Research Progress of Age Estimation in the Living by Knee Joint MRI / 法医学杂志

Bone development shows certain regularity with age. The regularity can be used to infer age and serve many fields such as justice, medicine, archaeology, etc. As a non-invasive evaluation method of the epiphyseal development stage, MRI is widely used in living age estimation. In recent years, the rapid development of machine learning has significantly improved the effectiveness and reliability of living age estimation, which is one of the main development directions of current research. This paper summarizes the analysis methods of age estimation by knee joint MRI, introduces the current research trends, and future application trend.

Establishment of Mathematical Models for Skeletal Age Determination of Extremitas Sternalis of Clavicle in Shanxi Adolescents / 法医学杂志

Objective To develop mathematical models for skeletal age determination with multiple statistic method based on the correlation between age and the growth of the epiphysis of extremitas sternalis of clavicle in Shanxi adolescents. Methods The 562 Shanxi sternoclavicular joint samples （454 cases of modelling, 108 cases of external verification） were scanned by the thin-section computed tomography. After volume rendering was obtained, indicators such as area of epiphysis, area of metaphysis, longest diameter of epiphysis and longest diameter of metaphysis of both extremitas sternalis of clavicle were collected. Indicators such as the ratio of area of epiphysis to area of metaphysis, and the ratio of longest diameter of epiphysis to longest diameter of metaphysis of both sides were calculated. Then multiple linear regression and random forest discriminant models were used to build mathematical models for age determination of adolescents. Results The obtained indicators exhibited a strong correlation with age （r>0.85）. The multiple linear regression model for males and females （all 4 indicators entering the model） based on the ratio of longest diameter of epiphysis to longest diameter of metaphysis and the ratio of area of epiphysis to area of metaphysis had an internal validation accuracy rate （±1.0 year） of over 92% and 108 cases had an external validation accuracy rate of over 70% （±1.0 year）. The out of bag error rates of random forest discriminant models were less than 2% for people over 18.0 years old （≥18.0 years old） and under 18.0 years old. The external validation accuracy rates of the 108 cases were over 80%. Conclusion The regression and discriminant models established in this study have certain reliability and accuracy and can be used in age determination of Shanxi adolescents.

Displasia epifisaria con falanges en forma de ángel: Caso clínico / Angel-shaped phalango-epiphyseal dysplasia: Case report

Se describe una patología de aparición poco frecuente y esporádica que se caracteriza por deformidad en cuello de cisne en las manos, artrosis de cadera en la adultez, retardo en la edad ósea y malformaciones de las falanges medias, en forma de ángel. El paciente es un niño de 4 años de edad que sufrió un traumatismo de mano, por lo cual se le realizó una radiografía donde se observaron falanges con forma de ángel. A partir de este hallazgo, se obtuvieron otras radiografías y se diagnosticó una displasia epifisaria con falanges en forma de ángel. A raíz de este diagnóstico en el niño y de consultas con el Servicio de Genética, se diagnosticó el mismo síndrome en la madre.

We describe a rare and sporadic condition, characterized by swan neck deformity in hands, hip osteoarthritis in adulthood and malformations of the middle phalanges with an angel shape. The patient is a 4 year old boy who suffered hand trauma and on x-ray examination he was diagnosed with angel-shaped phalango-epiphyseal dysplasia. Based on this diagnosis, his mother, who suffered from constant pain in her hips and lower limbs, was diagnosed with this syndrome as well.

Age estimation from ossification of the medial clavicular epiphysis by computed tomography / Estimación de la edad de osificación de la epífisis medial clavicular por tomografía computadorizada

The current study intended to evaluate the accuracy of age estimation from the development of the medial clavicular epiphysis (sternal end of the clavicle) in Egyptian population using computed tomography (CT) and to develop a discriminant formula that can be used in Egyptians. The study was conducted on 142 subjects (84 males and 58 females) after taken informed consent. They were subjected to multi-slice CT on the medial end of clavicles of both sides. The results revealed that the age of non - union was seen at 8­17 years; incomplete union at 15­20 years and complete union was seen at 20 years. It is concluded that the ossification of medial clavicular end could be used for age estimation. Also CT is a good visualization tool to be used. Regression analysis for each and both clavicles in both sexes is specific to Egyptian population and should be used after validation of the results in other ones. The study recommended using stage 1 to be <17 years; stage 2 to be >15 years; Stage 3 to be >15 years; stage 4 of maturation to be >19 years and stage 5 to be >21 years.

