years and by females at the age of 21.37 years. The earliest appearance of stage 3 was 26.85 years in males and 24.92 years in females. If stage 1 is determined, it is possible to prove that an individual has already attained the age of 18 years. Stages 2 and 3 can be used to determine that a person is over 21 years of age. However, it should also be noted that in 271 cases of tooth 38 and 255 cases of tooth 48, the visibility stage could not be reliably assessed because of fused roots or narrowed furcations. Therefore, this method seems to be of limited value for age estimation in the Chinese population.
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Affiliation(s)
- Yu-Cheng Guo
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi'an Jiaotong University, 98 XiWu Road, Xi'an, 710004, Shaanxi, People's Republic of China.,Department of Orthodontics, Stomatological Hospital of Xi'an Jiaotong University, 98 XiWu Road, Xi'an, 710004, Shaanxi, People's Republic of China.,Institute of Legal Medicine, University Hospital Münster, Röntgenstraße 23, 48149, Münster, Germany
| | - Mu-Jia Li
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi'an Jiaotong University, 98 XiWu Road, Xi'an, 710004, Shaanxi, People's Republic of China
| | - Andreas Olze
- Institute of Legal Medicine, Charité-Universitätsmedizin, Turmstraße 21, 10559, Berlin, Germany
| | - Sven Schmidt
- Institute of Legal Medicine, University Hospital Münster, Röntgenstraße 23, 48149, Münster, Germany
| | - Ronald Schulz
- Institute of Legal Medicine, University Hospital Münster, Röntgenstraße 23, 48149, Münster, Germany
| | - Hong Zhou
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi'an Jiaotong University, 98 XiWu Road, Xi'an, 710004, Shaanxi, People's Republic of China.,Department of Orthodontics, Stomatological Hospital of Xi'an Jiaotong University, 98 XiWu Road, Xi'an, 710004, Shaanxi, People's Republic of China
| | - Heidi Pfeiffer
- Institute of Legal Medicine, University Hospital Münster, Röntgenstraße 23, 48149, Münster, Germany
| | - Teng Chen
- College of Medicine and Forensics, Xi'an Jiaotong University Health Science Center, 76 West Yanta Road, Xi'an, 710004, Shaanxi, People's Republic of China.
| | - Andreas Schmeling
- Institute of Legal Medicine, University Hospital Münster, Röntgenstraße 23, 48149, Münster, Germany
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29
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Methodology for the identification of vulnerable asylum seekers. Int J Legal Med 2017; 131:1719-1730. [DOI: 10.1007/s00414-017-1645-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 07/04/2017] [Indexed: 12/28/2022]
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30
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Scharte P, Vieth V, Schulz R, Ramsthaler F, Püschel K, Bajanowski T, Pfeiffer H, Schmeling A, Schmidt S, Wittschieber D. Comparison of imaging planes during CT-based evaluation of clavicular ossification: a multi-center study. Int J Legal Med 2017; 131:1391-1397. [PMID: 28608146 DOI: 10.1007/s00414-017-1615-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 05/23/2017] [Indexed: 11/26/2022]
Abstract
Determining the ossification stage of the medial clavicular epiphysis by computed tomography represents the currently recommended methodology for the question of whether a living individual has completed the 18th or 21st year of life. In the present study, thin-slice CT scans of 1078 sternoclavicular joints were reconstructed in axial and coronal image series and evaluated according to the two classification systems established for age diagnostics using the clavicle. Both image series (axial and coronal) were analyzed separately. When comparing the results of axial and coronal view, a different ossification stage was found in 35.6% of the clavicles. The results suggest an influence of the imaging plane on the process of stage determination. In order to further approximate the three-dimensional and asymmetrical structure of the epiphyseal ossification center, the usage of at least two different reformation types may be recommended. In practice, only those reference studies should be applied which exactly employed the same number and orientations of the reformation types that are going to be used in the respective routine case.
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Affiliation(s)
- Philipp Scharte
- Institute of Legal Medicine, University Hospital Münster, Röntgenstraße 23, 48149, Münster, Germany
| | - Volker Vieth
- Institute of Clinical Radiology, University Hospital Münster, Münster, Germany
- Clinic of Radiology, Ibbenbüren Hospital, Ibbenbüren, Germany
| | - Ronald Schulz
- Institute of Legal Medicine, University Hospital Münster, Röntgenstraße 23, 48149, Münster, Germany
| | - Frank Ramsthaler
- Institute of Legal Medicine, University of the Saarland, Homburg, Saar, Germany
- Institute of Legal Medicine, University Hospital Frankfurt/Main, Frankfurt/Main, Germany
| | - Klaus Püschel
- Institute of Legal Medicine, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Bajanowski
- Institute of Legal Medicine, University Hospital Essen, Essen, Germany
| | - Heidi Pfeiffer
- Institute of Legal Medicine, University Hospital Münster, Röntgenstraße 23, 48149, Münster, Germany
| | - Andreas Schmeling
- Institute of Legal Medicine, University Hospital Münster, Röntgenstraße 23, 48149, Münster, Germany
| | - Sven Schmidt
- Institute of Legal Medicine, University Hospital Münster, Röntgenstraße 23, 48149, Münster, Germany
- Institute of Legal Medicine, Charité University Hospital, Berlin, Germany
| | - Daniel Wittschieber
- Institute of Legal Medicine, University Hospital Münster, Röntgenstraße 23, 48149, Münster, Germany.
