Cumhuriyet Medical Journal
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Adli yaş tayininde iliyak krestin çok kesitli bilgisayarlı tomografi ile değerlendirilmesi

Year 2017, Volume 39, Issue 3, 576 - 585, 19.09.2017

Eda Albayrak

https://doi.org/10.7197/223.v39i31705.347457

Abstract

Amaç: Bu çalışmanın amacı adli kemik yaşı tayininde iliyak krestin çok kesitli bilgisayarlı tomografi (ÇKBT) ile değerlendirilmesi ve kemik yaşı tayininde beşli derecelendirme sistemi olarak kullanılan Schmeling Metodu’nun, ÇKBT eşliğinde iliyak kreste uygulanabilirliğinin araştırılmasıdır.

Yöntem: Kliniğimizde daha önce çeşitli sebeplerle elde edilen 10-30 yaşları arasındaki 551 bireye ait alt abdomen bilgisayarlı tomografi tetkiki değerlendirildi.  Beşli evreleme sistemine göre evre 4’de apofizyal skar fluluk şeklinde ve belli belirsiz, sığ, ince bir çentik şeklinde izlenmekte iken evre 5’te ossifikasyon tamamlanmış olup, skar hiçbir kesitte izlenmemekteydi.

Bulgular: En erken görülme yaşları evre 2’de, erkeklerde 11.5, kızlarda 11.6, evre 3’te erkeklerde 14.3 kızlarda 13.4, evre 4’te erkeklerde 17.4, kızlarda 16.5 ve evre 5’te her iki cinsiyet için 18 olarak bulunmuştur.

Sonuç: Önceki çalışmalarda illiyak krest için kullanılan dörtlü evreleme sistemine göre son evrenin en erken görülme yaşı 17 olmasına karşın, mevcut çalışmada beşli evreleme sistemine göre 5. evrenin her iki cinsiyette en erken görülme yaşı 18 olarak belirlenmiştir ve elde edilen bulgular, iliyak kemik ile adli yaş tayininde 18 yaş sınırını belirlemek amacıyla beşli evreleme sisteminin, dörtlü evreleme sistemine göre daha avantajlı olabileceğini göstermektedir. 

Keywords

İliak apofiz, çok kesitli bilgisayarlı tomografi, evreleme, yaş tahmini, adli tıp