El objetivo de esta investigación fue evaluar en la población egipcia, la exactitud de estimación de edad del desarrollo de la extremidad esternal de la clavícula, mediante tomografía computadorizada (TC), y desarrollar una fórmula discriminante que se pueda utilizar en egipcios. La investigación se realizó en 142 pacientes (84 hombres y 58 mujeres) después de obtener el consentimiento informado. Los pacientes fueron sometidos a TC de cortes múltiples en la extremidad esternal de la clavícula en ambos lados. Los resultados revelaron que la no unión fue observada entre los 8­17 años; la unión incompleta entre 15­20 años y la unión completa a los 20 años. Se concluye que la osificación de la extremidad esternal de la clavícula podría ser utilizada para la estimación de la edad utilizando la TC como herramienta de visualización. El análisis de regresión para ambas clavículas en los dos sexos es específico de la población egipcia y se debe utilizar después de validar los resultados. El estudio recomienda el uso de la etapa 1 en <17 años, etapa 2 en >15 años, etapa 3 en >15 años, etapa 4 en la maduración >19 años y la etapa 5 >21 años.

Skeletal age estimation by pelvic X-ray of Han teenagers in Sichuan / 法医学杂志

OBJECTIVE@#To estimate the chronological age of Han teenagers in Sichuan by the epiphyses development characteristics of iliac crest and ischial tuberosity in X-ray digital images.@*METHODS@#According to TW2 classification principle, combining with the age range of our subjects and epiphyses development regularity, the degree of epiphyses development of iliac crest and ischial tuberosity had been divided into 8 grades (0-7) and 7 grades (0-6), respectively. Based on the degrees, the pelvic X-rays digital images of 691 samples of 16-20 aged teenagers were read and statistically analyzed by SPSS 19.0 software. The multiple linear regression equation was established by skeletal age (Y), development degree of iliac crest epiphyses (X1) and ischial tuberosity epiphyses (X2).@*RESULTS@#There were no statistical differences between two sides of epiphyses development of iliac crest and ischial tuberosity (P>0.05). There were no statistical difference between genders (P>0.05). The re-substitution method of the samples showed that the accuracy of equation as Y=15.269+0.444X1+0.236 X2 was high. The result of the re-substitution method showed a high accuracy of the equation.@*CONCLUSION@#The multiple linear regression equation could be used to identify the skeletal age for providing the scientific basis to identify the 18-year-old Han population in Sichuan.

Age determination from pelvis A radiological study in Mumbai region.

The bones of human skeletons develop from separate ossification centers. From these centers ossification progresses till the bone is completely formed. These changes can be studied by means of X-rays and these changes are age related. It is therefore possible to determine the approximate age of an individual by radiological examination of bones till ossification is complete. This radiological study was carried out with the objective to assess the general skeletal maturity around crest of ilium and ischial tuberosity, of subjects in Mumbai region. 99 males between age group of 9-25 years and 76 females between age group of 3-23 years attending the outpatient department of this hospital were selected. Age confirmed from history and noting the birth dates from driving license, passport, rations card or voter’s card. The cases were selected after ruling out the nutritional, developmental, and endocrinal abnormality which affects the skeletal growth. Data analysis was done in P4 computer using HPSS software. At the end conclusions were drawn which are compared with available results of various previous studies

Age Determination from Clavicle A Radiological Study in Mumbai Region.

The bones of human skeletons develop from separate ossification centres. From these centers ossification progresses till the bone is completely formed. These changes can be studied by means of X-rays and these changes are age related. It is therefore possible to determine the approximate age of an individual by radiological examination of bones till ossification is complete. This radiological study was carried out with the objective to assess the general skeletal maturity around Medial end of clavicle, of subjects in Mumbai region. 131 males between age group of 9-25 years and 68 females between age group of 3-23 years attending the outpatient department of this hospital were selected. Age confirmed from history and noting the birth dates from driving license, passport, rations card or voter‘s card. The cases were selected after ruling out the nutritional, developmental, and endocrinal abnormality which affects the skeletal growth. Data analysis was done in P4 computer using HPSS software. At the end conclusions were drawn which are compared with available results of various previous studies.

