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International Journal of Legal Medicine
Published in: International Journal of Legal Medicine 6/2012

01-11-2012 | Original Article

Radiographic analysis of epiphyseal fusion at knee joint to assess likelihood of having attained 18 years of age

Authors: R. Cameriere, M. Cingolani, A. Giuliodori, S. De Luca, L. Ferrante

Published in: International Journal of Legal Medicine | Issue 6/2012

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Abstract

Radiological analysis of the epiphyses of the knee joint provides new valuable information, which may be used in combination with these well-established techniques in order to maximise the accuracy in the assessment of age of 18 years. A total of 215 antero-posterior radiographs of the knee was reviewed retrospectively in patients aged between 14 and 24 years old (99 boys, 116 girls). Fusion was scored as stage 1, epiphysis not fused; stage 2, epiphysis is fully ossified and epiphyseal scar is visible; and stage 3, epiphysis is fully ossified and epiphyseal scar is not visible. Scores of 0, 1 and 2 were assigned to stages 1, 2 and 3, respectively. Lastly, the score related to epiphyseal fusion at the knee joint was obtained by adding the three scores of the distal femur, proximal tibia and proximal fibula. Age distribution gradually increased with each score, for both genders. The mean age (±standard error) in each score category varied between genders, but the differences were not significant (p > 0.11). Five tests were performed to discriminate between individuals who were or were not at age 18 years or more, according to the receiver operating curve. For boys, the highest value of accuracy was obtained with score 3, with high sensitivity (Se = 93.33 %) and specificity (Sp = 89.29 %). For girls, it was obtained with score 4, with high accuracy (Acc = 85.86 %). These results indicate that radiographic analysis of the knee is a valuable alternative as a non-invasive method of estimation of 18 years of age.
Literature
1.
Cunha E, Baccino E, Martrille L, Ramsthaler F, Prieto J, Schuliar Y, Lynnerup N, Cattaneo C (2009) The problem of ageing human remains and living individuals: a review. Forensic Sci Int 193:1–13PubMedCrossRef
2.
Schmeling A, Reisinger W, Geserick G, Olze A (2006) Age estimation of unaccompanied minors Part I. General considerations. Forensic Sci Int 159s:s61–s64CrossRef
3.
Olze A, Reisinger W, Geserick G, Schmeling A (2006) Age estimation of unaccompanied minors Part II. Forensic Sci Int 159s:s65–s67CrossRef
4.
5.
Kvittingen AV (2011) Negotiating childhood: age assessment in the UK asylum system. Working paper series Oxford: Refugee Studies Centre, Oxford Department of International Development, University of Oxford
6.
Department of Homeland Security (2009) Age determination practices for unaccompanied alien children in ICE custody. Department of Homeland Security, Washington, DC
7.
Lewis ME, Flavel A (2006) Age assessment of child skeletal remains in forensic context. In: Cunha E, Pinhero J (eds) Forensic Anthropology and Medicine. Humana, Totowa, p 464
8.
Schmeling A, Olze A, Reisinger W, Geserick G (2001) Age estimation of living people undergoing criminal proceedings. Lancet 358:89–90PubMedCrossRef
9.
Olze A, Solheim T, Schulz R, Kupfer M, Schmeling A (2010) Evaluation of the radiographic visibility of the root pulp in the lower third molars for the purpose of forensic age estimation in living individuals. Int J Legal Med 124:183–186PubMedCrossRef
10.
11.
Knottnerus JA, Muris JW (2009) The evidence base of clinical diagnosis, 2nd edn, Assessment of the accuracy of diagnostic tests: the cross-sectional study. BMJ Publishing, London, pp 42–62