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31
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Uysal Ramadan S, Gurses MS, Inanir NT, Hacifazlioglu C, Fedakar R, Hizli S. Evaluation of the medial clavicular epiphysis according to the Schmeling and Kellinghaus method in living individuals: A retrospective CT study. Leg Med (Tokyo) 2017; 25:16-22. [DOI: 10.1016/j.legalmed.2016.12.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 12/27/2016] [Accepted: 12/29/2016] [Indexed: 11/27/2022]
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32
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Forensic age estimation in anti-piracy trials in Seychelles: Experiences and challenges faced. Forensic Sci Int 2017; 270:278.e1-278.e7. [DOI: 10.1016/j.forsciint.2016.11.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 10/04/2016] [Accepted: 11/06/2016] [Indexed: 11/18/2022]
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33
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The role of forensic medicine and forensic dentistry in estimating the chronological age of living individuals in Hamburg, Germany. Int J Legal Med 2016; 131:593-601. [PMID: 28032243 DOI: 10.1007/s00414-016-1517-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 12/07/2016] [Indexed: 10/20/2022]
Abstract
Age estimation represents one of the primary responsibilities of forensic medicine and forensic dentistry. It is an integral procedure aiming to estimate the chronological age of an individual, whose age is either unknown or doubtful, by means of assessing the stage of dental, skeletal, and physical development. The present publication reviews the methods and procedures used in estimating the age of young living individuals as well as the experiences of the Institute of Legal Medicine in Hamburg-Eppendorf, Germany, during the last 25 years. From 1990 to 2015, 4223 age estimations were carried out in Hamburg. During this time, forensic age estimation was requested by different concerned authorities including courts, the foreigners' registration office (Zentrale Ausländerbehörde), and the state office of education and consultation (Landesbetrieb Erziehung und Beratung). In the context of judicial proceedings, orthopantomograms, as well as X-ray examinations of both the left hand and the medial clavicular epiphyses were carried out in accordance with AGFAD recommendations. For investigations not associated with judicial proceedings, orthopantomogram examinations play a key role in the process of age estimation, due to their high diagnostic value and low radiation exposure. Since 2009, mainly unaccompanied young refugees were examined for age estimation. Orthopantomograms and clinical-physical examinations have been used as essential steps in this context to determine whether an individual is 18 years or less. Additional X-ray examinations of the left hand and the medial clavicular epiphyses have been used less frequently.
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34
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Evaluation of the ossification of the medial clavicle according to the Kellinghaus substage system in identifying the 18-year-old age limit in the estimation of forensic age-is it necessary? Int J Legal Med 2016; 131:585-592. [PMID: 27981359 DOI: 10.1007/s00414-016-1515-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Accepted: 12/02/2016] [Indexed: 10/20/2022]
Abstract
The evaluation of the ossification of the medial clavicular epiphysis being part of an assigned expert approach according to standard plays an important role within civil and criminal proceedings in assessing whether a person has reached her/his 19th or 22nd year of age. Evaluation of the medial clavicular epiphysis with thin-section CT is one of the methods recommended by the Study Group on Forensic Age Diagnostics of the German Association of Forensic Medicine. In this retrospective study, we evaluated the thin-section CT (section thickness of 0.6 and 1 mm) images of 254 patients (146 male, 108 female) with an age range of 13-28 years according to the Kellinghaus substage system. The mean values of female patients were observed to be about 10 months lower for stage 2a than the mean values of the male patients, about 13 months lower for stage 2b, and about 18 months lower for stage 2c. The earliest appearance for stage 3c was at 19 years in both sexes. Our data from this study were consistent with both our previous studies and the data of other studies. We think that stage 3c is important in determining whether a person has reached the age of 18 or not and, therefore, that the Kellinghaus substage system is a requirement in the assessment of forensic age.