Original research paper radiological study of disappearance of tri-radiate cartilage in pelvic-bone in Gujarati population.

For medico-legal purposes evidence of age is very essential in various types of cases such as Identification, Consent, Rape, Attainment of Majority, and Eligibility for Employment, etc. Various work done on the study of age determination by the study of appearance of ossification centers and epiphyseal union of different bones in India as well as abroad indicate a reasonable variation. Majority of them conclude that, the ossification and epiphyseal union of a bone vary in different part of the world. To the best of our knowledge very little work has been done on the study of disappearance of tri-radiate cartilage out of various bony parts useful for age estimation. The present study comprising of 50 subjects ( male=35; female=15),was carried out during the period January 2000 to July 2001 at the Forensic Medicine department and Department of radiology, B.J. Medical College, Ahmedabad.

Computed tomographic studies on ossification status of medial epiphysis of clavicle: Effect of slice thickness and dose distribution.

The accuracy of technique adopted for Forensic age diagnostics of young adults and adolescents especially in case of livings lies in the standardization of the technical parameters used. The emerging radiological techniques, when used in standardized way may minimize the possibilities of misinterpretation, as it has been practically shown in present study. CT scans of 100 live subjects were performed on 16-slice (Siemen’s Sensation 16) CT scan machine and the volumetric data acquired was reconstructed into five separate sets of slice thickness for each one of the subjects included in the study and the ossification status for each set of slice thickness was determined for all the subjects separately. The results are almost identical while evaluating ossification stages from 1 and 2 mm thick slice data but the differences are found in the ossification stages when evaluated using 3 mm, 5 mm and 7 mm slice thickness as compared those found in 1 and 2 mm slice thickness. It was concluded that by increasing slice thickness the rate of error-nous interpretation are also increasing. Thus, the minimum reliable thickness to produce high resolution scans in order to get maximum accuracy is 2 mm for staging medial clavicular ossification from CT scan and the reconstruction should be done using kernel (filter) B60F at window setting osteo (1500/450HU).

Age estimation from medial end of clavicle by x- ray examination.

Fixing up of the individuality of a person, no matter if it is new born baby in the hospital or in criminal cases and in civil cases like marriage, inheritance of property, passport, insurance claims, disputed sex and missing persons etc. has got its own importance. In the present study 100 individuals are studied between the age group of 16 to 25 years in male and female (separately), whose X- ray examination is done at Rajindra Hospital ; Patiala, Punjab. Male and female individuals were studied with age interval of two years and ten cases from each age interval were taken. The study is undertaken to know the fusion of medial end of clavicle to know the fusion of epiphysis. In this study, every individual’s X-ray chest AP view is taken to know fusion of epiphysis at medial end of clavicle.

The trend of epiphyseal development of knee and ankle joints in teenagers and age estimation / 法医学杂志

OBJECTIVE@#According to the features of epiphyseal development of knee and ankle joints in male and female teenagers, the trend of epiphyseal development was analyzed and the possibility of its application in age estimation was discussed.@*METHODS@#Firstly, radiographs of adem position were taken from both sides of knee and ankle joints from 1709 individuals from Eastern China, Central China, and Southern China (Age: 11-21 years old). Secondly, 5 osteal loci were selected as bone age markers from the two joints. Thirdly, characteristics of epiphyseal development were observed systematically and comprehensively. Fourthly, the proportions of "epiphyseal fusion" in different age groups were calculated, and confirmed the numbers of people which were included by epiphyseal fusion of knee and ankle joints. Finally, age range of each epiphyseal fusion was calculated by mathematical statistical analysis.@*RESULTS@#Compared with the data of 1960s', the age of 5 epiphyseal fusions was earlier about 2-3 years. However, the results were basically the same as the recent studies.@*CONCLUSION@#The data on the time of epiphyseal fusion were updated. It is important to determine the accuracy in age estimation in male and female teenagers.

