Accuracy of MRI skeletal age estimation for subjects 12–19. Potential use for subjects of unknown age (original) (raw)
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Pediatric Radiology
Background The use of magnetic resonance imaging (MRI) in forensic age estimation has been explored extensively during the past decade. Objective To synthesize the available MRI data for forensic age estimation in living children and young adults, and to provide a comprehensive overview that can guide age estimation practice and future research. Materials and Methods MEDLINE, Embase and Web of Science were searched. Additionally, cited and citing articles and study registers were searched. Two authors independently selected articles, conducted data extraction, and assessed risk of bias. Study populations including living subjects up to 30 years were considered. Results Fifty-five studies were included in qualitative analysis and 33 in quantitative analysis. Most studies suffered from bias, including relatively small European (Caucasian) populations, varying MR-approaches and varying staging techniques. Therefore, pooling of the age distribution data was not appropriate. Reproducibility of staging was remarkably lower in clavicles than in any other anatomical structure. Age estimation performance was in line with the gold standard, which uses radiographs, with mean absolute errors ranging from 0.85 to 2.0 years. The proportion of correctly classified minors ranged from 65% to 91%. Multifactorial age estimation performed better than based on a single anatomical site. Conclusion More multi-factorial age estimation studies are necessary, together with studies testing if the MRI data can safely be pooled. The current review results can guide future studies, help medical professionals to decide on the preferred approach for specific cases, and help judicial professionals to interpret the evidential value of age estimation results.
Skeletal age assessment: A comparison of 3 methods
American Journal of Orthodontics and Dentofacial Orthopedics, 2006
The aim of this study was to evaluate the applicability of 3 methods of skeletal age assessment. Methods: The skeletal assessment methods of Greulich and Pyle (GP), Tanner et al (TW3), and Eklöf and Ringertz (ER) were used to analyze the dorsopalmar hand-wrist radiographs of 360 Brazilian children and adolescents (180 boys, 180 girls; ages, 7-15 years). The standard error of the mean and confidence intervals of the 3 assessment methods as well as the mean chronologic ages of both sexes and the age ranges studied were calculated. Results: Skeletal age means obtained with the GP and TW3 methods were close to chronologic age for both sexes. The ER method tended to overestimate skeletal age for the lower age groups, to correspond for the intermediate age groups, and to underestimate for the higher age groups in both sexes. The confidence interval confirmed that these data did not represent a statistically significant difference between chronologic and assessed skeletal ages; this means there is a high relationship between the studied sample data and the 3 standard methods. Determinate correction factors (regression equation) make each method more useful for the studied population. Conclusions: Although all methods reliably assessed age, correction factors are recommended for better adaptability to the studied population. (Am J Orthod Dentofacial Orthop 2006;130:435.e15-435.e20) a Chairman and professor,
International Journal of Legal Medicine, 2015
In recent years, methods by which to decrease radiation exposure during age estimation have gained importance and become a main research area in the forensic sciences. Imaging tools such as X-ray and computed tomography (CT) are accepted as the main diagnostic methods for evaluation of the epiphysis in living individuals; however, radiation exposure and superimposition are the main disadvantages of these techniques. Magnetic resonance (MR) imaging provides an advantage in terms of preventing radiation exposure. In this study, we performed an MR analysis of the degree of fusion of the distal tibia and calcaneal epiphysis and investigated the utility of this technique in the Turkish population. Using the three-stage method described by Saint-Martin et al., we retrospectively evaluated 167 MR images (97 males, 70 females; mean age, 17.7±4.8 years for males and 17.6±4.9 years for females; age range of all subjects, 8-25 years). Intraobserver and interobserver evaluation showed good repeatability and consistency of this method. Stages 2 and 3 ossification of the distal tibial epiphysis first occurred at age 14 and 15 years in males and 12 and 14 years in females, respectively. Stages 2 and 3 ossification of the calcaneal epiphysis first occurred at age 14 and 16 years in males and 10 and 12 years in females, respectively. When performed alone, MR analysis of the distal tibial and calcaneal epiphysis offers limited information for forensic age estimation. However, we suggest that MR analysis can be used as a supportive method when it is necessary to avoid repeated radiation exposure.