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35
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Friedrich RE, Schmidt K, Treszl A, Kersten JF. Predictive values derived from lower wisdom teeth developmental stages on orthopantomograms to calculate the chronological age in adolescence and young adults as a prerequisite to obtain age-adjusted informed patient consent prior to elective surgical procedures in young patients with incomplete or mismatched personal data. GMS INTERDISCIPLINARY PLASTIC AND RECONSTRUCTIVE SURGERY DGPW 2016; 5:Doc23. [PMID: 27975042 PMCID: PMC5141618 DOI: 10.3205/iprs000102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Introduction: Surgical procedures require informed patient consent, which is mandatory prior to any procedure. These requirements apply in particular to elective surgical procedures. The communication with the patient about the procedure has to be comprehensive and based on mutual understanding. Furthermore, the informed consent has to take into account whether a patient is of legal age. As a result of large-scale migration, there are eventually patients planned for medical procedures, whose chronological age can't be assessed reliably by physical inspection alone. Age determination based on assessing wisdom tooth development stages can be used to help determining whether individuals involved in medical procedures are of legal age, i.e., responsible and accountable. At present, the assessment of wisdom tooth developmental stages barely allows a crude estimate of an individual's age. This study explores possibilities for more precise predictions of the age of individuals with emphasis on the legal age threshold of 18 years. Material and Methods: 1,900 dental orthopantomograms (female 938, male 962, age: 15-24 years), taken between the years 2000 and 2013 for diagnosis and treatment of diseases of the jaws, were evaluated. 1,895 orthopantomograms (female 935, male 960) of 1,804 patients (female 872, male 932) met the inclusion criteria. The archives of the Department of Diagnostic Radiology in Dentistry, University Medical Center Hamburg-Eppendorf, and of an oral and maxillofacial office in Rostock, Germany, were used to collect a sufficient number of radiographs. An effort was made to achieve almost equal distribution of age categories in this study group; 'age' was given on a particular day. The radiological criteria of lower third molar investigation were: presence and extension of periodontal space, alveolar bone loss, emergence of tooth, and stage of tooth mineralization (according to Demirjian). Univariate and multivariate general linear models were calculated. Using hierarchical multivariate analyses a formula was derived quantifying the development of the four parameters of wisdom tooth over time. This model took repeated measurements of the same persons into account and is only applicable when a person is assessed a second time. The second approach investigates a linear regression model in order to predict the age. In a third approach, a classification and regression tree (CART) was developed to derive cut-off values for the four parameters, resulting in a classification with estimates for sensitivity and specificity. Results: No statistically significant differences were found between parameters related to wisdom tooth localization (right or left side). In univariate analyses being of legal age was associated with consecutive stages of wisdom tooth development, the obliteration of the periodontal space, and tooth emergence, as well with alveolar bone loss; no association was found with tooth mineralization. Multivariate models without repeated measurements revealed imprecise estimates because of the unknown individual-related variability. The precision of these models is thus not very good, although it improves with advancing age. When calculating a CART-analysis and a receiver operating characteristics - area under the curve of 78% was achieved; when maximizing both specificity and sensitivity, a Youden's index of 47% was achieved (with 73% specificity and 74% sensitivity). Discussion: This study provides a basis to help determine whether a person is 18 years or older in individuals who are assumed to be between 15 and 24 years old. From repeated measurements, we found a linear effect of age on the four parameters in the individuals. However, this information can't be used for prognosis, because of the large intra-individual variability. Thus, although the development of the four parameters can be estimated over time, a direct conclusion with regard to age can't be drawn from the parameters without previous biographic information about a person. While a single parameter is of limited value for calculating the target age of 18 years, combining several findings, that can be determined on a standard radiography, may potentially be a more reliable diagnostic tool for estimating the target age in both sexes. However, a high degree of precision can't be achieved. The reason for persistent uncertainty lies in the wide chronological range of wisdom tooth development, which stretches from well below to above the 18th life year. The regression approach thus seems not optimal. Although sensitivity and specificity of the CART-model are moderately high, this model is still not reliable as a diagnostic tool. Our findings could have impact, e.g. on elective surgeries for young individuals with unknown biography. However, these results cannot replace social engagement, in particular thorough physical examination of patients and careful registration of their histories. Further studies on the use of this calculation method in different ethnic groups would be desirable.
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Affiliation(s)
- Reinhard E. Friedrich
- Klinik für Mund-, Kiefer- und Gesichtschirurgie, Kopf- und Neuro-Zentrum, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Kirsten Schmidt
- Klinik für Mund-, Kiefer- und Gesichtschirurgie, Kopf- und Neuro-Zentrum, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - András Treszl
- Institut für Medizinische Biometrie und Epidemiologie, Zentrum für Experimentelle Medizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Jan F. Kersten
- Institut für Medizinische Biometrie und Epidemiologie, Zentrum für Experimentelle Medizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
- Competenzzentrum Epidemiologie und Versorgungsforschung bei Pflegeberufen (CVcare), Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP), Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg, Deutschland
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36
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Metsäniitty M, Varkkola O, Waltimo-Sirén J, Ranta H. Forensic age assessment of asylum seekers in Finland. Int J Legal Med 2016; 131:243-250. [DOI: 10.1007/s00414-016-1498-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Accepted: 11/10/2016] [Indexed: 10/20/2022]
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Nougarolis F, Mokrane FZ, Sans N, Rousseau H, Dedouit F, Telmon N. Bone age estimation based on multislice computed tomography study of the scapula. Int J Legal Med 2016; 131:547-558. [PMID: 27822642 DOI: 10.1007/s00414-016-1466-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 10/06/2016] [Indexed: 11/28/2022]
Abstract
Progress in medical imaging has opened new areas of research in forensic anthropology, especially in the context of the study of bone age assessment. The study of bone age has become a useful tool for age estimation at death or age of young adult migrants in an anthropological context. We retrospectively evaluated multislice computed tomography (MSCT) explorations focused on scapulae of 232 individuals (123 males; 109 females) aged between 8 and 30 years old. Computed tomography (CT) scans were viewed in axial and multiplanar reconstructed images using OsiriX 5.9 (64 bit)®. The ossification centers of the scapula studied were as follows: acromial, sub-coracoid, glenoid, coracoid, coracoid apex, and inferior angle epiphyses. Fusion status was scored based on a five-stage system (stage 1: no ossification, stage 2: visualization of an ossification center, stage 3: partial ossification, stage 4: full ossification associated to an epiphyseal scar, and stage 5: full ossification without epiphyseal scar). Intra-observer variability was excellent, and inter-observer variability was good, demonstrating the reliability of this MSCT staging system. The fusion of scapular ossification centers was statistically associated with age (p < 0.001) but not with sex (p > 0.05). In conclusion, MSCT of the scapula is an efficient method for age assessment, which is complementary to preexisting methods particularly for specifying the 18-year threshold. Further studies with larger groups are needed to support our results.