References

  • 1- Serinelli S, Panebianco V, Martino M, Battisti S, Rodacki K, Marinelli E, Zaccagna F, Semelka RC, Tomei E. Accuracy of MRI skeletal age estimation for subjects 12-19. Potential use for subjects of unknown age. Int J Legal Med 2015; 129: 609-17.
  • 2-Separated Children in Europe Programme—Thematic Group on Age Assessment. Review of current laws, policies and practices relating to age assessment in sixteen European Countries. Available at: http://www.separated-children-europe-programme.org/publications/reports/Age_Assessment_report_review_of_current_policies_and_practice_in_Europe_2011
  • 3- Schmeling A, Olze A, Reisinger W, Geserick G. Age estimation of living people undergoing criminal proceedings. Lancet 2001; 358: 89-90.
  • 4. Baransel Isır A, Dülger HE. 1998-2005 yılları arasında Gaziantep Üniversitesi Adli Tıp Anabilim Dalında raporlandırılan yaş tayini olgularının irdelenmesi. Türkiye Klinikleri Adli Tıp Dergisi 2007; 4: 1-6.
  • 5. Koç A, Karaoğlanoğlu M, Erdoğan M, Kosecik M, Cesur Y. Assessment of bone ages: Is the Greulich-Pyle method sufficient for Turkish boys? Pediatr Int 2001; 43: 662-5.
  • 6. Kinik E, Karaman O, Büyükgebiz A. Determination of various parameters of sexuel maturity in adolescent boys in Ankara. Turk J Pediatr 1987; 29: 217-26.
  • 7. Büyükgebiz A, Eroğlu Y, Karaman O, Kinik E. Height and weight measurements of male Turkish adolescents according to biological maturation. Acta Pediatr Jpn 1994; 36: 80-3.
  • 8. Mayda AS, Koçoğlu G. Antropometrik değerler. In: Mayda AS, Koçoğlu G, eds; Sivas il merkezindeki ilkokul çocukları için referans antropometrik değerler. 1. Baskı. Sivas: Cumhuriyet Üniversitesi Yayınları No:79; 1999: 1-46.
  • 9. Isır, Aysun Baransel. Adli Hekimlikte Yaş Tayini. In: Sermet KOÇ, Muhammet CAN, eds; Birinci Basamakta Adli Tıp. 2. Baskı. İstanbul: İstanbul Tabip Odası yayınları; 2011: 222-31.
  • 10. Sarıkardaşoğlu İ. Adli tıpta ana konular ve örneklerle rapor yazma tekniği. Anadolu Üniversitesi Yayınları No:369, Eskişehir; 1990: 22-35.
  • 11- Schmeling A, Grundmann C, Fuhrmann A, Kaatsch HJ, Knell B, Ramsthaler F, Reisinger W, Riepert T, Ritz-Timme S, Rösing FW, Rötzscher K, Geserick G. Criteria for age estimation in living individuals. Int J Legal Med 2008; 122: 457-60.
  • 12- Scoles PV, Salvagno R, Villalba K, Riew D. Relationship of iliac crest maturation to skeletal and chronologic age. J Pediatr Orthop 1988; 8: 639-44.
  • 13- Güvener M, Korel N, Reimann F. Can the development and maturation of the pelvic bones be used to support and amplify the determination of bone age in adolescents and young adults? Rontgenpraxis 1984; 37: 264-8.
  • 14- Wittschieber D, Schmeling A, Schmidt S, Heindel W, Pfeiffer H, Vieth V. The Risser signfor forensic age estimation in living individuals: a study of 643 pelvic radiographs. Forensic Sci Med Pathol 2013; 9: 36-43.
  • 15- Wittschieber D, Vieth V, Domnick C, Pfeiffer H, Schmeling A. The iliac crest in forensicage diagnostics: evaluation of the apophyseal ossification in conventional radiography. Int J Legal Med 2013; 127: 473-9.
  • 16- Wittschieber D, Vieth V, Wierer T, Pfeiffer H, Schmeling A. Cameriere’s approach modified for pelvic radiographs: a novel method to assess apophyseal iliac crest ossification for the purpose of forensic age diagnostics. Int J Legal Med 2013; 127: 825-9.
  • 17- Schmidt S, Schmeling A, Zwiesigk P, Pfeiffer H, Schulz R. Sonographic evaluation of apophyseal ossification of the iliac crest in forensic age diagnostics in living individuals. Int J Legal Med 2011; 125: 271-6.
  • 18- Schmidt S, Schiborr M, Pfeiffer H, Schmeling A, Schulz R. Sonographic examination of the apophysis of the iliac crest for forensic age estimation in living individuals. Sci Justice 2013; 53: 395-401.
  • 19- Wittschieber D, Vieth V, Timme M, Dvorak J, Schmeling A. Magnetic resonance imaging of the iliac crest: age estimation in under 20 soccer players. Forensic Sci Med Pathol 2014; 10: 198-202.