Staging methods of skeletal growth by X-ray in teenagers / 法医学杂志

OBJECTIVE@#To establish staging criteria for teenager's skeletal growth by examining osteoarticular X-rays.@*METHODS@#Review publications on skeletal growth staging systems by domestic and overseas authorities. Abided by the staging principles on theory of cartilage epiphyseal growth and X-ray images of skeletal growth, X-ray imaging characteristics were studied through three hundred male and female teenagers epiphyseal growth of both sternal ends of clavicle and the left side of shoulder, elbow, carpal, hip, knee and ankle joints transversally and longitudinally. The subjects were from 11 to 20 years old, selected from Henan, Hainan and Zhejiang province in China. Twenty-four skeletal growth indexes were selected closely related to age.@*RESULTS@#Based on regular changing characteristics of epiphyseal growth at different joints, 24 skeletal development indexes were divided into 2 to 8 stages. The stage number of different indexes of the single joint were similar. It was shown that the time of different epiphyseal growth in identical joints had isochromism.@*CONCLUSION@#These staging criteria have merits of extensive skeletal growth indexes, and are applicable to wide age range with a strong maneuverability. It provides a favorable fundamental platform for forensic evaluating skeletal age in living subjects in China.

Development of hand-wrist bones of 14 year-old adolescents. II. Standard of bony age for girls / 法医学杂志

OBJECTIVE@#To study the current development of hand-wrist bones of adolescents in China, and establish special forensic bony age standard for estimating 14 years of criminal responsible age in female adolescents.@*METHODS@#One hundred and ten healthy girls aged from 13 years and 9 months to 14 years and 3 months in Lengshuijiang district of Hunan province were enrolled in this study. X-ray films of their left hand-wrists were taken dorsaventrally, and 15 sites on the wrist x-ray films were examined and measured under standard condition. The development grade was confirmed by maximal percentage to establish a method to estimate the bony age, which was then checked by single blind method.@*RESULTS@#Development grade of the radius, the middle third phalanx and the fourth phalanx was partially closed (> 2/3), and the rest was wholly-closed with existence of the epiphyseal line. The development grade of the middle third phalanx and fourth phalanx was different between the younger group (< 14 years, partially closed, > 2/3) and the older group (> 14 years, mostly closed with existence of only epiphyseal line). The cross diameter of the osteoepiphysises were wider than that of all the diaphysises. The confirmed accuracy (in 30 girls) was 83.3%.@*CONCLUSION@#Our study seemes to be feasible in establishing the estimation standard for bony age determination. The standard established by developmental metaphysis and authropometry may be particularly helpful in forensic practice for estimation of accurate criminal responsible age in adolescents.

Pattern of epiphyseal union at knee in the children and young adults of Peshawar

Objectives of the study were to: 1. Determine the age of epiphyseal union at distal end of femur and proximal end of tibia and fibula in the children and young adults of Peshawar. 2. Compare the pattern of epiphyseal union at knee among males and females. Non-interventional descriptive. Department of Forensic Medicine, Khyber Medical College Peshawar. In the study 120 healthy, young volunteer students of both sexes and original residents of NWFP were included. Males were 15-19 years and females were 13-17 years of age. Age was certified by means of birth record, school certificates and interview with the parents. Radiographs of right knee were taken using conventional x-rays apparatus. Non-probability purposive sampling technique was used. Radiological findings regarding epiphyseal union were classified as follow; a. Stage of non-union b. Stage of partial union c. Stage of complete Union Data was compiled and significance of results was evaluated through statistical analysis of the data using Chi-square and t-test. In males average age of epiphyseal union of femur, tibia and fibula is 16.5, 17 and 17.5 years respectively. In comparison, in females epiphyseal union of femur and tibia takes place at the age of 14 years while that of fibula at the age of 15 years. Epiphyseal union is 2.5 to 3 years earlier in females as compared to males. Epiphyseal union occurs earlier in Pakistan than in European countries. Europeans norms and standards of skeletal growth used for age estimation are not valid for Pakistani children. Further studies on pattern of epiphyseal union must be conducted to develop local reference standard that may be used for age estimation

Age determination in girls of north – eastern region of India.