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Affiliation(s)
- Florence Nougarolis
- Laboratoire d'Anthropologie Moléculaire et Imagerie de Synthèse (AMIS), UMR 5288 CNRS, Faculté de Médecine, 37 Allées Jules Guesde, 31073, Toulouse, France. .,Service de Médecine Légale, Centre Hospitalier Universitaire Toulouse - Rangueil, 1 Avenue du Professeur Jean Poulhès, TSA 50032, 31059, Toulouse, France. .,Service de Radiologie, Centre Hospitalier Universitaire Toulouse - Rangueil, 1 Avenue du Professeur Jean Poulhès, TSA 50032, 31059, Toulouse, France.
| | - Fatima-Zohra Mokrane
- Laboratoire d'Anthropologie Moléculaire et Imagerie de Synthèse (AMIS), UMR 5288 CNRS, Faculté de Médecine, 37 Allées Jules Guesde, 31073, Toulouse, France.,Service de Radiologie, Centre Hospitalier Universitaire Toulouse - Rangueil, 1 Avenue du Professeur Jean Poulhès, TSA 50032, 31059, Toulouse, France
| | - Nicolas Sans
- Service de Radiologie, Centre Hospitalier Universitaire Toulouse - Purpan - Hôpital Pierre Paul Riquet, 330 Avenue de Grande Bretagne, 31059, Toulouse, France
| | - Hervé Rousseau
- Service de Radiologie, Centre Hospitalier Universitaire Toulouse - Rangueil, 1 Avenue du Professeur Jean Poulhès, TSA 50032, 31059, Toulouse, France
| | - Fabrice Dedouit
- Laboratoire d'Anthropologie Moléculaire et Imagerie de Synthèse (AMIS), UMR 5288 CNRS, Faculté de Médecine, 37 Allées Jules Guesde, 31073, Toulouse, France.,Service de Médecine Légale, Centre Hospitalier Universitaire Toulouse - Rangueil, 1 Avenue du Professeur Jean Poulhès, TSA 50032, 31059, Toulouse, France.,Service de Radiologie, Centre Hospitalier Universitaire Toulouse - Rangueil, 1 Avenue du Professeur Jean Poulhès, TSA 50032, 31059, Toulouse, France
| | - Norbert Telmon
- Laboratoire d'Anthropologie Moléculaire et Imagerie de Synthèse (AMIS), UMR 5288 CNRS, Faculté de Médecine, 37 Allées Jules Guesde, 31073, Toulouse, France.,Service de Médecine Légale, Centre Hospitalier Universitaire Toulouse - Rangueil, 1 Avenue du Professeur Jean Poulhès, TSA 50032, 31059, Toulouse, France
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Fan F, Zhang K, Peng Z, Cui JH, Hu N, Deng ZH. Forensic age estimation of living persons from the knee: Comparison of MRI with radiographs. Forensic Sci Int 2016; 268:145-150. [PMID: 27770721 DOI: 10.1016/j.forsciint.2016.10.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 08/17/2016] [Accepted: 10/03/2016] [Indexed: 02/05/2023]
Abstract
To perform a study to clarify how strong the chronological age relates to ossification of the knee in Chinese on X-rays and the MRI when a similar four-stage grading system was used. 322 individuals with conventional radiographs and MRI were collected from routine medical investigations and evaluated retrospectively. Bland Altman plots were performed to reveal the agreement of grading of MRI and radiograph. Regression analysis was conducted to establish a mathematical model for age estimation. The ossification process of the knee occurs earlier in females than in males for about 1-2 years. The process on X-ray grading is consistently higher than that of MRI. The chronological age is well correlated with both grading of MRI and radiograph (all p values were less than 0.001). By comparison, the R-square of grading of MRI were relatively higher than that of radiograph. Finally, the chronological age is well correlated with the ossification of the knee when both grading of MRI and radiograph were used, with the R-square for MRI were relatively higher than that of radiograph. Furthermore, the use of MRI will reduce exposure to X-ray radiation as much as possible.
