Age Estimation Based on Computed Tomography Analysis of the Scapula.

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.

The Association between Vitamin D deficiency and Hepatosteatosis in Children and Adolescents with Obesity.

INTRODUCTION: Increasingly, research groups have been studying the association of serum vitamin D and metabolic health indicators, especially in patients with obesity. We compared the serum 25-hydroxy Vitamin D [25(OH)D] concentrations in children and adolescents who had obesity and hepatosteatosis with children and adolescents who had obesity without hepatosteatosis, and investigate the relationship between serum 25(OH)D concentrations and severity of hepatosteatosis. We also aimed to assess the effect of vitamin D treatment after 6 months on hepatosteatosis and liver biochemistry. METHODS: One hundred thirty-three patients with obesity (body mass index (BMI) > +2 standard deviations (SD) for their age and gender) and vitamin D deficiency [serum 25(OH)D < 12 ng/ml] were recruited. Anthropometric measurements, biochemical parameters [serum calcium, phosphate, alkaline phosphatase, parathyroid hormone, 25(OH)D, glucose and insulin concentrations] and ultrasonographic findings of hepatosteatosis were recorded before and six months after Vitamin D treatment. Chi-square, Student's t tests and multivariate analysis were performed. RESULTS: Grade 1, 2 and 3 hepatosteatosis at baseline was present in 51 (38.4%) , 43 (32.3%) and 10 (7.5%) subjects respectively. Mean (± SD) serum 25(OH)D concentrations were significantly lower in those with hepatosteatosis (8.4 ± 2.4 ng/ml) compared with those without hepatosteatosis (9.9 ± 2.4 ng/ml, P < 0.005). Multivariable logistic regression analysis showed serum 25(OH)D concentration was the independent predictor for hepatosteatosis (P < 0.005), whereas age, sex, weight SD, BMI SD and HOMA-IR were not (P > 0.05). There was no significant difference in BMI SD, HOMA-IR and liver enzymes between subjects with and without hepatosteatosis (P > 0.05). Despite improvement in serum 25(OH)D concentrations at 6 months post-treatment (34.7 ± 10.6 ng/ml vs. 8.7 ± 2.4 ng/ml; p < 0.0001), there was no significant difference in the proportion of patients with different severity of hepatosteatosis as compared to before treatment (p = 0.88). CONCLUSION: Serum 25(OH)D concentrations were lower in children and adolescents with obesity and hepatic steatosis as compared to those without hepatic steatosis, with an inverse association between the severity of hepatosteatosis and serum 25(OH)D concentrations. Vitamin D treatment in children and adolescents with obesity and hypovitaminosis D did not improve severity of hepatic steatosis on ultrasonography at 6 months.

The accuracy of three-dimensional ultrasonography in the diagnosis of Müllerian duct anomalies and its concordance with magnetic resonance imaging.

This retrospective study was performed to comparatively evaluate the diagnostic accuracies of three-dimensional ultrasonography (3D-US) and magnetic resonance imaging (MRI) for identification of Müllerian duct anomalies (MDAs). A total of 27 women with suspected MDAs underwent gynaecological examination, 2D-US, 3D-US and MRI, respectively. The MDAs were classified with respect to the European Society of Human Reproduction and Embryology-European Society for Gynaecological Endoscopy (ESHRE/ESGE) and American Society of Reproductive Medicine (ASRM) systems. Based on the ESHRE/ESGE classification, there was a discrepancy for only one patient between US and MRI. Thus, the concordance between US and MRI was 26/27 (96.3%). With respect to ASRM classification, there was a disagreement between MRI and 3D-US in three patients, thus the concordance between MRI and 3D-US was 24/27 (88.9%). To conclude, the 3D-US has a good level of agreement with MRI for recognition of MDAs.Impact StatementWhat is already known on this subject? Müllerian duct anomalies (MDAs) are relatively common malformations of the female genital tract and they may adversely affect the reproductive potential. The establishment of accurate and timely diagnosis of these malformations is critical to overcome clinical consequences of MDAs.What the results of this study add? The concordance between US and MRI for diagnosis of MDAs based on ESHRE-ESGE classification and ASRM were 96.3% and 88.9%, respectively. These results indicate that 3D US has a satisfactory level of diagnostic accuracy for MDAs and it can be used in conjunction with MRI. Minimisation of diagnostic errors is important to improve reproductive outcome and to avoid unnecessary surgical interventions.What the implications are of these findings for clinical practice and/or further research? Efforts must be spent to eliminate the discrepancies between the clinical and radiological diagnosis of MDAs. Further trials should be implemented for establishment and standardisation of radiological images for identification and classification of MDAs.

Evaluation of computed tomography images of calcaneus for estimation of sex.

Estimation of sex from bone remnants after medicolegal issues or mass disasters constitute a challenge. Our objective was to investigate if morphometric measurements performed on computed tomography (CT) images of the calcaneus can be useful for sex estimation. The measurements were performed on CT images of calcaneus bones of 489 patients (203 women, 286 men). The parameters under investigation were maximum length (MAXL), load arm length (LAL), minimum breadth (MINB), body height (BH), maximum height (MAXH), dorsal articular facet length (DAFL), dorsal articular facet breadth (DAFB), and cuboidal facet height (CFH). All parameters were remarkably increased in men compared to women (p < 0.001, for all). The highest performances for sex estimation were displayed by DAFL (92.8%) and BH (92.6%). The concomitant use of variables MAXL, BH, CFH, and DAFL revealed accuracy as high as 96% for gender discrimination. We suggest that morphometric measurements performed on CT images of the calcaneus can provide useful data for the estimation of sex.

Evaluation of the Ossification Stage of Proximal Humeral Epiphysis by 1.5-T Magnetic Resonance Imaging for Determination of Skeletal Age.

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.

Estimation of sex using morphometric measurements performed on cranial computerized tomography scans.

We aimed to evaluate the usefulness of morphometric measurements performed on cranial computerized tomography (CT) images for the estimation of sex. A retrospective study was performed in the radiology department of a tertiary care center using data collected from cranial CT scans of 616 Caucasian cases (307 women, 309 men) with an average age of 44.70 ± 16.43. The parameters under investigation consisted of maximum cranial length (MCL), minimum frontal breadth, bi-zygomatic breadth (BZB), parietal chord, maximum cranial breadth, bi-mastoid diameter (BIM) and the length of cranial base. Any statistically significant difference in terms of these parameters was found between males and females. In our series, women were remarkably older than men (47.56 ± 15.87 vs. 41.39 ± 16.43; p < 0.001). We observed that there was a statistically significant difference between males and females concerning all morphometric measurements and males displayed higher values in terms of all parameters (p < 0.001, for all). The variables with the most successful performance for discrimination of gender were BZB (89.2%), MCL (87.4%) and BIM (84.8%). The concomitant use of these morphometric measurements seems to improve the accuracy of sex estimation. We suggest that morphometric measurements performed on cranial CT images can be useful for the estimation of sex.