  • 20- Lottering N, Alston-Knox CL, MacGregor DM, Izatt MT, Grant CA, Adam CJ, Gregory LS. Apophyseal ossification of the iliac crest in forensic age estimation: computed tomography standards for modern Australian subadults. J Forensic Sci 2017; 62: 292-307.
  • 21- Ekizoglu O, Inci E, Erdil I, Hocaoglu E, Bilgili MG, Kazimoglu C. Reisoglu A, Can IO. Computed tomography evaluation of the iliac crest apophysis: age estimation in living individuals. Int J Legal Med 2016; 130: 1101-7.
  • 22- Karami M, Rabiei M, Riahinezhad M. Evaluation of the pelvic apophysis with multidetector computed tomography for legal age estimation in living individuals. J Res Med Sci 2015; 20: 209-13.
  • 23- Wittschieber D, Ottow C, Vieth V, Küppers M, Schulz R, Hassu J. Bajanowski T, Püschel K, Ramsthaler F, Pfeiffer H, Schmidt S, Schmeling A. A Projection radiography of the clavicle: still recommendable for forensic age diagnostics in living individuals? Int J Legal Med 2015; 129: 187-93.
  • 24- Brown AA, Derkyi-Kwarteng L, Amonoo-Kuofi HS. Study on the time frame for ossification of the medial clavicular epiphyseal cartilage by X-ray in Ghanaian students. Int J Morphol 2013; 31: 491-6.
  • 25- Gurses MS, Inanir NT, Gokalp G, Fedakar R, Tobcu E, Ocakoglu G. Evaluation of age estimation in forensic medicine by examination of medial clavicular ossification from thin slice computed tomography images. Int J Legal Med 2016; 130: 1343-52.
  • 26- Ufuk F, Agladioglu K, Karabulut N. CT evaluation of medial clavicular epiphysis as a method of bone age determination in adolescents and young adults. Diagn Interv Radiol 2016; 22: 241-6.
  • 27- Milenkovic P, Djuric M, Milovanovic P, Djukic K, Zivkovic V, Nikolic S. The role of CT analyses of the sternal end of the clavicle and the first costal cartilage in age estimation. Int J Legal Med 2014; 128: 825-39.
  • 28- Kreitner KF, Schweden F, Schild HH, Riepert T, Nafe B. Die computertomographisch bestimmte Ausreifung der medialen Klavikulaepiphyse—eine additive Methode zur Altersbestimmung im Adoleszentenalter und in der dritten Lebensdekade? Fortschr Röntgenstr 1997; 166: 481-6.
  • 29- Kreitner KF, Schweden FJ, Riepert T, Nafe B, Thelen M. Bone age determination based on the study of the medial extremity of the clavicle. Eur Radiol 1998; 8: 1116-22.
  • 30- Schmeling A, Schulz R, Reisinger W, Mühler M, Wernecke KD, Geserick G. Studies on the time frame for ossification of medial clavicular epiphyseal cartilage in conventional radiography. Int J Legal Med 2004; 118: 5-8.
  • 31- Risser JC, Ferguson AB. Scoliosis: its prognosis. J Bone Joint Surg 1936; 18: 667-70.
  • 32- Risser JC. Important practical facts in the treatment of scoliosis. Instr Course Lect 1948; 5: 248-60.
  • 33. Risser JC. The Iliac apophysis; an invaluable sign in the management of scoliosis. Clin Orthop 1958; 11: 111-9.
  • 34- Risser JC. Treatment of scoliosis during the past 50 years. Clin Orthop Relat Res 1966; 44: 109-13.
  • 35- Bitan FD, Veliskakis KP, Campbell BC. Differences in the Risser grading systems in the United States and France. Clin Orthop Relat Res 2005; 436: 190-5.
  • 36- Schmeling A, Reisinger W, Loreck D, Vendura K, Markus W, Geserick G. Effects of ethnicity on skeletal maturation: consequences for forensic age estimations. Int J Legal Med 2000; 113: 253-8.
  • 37- Meijerman L, Maat GJ, Schulz R, Schmeling A. Variables affecting the probability of complete fusion of the medial clavicular epiphysis. Int J Legal Med 2007; 121: 463-8.
  • 38- Owings-Webb PA, Myers-Suchey J. Epiphyseal union of the anterior iliac crest and medial clavicle in a modern multiracial sample of American males and females. Am J Phys Anthropol 1985; 68: 457-66.
  • 39- Coqueugniot H, Weaver TD. Brief communication: infracranial maturation in the skeletal collection from Coimbra, Portugal: new aging standards for epiphyseal union. Am J Phys Anthropol 2007; 134: 424-37.
  • 40- Ramsthaler F, Proschek P, Betz W, Verhoff MA. How reliable are the risk estimates for X-ray examinations in forensic age estimations? A safety update. Int J Legal Med 2009; 123: 199-204.
  • 41. Okkalides D, FotakisM. Patient effective dose resulting from radiographic examinations. Br J Radiol 1994; 67: 564-72.