12.
Habemma JDF, Eijkemans R, Krinjen P, Knottnerus A (2009) Analysis of data on the accuracy of diagnostic tests. In: Knottnerus JA Buntinx F (ed) The evidence base of clinical diagnosis, 2nd edn. BMJ Publishing, London, pp 118–145
13.
Konigsberg LW, Herrmann NP, Westcott DJ, Kimmerle EH (2008) Estimation and evidence in forensic anthropology: age-at-death. J Forensic Sci 53:541–557PubMedCrossRef
14.
Bhat VJ, Kamath GP (2007) Age estimation from root development of mandibular third molars in comparison with skeletal age of wrist joint. Am J Forensic Med Pathol 28:238–241PubMedCrossRef
15.
Schmidt S, Baumann U, Schulz R, Reisinger W, Schmeling A (2008) Study of age dependence of epiphyseal ossification of the hand skeleton. Int J Legal Med 122:51–54PubMedCrossRef
16.
Schmidt S, Nitz I, Schulz R, Schmeling A (2008) Applicability of the skeletal age determination method of Tanner and Whitehouse for forensic age diagnostics. Int J Legal Med 122:309–314PubMedCrossRef
17.
Cardoso HF (2008) Epiphyseal union at the innominate and lower limb in a modern Portuguese skeletal sample, and age estimation in adolescent and young adult male and female skeletons. Am J Phys Anthropol 135:161–170PubMedCrossRef
18.
Hedge RJ, Sood PB (2002) Dental maturity as an indicator of chronological age:adiographic evaluation of dental age in 6 to 13 years children of Belgaum using Demirjian's methods. J Indian Soc Pedod Prev Dent 20:132–138
19.
Solari AC, Abramovitch AK (2002) The accuracy and precision of third molar development as an indicator of chronological age in Hispanics. J Forensic Sci 47:531–535PubMed
20.
Willems G, Van Olmen A, Spiessens B, Carels C (2001) Dental age estimation in Belgian children: Demirjian's technique revisited. J Forensic Sci 46:893–895PubMed
21.
22.
Schmidt S, Koch B, Schulz R, Reisinger W, Schmeling A (2007) Comparative analysis of the applicability of the skeletal age determination methods of Greulich–Pyle and Thiemann–Nitz for forensic age estimation in living subjects. Int J Legal Med 121:293–296PubMedCrossRef
23.
Cameriere R, De Luca S, Biagi R, Cingolani M, Farronato G, Ferrante L (2012) Accuracy of three age estimation methods in children by measurements of developing teeth and carpals and epiphyses of the ulna and radius. J Forensic Sci. doi:10.​1111/​j.​1556-4029.​2012.​02120
24.
Liversidge HM, Smith HB, Maber M (2010) Bias and accuracy of age estimation using developing teeth in 946 children. Am J Phys Anthropol. doi:10.​1002/​ajpa.​21349
25.
Liversidge HM (2010) Demirjian stage tooth formation results from a large group of children. Dent Anthropol 23:16–24
26.
Hillewig E, De Tobel J, Cuche O, Vandemaele P, Piette M, Verstraete K (2010) Magnetic resonance imaging of the medial extremity of the clavicle in forensic bone age determination: a new four-minute approach. Eur Radiol 21:757–767PubMedCrossRef
27.
Mincer HH, Harris EF, Berryman HE (1993) The ABFO study of third molar development and its use as an estimator of chronological age. J Forensic Sci 38:379–390PubMed
28.
Liliequist B, Lundberg M (1971) Skeletal and tooth development, a methodological investigation. Acta Radiol 11:97–112
29.
30.
Kullman L, Johanson G, Akesson L (1992) Root development of the lower third molar and its relation to chronological age. Swed Dent J 16:161–167PubMed
31.
Kieser JA (1990) Human adult odontometrics: The study of variation in adult tooth size. Cambridge University Press, New YorkCrossRef
32.
Bolaños MV, Moussa H, Manrique MC, Bolaños MJ (2003) Radiographic evaluation of third molar development in Spanish children and young people. Forensic Sci Int 133:212–219PubMedCrossRef
