Forensic age estimation based on T1 SE and VIBE wrist MRI: do a one-fits-all staging technique and age estimation model apply?

  • Jannick De TobelEmail author
  • Elke Hillewig
  • Michiel Bart de Haas
  • Bram Van Eeckhout
  • Steffen Fieuws
  • Patrick Werner Thevissen
  • Koenraad Luc Verstraete
Forensic Medicine



Providing recommendations for wrist MRI in age estimation by determining (1) which anatomical structures to include in the statistical model, (2) which MRI sequence to conduct, and (3) which staging technique to apply.


Radius and ulna were prospectively studied on 3 T MRI in 363 healthy Caucasian participants (185 females, 178 males) between 14 and 26 years old, using T1 spin echo (SE) and T1 gradient echo VIBE. Bone development was assessed applying a 5-stage staging technique with several amelioration attempts to optimise staging. A Bayesian model rendered point predictions of age and diagnostic indices to discern minors from adults.


All approaches rendered similar results, with none of them outperforming the others. A single bone assessment of radius or ulna sufficed. SE and VIBE sequences were both suitable, but needed sequence-specific age estimation. A one-fits-all 5-stage staging technique—with substages in stage 3—was suitable and did not benefit from profound substaging. Age estimation based on SE radius resulted in a mean absolute error of 1.79 years, a specificity (correctly identified minors) of 93%, and a discrimination slope of 0.640.


Radius and ulna perform similarly to estimate age, and so do SE and VIBE. A one-fits-all staging technique can be applied.

Key Points

Radius and ulna perform similarly to estimate age.

• SE and VIBE perform similarly, but age estimation should be based on the corresponding sequence-specific reference data.

• A one-fits-all 5-stage staging technique with substages 3a, 3b, and 3c can be applied to both bones and both sequences.


Age determination by skeleton Wrist Adolescent Adult Magnetic resonance imaging 



Confidence interval


End stage


Mean absolute error


Specific absorption rate


T1-weighted spin echo MR-sequence


Threefold stratification sign


T1-weighted gradient echo volumetric interpolated breath-hold examination MR-sequence



The authors wish to express their gratitude to all participants and everyone who helped with the recruitment. We thank Maarten Peleman and Dries Ovaere for installing the viewing software on the department’s computers. Finally, we wish to acknowledge Inès Phlypo for her indispensable critical appraisal of the manuscript.

Results described in this manuscript were presented at the 20th Meeting of the Study Group on Forensic Age Diagnostics (Arbeitsgemeinschaft für Forensische Altersdiagnostik, AGFAD) in Berlin, Germany, on March 17, 2017.


Funding for this research was entirely provided by the Department of Radiology and Nuclear Medicine at Ghent University and the Department of Imaging and Pathology - Forensic Odontology at KU Leuven.

Compliance with ethical standards


The scientific guarantor of this publication is Koenraad Verstraete, Ghent University.

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

One of the authors has significant statistical expertise.

Informed consent

Written informed consent was obtained from all participants in this study. In case of minors, written informed consent was also obtained from the parents.

Ethical approval

The study was approved by the Ghent University Hospital Ethics Committee.

Study subjects or cohorts overlap

Parts of the study population have been previously reported in [2, 3, 26, 27, 28, 36]. In those studies, the development of their clavicles and third molars was studied for age estimation.


• prospective

• cross sectional study/observational

• performed at one institution

Supplementary material

330_2018_5944_MOESM1_ESM.docx (392 kb)
ESM 1 (DOCX 392 kb)


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Copyright information

© European Society of Radiology 2019

Authors and Affiliations

  1. 1.Department of Radiology and Nuclear MedicineGhent UniversityGhentBelgium
  2. 2.Department of Imaging and Pathology – Forensic OdontologyKU LeuvenLeuvenBelgium
  3. 3.Department of Head, Neck and Maxillofacial SurgeryGhent University HospitalGhentBelgium
  4. 4.Department of Forensic AnthropologyNetherlands Forensic InstituteDen HaagThe Netherlands
  5. 5.Department Public Health and Primary CareKU Leuven – University of Leuven & Universiteit HasseltLeuvenBelgium

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