Forensic age assessment by 3.0T MRI of the knee: proposal of a new MRI classification of ossification stages
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To explore the possibility of determining majority via a morphology-based examination of the epiphyseal-diaphyseal fusion by 3.0 T magnetic resonance imaging (MRI), a prospective cross-sectional study developing and applying a new stage classification was conducted.
Materials and methods
344 male and 350 female volunteers of German nationality between the ages of 12-24 years were scanned between May 2013 and June 2015. A 3.0 T MRI scanner was used, acquiring a T1-weighted (T1-w) turbo spin-echo sequence (TSE) and a T2-weighted (T2-w) TSE sequence with fat suppression by spectral pre-saturation with inversion recovery (SPIR). The gathered information was sifted and a five-stage classification was formulated as a hypothesis. The images were then assessed using this classification. The relevant statistics were defined, the intra- and interobserver agreements were determined, and the differences between the sexes were analysed.
The application of the new classification made it possible to correctly assess majority in both sexes by the examination of the epiphyses of the knee joint. The intra- and interobserver agreement levels were very good (κ > 0.80). The Mann-Whitney-U Test implied significant sex-related differences for most stages.
Applying the presented MRI classification, it is possible to determine the completion of the 18th year of life in either sex by 3.0 T MRI of the knee joint.
• Based on prospective referential data a new MRI classification was formulated.
• The setting allows assessment of the age of an individual’s skeletal development.
• The classification scheme allows the reliable determination of majority in both sexes.
• The staging shows a high reproducibility for instructed and trained professional personnel.
• The proposed classification is likely to be adaptable to other long bone epiphyses.
KeywordsAge determination by skeleton Forensic medicine Bone development Knee Magnetic resonance imaging
Magnetic resonance imaging
Signal pre-saturation with inversion recovery
The study was funded by the European Refugee Fund, the German Federal Office for Migration and Refugees and the Westphalian Wilhelms-University of Münster, Germany.
Compliance with ethical standards
The scientific guarantor of this publication is Prof. Andreas Schmeling.
Conflict of interest
The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.
Statistics and biometry
No complex statistical methods were necessary for this paper.
Written informed consent was obtained from all subjects (patients) in this study.
Institutional Review Board approval was obtained.
Study subjects or cohorts overlap
Some study subjects or cohorts have been previously reported in:
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Ottow C, Schulz R, Pfeiffer H, Heindel W, Schmeling A, Vieth V (2017) Forensic age estimation by magnetic resonance imaging of the knee: the definite relevance in bony fusion of the distal femoral- and the proximal tibial epiphyses using closest-to-bone T1 TSE sequence. Eur Radiol 27:5041-5048
Guo Y, Olze A, Ottow C, et al. Dental age estimation in living individuals using 3.0 T MRI of lower third molars. Int J Legal Med. 2015;129(6):1265-70.
Timme M, Ottow C, Schulz R, et al. Magnetic resonance imaging of the distal radial epiphysis: a new criterion of maturity for determining whether the age of 18 has been completed? Int J Legal Med. 2017;131(2):579-84.
• cross-sectional study
• performed at one institution
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