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Staging clavicular development on MRI : pitfalls and suggestions for age estimation

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Abstract
Background MRI of the clavicle's sternal end has been studied for age estimation. Several pitfalls have been noted, but how they affect age estimation performance remains unclear. Purpose/Hypothesis To further study these pitfalls and to make suggestions for a proper use of clavicle MRI for forensic age estimation. Our hypotheses were that age estimation would benefit from 1) discarding stages 1 and 4/5; 2) including advanced substages 3aa, 3ab, and 3ac; 3) taking both clavicles into account; and 4) excluding morphological variants. Study Type Prospective cross-sectional. Population Healthy Caucasian volunteers between 11 and 30 years old (524; 277 females, 247 males). Field Strength/Sequence 3T, T-1-weighted gradient echo volumetric interpolated breath-hold examination (VIBE) MR-sequence. Assessment Four observers applied the most elaborate staging technique for long bone development that has been described in the current literature (including stages, substages, and advanced substages). One of the observers repeated a random selection of the assessments in 110 participants after a 2-week interval. Furthermore, all observers documented morphological variants. Statistical Tests Weighted kappa quantified reproducibility of staging. Bayes' rule was applied for age estimation with a continuation ratio model for the distribution of the stages. According to the hypotheses, different models were tested. Mean absolute error (MAE) differences between models were compared, as were MAEs between cases with and without morphological variants. Results Weighted kappa equaled 0.82 for intraobserver and ranged between 0.60 and 0.64 for interobserver agreement. Stages 1 and 4/5 were allocated interchangeably in 4.3% (54/1258). Age increased steadily in advanced substages of stage 3, but improvement in age estimation was not significant (right P = 0.596; left P = 0.313). The model that included both clavicles and discarded stages 1 and 4/5 yielded an MAE of 1.97 years, a root mean squared error of 2.60 years, and 69% correctly classified minors. Morphological variants rendered significantly higher MAEs (right 3.84 years, P = 0.015; left 2.93 years, P = 0.022). Data Conclusion Our results confirmed hypotheses 3) and 4), while hypotheses 1) and 2) remain to be investigated in larger studies. Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019.
Keywords
Age Determination by Skeleton, Clavicle, Adolescent, Adult, Magnetic Resonance Imaging, IMAGING-BASED EVALUATION, EPIPHYSEAL SCAR, OSSIFICATION, CT, PERSISTENCE, SKELETAL

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MLA
De Tobel, Jannick, et al. “Staging Clavicular Development on MRI : Pitfalls and Suggestions for Age Estimation.” JOURNAL OF MAGNETIC RESONANCE IMAGING, vol. 51, no. 2, 2020, pp. 377–88, doi:10.1002/jmri.26889.
APA
De Tobel, J., Hillewig, E., van Wijk, M., Fieuws, S., de Haas, M. B., van Rijn, R. R., … Verstraete, K. (2020). Staging clavicular development on MRI : pitfalls and suggestions for age estimation. JOURNAL OF MAGNETIC RESONANCE IMAGING, 51(2), 377–388. https://doi.org/10.1002/jmri.26889
Chicago author-date
De Tobel, Jannick, Elke Hillewig, Mayonne van Wijk, Steffen Fieuws, Michiel B de Haas, Rick R van Rijn, Patrick W Thevissen, and Koenraad Verstraete. 2020. “Staging Clavicular Development on MRI : Pitfalls and Suggestions for Age Estimation.” JOURNAL OF MAGNETIC RESONANCE IMAGING 51 (2): 377–88. https://doi.org/10.1002/jmri.26889.
Chicago author-date (all authors)
De Tobel, Jannick, Elke Hillewig, Mayonne van Wijk, Steffen Fieuws, Michiel B de Haas, Rick R van Rijn, Patrick W Thevissen, and Koenraad Verstraete. 2020. “Staging Clavicular Development on MRI : Pitfalls and Suggestions for Age Estimation.” JOURNAL OF MAGNETIC RESONANCE IMAGING 51 (2): 377–388. doi:10.1002/jmri.26889.
Vancouver
1.
De Tobel J, Hillewig E, van Wijk M, Fieuws S, de Haas MB, van Rijn RR, et al. Staging clavicular development on MRI : pitfalls and suggestions for age estimation. JOURNAL OF MAGNETIC RESONANCE IMAGING. 2020;51(2):377–88.
IEEE
[1]
J. De Tobel et al., “Staging clavicular development on MRI : pitfalls and suggestions for age estimation,” JOURNAL OF MAGNETIC RESONANCE IMAGING, vol. 51, no. 2, pp. 377–388, 2020.
@article{8624245,
  abstract     = {Background MRI of the clavicle's sternal end has been studied for age estimation. Several pitfalls have been noted, but how they affect age estimation performance remains unclear. Purpose/Hypothesis To further study these pitfalls and to make suggestions for a proper use of clavicle MRI for forensic age estimation. Our hypotheses were that age estimation would benefit from 1) discarding stages 1 and 4/5; 2) including advanced substages 3aa, 3ab, and 3ac; 3) taking both clavicles into account; and 4) excluding morphological variants. Study Type Prospective cross-sectional. Population Healthy Caucasian volunteers between 11 and 30 years old (524; 277 females, 247 males). Field Strength/Sequence 3T, T-1-weighted gradient echo volumetric interpolated breath-hold examination (VIBE) MR-sequence. Assessment Four observers applied the most elaborate staging technique for long bone development that has been described in the current literature (including stages, substages, and advanced substages). One of the observers repeated a random selection of the assessments in 110 participants after a 2-week interval. Furthermore, all observers documented morphological variants. Statistical Tests Weighted kappa quantified reproducibility of staging. Bayes' rule was applied for age estimation with a continuation ratio model for the distribution of the stages. According to the hypotheses, different models were tested. Mean absolute error (MAE) differences between models were compared, as were MAEs between cases with and without morphological variants. Results Weighted kappa equaled 0.82 for intraobserver and ranged between 0.60 and 0.64 for interobserver agreement. Stages 1 and 4/5 were allocated interchangeably in 4.3% (54/1258). Age increased steadily in advanced substages of stage 3, but improvement in age estimation was not significant (right P = 0.596; left P = 0.313). The model that included both clavicles and discarded stages 1 and 4/5 yielded an MAE of 1.97 years, a root mean squared error of 2.60 years, and 69% correctly classified minors. Morphological variants rendered significantly higher MAEs (right 3.84 years, P = 0.015; left 2.93 years, P = 0.022). Data Conclusion Our results confirmed hypotheses 3) and 4), while hypotheses 1) and 2) remain to be investigated in larger studies. Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019.},
  author       = {De Tobel, Jannick and Hillewig, Elke and van Wijk, Mayonne and Fieuws, Steffen and de Haas, Michiel B and van Rijn, Rick R and Thevissen, Patrick W and Verstraete, Koenraad},
  issn         = {1053-1807},
  journal      = {JOURNAL OF MAGNETIC RESONANCE IMAGING},
  keywords     = {Age Determination by Skeleton,Clavicle,Adolescent,Adult,Magnetic Resonance Imaging,IMAGING-BASED EVALUATION,EPIPHYSEAL SCAR,OSSIFICATION,CT,PERSISTENCE,SKELETAL},
  language     = {eng},
  number       = {2},
  pages        = {377--388},
  title        = {Staging clavicular development on MRI : pitfalls and suggestions for age estimation},
  url          = {http://dx.doi.org/10.1002/jmri.26889},
  volume       = {51},
  year         = {2020},
}

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