The role of multidetector computed tomography of the iliac crest in forensic age estimation

Year 2017, Volume 39, Issue 3, 576 - 585, 19.09.2017

Eda Albayrak

https://doi.org/10.7197/223.v39i31705.347457

Abstract

Objective: The aim of the present study is to evaluate the iliac bone for skeletal age assessment and to determine whether Schmeling methods are applicable to the evaluation of iliac crest maturation by multidetector computed tomography (MDCT). 

Method: 551 individuals ranginig in age 10-30 years who previously underwent abdominal CT examinations at various occasions in our clinic. At 5-stage method;  criteria for stage 4 are that the apophyseal scar is seen as a unsharp image, or appears as an indistinct, shallow, thin notch and criteria for stage 5 are apophyseal cartilage fully ossified, apophyseal scar no longer visible.

Results: Based on the 5-stage method, the earliest ages for stage 2 are at 11.5 years in boys and 11.6 years in girls; for stage 3, 14.3 in boys and13.4 years in girls; for stage 4, 17.4 years in boys and 16.5 years in girls; for stage 5, 18 years for both sexes.

Conclusion: Although the earliest age of last stage was 17 according to the 4-stage method in previous studies, the earliest age of the 5-stage method was determined to be 18 according to the the present study. These results show that the 5-staging system may be more advantageous than the 4-staging system in order to determine the 18-year age limit in forensic age assessment using the iliac crest.

Keywords

Iliac apophysis, multidetector computed tomography, staging, age estimation, forensic medicine