Introduction: The aim of this study was to examine the agreement of skeletal age assessment based on hand-wrist radiographs with cephalogram-based cervical vertebrae evaluation. To circumvent bias and loss of information from staging, a quantitative approach was applied to determine morphologic changes. Methods: We analyzed 730 sets of radiographs (cephalogram and hand-wrist) of untreated subjects (352 boys, 378 girls; age range, 6-18 years) from a growth study, each sex as a separate sample. Skeletal age was determined on the hand-wrist radiographs according to the method of Greulich and Pyle. Morphometric changes of the vertebral bodies C2 through C4 were measured (concavity, anterior height, and angle) and tested for correlations with the method of Greulich and Pyle. All correlating variables were included in a multiple linear regression to generate a calculated skeletal age. To establish the agreement between the method of Greulich and Pyle and calculated skeletal age, Bland-Altman plots were made, limits of agreement were identified, and cross-tables (before and after peak height velocity) were computed. Similarly, the agreement between the method of Greulich and Pyle and each subject's chronologic age was estimated for comparison. Results: Concavity of C2, C3, and C4; anterior height of C3 and C4; and the angle of C3 correlated with skeletal age highly significantly (P \0.0001) in both sexes, and calculated skeletal age was established based on a linear regression. The agreement between the method of Greulich and Pyle and calculated skeletal age was modest (limits of agreement: boys, 63.5 years; girls, 63.3 years) and substantially weaker than the agreement between the method of Greulich and Pyle and chronologic age (limits of agreement: boys, 12.1 to À1.7 years; girls, 12.2 to À1.2 years). Similarly, calculated skeletal age resulted in considerably more false predictions of peak height velocity (boys, 18.9%; girls, 12.9%) than did chronologic age (boys, 7.1%; girls, 7.4%). Conclusions: Morphometric assessment of age-dependent changes in the cervical spine offers no advantage over chronologic age, in either assessing skeletal age or predicting the pubertal growth spurt. (Am J Orthod Dentofacial Orthop 2013;144:838-47)
Age determination by magnetic resonance imaging of the wrist in adolescent male football players
British Journal of Sports Medicine, 2006
Background: In football there are established age-related tournaments for males and females to guarantee equal chances within the game for all the different age groups. To prevent participation in the incorrect age group, and owing to the fact that in some Asian and African countries registration at birth is not compulsory, other methods of age determination need to be available. Standard radiographs of the left wrist have been used for assessment of skeletal age for many years. This is, however, not ethical in the sporting environment. Aim: To study the possible use of magnetic resonance imaging (MRI), which has no radiation risk, in estimating the age of healthy adolescent football players. Methods: The examination protocol was applied in four countries using, their respective MRI equipment using a 1-T or 1.5-T magnet and a wrist coil. 496 healthy male adolescent football players between the ages of 14 and 19 years from Switzerland, Malaysia, Algeria and Argentina were selected for the study. The degree of fusion of the left distal radial physis was determined by three independent raters by a newly developed grading system which can be used in future MRI epiphysial fusion grading studies. Results: The inter-rater reliability for grading was high (r = 0.91 and 0.92); all correlations were highly significant (p,0.001). The average age increased with a higher grading of fusion, and the correlation between age and grade of fusion was highly significant (r = 0.69, p,0.001). Only one player (0.8%) in the 16-year-old age group was graded as completely fused. Conclusion: MRI of the wrist offers an alternative as a non-invasive method of age determination in 14-19year-old male adolescents. The grading system presented here clearly identifies the skeletal maturity by complete fusion in all MRI slices, which eliminates any risk associated with standard radiographic rating as determined by the International Atomic Energy Agency.