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Affiliation(s)
- Fei Fan
- Department of Forensic Pathology, West China School of Preclinical and Forensic Medicine, Sichuan University, Chengdu, Sichuan 610041, PR China
| | - Kui Zhang
- Department of Forensic Pathology, West China School of Preclinical and Forensic Medicine, Sichuan University, Chengdu, Sichuan 610041, PR China
| | - Zhao Peng
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, PR China
| | - Jing-Hui Cui
- Department of Forensic Pathology, West China School of Preclinical and Forensic Medicine, Sichuan University, Chengdu, Sichuan 610041, PR China
| | - Na Hu
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, PR China
| | - Zhen-Hua Deng
- Department of Forensic Pathology, West China School of Preclinical and Forensic Medicine, Sichuan University, Chengdu, Sichuan 610041, PR China.
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Yoon SH, Yoo HJ, Yoo RE, Lim HJ, Yoon JH, Park CM, Lee SS, Yoo SH. Ossification of the Medial Clavicular Epiphysis on Chest Radiographs: Utility and Diagnostic Accuracy in Identifying Korean Adolescents and Young Adults under the Age of Majority. J Korean Med Sci 2016; 31:1538-45. [PMID: 27550480 PMCID: PMC4999394 DOI: 10.3346/jkms.2016.31.10.1538] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 06/12/2016] [Indexed: 11/20/2022] Open
Abstract
The aim of our study was to evaluate the utility and diagnostic accuracy of the ossification grade of medial clavicular epiphysis on chest radiographs for identifying Korean adolescents and young adults under the age of majority. Overall, 1,151 patients (age, 16-30) without any systemic disease and who underwent chest radiography were included for ossification grading. Two radiologists independently classified the ossification of the medial clavicular epiphysis from chest radiographs into five grades. The age distribution and inter-observer agreement on the ossification grade were assessed. The diagnostic accuracy of the averaged ossification grades for determining whether the patient is under the age of majority was analyzed by using receiver operating characteristic (ROC) curves. Two separate inexperienced radiologists assessed the ossification grade in a subgroup of the patients after reviewing the detailed descriptions and image atlases developed for ossification grading. The median value of the ossification grades increased with increasing age (from 16 to 30 years), and the trend was best fitted by a quadratic function (R-square, 0.978). The inter-observer agreements on the ossification grade were 0.420 (right) and 0.404 (left). The area under the ROC curve (AUC) was 0.922 (95% CI, 0.902-0.942). The averaged ossification scores of 2.62 and 4.37 provided 95% specificity for a person < 19 years of age and a person ≥ 19 years of age, respectively. A preliminary assessment by inexperienced radiologists resulted in an AUC of 0.860 (95% CI, 0.740-0.981). The age of majority in Korean adolescents and young adults can be estimated using chest radiographs.
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Affiliation(s)
- Soon Ho Yoon
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
| | - Hye Jin Yoo
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
| | - Roh Eul Yoo
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
| | - Hyun Ju Lim
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
| | - Jeong Hwa Yoon
- Inter-disciplinary Program in Medical Informatics, Seoul National University College of Medicine, Seoul, Korea
| | - Chang Min Park
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Sang Seob Lee
- Medical Examiner's Office, National Forensic Service, Wonju, Korea
| | - Seong Ho Yoo
- Institute of Forensic Medicine, Seoul National University College of Medicine, Seoul, Korea.
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Wittschieber D, Schulz R, Pfeiffer H, Schmeling A, Schmidt S. Systematic procedure for identifying the five main ossification stages of the medial clavicular epiphysis using computed tomography: a practical proposal for forensic age diagnostics. Int J Legal Med 2016; 131:217-224. [PMID: 27658782 DOI: 10.1007/s00414-016-1444-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 08/23/2016] [Indexed: 11/24/2022]
Abstract
In forensic age estimations of living individuals, computed tomography of the clavicle is widely used for determining the age of majority. To this end, the degree of ossification of the medial clavicular epiphysis can be determined by means of two classification systems complementing each other: a 5-stage system and an additional 6-stage system that further sub-classifies the stages 2 and 3. In recent years, practical experience and new data revealed that difficulties and even wrong stage determinations may occur especially when following the short descriptions of the fundamental 5-stage system only. Based on current literature, this article provides a systematic procedure for identifying the five main ossification stages by listing important preconditions and presenting an algorithm that is comprised of four specific questions. Each question is accompanied by comprehensive and detailed descriptions which specify the criteria used for differentiation. The information is subdivided into "single-slice view" and "multi-slice view." In addition, illustrative case examples and schematic drawings facilitate application of the procedure in forensic practice. The pitfalls associated with the criteria of stage determination will be discussed in detail. Eventually, two general rules will be inferred to assign correct ossification stages of the medial clavicular epiphysis by means of computed tomography.