References

  • 1- Serinelli S, Panebianco V, Martino M, Battisti S, Rodacki K, Marinelli E, Zaccagna F, Semelka RC, Tomei E. Accuracy of MRI skeletal age estimation for subjects 12-19. Potential use for subjects of unknown age. Int J Legal Med 2015; 129: 609-17.
  • 2-Separated Children in Europe Programme—Thematic Group on Age Assessment. Review of current laws, policies and practices relating to age assessment in sixteen European Countries. Available at: http://www.separated-children-europe-programme.org/publications/reports/Age_Assessment_report_review_of_current_policies_and_practice_in_Europe_2011
  • 3- Schmeling A, Olze A, Reisinger W, Geserick G. Age estimation of living people undergoing criminal proceedings. Lancet 2001; 358: 89-90.
  • 4. Baransel Isır A, Dülger HE. 1998-2005 yılları arasında Gaziantep Üniversitesi Adli Tıp Anabilim Dalında raporlandırılan yaş tayini olgularının irdelenmesi. Türkiye Klinikleri Adli Tıp Dergisi 2007; 4: 1-6.
  • 5. Koç A, Karaoğlanoğlu M, Erdoğan M, Kosecik M, Cesur Y. Assessment of bone ages: Is the Greulich-Pyle method sufficient for Turkish boys? Pediatr Int 2001; 43: 662-5.
  • 6. Kinik E, Karaman O, Büyükgebiz A. Determination of various parameters of sexuel maturity in adolescent boys in Ankara. Turk J Pediatr 1987; 29: 217-26.
  • 7. Büyükgebiz A, Eroğlu Y, Karaman O, Kinik E. Height and weight measurements of male Turkish adolescents according to biological maturation. Acta Pediatr Jpn 1994; 36: 80-3.
  • 8. Mayda AS, Koçoğlu G. Antropometrik değerler. In: Mayda AS, Koçoğlu G, eds; Sivas il merkezindeki ilkokul çocukları için referans antropometrik değerler. 1. Baskı. Sivas: Cumhuriyet Üniversitesi Yayınları No:79; 1999: 1-46.
  • 9. Isır, Aysun Baransel. Adli Hekimlikte Yaş Tayini. In: Sermet KOÇ, Muhammet CAN, eds; Birinci Basamakta Adli Tıp. 2. Baskı. İstanbul: İstanbul Tabip Odası yayınları; 2011: 222-31.
  • 10. Sarıkardaşoğlu İ. Adli tıpta ana konular ve örneklerle rapor yazma tekniği. Anadolu Üniversitesi Yayınları No:369, Eskişehir; 1990: 22-35.
  • 11- Schmeling A, Grundmann C, Fuhrmann A, Kaatsch HJ, Knell B, Ramsthaler F, Reisinger W, Riepert T, Ritz-Timme S, Rösing FW, Rötzscher K, Geserick G. Criteria for age estimation in living individuals. Int J Legal Med 2008; 122: 457-60.
  • 12- Scoles PV, Salvagno R, Villalba K, Riew D. Relationship of iliac crest maturation to skeletal and chronologic age. J Pediatr Orthop 1988; 8: 639-44.
  • 13- Güvener M, Korel N, Reimann F. Can the development and maturation of the pelvic bones be used to support and amplify the determination of bone age in adolescents and young adults? Rontgenpraxis 1984; 37: 264-8.
  • 14- Wittschieber D, Schmeling A, Schmidt S, Heindel W, Pfeiffer H, Vieth V. The Risser signfor forensic age estimation in living individuals: a study of 643 pelvic radiographs. Forensic Sci Med Pathol 2013; 9: 36-43.
  • 15- Wittschieber D, Vieth V, Domnick C, Pfeiffer H, Schmeling A. The iliac crest in forensicage diagnostics: evaluation of the apophyseal ossification in conventional radiography. Int J Legal Med 2013; 127: 473-9.
  • 16- Wittschieber D, Vieth V, Wierer T, Pfeiffer H, Schmeling A. Cameriere’s approach modified for pelvic radiographs: a novel method to assess apophyseal iliac crest ossification for the purpose of forensic age diagnostics. Int J Legal Med 2013; 127: 825-9.
  • 17- Schmidt S, Schmeling A, Zwiesigk P, Pfeiffer H, Schulz R. Sonographic evaluation of apophyseal ossification of the iliac crest in forensic age diagnostics in living individuals. Int J Legal Med 2011; 125: 271-6.
  • 18- Schmidt S, Schiborr M, Pfeiffer H, Schmeling A, Schulz R. Sonographic examination of the apophysis of the iliac crest for forensic age estimation in living individuals. Sci Justice 2013; 53: 395-401.
  • 19- Wittschieber D, Vieth V, Timme M, Dvorak J, Schmeling A. Magnetic resonance imaging of the iliac crest: age estimation in under 20 soccer players. Forensic Sci Med Pathol 2014; 10: 198-202.
  • 20- Lottering N, Alston-Knox CL, MacGregor DM, Izatt MT, Grant CA, Adam CJ, Gregory LS. Apophyseal ossification of the iliac crest in forensic age estimation: computed tomography standards for modern Australian subadults. J Forensic Sci 2017; 62: 292-307.