Estimation of skeletal age using radiographic images is widely used in assessing biological growth in clinical and auxological studies. The most frequently used areas for age estimation in children and adolescents are tooth and wrist/hand, both giving good results with only a low level of radiation. This pilot study of a sample of 150 Italian children and adolescents aged between 5 and 15 years focused on analyzing the possible applications of the proportion of carpal area (Ca) and teeth mineralization as a criterion of age estimation. The regression model, describing age as a linear function of gender (g), the ratio between carpal bones area and carpal area (Bo/Ca) and the measurement of open apices, yielded the following equation: Age ¼ 4:619 þ 0:401g þ 0:551N 0 À 0:647s þ 7:163Bo=Ca À 0:123N 0 s: The model explained 93% of the total variance (R 2 = 0.93), the median of the absolute values of residuals (observed age minus predicted age) was 0.465 years, with an inter-quartile range (IQR) equalling 0.529 years, and a standard error of estimate of 0.73 years.
Contribution of Anatomy in Forensic Age Evaluation: A Systematic Review
Curēus, 2024
The field of forensic anthropology is characterised by its ongoing development and growth. Forensic anatomy is a burgeoning discipline that focuses on the analysis and identification of both preserved and unpreserved human body parts, both in deceased individuals and the living. This subject plays a crucial role in establishing the four key factors of forensic anthropology, namely sex, age, race, and height. The objective of this research endeavour was to evaluate the significance of anatomical information in the process of forensic age estimation. The researchers established the inclusion criteria in accordance with the globally recognised Population, Intervention, Comparison, Outcome (PICOS) framework, as advised by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations. The research included many methodologies in order to ascertain the age. Upon conducting a comprehensive review of the existing literature pertaining to anatomical knowledge in the field of forensic age estimate, we have identified many notable applications. These include the utilisation of various anatomical features such as the dental pulp chamber, fingerprints, acetabulum, sternal end of the fourth rib, as well as hand and wrist bones for the purpose of age estimation. It is important for anatomists and other forensic scientists to engage in collaborative efforts to facilitate the exchange of ideas and ensure thorough investigations. This cooperation is particularly crucial in areas where anatomical sciences play a significant role in forensic science and investigation. Nevertheless, in order to mitigate the potential for estimating error, it is still advisable to use a multi-factorial evaluation approach that involves examining many body areas.
Skeletal Maturation Using Cervical Vertebrae Versus Dental Age For Age Estimation
Mansoura Journal of Forensic Medicine and Clinical Toxicology
In forensic science, few data exist regarding cervical vertebrae stages for age estimation, meanwhile, teeth are frequently used to estimate age. The present study tested the cervical vertebrae skeletal maturation as an indicator for chronological age. A total of 149 radiographs (68 boys and 81 girls) were analyzed. Their ages ranged from 5.94-18.00 years. Cervical vertebral skeletal maturation (CVM) staging and dental age estimation by Willem's method were estimated. Results show that there is significant correlation between dental age, CVM and chronological age. However, CVM staging is not accurate to depend on solely for age estimation especially in forensic investigations. Willem's method underestimated age by 0.01 years in girls and 0.16 years in boys. It can be concluded that CVM can give rough idea about age and accuracy will be enhanced if combined with dental age estimation.
International Journal of Legal Medicine, 2018
Age estimation is an actual topic in the area of forensic medicine with a special focus on the age limits of 16 and 18 years. Current research on this topic relies on retrospective data of inhomogeneous populations relating to sex, age range, and socioeconomic status. In this work, we present a 2-year follow-up study for the evaluation of an age estimation method on a prospective magnetic resonance imaging (MRI) knee data collective of a homogeneous population. The study includes 40 male subjects from northern Germany aged 14 to 21 years. Three MRI examinations were evenly acquired within 2 years for each subject. As a first evaluation, a three-stage system was used to assess the ossification status of the knee (I:"open", II:"partially ossified", III:"fully ossified"). Three raters assessed the growth plate of the distal femur, proximal tibia, and proximal fibula based on central 2D slices. A good inter-rater agreement was attained (κ = 0.84). All subjects younger than 18 years were rated as stage I and had a cumulative knee score (SKJ) ≤ 5. Based on the follow-up datasets, new parameters quantifying the intra-individual ossification process were calculated. The results of this follow-up analysis show a different start, end, and speed of each growth plate's maturation as well as an ossification peak for individuals at the age of 16. The generated MRI database provides new insights into the ossification process over time and serves as a basis for further evaluations of age estimation methods.