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Affiliation(s)
- Daniel Wittschieber
- Institute of Legal Medicine, University Hospital Münster, Röntgenstraße 23, 48149, Münster, Germany.
| | - Ronald Schulz
- Institute of Legal Medicine, University Hospital Münster, Röntgenstraße 23, 48149, Münster, Germany
| | - Heidi Pfeiffer
- Institute of Legal Medicine, University Hospital Münster, Röntgenstraße 23, 48149, Münster, Germany
| | - Andreas Schmeling
- Institute of Legal Medicine, University Hospital Münster, Röntgenstraße 23, 48149, Münster, Germany
| | - Sven Schmidt
- Institute of Legal Medicine, University Hospital Münster, Röntgenstraße 23, 48149, Münster, Germany
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Optimising magnetic resonance imaging-based evaluation of the ossification of the medial clavicular epiphysis: a multi-centre study. Int J Legal Med 2016; 130:1615-1621. [PMID: 27631994 DOI: 10.1007/s00414-016-1442-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Accepted: 08/19/2016] [Indexed: 10/21/2022]
Abstract
Evaluation of the ossification of the medial clavicular epiphysis plays a key role in forensic age estimation, particularly in determining whether the age of 18 has been attained. A key research objective in the forensic age estimation field at present is to establish non-X-ray methods for investigating the clavicle. This paper looks at the use of magnetic resonance imaging for evaluating the developmental state of the medial clavicular epiphysis. Clavicle specimens obtained from autopsies of 125 female and 270 male subjects aged from 10 to 30 were examined using a 3-T magnetic resonance scanner. One FFE-3D-T1 gradient echo sequence and one 2D-T2 turbo spin echo sequence were acquired. In each case, two investigators undertook a consensual determination of the ossification stage of the medial clavicular epiphysis using recognised classification systems. To determine intra-observer and inter-observer agreement, 80 clavicle specimens were subjected to repeat evaluation. We present statistics relating to the ossification stages. The inclusion of established sub-stages of clavicular ossification offers an additional option for determining whether a subject has attained the age of 18 which is applicable in both sexes. For both sexes, the minimum ages for ossification stages 4 and 5 allow conclusions to be drawn about a subject's age at a point in time lying several years in the past. Magnetic resonance imaging is a valid investigatory procedure for determining the ossification stage of the medial clavicular epiphysis. This paper makes a contribution to expanding the range of methods available for forensic age estimation.
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Gonsior M, Ramsthaler F, Birngruber C, Obert M, Verhoff MA. The completely fused medial clavicular epiphysis in high-frequency ultrasound scans as a diagnostic criterion for forensic age estimations in the living. Int J Legal Med 2016; 130:1603-1613. [PMID: 27544359 DOI: 10.1007/s00414-016-1435-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 08/01/2016] [Indexed: 10/21/2022]
Abstract
The assessment of ossification of the medial clavicular epiphysis plays a decisive role in the forensic age estimation of living subjects. Primarily for reasons of minimizing the radiation exposure currently associated with such evaluations, non-ionizing methods would be an advance.This study pursued the question whether full union of the medial clavicular epiphysis, visualized by high-frequency sonography, is a reliable criterion for age-threshold determinations. The ossification stage of the medial clavicular epiphysis of 215 female and 195 male volunteers, aged between 14 and 26 years, was evaluated in bilateral sonograms. Stage 4, defined as complete fusion by Schulz et al. (Int J Legal Med 122:163-167, 2008), was observed on at least one body side in 48 of 334 individuals younger than 21 years (14.4 %) and in 32 of 264 individuals younger than 18 years (12.1 %).With the high-frequency ultrasound used in this study, even the smallest convexities of the medial clavicular ending can be visualized. This may have led to overestimation of the ossification stage. It is not clear whether any observed roundings in the sonograms should actually be interpreted in terms of stages 3 and 4 as defined by Schulz. Also, due to the low penetration depth of high-frequency ultrasound waves, epiphyseal plate residues and ossification centers may have remained undetected. Reliable differentiation of the stages 1-4 with high-frequency sonography is thus difficult, and the results suggest that this method is not a radiation-free alternative to computed tomography, the current gold standard for determining age thresholds.
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Affiliation(s)
- Michael Gonsior
- Department of Legal Medicine, University of Gießen, Frankfurter Straße 58, D-35392, Gießen, Germany
| | - Frank Ramsthaler
- Department of Legal Medicine, University Hospital of Saarland, Building 42, D-66421, Homburg/Saar, Germany
| | - Christoph Birngruber
- Department of Legal Medicine, University of Gießen, Frankfurter Straße 58, D-35392, Gießen, Germany
| | - Martin Obert
- Department of Neuroradiology, University of Gießen, Klinikstraße 33, D-35385, Gießen, Germany
| | - Marcel A Verhoff
- Department of Legal Medicine, University Hospital of Frankfurt, Goethe University, Kennedyallee 104, D-60596, Frankfurt am Main, Germany.