33.
Koc A, Karaoglanoglu M, Erdogan M, Kosecik M, Cesur Y (2001) Assessment of bone ages: is the Greulich–Pyle method sufficient for Turkish boys? Pediatr Int 43:662–665PubMedCrossRef
34.
Cameriere R, Ferrante L (2008) Age estimation in children by measurement of carpals and epiphyses of radius and ulna and open apices in teeth: a pilot study. Forensic Sci Int 174:60–63PubMedCrossRef
35.
Berst MJ, Dolan L, Bogdanowicz MM, Stevens MA, Chow S, Brandser EA (2001) Effect of knowledge of chronologic age on the variability of pediatric bone age determined using the Greulich and Pyle Standards. AJR 176:507–510PubMed
36.
McKern TW, Stewart TD (1957) Skeletal age changes in young American males. Analysed from the Standpoint of Age Identification. Technical Report EP-45 Natick Mass
37.
Pyle SI, Hoerr NL (1955) Radiographic atlas of skeletal development of the knee. A Standard of Reference Thomas Springfield IL
38.
O'Connor JE, Bogue C, Spence LD, Last J (2008) A method to establish the relationship between chronological age and stage of union from radiographic assessment of epiphyseal fusion at the knee: an Irish population study. J Anat 212:198–209PubMedCrossRef
39.
Schaefer MC, Black SM (2005) Comparison of ages of epiphyseal union in North American and Bosnian skeletal material. J Forensic Sci 50:777–784PubMedCrossRef
40.
Schaefer MC, Black SM (2007) Epiphyseal union sequencing: aiding in the recognition and sorting of commingled remains. J Forensic Sci 52:277–285PubMedCrossRef
41.
Das Gupta SM, Prasad V, Singh S (1974) A roentgenologic study of epiphyseal union around elbow, wrist and knee joints and the pelvis in boys and girls of Uttar Pradesh. J Indian Med Assoc 62:10–12PubMed
42.
Acheson RM (1952) Radiographs of the hand as an index of skeletal maturity in infants. Arch Dis Child 27:382–385PubMedCrossRef
43.
Roche AF, Davila GH (1976) The reliability of assessments of the maturity of individual hand-wrist bones. Hum Biol 48:585PubMed
44.
Albert AM, Greene DL (1999) Bilateral asymmetry in skeletal growth and maturation as an indicator of environmental stress. Am J Phys Anthropol 110:341–349PubMedCrossRef
45.
Schmeling A, Schulz R, Reisinger W, Muhler M, Wernecke KD, Geserick G (2004) Studies on the time frame for ossification of the medial clavicular epiphyseal cartilage in conventional radiography. Int J Legal Med 118:5–8PubMedCrossRef
46.
Falys CG, Schutkowski H, Weston DA (2006) Auricular surface aging: worse than expected? A test of the revised method on a documented historic skeletal assemblage. Am J Phys Anthropol 130:508–513PubMedCrossRef
47.
Auerbach BM, Ruff C (2006) Limb bone bilateral asymmetry: variability and commonality among modern humans. J Hum Evol 50:203–218PubMedCrossRef
48.
Prieto JL, Barbería E, Ortega R, Magaña C (2005) Evaluation of chronological age based on third molar development in the Spanish population. Int J Legal Med 119:349–354PubMedCrossRef
49.
Martín-de las Heras S, García-Fortea P, Ortega A, Zodocovich S, Valenzuela A (2008) Third molar development according to chronological age in populations from Spanish and Magrebian origin. Forensic Sci Int 174:47–53PubMedCrossRef
50.
51.
R Development Core Team (2008) R: a language and environment for statistical computing. R Foundation for Statistical Computing, Vienna Austria. ISBN 3-900051-07-0, URL http://​www.​R-project.​org (Last access 28/05/2012).
52.
Schmeling A, Garamendi PM, Prieto JL, Landa MI (2011) Forensic age estimation in unaccompanied minors and young living adults. In: Duarte NV (ed) Forensic medicine—from old problems to new challenges InTech, 77–120.