Epiphyseal union of the elbow, knee, wrist joints and pelvis was studied retrospectively on 104 girls between the age group of 16 -22 yrs to determine the age roentgenographically. Regression formula with the standard errors was derived for the respective joints. The Y-values predicted by the Regression equation may not be valid if they are out side the range of the Y-values used to determine the equation. The present study establishes a reference population for age determination of girls from epiphyseal union in North – Eastern region of India.

Image analysis of avulsion fracture, permanent osteoepiphyte, sesamoid and accessory bones / 法医学杂志

OBJECTIVE@#To investigate a method to distinguish avulsion fracture from sesamoid, accessory bone, and permanent osteoepiphyte.@*METHODS@#Fourteen cases of suspicious avulsion fractures of articular portion of tubular bones were reviewed. Direct/indirect signs and the injury mechanism of avulsion fractures were analyzed and compared with permanent osteoepiphyte, sesamoid and accessory bones for their morphological characteristics.@*RESULTS@#There are two cases of permanent osteoepiphytes, three cases of sesamoids, and three cases of accessory bones. These cases were characterized by smooth edges, contiguous bony cortex, without swelling of the surrounding soft tissue or obvious image changes after consecutive radiography.@*CONCLUSION@#It is fundamental in image analysis to distinguish avulsion fracture from physiological small osteoepiphyte, sesamoid bone, and aberrant accessory bone.

Anatermic separated epiphysis or avulsion fracture: image observation / 法医学杂志

OBJECTIVE@#To explore an approach to distinguish avulsion fracture of articular portion from anatomic separated epiphysis.@*METHODS@#21 cases with suspicioned avulsion fracture of articular portion of tubular bone were reviewed. The cortical continuity of separate small bone and contiguous bone portion was investigated. The swell of soft tissue around these small bones was observed simultaneously. Then the configuration of the fracture was researched by injury mechanics.@*RESULTS@#Continued bone cortex between separate small bone and corresponding bone was seen in 15 cases, so they were considered as a separate epiphysis. Sharp linear fracture between the separate small bone and corresponding bone were seen in 6 cases. The swell of soft tissue around the separate small bone was observed in all cases, so they were considered as a avulsion fracture.@*CONCLUSION@#The meticulous investigation of separated small bone at the articular portion by image observation is of important value for distinguishing avulsion fracture from anatomic separate epiphysis.

value of ultrasonic epiphyseal ossification centers and placental grading in the predication of fetal lung maturity in normal, preeclamptic and diabetic pregnancies

In the present study, a non-invasive method for assessment of fetal lung maturity via sonographic characterization of placental maturity and fetal epiphyseal ossification centers around the knee and shoulder was evaluated. These sonographic parameters were correlated with the amniocentesis phospholipid profile as an indicator of accuracy. They were studied in 40 normal pregnancies, 40 preeclamptic and 40 diabetic pregnancies with gestational ages ranging between 32-41 weeks. It was found that in normal pregnancies, the presence of grade 3 placenta, or DFE >/5 mm or PTE >/3 mm or the presence of PHE predicts a mature phospholipid profile in 100% of patients. However, in preeclamptic patients, the presence of grade 3 placenta is not a reliable predictor of lung maturity, but the presence of DFE >/5 mm or PTE >/3 mm or the presence of PHE has 100% positive predictive value of mature phospholipid profile. On the other hand, in diabetic pregnancies neither grade 3 placenta nor DFE >/ 5 mm are reliable indicators of fetal lung maturity. Finally, the identification of PTE >/5 mm or the presence of PHE can reliably identify a mature phospholipid profile in all studied groups with 100% accuracy. Such a perfect correlation between these epiphyseal ossification dimensions and fetal lung maturity favors the use of these selective noninvasive sonographic parameters as an alternative to invasive amniocentesis phospholipid profile in prediction of fetal lung maturity. This could save time, money, emotional investment, fetal and maternal morbidity

Physical remodeling of valgus slipped capital femoral epiphyses

Valgus displacement of the capital femoral epiphysis occurs very rarely. Physeal remodelling, not previously reported in valgus slips, is herein described in three hips. It provides further support for the concept of initial pin fixation and observing for any remodelling to occur that may obviate the need for femoral neck osteotomies