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Gurses MS, Inanir NT, Gokalp G, Fedakar R, Tobcu E, Ocakoglu G. Evaluation of age estimation in forensic medicine by examination of medial clavicular ossification from thin-slice computed tomography images. Int J Legal Med 2016; 130:1343-52. [DOI: 10.1007/s00414-016-1408-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 06/17/2016] [Indexed: 11/30/2022]
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Zhang K, Dong XA, Fan F, Deng ZH. Age estimation based on pelvic ossification using regression models from conventional radiography. Int J Legal Med 2016; 130:1143-1148. [PMID: 27169673 DOI: 10.1007/s00414-016-1383-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Accepted: 05/02/2016] [Indexed: 11/25/2022]
Abstract
To establish regression models for age estimation from the combination of the ossification of iliac crest and ischial tuberosity. One thousand three hundred and seventy-nine conventional pelvic radiographs at the West China Hospital of Sichuan University between January 2010 and June 2012 were evaluated retrospectively. The receiver operating characteristic analysis was performed to measure the value of estimation of 18 years of age with the classification scheme for the iliac crest and ischial tuberosity. Regression analysis was performed, and formulas for calculating approximate chronological age according to the combination developmental status of the ossification for the iliac crest and ischial tuberosity were developed. The areas under the receiver operating characteristic (ROC) curves were above 0.9 (p < 0.001), indicating a good prediction of the grading systems, and the cubic regression model was found to have the highest R-square value (R (2) = 0.744 for female and R (2) = 0.753 for male). The present classification scheme for apophyseal iliac crest ossification and the ischial tuberosity may be used for age estimation. And the present established cubic regression model according to the combination developmental status of the ossification for the iliac crest and ischial tuberosity can be used for age estimation.
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Affiliation(s)
- Kui Zhang
- Department of Forensic Pathology, West China School of Preclinical and Forensic Medicine, Sichuan University, Chengdu, Sichuan, 610041, People's Republic of China
| | - Xiao-Ai Dong
- Department of Forensic Pathology, West China School of Preclinical and Forensic Medicine, Sichuan University, Chengdu, Sichuan, 610041, People's Republic of China
| | - Fei Fan
- Department of Forensic Pathology, West China School of Preclinical and Forensic Medicine, Sichuan University, Chengdu, Sichuan, 610041, People's Republic of China
| | - Zhen-Hua Deng
- Department of Forensic Pathology, West China School of Preclinical and Forensic Medicine, Sichuan University, Chengdu, Sichuan, 610041, People's Republic of China.
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Tisè M, Ferrante L, Mora S, Tagliabracci A. A biochemical approach for assessing cutoffs at the age thresholds of 14 and 18 years: a pilot study on the applicability of bone specific alkaline phosphatase on an Italian sample. Int J Legal Med 2016; 130:1149-1158. [PMID: 27169674 DOI: 10.1007/s00414-016-1382-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 05/02/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND The majority of age estimation methods analyze morphological changes of specific skeletal (or dental) structures reflecting global bone development (biological parameter) in order to estimate a chronological value. This morphological and structural development is the consequence of a very active tissue metabolism and intensive modeling process which involve both bone formation and bone resorption. Several biochemical markers of bone formation and bone resorption are available, and specific biochemical tests can be performed on blood or urine samples, but such markers of bone turnover have never been employed for age estimation in living individuals for forensic purposes. The aim of this study was to ascertain the applicability of serum bone alkaline phosphatase (BALP) concentration in the age estimation for forensic purposes. We focused on the legal age thresholds of 14 and 18 years (LAT) because, in Italy, the former is considered the minimum age for criminal responsibility and the latter defines adult age and the possibility of applying general criminal laws. MATERIALS AND METHODS This study analyzed, from a forensic point of view, BALP and Tanner stages of 202 healthy white individuals (116 females and 86 males) between the ages of 10 and 30 years. We derived a linear logistic model to estimate the probability that an individual was older or younger than LAT using two variables: BALP concentration and Tanner stages. The predictive accuracy of the test was assessed by the determination of the receiver-operating characteristic curve (ROC curve). The test was performed to identify a threshold (cutoff) that could be used to assign an individual to the population of those younger or older than LAT. RESULTS ROC curve showed that the use of both serum BALP concentration and Tanner stages has a very good level of reliability in age assessment (the area under the ROC curve, AUC, ranged from 0.918 to 0.962). Best results were obtained in the assessment of male over 18 years of age (sensibility and specificity respectively of 0.90 and 0.93 with an accuracy of 0.92). Worst results were obtained in the assessment of female over 18 years of age (sensibility and specificity respectively of 0.87 and 0.82 with an accuracy of 0.84). We also calculated the probability of the correctness in the age estimation. CONCLUSION The results showed that the use of serum BALP concentration in the age assessment could be a promising and integrative method to established ones, but more research has to be done to validate the value of the proposed method in the forensic practice.
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Affiliation(s)
- Marco Tisè
- Section of Legal Medicine, Department of Biomedical Sciences and Public Health, Polytechnic University of Marche, 60020, Torrette di Ancona, Italy
| | - Luigi Ferrante
- Center of Epidemiology, Biostatistics, and Medical Information Technology, Department of Biomedical Sciences and Public Health, Polytechnic University of Marche, 60020, Torrette di Ancona, Italy
| | - Stefano Mora
- Laboratory of Pediatric Endocrinology, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Adriano Tagliabracci
- Section of Legal Medicine, Department of Biomedical Sciences and Public Health, Polytechnic University of Marche, 60020, Torrette di Ancona, Italy.