53.
Singh J, Chavali KH (2011) Age estimation from clavicular epiphyseal union sequencing in a Northwest Indian population of the Chandigarh region. J Forensic Legal Med 18:82–87CrossRef
54.
Schmeling A, Schulz R, Reisinger W, Mühler M, Wernecke KD, Geserick G (2004) Studies on the time frame for ossification of medial clavicular epiphyseal cartilage in conventional radiography. Int J Legal Med 118:5–8PubMedCrossRef
55.
Garamendi PM, Landa MI, Botella MC, Alemán I (2011) Forensic age estimation on digital X-ray images: medial epiphyses of the clavicle and first rib ossification in relation to chronological age. J Forensic Sci 56:S3–S12PubMedCrossRef
56.
Kellinghaus M, Schulz R, Vieth V, Schmidt S, Pfeiffer H, Schmeling A (2010) Enhanced possibilities to make statements on the ossification status of the medial clavicular epiphysis using an amplified staging scheme in evaluating thin-slice CT scans. Int J Legal Med 124:321–325PubMedCrossRef
57.
Kellinghaus M, Schulz R, Vieth V, Schmidt S, Schmeling A (2010) Forensic age estimation in living subjects based on the ossification status of the medial clavicular epiphysis as revealed by thin-slice multidetector computed tomography. Int J Legal Med 124:149–154PubMedCrossRef
58.
Hillewig E, De Tobel J, Cuche O, Vandemaele P, Piette M, Verstraete K (2011) Magnetic resonance imaging of the medial extremity of the clavicle in forensic bone age determination: a new four-minute approach. Eur Radiol 21:757–767PubMedCrossRef
59.
Schulz R, Zwiesigk P, Schiborr M, Schmidt S, Schmeling A (2008) Ultrasound studies on the time course of clavicular ossification. Int J Legal Med 122:163–167PubMedCrossRef
60.
Greulich W, Pyle SI (1959) Radiographic atlas of skeletal development of the hand and wrist, 2nd edn. Stanford University Press, Stanford
61.
Jopp E, Schröder I, Maas R, Adam G, Püschel K, Hertzog C (2010) A Proximale Tibiaepiphyse im Magnetresonanztomogramm. Rechtsmedizin 20:464–468CrossRef
62.
Dedouit F, Auriol J, Rousseau H, Rougé D, Crubézy E, Telmon N (2012) Age assessment by magnetic resonance imaging of the knee: a preliminary study. Forensic Sci Int 217:232.e1–232.e7CrossRef
63.
Flecker H (1932) Roentgenographic observations of the times of appearance of epiphyses and their fusion with the diaphyses. J Anat 67:118–164PubMed
64.
65.
Ramsthaler F, Proschek P, Betz W, Verhoff MA (2009) How reliable are the risk estimates for X-ray examinations in forensic age estimations? A safety update. Int J Legal Med 123:199–204PubMedCrossRef
66.
Willems G, Moulin-Romsee C, Solheim T (2002) Non-destructive dental-age calculation methods in adults: intra- and inter-observer effects. Forensic Sci Int 126:221–226PubMedCrossRef
67.
Huda W, Atherton JV, Ware DE, Cumming WA (1997) An approach for the estimation of effective radiation dose at CT in pediatric patients. Radiology 203:417–422PubMed
68.
Maher MM, Kalra MK, Toth TL, Wittram C, Saini S, Shepard J (2004) Application of rational practice and technical advances for optimizing radiation dose for chest CT. J Thorac Imaging 19:16–23PubMedCrossRef
69.
Hall EJ (2009) Radiation biology for pediatric radiologists. Pediatr Radiol 39(suppl 1):57–64CrossRef
70.
Metadata
Title
Radiographic analysis of epiphyseal fusion at knee joint to assess likelihood of having attained 18 years of age
Authors
R. Cameriere
M. Cingolani
A. Giuliodori
S. De Luca
L. Ferrante
Publication date
01-11-2012
Publisher
Springer-Verlag
Published in
International Journal of Legal Medicine / Issue 6/2012
Print ISSN: 0937-9827
Electronic ISSN: 1437-1596
DOI
https://doi.org/10.1007/s00414-012-0754-y

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