  • 21- Ekizoglu O, Inci E, Erdil I, Hocaoglu E, Bilgili MG, Kazimoglu C. Reisoglu A, Can IO. Computed tomography evaluation of the iliac crest apophysis: age estimation in living individuals. Int J Legal Med 2016; 130: 1101-7.
  • 22- Karami M, Rabiei M, Riahinezhad M. Evaluation of the pelvic apophysis with multidetector computed tomography for legal age estimation in living individuals. J Res Med Sci 2015; 20: 209-13.
  • 23- Wittschieber D, Ottow C, Vieth V, Küppers M, Schulz R, Hassu J. Bajanowski T, Püschel K, Ramsthaler F, Pfeiffer H, Schmidt S, Schmeling A. A Projection radiography of the clavicle: still recommendable for forensic age diagnostics in living individuals? Int J Legal Med 2015; 129: 187-93.
  • 24- Brown AA, Derkyi-Kwarteng L, Amonoo-Kuofi HS. Study on the time frame for ossification of the medial clavicular epiphyseal cartilage by X-ray in Ghanaian students. Int J Morphol 2013; 31: 491-6.
  • 25- Gurses MS, Inanir NT, Gokalp G, Fedakar R, Tobcu E, Ocakoglu G. Evaluation of age estimation in forensic medicine by examination of medial clavicular ossification from thin slice computed tomography images. Int J Legal Med 2016; 130: 1343-52.
  • 26- Ufuk F, Agladioglu K, Karabulut N. CT evaluation of medial clavicular epiphysis as a method of bone age determination in adolescents and young adults. Diagn Interv Radiol 2016; 22: 241-6.
  • 27- Milenkovic P, Djuric M, Milovanovic P, Djukic K, Zivkovic V, Nikolic S. The role of CT analyses of the sternal end of the clavicle and the first costal cartilage in age estimation. Int J Legal Med 2014; 128: 825-39.
  • 28- Kreitner KF, Schweden F, Schild HH, Riepert T, Nafe B. Die computertomographisch bestimmte Ausreifung der medialen Klavikulaepiphyse—eine additive Methode zur Altersbestimmung im Adoleszentenalter und in der dritten Lebensdekade? Fortschr Röntgenstr 1997; 166: 481-6.
  • 29- Kreitner KF, Schweden FJ, Riepert T, Nafe B, Thelen M. Bone age determination based on the study of the medial extremity of the clavicle. Eur Radiol 1998; 8: 1116-22.
  • 30- Schmeling A, Schulz R, Reisinger W, Mühler M, Wernecke KD, Geserick G. Studies on the time frame for ossification of medial clavicular epiphyseal cartilage in conventional radiography. Int J Legal Med 2004; 118: 5-8.
  • 31- Risser JC, Ferguson AB. Scoliosis: its prognosis. J Bone Joint Surg 1936; 18: 667-70.
  • 32- Risser JC. Important practical facts in the treatment of scoliosis. Instr Course Lect 1948; 5: 248-60.
  • 33. Risser JC. The Iliac apophysis; an invaluable sign in the management of scoliosis. Clin Orthop 1958; 11: 111-9.
  • 34- Risser JC. Treatment of scoliosis during the past 50 years. Clin Orthop Relat Res 1966; 44: 109-13.
  • 35- Bitan FD, Veliskakis KP, Campbell BC. Differences in the Risser grading systems in the United States and France. Clin Orthop Relat Res 2005; 436: 190-5.
  • 36- Schmeling A, Reisinger W, Loreck D, Vendura K, Markus W, Geserick G. Effects of ethnicity on skeletal maturation: consequences for forensic age estimations. Int J Legal Med 2000; 113: 253-8.
  • 37- Meijerman L, Maat GJ, Schulz R, Schmeling A. Variables affecting the probability of complete fusion of the medial clavicular epiphysis. Int J Legal Med 2007; 121: 463-8.
  • 38- Owings-Webb PA, Myers-Suchey J. Epiphyseal union of the anterior iliac crest and medial clavicle in a modern multiracial sample of American males and females. Am J Phys Anthropol 1985; 68: 457-66.
  • 39- Coqueugniot H, Weaver TD. Brief communication: infracranial maturation in the skeletal collection from Coimbra, Portugal: new aging standards for epiphyseal union. Am J Phys Anthropol 2007; 134: 424-37.
  • 40- Ramsthaler F, Proschek P, Betz W, Verhoff MA. How reliable are the risk estimates for X-ray examinations in forensic age estimations? A safety update. Int J Legal Med 2009; 123: 199-204.
  • 41. Okkalides D, FotakisM. Patient effective dose resulting from radiographic examinations. Br J Radiol 1994; 67: 564-72.

Details

Subjects Health Care Sciences and Services
Journal Section Medical Science Research Articles
Authors

Eda Albayrak>

Publication Date September 19, 2017
Published in Issue Year 2017, Volume 39Issue 3

Cite

APA Albayrak, E. (2017). The role of multidetector computed tomography of the iliac crest in forensic age estimation . Cumhuriyet Medical Journal , 39 (3) , 576-585 . DOI: 10.7197/223.v39i31705.347457