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Galić I, Mihanović F, Giuliodori A, Conforti F, Cingolani M, Cameriere R. Accuracy of scoring of the epiphyses at the knee joint (SKJ) for assessing legal adult age of 18 years. Int J Legal Med 2016; 130:1129-1142. [DOI: 10.1007/s00414-016-1348-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 02/22/2016] [Indexed: 11/29/2022]
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Schmeling A, Dettmeyer R, Rudolf E, Vieth V, Geserick G. Forensic Age Estimation. DEUTSCHES ARZTEBLATT INTERNATIONAL 2016; 113:44-50. [PMID: 26883413 PMCID: PMC4760148 DOI: 10.3238/arztebl.2016.0044] [Citation(s) in RCA: 99] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Revised: 11/23/2015] [Accepted: 11/23/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND Forensic age estimation is requested by courts and other government authorities so that immigrants whose real age is unknown should not suffer unfair disadvantages because of their supposed age, and so that all legal procedures to which an individual's age is relevant can be properly followed. 157 age estimations were requested in Berlin in 2014, more than twice as many as in 2004. METHODS This review is based on pertinent articles retrieved by a selective search in the PubMed and MEDPILOT databases, supplemented by relevant recommendations and by the findings of the authors' own research. RESULTS The essential components of age estimation are the history, physical examination, X-rays of the hands, panorama films of the jaws, and, if indicated, a thin-slice CT of the medial clavicular epiphyses, provided that there is a legal basis for X-ray examinations without a medical indication. Multiple methods are always used in combination, for optimal accuracy. Depending on the legal issues at hand, the examiner may be asked to estimate the individual's minimum age and/or his or her most probable age. The minimum-age concept can be used in determinations whether an individual has reached the age of legal majority. It is designed to ensure that practically all persons classified as adults have, in fact, attained legal majority, even though some other persons will be incorrectly classified as minors. CONCLUSION Forensic age estimation lets courts and other government authorities determine the official age of persons whose actual age is unknown-in most cases, unaccompanied refugees who may be minors. The goal is to carry out age-dependent legal procedures appropriately in accordance with the rule of law. The minimum-age concept is designed to prevent the erroneous classification of minors as legal adults.
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Affiliation(s)
| | | | | | - Volker Vieth
- Department of Clinical Radiology, University Hospital Münster; Department of Radiology, Hospital Ibbenbüren
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48
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Forensic age diagnostics using projection radiography of the clavicle: a prospective multi-center validation study. Int J Legal Med 2015; 130:213-9. [DOI: 10.1007/s00414-015-1285-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 10/21/2015] [Indexed: 10/22/2022]
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49
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The lateral clavicular epiphysis: fusion timing and age estimation. Int J Legal Med 2015; 130:511-7. [DOI: 10.1007/s00414-015-1236-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2015] [Accepted: 07/07/2015] [Indexed: 10/23/2022]
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50
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Guo Y, Olze A, Ottow C, Schmidt S, Schulz R, Heindel W, Pfeiffer H, Vieth V, Schmeling A. Dental age estimation in living individuals using 3.0 T MRI of lower third molars. Int J Legal Med 2015; 129:1265-70. [PMID: 26232290 DOI: 10.1007/s00414-015-1238-7] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 07/16/2015] [Indexed: 11/26/2022]
Abstract
In order to increase the validity of age estimation in adolescents and young adults when there is no legitimation for X-ray examinations, it seems desirable to be able to assess the mineralization of third molars using X-ray-free imaging procedures. In the present study, the mineralization stages of lower third molars were determined prospectively in 269 male and 248 female individuals aged 12 to 24 years using 3.0 T MRI. The classification system of Demirjian et al. was used to determine the stages. This study presents the minima and maxima, means and standard deviations, median values, and lower and upper quartiles separately for both sexes, for the mineralization stages B-H. Statistically significant sex differences were observed for the mineralization stages C, E, F, and G, and a faster developmental rate was observed for males. It was concluded that magnetic resonance imaging is an X-ray-free alternative to orthopantomography when assessing mineralization of third molars.
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Affiliation(s)
- Yucheng Guo
- College of Medicine and Forensics, Xi'an Jiaotong University Health Science Center, 76 West Yanta Road, Xi'an, 710061, Shaanxi, People's Republic of China
- College of Stomatology, Xi'an Jiaotong University, 98 Xiwu Road, Xi'an, 710004, Shaanxi, People's Republic of China
- Institute of Legal Medicine, University Hospital Münster, Röntgenstraße 23, 48149, Münster, Germany
| | - Andreas Olze
- Institute of Legal Medicine, Charité-Universitätsmedizin Berlin, Turmstraße 21, 10559, Berlin, Germany
| | - Christian Ottow
- Department of Clinical Radiology, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Sven Schmidt
- Institute of Legal Medicine, University Hospital Münster, Röntgenstraße 23, 48149, Münster, Germany
| | - Ronald Schulz
- Institute of Legal Medicine, University Hospital Münster, Röntgenstraße 23, 48149, Münster, Germany
| | - Walter Heindel
- Department of Clinical Radiology, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Heidi Pfeiffer
- Institute of Legal Medicine, University Hospital Münster, Röntgenstraße 23, 48149, Münster, Germany
| | - Volker Vieth
- Department of Clinical Radiology, Hospital Ibbenbüren, Große Straße 4, 49477, Ibbenbüren, Germany
| | - Andreas Schmeling
- Institute of Legal Medicine, University Hospital Münster, Röntgenstraße 23, 48149, Münster, Germany.
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